Is a body temperature of 30 degrees Celsius in a clinically stable and asymptomatic patient likely an error with the thermometer, given the presence of hypothermia?

From the Guidelines

A temperature of 30°C represents severe hypothermia and should not be dismissed as a thermometer error, even if the patient appears asymptomatic, requiring immediate medical intervention. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, a hypothermia level of <28°C is considered severe and is a medical emergency. The patient's temperature of 30°C falls into the category of severe hypothermia, which may present with decreased level of responsiveness, and the absence of shivering is concerning.

Key considerations in managing this patient include:

• Continuous cardiac monitoring due to the high risk of arrhythmias, particularly ventricular fibrillation
• Active rewarming with warmed IV fluids, warm blankets, and a forced-air warming system
• Monitoring core temperature continuously using rectal, esophageal, or bladder probes
• Gradual warming at 0.5-2°C per hour to avoid rewarming shock
• Laboratory tests to check for electrolyte abnormalities, coagulopathy, and acidosis that commonly accompany severe hypothermia, as indicated in the guidelines 1.

It is crucial to handle the patient gently and activate the emergency response system, as severe hypothermia is a life-threatening condition that requires prompt and careful management, as outlined in the guidelines 1.

From the Research

Hypothermia Definition and Temperature Measurement

• Accidental hypothermia is defined as a body core temperature of less than 35°C without a primary defect in the thermoregulatory system 2.
• A patient with a temperature of 30°C is considered hypothermic, as it falls below the threshold of 35°C.
• Non-invasive methods can be used to measure a patient's temperature, but the accuracy of the measurement is crucial 3.

Clinical Stability and Asymptomatic Hypothermia

• A hypothermic patient who is clinically stable and asymptomatic may still require monitoring and treatment to prevent further heat loss and potential complications 2, 4.
• The use of warmed intravenous fluids and passive rewarming measures can be effective in increasing body temperature and preventing hypothermia 5, 4.

Error with the Thermometer

• There is no direct evidence to suggest that an error with the thermometer is the probable cause of the patient's hypothermic reading.
• However, it is essential to ensure that the temperature measurement is accurate, and the thermometer is functioning correctly 3.

Management of Hypothermia

• The management of hypothermia should consider the initial temperature, the season, the available rewarming measures, and the objectives to be achieved 4.
• Active internal rewarming and the use of a controlled intravascular active heating system may be utilized in severe cases of hypothermia 6.