Cold-Related Injuries #10 Hospital Management of Hypothermia

1.  Recognize Hypothermia:
Use low-reading thermometers and use esophageal thermometer to monitor core temperature.

2.  Airway: 
Obtain a patent airway and ventilate. 
Beware - using heated, moist air will suppress the shivering mechanism.
Shivering is the most efficient way to rewarm.

3.  ECG and continuous cardiac monitoring:

4.  Monitor Labs:
CBC, electrolytes, glucose, ABG (do not adjust for temperature)

5.  Initiate rewarming:
Shell: if > 30°C, maintain blood sugar to encourage shivering, peripheral rewarming.
Core: if < 30°C and unconscious, arteriovenous fistula and body cavity lavage.
In cardiac arrest, cardiopulmonary bypass is preferred for rewarming.

6.  Warning:
Low core temperature potentiates the fibrillatory effect of elevated K and a low pH.

An excellent reference is:
Chapter 58, Hypothermia and Hyperthermia, Clinical Critical Care Medicine, Albert, et. al., published by Mosby 2006.

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