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