Hypothermia

 

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) ?

 

  • No

 

    • See appropriate protocol based on symptoms

 

  • Yes

 

 

 

    • Handle very gently
    • Remove wet clothing
    • Apply hot packs and blankets
    • Determine Respiratory Rate
    • Oxygen

 

 

 

    • Obtain BGL

 

 

    • Initiate IV

 

Respiratory rate ≤ 4 bpm ?

 

  • Yes

 

 

 

    • Intubate and ventilate

 

Respiratory rate ≥4 bpm

 

  • Yes

 

 

    • Do not intubate, ventilate as necessary

 

Glucose ≤ 60 with signs of hypoglycemia ?

 

  • Yes

 

 

 

 

 

 

 

  • No

 

    • 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.

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRAEMT

National Registry Advance Emergency Technician