Rationale:

• Patients with moderate to severe hypothermia should be handled gently because sudden movements or manipulations (endotracheal intubation, suctioning, lifting) can trigger malignant arrhythmias.
• Removal of wet clothing decreases conduction heat away from the patient.
• Transportation to a medical center provides access to advanced medical care and equipment.
• Warm intravenous fluids (normal saline with 5% dextrose or one-half normal saline with dextrose for hypernatremia) are used for the treatment of hypovolemia and decreased blood viscosity.
• The general approach to treat hypothermia is to use an active rewarming strategy, which may include forced-air warming blankets, circulating-water mattresses, electric blankets, radiant warmers, warm intravenous fluids, peritoneal lavage, extracorporeal rewarming (veno-venous or arterial-venous bypass), gastric lavage, or thoracic lavage.

Evidence:

• Rough movements or transportation of the hypothermia victim can provoke severe arrhythmias and ventricular fibrillation. Knowledge of the pathophysiology of hypothermia allows for early diagnosis and initiation of therapy to limit morbidity (37; 112).
• Studies of hypothermic trauma victims and volunteer subjects show the superiority of active rewarming versus passive rewarming (i.e., insulation), significantly reducing the volume of fluid needed for resuscitation as well as short-term mortality (145; 146; 147).

Comments:

• In trauma patients, hypothermia correlates with the severity of injury but is independently associated with worse outcomes. In one series, mortality in patients with core temperatures <34°C (93.2°F) was 40% compared to 7% for those with core temperatures 34°C (93.2°F) (148).