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


  • Patients Should Not be transferred with Temp <32ºC
  • In exceptional circumstances ICU may wish to transfer prior to this on instruction of ICU Consultant



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