From the Guidelines
Hypothermia is a medical emergency that requires immediate attention, and treatment should be guided by the severity of the condition, with mild cases managed with passive rewarming and more severe cases requiring active rewarming techniques, as outlined in the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
Symptoms of Hypothermia
The symptoms of hypothermia progress from mild to severe and include:
- Shivering
- Confusion
- Slurred speech
- Drowsiness
- Weak pulse
- Slow breathing
- Eventually, loss of consciousness In severe cases, the person may appear dead with no detectable pulse or breathing.
Treatment of Hypothermia
Treatment of hypothermia begins with removing wet clothing and moving to a warm environment.
- For mild hypothermia (temperature >34°C [93.2°F]), passive rewarming with blankets and warm, non-alcoholic beverages is often adequate 1.
- More severe cases require active rewarming techniques such as:
- Heated blankets
- Warm IV fluids
- Warm, humidified oxygen
- In hospital settings, more invasive warming methods like warm water lavage of body cavities may be used 1.
Prevention and Handling
Prevention is crucial and includes:
- Wearing appropriate clothing in cold environments
- Staying dry
- Maintaining adequate nutrition and hydration
- Recognizing early symptoms During rewarming, the person should be handled gently as rough movement can trigger cardiac arrhythmias 1. Hypothermia is dangerous because as core temperature drops, cellular metabolism slows, affecting brain function, heart rate, and other vital processes, which is why prompt recognition and treatment are essential for survival 1.
From the Research
Hypothermia Causes and Symptoms
- Hypothermia can develop secondary to toxin exposure, metabolic derangements, infections, and dysfunction of the central nervous and endocrine systems 2
- The clinical presentation of hypothermia includes a spectrum of symptoms and is grouped into the following three categories: mild, moderate, and severe 2
- Physiologic derangements include hypoxemia, hypotension, acidosis, and arrhythmias 3
Treatment of Hypothermia
- Management depends on the degree of hypothermia present, ranging from noninvasive, passive external warming techniques to active external rewarming and active core rewarming 2
- Initial management should include CPR if the victim is not breathing or is pulseless, and further core heat loss should be prevented by removing wet garments, insulating the victim, and ventilating with warm humidified air/oxygen 4
- Active core rewarming is recommended for hypothermia with associated cardiovascular insufficiency or instability, and rapid core rewarming for hypothermia with cardiovascular collapse 3
- Treatment modalities also include heated intravenous fluid infusions, heated humidified oxygen, body cavity lavage, and extracorporeal blood warming 2, 4
- A combination of core rewarming techniques, such as warmed IV fluids and heated aerosol masks, can be effective in treating moderate-to-severe hypothermia 5
- Minimally invasive central catheters can also be used for successful recovery of severe hypothermia 6