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- Remove victim from the cold environment and begin general resuscitative and rewarming measures as soon as possible.
- Treat stable patients with mild or moderate hypothermia with conservative, noninvasive rewarming techniques.
- Initiate active rewarming in patients with severe hypothermia or in hemodynamically unstable patients with moderate hypothermia.
- Defer management of non-emergent hemodynamic instability related to cardiac rhythm disturbances until specialized monitoring and rewarming resources are available to avoid triggering a potentially life-threatening arrhythmia.
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Remove victim from the cold environment and begin general resuscitative and rewarming measures as soon as possible.  |
- Remove victim from environmental exposure.
- Gently examine victim.
- Initiate CPR if necessary, and continue until the patient is hemodynamically stabile or until such time that the patient is rewarmed to 37°C (98.6°F) and a diagnosis of death can be rendered.
- Assess severity of hypothermia.
- Determine the presence of coincident disease or trauma.
- Remove wet clothing to stop heat conduction away from the patient.
- Wrap patient in warm, dry blankets or clothes.
- Transport patient to medical center for further evaluation.
- Start warm intravenous fluids.
- Treat local cold injuries, such as frostnip, frostbite, and trench (immersion) foot.
| Background | Back to top
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Treat stable patients with mild or moderate hypothermia with conservative, noninvasive rewarming techniques.  |
- Monitor the core and shell temperatures during the rewarming process.
- Monitor hemodynamic and respiratory function.
- Initiate passive rewarming with warm blankets or “space” blankets (plastic blankets with mirror-quality reflective surfaces that reflect body heat) until active rewarming can be initiated.
- Initiate active rewarming:
- Warming intravenous fluids
- Warm forced-air blankets
- Heated and humidified respiratory gases
- Use of electric or hot water heating blankets should be avoided because of complications related to focal tissue thermal damage.
- Establish intravenous access and infuse warm intravenous fluids (normal saline with 5% dextrose at 40°C [104°F]) used for the treatment of hypovolemia, and decreased blood viscosity.
- Treat local cold injuries, such as frostnip, frostbite, and trench (immersion) foot.
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Initiate active rewarming in patients with severe hypothermia or in hemodynamically unstable patients with moderate hypothermia. |
- Gently handle patients with moderate to severe hypothermia.
- Monitor hemodynamic, respiratory, and urinary function.
- In patients having respiratory insufficiency, secure the airway by endotracheal intubation and initiate mechanical ventilation initiated using humidified and heated (40°C [104°F]) gases.
- Establish intravenous access and infuse warm intravenous fluids (normal saline with 5% dextrose) used for the treatment of hypovolemia, and decreased blood viscosity.
- Base the choice of active, invasive rewarming techniques or forced-air rewarming on equipment availability and technical abilities of the medical staff.
- Perform forced-air rewarming by circulating hot air (maximum 42°C [107.6°F]) through a specially designed blanket.
- Consider alternative techniques of active rewarming, including:
- Peritoneal lavage with warmed fluids using a dialysis catheter
- Stomach lavage using heated irrigation fluids using an oral gastric tube
- Pleural cavity lavage with warmed fluids using a chest tube
- Institution of veno-venous extracorporeal circulation (dialysis) or arterial-venous extracorporeal circulation for hemodynamically compromised patients (cardiopulmonary bypass)
- Recognize that the invasive techniques of bypass or extracorporeal circulatory management require the use of anticoagulation, and:
- Can lead to bleeding
- May be contraindicated in cases of trauma or neurologic injury
- Recognize that when anticoagulation is contraindicated and the patient is hemodynamically stable, forced-air rewarming may be an effective alternative to active rewarming.
- Monitor core and peripheral body temperatures during rewarming.
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Defer management of non-emergent hemodynamic instability related to cardiac rhythm disturbances until specialized monitoring and rewarming resources are available to avoid triggering a potentially life-threatening arrhythmia. |
- Do not initiate cardiac pacing in patients with bradycardia unless the bradycardia persists after rewarming.
- Be certain that the patient is truly pulseless before initiating chest compressions.
- Limit electric defibrillation for ventricular tachycardia/fibrillation to three attempts in severely hypothermic patients.
- If defibrillation is unsuccessful, resume CPR and initiate cardiopulmonary bypass to support hemodynamic function.
- Defer subsequent attempts at cardioversion until the core temperature is increased to >30°C (86°F).
- Defer subsequent attempts at cardioversion until respiratory and metabolic perturbations have been addressed.
| Background | Back to top
| | | FAQs |
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| Albert Cheung, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Dmitri Guvakov, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Stuart Weiss, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Wenjun Zhou Martini, PhD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Darren B. Taichman, MD, PhD, Editor, PIER, has received grant support from Actelion Pharmaceuticals Ltd , and honoraria for continuing medical education grand rounds and lectures given. |
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
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PIER is copyrighted (c) 2010 by the American College of Physicians,
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Hypothermia
