Hypothermia/Cold Exposure (Paediatric)
 
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 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.