What is the immediate treatment for hypothermia?

Immediate Treatment for Hypothermia

Immediately move the patient to a warm environment, remove all wet clothing, protect from further heat loss with dry insulating blankets, and initiate active rewarming with forced-air warming devices or chemical heat packs while activating emergency services if the patient shows any decreased level of responsiveness. 1

Initial Assessment and Protection from Further Heat Loss

The first priority is preventing additional heat loss, which takes precedence even before active rewarming begins:

• Move the patient from cold to warm environment immediately 1
• Remove all saturated clothing to prevent ongoing evaporative heat loss 1
• Insulate from the ground and cover the head and neck, as significant heat loss occurs through these areas 1
• Shield from wind using plastic or foil vapor barrier layers in addition to dry insulating blankets 1

If the patient cannot be moved immediately to a warm environment, these protective measures become even more critical and should be implemented on-site 1.

Severity-Based Treatment Algorithm

Mild Hypothermia (32-35°C): Alert but Shivering

• Passive rewarming with blankets is often adequate in healthy individuals 1, 2
• Provide high-calorie foods or drinks if the patient is alert and can safely swallow, as shivering increases metabolic rate 5-6 times and requires substantial calorie expenditure 1, 2
• Monitor for deterioration as patients can progress to more severe stages 2
• Consider active external rewarming (heating pads, forced-air blankets) in tandem with passive methods 1, 2

Moderate Hypothermia (28-32°C): Decreased Responsiveness

This is a medical emergency requiring immediate activation of emergency services 1

• Activate emergency response system immediately 1
• Use all available passive AND active rewarming methods simultaneously 1
• Apply forced-air warming blankets (e.g., Bair Hugger) as primary active external rewarming 3, 4
• Administer warmed intravenous fluids (if available in medical setting) 2, 3
• Provide humidified, warmed oxygen 2, 3
• Handle the patient gently to avoid triggering cardiac arrhythmias 1, 3

Severe/Profound Hypothermia (<28°C): Unresponsive or Appearing Lifeless

• Continue all measures for moderate hypothermia 2, 3
• Emergency transport is mandatory - these patients require hospital-based active core rewarming 2, 3
• Extremely gentle handling is critical as the heart is highly irritable and prone to ventricular fibrillation 3
• Active core rewarming methods in hospital settings include warmed IV fluids, peritoneal lavage, and potentially extracorporeal circulation 2, 4, 5

Critical Safety Considerations for Active Rewarming

When using any heating devices, specific precautions prevent serious complications:

• Place insulation (cloth) between heat source and skin unless manufacturer instructions specify otherwise 1
• Follow manufacturer instructions precisely for all rewarming devices 1
• Monitor heated skin frequently for redness or signs of impending burn injury 1
• Avoid body-to-body rewarming as it is less effective than chemical heat packs or forced-air systems 1

Rewarming Targets and When to Stop

• Target minimum core temperature of 36°C before considering the patient stable 2, 3, 4
• Cease rewarming at 37°C as higher temperatures are associated with poor outcomes and increased mortality 2, 3, 4
• Monitor core temperature every 5-15 minutes depending on severity 2, 3

Special Circumstances: Damp Clothing in Field Settings

If the patient cannot be moved immediately and is wearing damp (not saturated) clothing like polyester fleece:

• Active rewarming through damp clothing is reasonable using the hypothermia wrap technique with chemical heat blankets, plastic/foil layers, and insulative blankets 1
• This approach prevents further heat loss from undressing in freezing, windy conditions 1

Common Pitfalls to Avoid

• Do not delay rewarming - delays and slower rewarming rates are the most important prognostic factors for increased mortality 6
• Do not overlook hypothermia during initial resuscitation - prevention and early treatment are far easier than rewarming severely hypothermic patients 4
• Do not rough-handle patients with moderate to severe hypothermia, as this can precipitate fatal arrhythmias 1, 3
• Do not provide hot oral fluids to confused or obtunded patients due to aspiration and burn risk 1