ENVIRONMENTAL EMERGENCIES■ Dry clothes
■ Move from cold environment
■ Active external rewarming:
■ For severe hypothermia without cardiovascular instability
■ Heating lamps (radiation)
■ Bair huggers (convection)
■ Warm blankets (conduction)
■ Warm intravenous fluids at 40–42°C
■ Warm humidified O 2 by mask (↓evaporative loss)
■ Active core rewarming
■ For severe hypothermia with cardiovascular instability
■ Warmed gastric, bladder, peritoneal, and pleural lavage
■ The best treatment for dysrhythmias, coagulopathy, and hyperglycemia =
rewarming.
■ Rehydrate with warmed IV fluids (most patients are dehydrated from “cold
diuresis”).
■ Many medications, including insulin, are ineffective until core temperature
is >30°C.
■ If patient is in cardiac arrest:
■ Administer CPR.
■ Consider surgical approaches to rewarming:
■ Cardiopulmonary bypass
■ Continuous arteriovenous and venovenous rewarming
■ Extracorporeal membrane oxygenation (ECMO)
■ Hemodialysis
■ Defibrillation and medications may not be effective at or below 30°C,
therefore continue CPR while the patient is warmed.
■ If in VFib, only one defibrillation attempt (2 J/kg) is indicated until the
core temperature exceeds 32°C.
■ Patient may be pronounced dead if core temperature is 32 – 35 °Cand
no vital signs are present.
■ Avoid
■ Suppressing shivering response.
■ Rough handling (may induce VF).
■ Transvenous pacing (may induce VF): Use transcutaneous pacing instead.
FIGURE 13.4. Osborne (“J”) waves.
(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emergency
Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:1180.)
Failure to rewarm? →consider
underlying endocrine failure.“The patient is not dead until
he is warm and dead.”