Hypothermia

• At what temperature is classed as hypothermia?

  <35 degrees celcius
• What are the classifications of hypothermia?

  Mild - 32-35

  Moderate - 28-32

  Severe - <28
• What is the risk of hypothermia?

  Haemodynamic instability
• What is important initial management for hypothermia?

  A-E

  Obtain IV access and consider starting warmed IV fluids

  ECG
• What would you see on ECG in hypothermia?

  Sinus tachycardia initially

  Can become sinus bradycardia or junctional rhythm

  Osborn/J waves in leads V3-V6 and height correlates with severity of hypothermia

  In severe cases there may be ventricular arrhythmias or even asystole
• What is a junctional rhythm?

  Bradycardia without p waves
• What are osborn/j waves?

  Positive deflections at junction between QRS and ST in leads V3-V6
• What would you see on physical examination of a patient with hypothermia?

  Core temperature <35 degrees celcius

  Hyperventilation initially

  Hypoventilation late sign

  Shivering

  Confusion

  Lethargy

  Reduced responsiveness
• Management of Mild hypothermia

  Passive external rewarming:

  Remove patient from cold

  Remove wet clothing

  Cover with blanket or dry garments
• Management of moderate hypothermia

  Passive and active external warming:

  Warm blankets

  Heating pads

  Warm baths

  Warm air
• Management of severe hypothermia

  Comprehensive rewarming

  Passive and active external warming and active internal rewarming:

  Warm IV fluids

  Peritoneal/pleural lavage
• If patient is in severe hypothermia, haemodynamically unstable or in cardiac arrest

  Consider extracorporeal rewarming:

  Haemodialysis

  Cardiopulmonary bypass

  Extracorporeal membrane oxygenation (ECMO)

  Cardiopulmonary resuscitation
• At what temperature can a patient with hypothermia be pronounced dead?

  32 degrees celcius

  Not dead until warm and dead