Severe hypothermia is a serious medical emergency. Patients with this stage of hypothermia are at an increased risk for sudden cardiac arrest due to the irritability of heart muscle tissues at lower temperatures. Even rewarming will require close monitoring in the event that the patient suffers a cardiac arrhythmia.
Full Answer
Does rewarming affect the whole body during therapeutic hypothermia?
Introduction Rewarming is a delicate phase of therapeutic hypothermia (TH). Adverse consequences of rewarming on the whole body may seriously limit the protective effects of hypothermia, leading to secondary injury. Thus, understanding, predicting, and managing possible systemic side effects of rewarming is important for guaranteeing TH efficacy.
How is hypothermia treated in the emergency room?
Depending on the severity of hypothermia, emergency medical care for hypothermia may include one of the following interventions to raise the body temperature: Passive rewarming. For someone with mild hypothermia, it is enough to cover them with heated blankets and offer warm fluids to drink. Blood rewarming.
What is severe hypothermia?
Severe hypothermia is a serious medical emergency. Patients with this stage of hypothermia are at an increased risk for sudden cardiac arrest due to the irritability of heart muscle tissues at lower temperatures.
When should resuscitation be initiated in the treatment of hypothermia?
A reasonable approach is to initiate resuscitation on all hypothermic patients unless a patient presents with a frozen chest or other obvious nonsurvivable injuries. A patient can be warmed aggressively and resuscitated until the core temperature rises above 32°C.
What are the long term effects of hypothermia?
If left untreated, hypothermia can cause a heart attack, liver damage, kidney failure, or death. Hypothermia is different from frostbite.
What are the complications of therapeutic hypothermia?
Therefore, patients treated with hypothermia are exposed to the risk of hyperglycemia; and increased blood sugar levels are associated with increased morbidity and mortality. Tight control of blood sugar levels and insulin therapy has been associated with decreased morbidity and mortality.
What electrolyte complication may develop during the rewarming phase of therapeutic hypothermia?
Rewarming phase Warming the patient too quickly or allowing continued shivering causes dangerous electrolyte shifts, leading to potentially lethal arrhythmias. Controlled rewarming of 0.15° to 0.5° C per hour is recommended.
Why should we avoid rewarming a victim of hypothermia too quickly?
Warming the extremities first can cause shock. It can also drive cold blood toward the heart and lead to heart failure. DO NOT warm the victim too fast. Rapid warming may cause heart arrhythmias.
What complication is the most common cause of delayed mortality after the successful resuscitation of a patient presenting with hypothermia?
A major complication of active external rewarming is “core temperature afterdrop,” which results when cold peripheral blood rapidly returns to the heart. Historically, this has led to many unwarranted deaths because patients were thought to be getting worse and rewarming was aborted.
Why does rewarming cause hyperkalemia?
Introduction: Hypothermia can induce electrolyte changes, particularly changes in potassium through transcellular shifts. Subsequent rewarming protocol can result in rebound hyperkalemia that may be associated with cardiac cell instability and cardiac arrhythmias.
Does rewarming cause hypotension?
Hypotension — Patients with moderate or severe hypothermia frequently become disproportionately hypotensive during rewarming due to severe dehydration and fluid shifts [10,24,26].
What happens during therapeutic hypothermia?
The therapeutic hypothermia will likely last around 24 hours. The medical team will slowly rewarm you over several hours. They may set cooling blankets at gradually higher temperatures. In some cases, they may use rewarming devices as well.
How do you rewarm hypothermia?
Medical treatmentPassive rewarming. For someone with mild hypothermia, it is enough to cover them with heated blankets and offer warm fluids to drink.Blood rewarming. Blood may be drawn, warmed and recirculated in the body. ... Warm intravenous fluids. ... Airway rewarming. ... Irrigation.
What happens after hyperthermia?
Patients who become acutely hyperthermic often display signs of neurological dysfunction. The neurological injury may manifest in several ways, including cognitive dysfunction, agitation, seizures, unsteadiness, or disturbance of consciousness from lethargy to coma.
When treating hyperthermia one should never?
Use cold wet towels or dampen clothing with tepid water when the heat is extreme. Avoid hot, heavy meals. Avoid alcohol. Determine if the person is taking any medications that increase hyperthermia risk; if so, consult with the patient's physician.
