Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:54

800 Hypothermia

differential diagnosis

n/a

management

What to Do First

■Confirm hypothermia

■Move patient to warm environment; replace wet clothing with clean,

dry insulating material

■Asystole NOT equivalent to death in cold patient; aggressive treat-

ment indicated

General Measures

■Avoid rough handling; do not place pulmonary artery catheters

because myocardium very irritable; high risk for ventricular fibrilla-

tion

■Intubate if comatose or depressed protective airway reflexes

■Obtain IV access, monitor on telemetry, and place urinary catheter

to monitor output

■Resuscitate with D-5 normal saline; most patients volume depleted

from cold-induced diuresis and third spacing

■Identify predisposing conditions and determine duration and sever-

ity of exposure

specific therapy

Treatment Options

■Altered mental status: D-50, naloxone, thiamine

■Passive external rewarming (for mild hypothermia that developed

over days): cover patient with insulating material (eg, aluminized

coverings) to prevent further heat loss; rate of temperature rise 0.3–

2.0◦C/h

■Active external rewarming (for mild hypothermia that developed

acutely: apply heat (hot packs, warm blankets, plumed garments, or

radiant heaters with temperature 40–45◦C) to skin on patient’s trunk;

immersion in 40◦C water bath another option; usually combined

with active core rewarming

■Active core rewarming (for moderate to severe hypothermia):

➣First-line treatment: heated oxygen (45◦C) delivered through a

cascade humidifier; raises temperature 1–2◦C/h

■Cardiopulmonary bypass most effective technique, esp in patients

with cardiac arrest or unstable arrhythmias; raises temperature 1◦C

q5to10min