Hypothermia - Emergency Management

Hypothermia

·        Signs: hypotension, bradycardia, J wave on ECG, SV arrhythmias, VF at 28 C, metabolic acidosis, loss of consciousness at 28 – 30 C, shivering replaced by rigidity at 33 C, pupils dilated.

·        Lengthens tolerance of arrest: don‟t discontinue till they‟ve been warmed

·        Arrest prevention:

o  Prevent further heat loss

o  Transport avoiding rough movement, which can precipitate VF 

o  If core temperature < 34 C, can rewarm with oesophageal rewarming tubes, peritoneal lavage (warmed saline or gas). Warm trunk not peripheries. Reduce movement (risk of VF). Rewarm slowly – 0.5 degrees/hour (unless fit and sudden hypothermia)

·        During arrest:

o  Take 30 – 45 secs to confirm cessation of ventilation and pulselessness

o  Don‟t assume death until resuscitation has failed in an adequately rewarmed patient

o  If < 30 C give maximum of 3 shocks until core temperature increases 

o  Reduced responsiveness to defibrillation and drugs. Impaired drug metabolism ® watch for toxicity 

o  Monitor fluids during rewarming