Which of the following methods is safe to use when warming a person who has hypothermia?
Warm the person by wrapping them in blankets or putting dry clothing on the person. Do not immerse the person in warm water. Rapid warming can cause heart arrhythmia. If using hot water bottles or chemical hot packs, wrap them in cloth; don't apply them directly to the skin.
How to help someone with hypothermia?
Be gentle. When you're helping a person with hypothermia, handle him or her gently. Limit movements to only those that are necessary. Don't massage or rub the person. Excessive, vigorous or jarring movements may trigger cardiac arrest.
What is passive rewarming?
Passive rewarming. For someone with mild hypothermia, it is enough to cover them with heated blankets and offer warm fluids to drink. Blood rewarming. Blood may be drawn, warmed and recirculated in the body.
How to raise body temperature?
Depending on the severity of hypothermia, emergency medical care for hypothermia may include one of the following interventions to raise the body temperature: 1 Passive rewarming. For someone with mild hypothermia, it is enough to cover them with heated blankets and offer warm fluids to drink. 2 Blood rewarming. Blood may be drawn, warmed and recirculated in the body. A common method of warming blood is the use of a hemodialysis machine, which is normally used to filter blood in people with poor kidney function. Heart bypass machines also may need to be used. 3 Warm intravenous fluids. A warmed intravenous solution of salt water may be put into a vein to help warm the blood. 4 Airway rewarming. The use of humidified oxygen administered with a mask or nasal tube can warm the airways and help raise the temperature of the body. 5 Irrigation. A warm saltwater solution may be used to warm certain areas of the body, such as the area around the lungs (pleura) or the abdominal cavity (peritoneal cavity). The warm liquid is introduced into the affected area with catheters.
How to warm blood?
Heart bypass machines also may need to be used. Warm intravenous fluids. A warmed intravenous solution of salt water may be put into a vein to help warm the blood.
How to protect yourself from cold weather?
Cut away clothing if necessary to avoid excessive movement. Cover the person with blankets. Use layers of dry blankets or coats to warm the person. Cover the person's head, leaving only the face exposed. Insulate the person's body from the cold ground.
What causes the body temperature to drop?
Heat applied to the arms and legs forces cold blood back toward the heart, lungs and brain, causing the core body temperature to drop. This can be fatal. Don't apply direct heat. Don't use hot water, a heating pad or a heating lamp to warm the person.
Can blood tests confirm hypothermia?
Blood tests also can help confirm hypothermia and its severity. A diagnosis may not be readily apparent, however, if the symptoms are mild, as when an older person who is indoors has symptoms of confusion, lack of coordination and speech problems.
What to do if you have hypothermia?
If hypothermia is more severe, seek immediate medical care or call 911. At the hospital, the medical team may insert an IV with warm fluids, give you warm air through a breathing mask, or use a machine to rewarm your blood. 2. Causes and Risk Factors of Hypothermia.
Which patients are more susceptible to hypothermia?
Elderly patients, very young patients, patients with diabetes or circulatory problems, and patients with low body fat are more susceptible to hypothermia and its complications compared to the rest of the population.
How to tell if you have hypothermia?
Signs of Mild Hypothermia 1 Uncontrollable shivering 2 Social withdrawal, becoming quiet and non-communicative 3 Difficulty concentrating 4 Fumbling fingers. For example, having more than just trouble texting—now the patient might drop her phone. 5 Sense of discomfort or pain
Why is hypothermia a risk factor for sudden cardiac arrest?
Patients with this stage of hypothermia are at an increased risk for sudden cardiac arrest due to the irritability of heart muscle tissues at lower temperatures. Even rewarming will require close monitoring in the event that the patient suffers a cardiac arrhythmia.
How are symptoms of hypothermia divided?
The signs and symptoms of hypothermia are divided roughly by the severity of the hypothermia. There isn't a universal definition of the categories of severity, but most healthcare providers use mild, moderate, and severe, defined by body temperature and associated signs. Cold exposure can come on slowly, affecting someone before he ...
What is the temperature of the body when you have hypothermia?
