Hypothermia (cont.)
How is hypothermia diagnosed?
Usually the diagnosis of hypothermia is evident because of circumstances. The
patient is found outside in the cold, and either the patient or a companion can
explain the situation. Sometimes, it is less apparent, especially if the patient
is found indoors and is confused.
The body core temperature needs to be measured; this may
be done with a special rectal thermometer that is designed for very low readings
or with a bladder catheter equipped with a temperature probe. Oral or ear
temperatures are
not accurate in very cold patients.
Aside from diagnosing hypothermia, the underlying cause
needs to be ascertained. While some causes may be readily apparent, there may be
confounding factors. Intoxicated patients may have fallen and sustained a head
injury. The elderly patient may have diabetes and have a low blood sugar. While it is
important to treat the low temperature, the individual medical history of the
patient needs to be considered and appropriate diagnostic tests performed to
rule out any associated injuries or conditions.
How is hypothermia treated?
Care for the hypothermic patient begins when the person is found.
- First aid
should be initiated.
- The patient should be removed from the cold environment and
placed in a warm shelter away from the wind. Wet clothing should be removed and
replaced with a warm, dry covering including head covering.
- Emergency medical services should be activated (call 911
if available) as soon as possible.
- The patient's breathing should be monitored, and if it becomes
dangerously slow or stops, CPR should be initiated.
- Rough handling or jerking of
the patient should be minimized if the person is lethargic or unconscious. This
may cause an irritable heart to develop electrical abnormalities such as
ventricular fibrillation.
- Rewarming should be started by applying warm compresses to the
chest,
neck,
and groin. Hot water should not be used. Because there may be associated
frostbite, direct heat should not be applied to the body. Instead, warm blankets
and body to body contact may be needed as a first aid measure.
- The severity of hypothermia and the patient's mental status and ability to
function will determine what further treatment is necessary. Passive rewarming
with warm clothing in a warm environment may be all that is required for a
conscious person who is shivering.
- Active rewarming may be considered for those who are
colder, showing signs of confusion, or have other medical conditions that need
attention. Warmed intravenous fluids, warming blankets, and warmed humidified air may be provided
in the hospital.
- More aggressive core rewarming may include infusing warm
fluids into the stomach or bladder, irrigating warm solutions into the chest or
abdominal cavity, and in some situations, placing the patient on
dialysis or
heart bypass
to rewarm the body.
Each of the above options needs to be specifically tailored to the patient's
situation and presentation.
One axiom that continues to be followed in emergency medical care is that a
patient is not dead until they are "warm and dead." Vital signs like breathing,
heartbeat, and blood pressure may be difficult to detect in a severely
hypothermic patient, and often efforts are made to try prolonged resuscitation
until the patient is warmed. Occasional stories are reported in the press about
patients, especially children, who have been resuscitated from severe
hypothermia due to immersion in cold water.
Next: When should I call the doctor for hypothermia? »
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