Severe Accidental Hypothermia

By Taylor Moran-Gates, MD

Please refer to EMCrit

1. >32c:
-Treatment is simple: Passive rewarming, warm blankets.
-Evaluate other causes: hypoglycemia, etoh, myxedema, Addison’s, sepsis.
-Labs: cbc, chemistry, tfts, cortisol, cultures.
-Bradycardia: sinus bradycardia is expected, and does not require treatment.

2. <32c: Unstable.
-Temperature probe: Thermometers will not give reliable temperatures. You need to place a temperature probe, esophageal is preferred.
- Active rewarming:
-IVF: Warm iv fluids maintain temperature but do not raise temperature. However if the patient needs fluid, only heated fluid is appropriate.
-Warm humidified air: If your ventilator is capable, will raise temp 1.5C per hour.
-Warming blankets: Minimal efficacy.
-Catheter warming devices: e.g. Alsius, probably effective if you have them.
-Peritoneal lavage: Ok rewarming rates, but there are significant risks to entering peritoneum.
-Thoracic lavage: 3-6C per hour. Place two chest tubes, 32F, 4th-5th intercostal space, one just anterior and the other just posterior to the mid axillary line. Ideally one anterior tip up, one posterior tip down. To connect with IV tubing, use Salem sump adaptor or equivalent.  To anterior chest tube attach level 1.  To posterior chest tube attach pleurovac.
-Bypass: Effective if you have this available.
-Dialysis: Effective warming of the patient, but not your first move given delays to get equipment involved.

3. Cardiac arrest.
- When do you stop?  No clear evidence in the literature, probably 30 to 32C.
-Vfib, one shock, then rewarm with CPR.  Try defibrillation again when the patients temperature is >30C
-Meds: One dose epinephrine.  Begin regular ACLS med algorithm when >30C.

 

Post-Test Here

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