From the Guidelines
Management of hypothermia requires prompt recognition and appropriate interventions based on severity, with the goal of preventing morbidity, mortality, and improving quality of life. The most recent and highest quality study, 1, provides a comprehensive guideline for the management of hypothermia. According to this study, the management of hypothermia can be categorized into different levels of severity:
- Cold stress (35-37°C): Remove from cold environment, protect from further heat loss, and use passive rewarming methods.
- Mild hypothermia (32-35°C): Protect from harm, use passive and active rewarming methods, and seek additional care.
- Moderate hypothermia (28-32°C): Handle gently, use all available passive and active rewarming methods, and activate the emergency response system.
- Severe hypothermia (<28°C): Requires more aggressive measures, including active core rewarming techniques. Another study, 1, highlights the importance of normothermia in trauma patients, with a target core temperature between 36 and 37°C to create optimal pre-conditions for coagulation. This study also emphasizes the use of forced air warming, warm fluid therapy, and extracorporeal re-warming devices to prevent hypothermia and hypothermia-induced coagulopathy. The key to managing hypothermia is to recognize its severity and implement appropriate rewarming strategies, while also addressing potential complications such as coagulopathy, arrhythmias, and electrolyte abnormalities. It is essential to handle patients gently, avoid administering cold fluids or medications, and extend medication intervals due to slowed metabolism in hypothermia. By following these guidelines and prioritizing the prevention of morbidity, mortality, and improvement of quality of life, healthcare providers can effectively manage hypothermia and improve patient outcomes.
From the Research
Management of Hypothermia
- Hypothermia is defined as an unintentional decrease in core body temperature to below 35 degrees C 2
- The management of hypothermic patients differs in several important respects from that of euthermic patients, and advance knowledge about hypothermia is prerequisite to optimal management 2
- The nursing management of a patient with hypothermia depends upon the severity of the condition, with the primary concern being to treat the symptoms and re-warm the patient appropriately 3
Rewarming Strategies
- Therapeutic peritoneal lavage with warm saline solution can be used as an option for rewarming a critically hypothermic trauma patient 4
- Rapid rewarming by immersion appears to be a safe, effective, and relatively simple method for treating accidental hypothermia victims 5
- Active external rewarming interventions include chemical, electrical and charcoal-burning heat packs; chemical or electrical heated blankets; and forced air warming 6
- The most effective insulation systems combined insulation with a vapor barrier, and mildly hypothermic patients may be able to rewarm themselves with only insulation and a vapor barrier 6
Prehospital Management
- Prehospital management of hypothermia is crucial, as it can induce a vicious cycle of the synergistic effects of hypothermia, acidosis and coagulopathy 6
- Treatment of hypothermia should ideally begin prehospital, and all intravenous fluids must be reliably warmed before infusion 6
- Modern designs of hypothermia wraps have shown promise, and battery-powered inline fluid warmers are practical devices to warm intravenous fluids prior to infusion 6