Hypothermia Transport And Mangement

Question 1

Patient’s trunk feels cold on examination or core temperature <35°C

Vital signs present

Conscious

NO
Trauma
Comorbidities
Suspected secondary Hypothermia

Answer 1

HT I
Warm environment and clothing
Warm sweet drinks
Active movement

Question 2

Patient’s trunk feels cold on examination or core temperature <35°C

Vital signs present

Conscious

WITH
Trauma
Comorbidities
Suspected secondary Hypothermia

Answer 2

Transport to nearest appropriate hospital

HT I, II, or III
Active external and minimally invasive rewarming (insulation, hot packs, or forced air blankets, warm IV
fluid, allow shivering)
Minimal and cautious movements to avoid arrhythmias
Airway management if required

Question 3

Patient’s trunk feels cold on examination or core temperature <35°C

Vital signs present

Impaired consciousness

POSITIVE for the ff:
Prehospital cardiac instability
SBP <90 mm Hg
Ventricular dysrhythmias
Core temperature <28°C

Answer 3

Transport to ECMO hospital

Question 4

Patient’s trunk feels cold on examination or core temperature <35°C

Vital signs present

Impaired consciousness

NEGATIVE for the ff:
Prehospital cardiac instability
SBP <90 mm Hg
Ventricular dysrhythmias
Core temperature <28°C

Answer 4

Transport to nearest appropriate hospital

HT I, II, or III
Active external and minimally invasive rewarming (insulation, hot packs, or forced air blankets, warm IV
fluid, allow shivering)
Minimal and cautious movements to avoid arrhythmias
Airway management if required

Question 5

Patient’s trunk feels cold on examination or core temperature <35°C

Vital signs present

POSITIVE for the ff.:
Obvious signs of irreversible death
Valid DNR order
Conditions unsafe for rescuer
Avalanche burial >35 min and airway
packed with snow

Answer 5

Consider termination of CPR

Question 6

Patient’s trunk feels cold on examination or core temperature <35°C

Vital signs present

NEGATIVE for the ff.:
Obvious signs of irreversible death
Valid DNR order
Conditions unsafe for rescuer
Avalanche burial >35 min and airway
packed with snow

Cardiac arrest from alternate cause prior to cooling
Major trauma
Witnessed normothermic arrest
Avalanche burial <35 min

Answer 6

Transport to nearest appropriate hospital or
manage as per supervising MD

Question 7

Patient’s trunk feels cold on examination or core temperature <35°C

Vital signs present

NEGATIVE for the ff.:
Obvious signs of irreversible death
Valid DNR order
Conditions unsafe for rescuer
Avalanche burial >35 min and airway
packed with snow

NEGATIVE for the ff:
Cardiac arrest from alternate cause prior to cooling
Major trauma
Witnessed normothermic arrest
Avalanche burial <35 min

Answer 7

Consider tests to confirm
need for ECMO/CPB
Core temperature <32°C
Serum potassium <12 mmol/L

HT IV
Do NOT terminate CPR
Transport to ECMO
Prevent further heat loss (insulation, warm environment,
do not apply heat to head)
Active external and minimally invasive rewarming during
transport is recommended but controversial; do not apply heat to head

If ECMO not available within 6 h
consider on-site rewarming with
hot packs or forced air blankets,
warm IVF +/– warm thoracic
lavage, +/– warm bladder lavage;
do not apply heat to head
Rewarm to ≥32°C

Question 8

ROSC

Answer 8

Prepare for multiorgan failure and need for ECMO respiratory support
Provide postarrest management
Consider targeted temperature management

If (-) despite HT IV Management: Consider termination of CPR