What is the treatment for a patient with subjective hypothermia?

Treatment of Subjective Hypothermia

Early application of measures to reduce heat loss and warm the hypothermic patient is recommended to achieve and maintain normothermia. 1

Assessment and Classification

First, determine the severity of hypothermia:

Severity Level	Temperature	Clinical Signs
Cold stress	35-37°C	Alert, possibly shivering
Mild hypothermia	32-35°C	Altered mental status, shivering
Moderate hypothermia	28-32°C	Decreased responsiveness, ±shivering
Severe/profound	<28°C	Unresponsive, appears lifeless

Use reliable core temperature measurement methods:

• Esophageal or nasopharyngeal probes
• Bladder temperature probe
• Oral temperature
• Tympanic measurement
• Avoid axillary measurements (consistently 1.5-1.9°C below core) 2

Treatment Algorithm

For All Hypothermic Patients:

1. Move patient to warm environment
2. Remove wet clothing
3. Apply passive warming (dry blankets, covering head/neck)
4. Monitor core temperature continuously 2

Based on Severity:

Cold Stress (35-37°C):

• Passive rewarming
• Provide high-calorie foods/drinks if alert 2

Mild Hypothermia (32-35°C):

• Passive rewarming
• Active external warming (forced air warming systems, warm blankets)
• Warm IV fluids (37-40°C) if needed
• Monitor for shivering 2

Moderate Hypothermia (28-32°C):

• All available passive and active warming methods
• Warm IV fluids (37-40°C) at 30 mL/kg if dehydrated
• Heated humidified oxygen
• Handle patient gently to prevent arrhythmias
• Monitor cardiac rhythm and blood pressure continuously 2

Severe/Profound Hypothermia (<28°C):

• Emergency intervention with active core rewarming
• Consider extracorporeal warming for refractory cases
• Limit defibrillation attempts until core temperature >30°C
• If cardiac arrest occurs, continue CPR
• Consider ECMO for severe cases 2

Rewarming Techniques

Passive External Rewarming:

• Remove wet clothing
• Cover with warm blankets
• Increase ambient temperature 1

Active External Rewarming:

• Forced air warming systems
• Warm blankets
• Radiant heaters 1, 2

Active Internal (Core) Rewarming:

• Warm IV fluids (37-40°C)
• Heated humidified oxygen
• Body cavity lavage
• Extracorporeal blood warming for severe cases 2

Target Rewarming Rate and Goals

• Aim for rewarming rate of 0.25-0.5°C per hour
• Target temperature of 36°C
• Avoid overheating (stop rewarming after reaching 37°C)
• Monitor for rebound hyperthermia (>38°C) 2

Special Considerations for Trauma Patients

• Hypothermia in trauma increases mortality and blood loss
• Hypothermia is associated with acidosis, hypotension, and coagulopathy
• Monitor for coagulopathy (a 1°C drop in temperature is associated with a 10% drop in coagulation function)
• Consider damage control surgery approach if hypothermia is present with ongoing bleeding 1

Monitoring During Treatment

• Continuous core temperature monitoring
• Cardiac rhythm monitoring
• Blood pressure monitoring
• Watch for complications:
  • Electrolyte abnormalities
  • Coagulopathy
  • Cardiac dysfunction
  • Shivering 2

Early recognition and implementation of appropriate warming strategies based on severity can significantly reduce morbidity and mortality in hypothermic patients 2.