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Environmental

HYPOTHERMIA

Signs and Symptoms: Differential Diagnosis:
• Cold, Clammy • Sepsis
• Shivering/Lack of Shivering • Environmental Exposure
• Mental Status Changes • Hypoglycemia
• Extremity Pain/Numbness • CNS Dysfunction
• Bradycardia/Arrhythmia • Toxic Ingestion
• Hypotension or Shock
Universal Patient Care Guideline FROSTBITE
Continued from: O2 (if Hypoxemic) • Extremity or body part with
Tactical Evacuation Guideline IV/IO Guideline suspected frostbite must be
Cardiac Monitor (ASAP) protected to prevent further
injury (wrapped and covered
with a dry blanket). Do not
Remove Wet Clothing attempt active rewarming
unless no risk of refreezing.
Assessment:
Core Temperature <95ºF/35ºC • Mental Status AMS Core Temp <95º/35ºC
Patient is Alert, w/o Arrhythmia, and • Rectal Temperature with AMS,
Arrhythmia,
is Actively Shivering • Glucose (treat per AMS Guideline
while re-warming) or Absence of Shivering
• Dry Blankets WARMED IV FLUIDS Handle Very Gently
• Hypothermia Blanket 1L IVF Bolus • HPMK Kit / Hypothermia
• Warm PO fluids (if available) Blankets
• Dry Clothing
Target re-warming
(D/C warmed IV Fluids) • Hot Packs to Groin, Axilla,
Abdomen (avoid contact burn)
12-lead EKG
Arrhythmia? YES
Submersion Injury Guideline Bradycardia with Pulse Guideline
NO
Airway Guideline Treat per Appropriate Cardiac Arrest Guideline
Guideline
When appropriate, return to: Transport to ECMO team or Tachycardia with Pulse Guideline
Tactical Evacuation Guideline nearest hospital
ENVIRONMENTAL
Pearls:
• “No patient is dead until they are warm and dead.”
• Hypothermia defined as core temperature <95ºF (35ºC).
• With temperatures <31ºC (88ºF) ventricular fibrillation is common. Cardiac muscle becomes very irritable as
temperature drops and rough handling may induce a cardiac dysrhythmia.
• With temperatures below 30ºC (86ºF) shivering ceases – removing an important heat production source.
• The pulse may be very slow in hypothermic patients – should wait at least one minute to feel pulse.
• Arrhythmias at temperature >30ºC (86ºF) treated similar to normo-thermic patients with the addition of active
re-warming.
• At temperatures <30ºC (86ºF) one defibrillation can be attempted, but withhold further attempts / meds until
temp >30ºC (86ºF).

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