The earliest signs of hypothermia occur when skin temperature (not core body temperature) falls below an average of about 95 degrees when measured over several areas of the body—what's known as the mean skin temperature. At this early stage, circulation to the skin is decreased, which keeps blood away from the cold surface ...
How to get your body to stay warm?
Eat nutritious foods and drink warm beverages so your body has the fuel it needs to keep warm. 1 Get to a warm, dry location and remove wet clothes if you notice early warning signs of hypothermia, like shivering and difficulty concentrating.
Why is immersion in warm water not recommended?
Immersion in warm water was not recommended by a 2014 expert panel review because of concerns for core temperature afterdrop and the risk of cardiovascular collapse. [ 8] Defibrillation also is difficult; however, defibrillation is likely futile once a patient's core temperature falls below 30°C.
What is rewarming shock?
Rewarming shock, or hypotension secondary to marked vasodilatation of rewarming. Rewarming acidosis due to recirculation of pooled lactic acid in the peripheral circulation. Rewarming electrolyte disturbances, in particular hypocalcemia and hypomagnesemia, indicate a poor prognosis. Aspiration pneumonia.
What is prehospital management?
This should be the preeminent concern. Conscious patients can develop ventricular fibrillation suddenly; prehospital workers, particularly those operating in remote search-and-rescue operations, should avoid inadvertent jerky movement of severely hypothermic patients. Patients who develop hypothermia-induced dysrhythmia in the field may be beyond resuscitation. How the hypothermic heart deteriorates into the rhythm of ventricular fibrillation remains under debate.
Where to put heat packs for rewarming?
Initiate active external rewarming with heat packs (eg, hot water bottles, chemical packs) placed in the axillae, on the groin, and on the abdomen. Be aware of the risk of causing body surface burns from exuberant active external rewarming.
Is hypothermia a real emergency?
Profound hypothermia is a true emergency, warranting the same resource-intensive resuscitation as myocardial infarction. Direct treatment at maintaining or restoring cardiac perfusion; maximizing oxygenation is indicated for a prolonged period until the core temperature is at least 32°C.
Is aggressive therapy recommended for hypothermia?
Most texts advocate aggressive therapy for severely hypothermic patients, basing the recommendation on anecdotal reports of success. Researchers recently confirmed justification for aggressive treatment in a 16-year longitudinal review of profound hypothermia.
Can a patient be resuscitated with hypothermia?
However, patients with profound hypothermia can be resuscitated successfully with good neurologic outcomes . The adage that "a patient is not dead until they are warm and dead" is of some use. In some cases, prolonged efforts to bring a patient with no signs of life to a normal body temperature canbe futile.
What are the risk factors for death from hypothermia?
Risk factors associated with death from accidental hypothermia include ethanol use, homelessness, psychiatric disease, and older age [ 2,24 ]. Geriatric population — Older adults are at increased risk of developing hypothermia and its complications and should be urgently assessed if found to be hypothermic [ 24,25 ].
What is passive external rewarming?
Passive external rewarming — Passive external rewarming is used for mild hypothermia. It is also used in patients undergoing aggressive rewarming for moderate to severe hypothermia. After wet clothing is removed, the patient is covered with blankets or other types of insulation.
Can bladder temperature be used during rewarming?
Bladder temperatures are commonly used and are adequate in mild to moderate hypothermia. However, bladder and rectal temperatures should not be used in critical patients during rewarming. Changes in rectal and bladder temperatures significantly lag behind core temperature changes during rewarming.
Is hypothermia sensitive to movement?
Physical examination — The hypothermic heart is very sensitive to movement . Rough handling of the patient may precipitate arrhythmias, including ventricular fibrillation. Take care to avoid jostling the patient during the physical examination or the performance of essential procedures.
Does cooling affect the brain?
Cooling decreases tissue metabolism and inhibits neural activity. During the initial phase of cooling, shivering in response to skin cooling produces heat and increases metabolism, ventilation, and cardiac output. Neurologic function begins declining even above a core temperature of 35°C.
Is hypothermia a poor prognosis?
In general, hypothermia associated with asphyxia by drowning or avalanche burial has a poor prognosis [ 81,105,106 ]. Among healthy patients who develop accidental hypothermia and are hemodynamically stable at presentation, evidence suggests that almost all survive neurologically intact [ 106,107 ].