From the Guidelines
Hypothermia requires immediate treatment, and the most effective approach is to call emergency services while taking steps to warm the person gradually, with the priority being to rewarm the core of the person, as stated in the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
Key Considerations
- Hypothermia occurs when body temperature drops below 95°F (35°C) and can be classified into different stages, including mild, moderate, and severe, each with distinct signs and symptoms 1.
- The treatment of hypothermia depends on the severity of the condition, with mild cases (temperature >34°C [93.2°F]) often managed with passive rewarming, and moderate to severe cases (temperature <34°C [93.2°F]) requiring active core rewarming techniques 1.
- It is essential to prevent further heat loss by removing wet clothing, insulating the victim from further environmental exposures, and using warm, dry blankets or coats to cover the person 1.
- Active rewarming methods, such as administration of warm humidified oxygen, warm IV fluids, and intrathoracic or intraperitoneal warm-water lavage, may be necessary for severe cases, but should not delay definitive care 1.
Prevention and Special Considerations
- Prevention of hypothermia includes dressing in layers, staying dry, avoiding alcohol in cold conditions, and being especially vigilant with children, elderly people, and those with certain medical conditions who are more susceptible 1.
- Frostbite is a common finding in hypothermic individuals, but rewarming the core of the person with hypothermia is the treatment priority, and rewarming the extremities first can cause the core temperature to decrease 1.
- The very young, the very old, and people with impaired temperature perception, regulation, and ability to communicate are at increased risk of hypothermia, and death rates are highest among men, the elderly, and people who live in rural areas 1.
From the Research
Definition and Causes of Hypothermia
- Hypothermia occurs when heat loss from the body exceeds heat gain and the core temperature of the body falls below 35 degrees C 2
- It can develop secondary to toxin exposure, metabolic derangements, infections, and dysfunction of the central nervous and endocrine systems 3
- Accidental hypothermia concerns a body core temperature of less than 35°C without a primary defect in the thermoregulatory system 4
Clinical Presentation and Management
- The clinical presentation of hypothermia includes a spectrum of symptoms and is grouped into the following three categories: mild, moderate, and severe 3
- Management depends on the degree of hypothermia present, with treatment modalities ranging from noninvasive, passive external warming techniques to active external rewarming and active core rewarming 3
- 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 2
Treatment and Rewarming Techniques
- Rewarming may be passive or active and/or internal or external, depending on severity and available resources 5
- Active external rewarming interventions include chemical, electrical and charcoal-burning heat packs; chemical or electrical heated blankets; and forced air warming 4
- Extracorporeal venovenous rewarming (EVR) is a technique that can rewarm patients more rapidly than standard techniques and may be most appropriate in patients with multisystem trauma 6
- Cardiopulmonary bypass is required in severely hypothermic patients with cardiac arrest 6
Prevention and Prehospital Management
- Prevention and recognition of atypical presentations are essential to reducing the rates of morbidity and mortality associated with hypothermia 3
- Treatment of hypothermia should ideally begin prehospital to prevent or manage deterioration of a cold patient 4
- The most effective insulation systems combined insulation with a vapor barrier, and active warming will still provide comfort and an energy-saving benefit 4