HYPOTHERMIA
ALL LEVELS
DESIGNATION OF CONDITION
Mild hypothermia: core body temperature is between 94° and 97° F (34-36° C). Moderate hypothermia: core body temperature 86 and 94° F (30-34° C). Patients with mild to moderate hypothermia may exhibit signs and symptoms of shivering, tachycardia, tachypnea, decreasing LOC, lethargic (may be fully oriented), and loss of fine motor coordination. Severe hypothermia: core temperature < 86° F (30° C) with signs and symptoms of pupil dilation, bradycardia, bradypnea, coma, no shivering, arrhythmia, and joint stiffness.
To change Celsius to Fahrenheit: 1.8 x C + 32 (example: 30 c * 1.8 + 32 = 86oF) EMPHASIS ON PATIENT CARE
Maintenance of body heat, airway management. LOC is the most reliable indicator of the severity of hypothermia.
1. Primary Management- Assess ABC’s and manage as indicated.
2. Remove patient from the environment.
3. Remove all wet clothing.
4. Secondary Management - History, physical exam, vital signs
5. Managing mild to moderate hypothermia.
a. Administer warmed, humidified oxygen titrated to patient condition.
b. If patient becomes hypoxic, administer oxygen and/or assist ventilations as needed.
6. Avoid rough handling when moving the patient.
7. Cover with blankets, preferably warmed.
8. Monitor the patient’s vital signs and rhythm closely.
9. Transport the patient to appropriate medical facility.
AEMT
1. In-route, initiate a large bore IV/IO of warm/tepid isotonic solution and infuse at a rate to maintain adequate end organ. In severe hypothermia IV fluid administration should be done with caution to avoid after-drop effect of circulating acidotic/toxic peripheral blood to the heart and brain.
HYPOTHERMIA
PARAMEDIC
1. Airway management should be limited to basic manual procedures and slow ventilatory assistance. If unable to manage the airway by basic maneuvers, adjuncts may be used, however this may induce ventricular dysrhythmias and overzealous ventilatory assistance can induce hypocapnia, resulting in ventricular irritability.
2. If ventricular arrhythmia develops may attempt defibrillation once.
3. Subsequent defibrillations or additional cardiac life support medications should be avoided until the patient has been re-warmed in the emergency department. Warm the patient’s core first to avoid after-drop effect. Ventilating patient via mouth to mask may be the most effective core warming device available pre-hospital.
ALL LEVELS
DESIGNATION OF CONDITION
Mild hypothermia: core body temperature is between 94° and 97° F (34-36° C). Moderate hypothermia: core body temperature 86 and 94° F (30-34° C). Patients with mild to moderate hypothermia may exhibit signs and symptoms of shivering, tachycardia, tachypnea, decreasing LOC, lethargic (may be fully oriented), and loss of fine motor coordination. Severe hypothermia: core temperature < 86° F (30° C) with signs and symptoms of pupil dilation, bradycardia, bradypnea, coma, no shivering, arrhythmia, and joint stiffness.
To change Celsius to Fahrenheit: 1.8 x C + 32 (example: 30 c * 1.8 + 32 = 86oF) EMPHASIS ON PATIENT CARE
Maintenance of body heat, airway management. LOC is the most reliable indicator of the severity of hypothermia.
1. Primary Management- Assess ABC’s and manage as indicated.
2. Remove patient from the environment.
3. Remove all wet clothing.
4. Secondary Management - History, physical exam, vital signs
5. Managing mild to moderate hypothermia.
a. Administer warmed, humidified oxygen titrated to patient condition.
b. If patient becomes hypoxic, administer oxygen and/or assist ventilations as needed.
6. Avoid rough handling when moving the patient.
7. Cover with blankets, preferably warmed.
8. Monitor the patient’s vital signs and rhythm closely.
9. Transport the patient to appropriate medical facility.
AEMT
1. In-route, initiate a large bore IV/IO of warm/tepid isotonic solution and infuse at a rate to maintain adequate end organ. In severe hypothermia IV fluid administration should be done with caution to avoid after-drop effect of circulating acidotic/toxic peripheral blood to the heart and brain.
HYPOTHERMIA
PARAMEDIC
1. Airway management should be limited to basic manual procedures and slow ventilatory assistance. If unable to manage the airway by basic maneuvers, adjuncts may be used, however this may induce ventricular dysrhythmias and overzealous ventilatory assistance can induce hypocapnia, resulting in ventricular irritability.
2. If ventricular arrhythmia develops may attempt defibrillation once.
3. Subsequent defibrillations or additional cardiac life support medications should be avoided until the patient has been re-warmed in the emergency department. Warm the patient’s core first to avoid after-drop effect. Ventilating patient via mouth to mask may be the most effective core warming device available pre-hospital.