History:
- Past medical history
- Medications
- Exposure to environment even in normal temperatures
- Exposure to extreme cold
- Extremes of age
- Drug use: alcohol/barbiturates
- Infections/sepsis
- Length of exposure/wetness
Significant Findings:
- Cold/clammy
- Shivering
- Mental status changes
- Extremity pain or sensory abnormality
- Bradycardia
- Hypotension or shock
Differential:
- Sepsis
- Environmental exposure
- Hypoglycemia
-
CNS dysfunction
- Stroke
- Head injury
- Spinal cord injury
Temperature ≤ 95⁰F (35⁰C) ?
-
- See appropriate protocol based on symptoms
-
- Handle very gently
- Remove wet clothing
- Apply hot packs and blankets
- Determine Respiratory Rate
- Oxygen
Respiratory rate ≤ 4 bpm ?
Respiratory rate ≥4 bpm
-
- Do not intubate, ventilate as necessary
Glucose ≤ 60 with signs of hypoglycemia ?
-
- Notify receiving facility or contact Medical Control
PEARLS:
- NO PATIENT IS DEAD UNTIL WARM AND DEAD!
- Defined as core temperature less than 95⁰F (35⁰C).
- Extremes of age are more susceptible (i.e., young and old).
- With temperature less than 86⁰F (30⁰C) ventricular fibrillation is a common cause of death. Handling patients gently may prevent this.
- If the temperature is unable to be measured, treat the patient based on the suspected temperature.
- Hypothermia may produce severe bradycardia so take at least 45 seconds to palpate a pulse.
- Hot packs can be activated and placed in the armpit and groin area. Care should be taken not to place the packs directly against the patient's skin.
- Intubation can cause ventricular fibrillation so it should be done gently by the most experienced person.
- Do not hyperventilate the patient as this can cause ventricular fibrillation.
- If the patient's temperature is less than 86⁰F (30⁰C) then only defibrillate one time if defibrillation is required. Normal defibrillation procedure may resume once the temperature reaches 86⁰F (30⁰C).
- Below 86⁰F (30⁰C) antiarrhythmics may not work and, if given, should be given at reduced intervals.
- Below 86⁰F (30⁰C) pacing should not be done.