Hypothermia/Cold Exposure (Adult)

Assess

• Mild Hypothermia 32-35˚C • Moderate Hypothermia 28-32˚C • Severe Hypothermia <28˚C • If alteration to Cardiac Arrest Mx required

Non cardiac arrest • Moderate/Severe Hypothermia <28-32˚C • Warmed Normal Saline 10ml/kg IV - Repeat Normal Saline 10ml/kg IV (max. 40ml/kg) to maintain perfusion • Avoid drug Mx of cardiac arrhythmia unless decompensated and until rewarming has commenced

Cardiac Arrest See also: Cardiac Arrest CPG     >32˚C • Standard Cardiac Arrest Guidelines           30-32˚C • Double dosage intervals in relevant cardiac arrest Guideline - Do not rewarm beyond 33˚C if ROSC           <30˚C • Continue CPR and rewarming until temp. >30˚C • One defibrillation shock only • One dose of Adrenaline • One dose of Atropine • One dose of Amiodarone Withhold Sodium Bicarbonate 8.4% IV

Special Notes

Hypothermia is insidious and rarely occurs in isolation. Where the Pt is in a group environment other members of the group should be carefully assessed for signs of hypothermia.

Arrhythmia in hypothermia is associated with temp. below 33˚C.

Atrial arrhythmias, bradycardia, or atrioventricular block do not generally require treatment with anti-arrhythmic agents unless decompensated, and resolve on rewarming.

Defibrillation and cardioactive drugs may not be effective at temp. below 30˚C. VF may resolve spontaneously upon rewarming.

The onset and duration of drugs is prolonged in hypothermia and the interval between doses is therefore doubled, for example doses of Adrenaline become 6 minutely.

General Care

Shelter from wind in heated environment.

Remove all damp or wet clothing.

Gently dry Pt with towels / blankets.

Wrap in warm sheet / blanket - cocoon.

Cover head with towel / blanket - hood.

Use thermal / space / plastic blanket if available.

Only warm frostbite if no chance of refreezing prior to arrival at hospital.

Assess BGL if altered conscious state.

Warmed fluid - Normal Saline warmed between 37-42˚C should be given to correct moderate/severe hypothermia and maintain perfusion if available. - Fluid <37˚C could be detrimental to Pt.