Hypothermia

Question 1

Hypothermia - Definition

Answer 1

A decrease in core body temperature below 35C

Question 2

Goal of Care

Answer 2

Stablize the pt, treat associated medical conditions, minimize further heat loss and provide rapid transport to a facility where definitive care can be provided

Question 3

Hypothermia classes

Answer 3

Mild (32-35C)

Moderate (28-32C)

Severe (<28C)

Question 4

Mild Hypothermia 32-35

Answer 4

peripheral vasoconstriction, shivering, hypertension and tachycardia

Question 5

Moderate Hypothermia 28-32

Answer 5

as the depth of hypothermia proceeds to moderate, the pt becomes confused and ataxic and shivering may cease

Question 6

Severe Hypothermia <28

Answer 6

pts will have significantly lower LOC w/ no response to pain, display an absence of reflexes and have severely diminished cardiac output
V-fib risk increases as the temperature drops and becomes most significant below 28 degrees

Question 7

Medical Conditions w/ risk to Hypothermia in an atypical environment

Answer 7

• Behavioural/psychiatric problem
• Seizure
• ETOH / drug OD
• CVA
• Diabetic emergency
• Frail elderly pts “found down” at their home

Question 8

Determining Hypothermia in the field

Answer 8

Esophageal temperature monitoring is the gold standard but not widely available
Rectal temp is another option using a low reading thermometer but difficult to obtain in the field setting.

Paramedics will have to rely on combination of assessment skills - history, nature of exposure and physical exam

Question 9

Guiding Principles

Answer 9

The hypothermic patient has reduced metabolic demands and may have a significant decrease in heart and respiratory rate. For this reason, 30-45 seconds should be taken to accurately detect the presence of spontaneous respirations and a pulse

Careful handling of the patient is warranted but the need for immediate transport to hospital should never be delayed for fear of inducing ventricular fibrillation.

For severe cases, re-warming in the pre-hospital setting is problematic and in most cases should be limited to passive re-warming, including removal of wet clothing and use of blankets to limit further cooling. Warm heat packs have limited utility in severe hypothermia and care must be taken not to induce thermal injury in the skin

Question 10

Intervention Guidelines - EMR/PCP/ACP

Answer 10

Remove pt from the environment

• Throughly assess pulse and resps - 30-45s
• VSA - Hypothermia Arrest TG
• O2
• Cap blood sugar if altered
• Assess for associated injs or medical conditions
• Immediate transport
• Obtain core temper where feasible
• Prevent further cooling
• Passive rewarming for severe cases

Question 11

Further Care

Answer 11

• Active core rewarming including blanket re-warmers
• Warm IV fluids, pleural, peritoneal and bladder lavage
• Warm humidified O2
• Caridopulmonary bypass
• Management of electrolyte and haemtological abnormalities
• Treatment of cardiac dysrhythmia