Remove COLD, Add WARM, Don’t SHAKE
- 32-35ºC [Mild] – Shivering, Tachycardia, Tachypnoeic, Vasoconstriction
- 30-32ºC [Moderate] – Shivering stops, Pale/Cyanosed, Hypotensive, Confused, Lethargic
- <30ºC [Severe] – Low GCS, Bradycardia/pnoeic, Hypotensive, Arrhythmias, Cardiac Arrest
Initial Management
- ABCD assessment
- Remove Wet/Cold clothing
- Dry Skin – Be Careful Excess Movement May Precipitate Arrhythmia
- Monitoring – Including ECG
- Warming Blanket
Not responding OR <32ºC
- Active Rewarming – Aim to increase by 0.5-2ºC/hr (Elderly aim for 0.5-1ºC – risk of Cerebral/pulmonary oedema)
- Core temperature probe – Required (Rectal/Oesophageal)
- Warm IV fluid [40ºC]
- Warm humidified Oxygen
- Warm bladder washouts – Consider
- Ensure blood glucose adequate
- Look for and treat cause e.g. Hypoglycaemia, Hypothyroid, Sepsis
Caution <30ºC
- Arrhythmias will usually respond to Rewarming
- Resus/Anaesthetic Drugs – May either have longer half-life or NOT WORK
- Defibrillation – If First 3 Shocks not worked Defer until Temp >30ºC
- Remember: You’re not Dead until You’re Warm and Dead – If prolonged use LUCAS
Transfer
- Patients Should Not be transferred with Temp <32ºC
- In exceptional circumstances ICU may wish to transfer prior to this on instruction of ICU Consultant
PDF:hypothermia
