Hypothermia (Extended Exposure to Cold) (cont.)

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When should I call my doctor for hypothermia?

Any person that is at risk for hypothermia (see previous section on risk factors) and has had exposure to cold weather or cold water immersion, and exhibits any symptoms of hypothermia should be seen in the emergency department. Individuals exhibiting intense shivering, numbness, clumsiness, confusion and/or amnesia after exposure to cold should be seen immediately.

How is hypothermia diagnosed?

For many people, hypothermia is diagnosed by the patient's history and physical exam; especially pertinent is the patient's core temperature. As previously stated any core temperature below 95 F or 35 C is considered to be hypothermic.

Most individuals with hypothermia are considered to have a medical emergency so that diagnosis and treatment begins simultaneously.

What is the treatment for hypothermia?

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For severe cases of hypothermia, treatment begins immediately in the field by careful handling of the patient to avoid developing ventricular fibrillation or any other cardiac dysrhythmia that hypothermic patients are prone to develop. Place the patient in an environment that is warm; remove all wet clothing and replace it with dry towels and blankets or sleeping bags. Simultaneously, be aware that the patient may have suffered other problems, like trauma and these problems may also need immediate attention (respiratory and/or cardiac failure).

External rewarming can begin prior to hospital arrival with warm packs (warm water bottles, warm chemical packs) placed on the person's armpits, groin, and abdomen. Be sure the warm packs (about 105.8 F or 41 C) are not hot to avoid skin burns. Do not attempt to warm extremities by rubbing them.

Core temperatures should be measured by a rectal, bladder, or esophageal thermometer. Do not use tympanic or skin thermometers. Hypothermic induced dysrhythmias have been treated with bretylium, but this drug may not be available as it is no longer being manufactured.

After warming has begun with dry coverings, most guidelines recommend using warm humidified oxygen and heated intravenous saline (heated to about 113 F or 45 C) as additional treatments. Others also suggest instilling warm fluid into the patient's bladder. Thoracic lavage (flushing the thoracic [chest] region with warm water) with isotonic saline (pre-warmed to about 105.8 F or 41 C) has also been done.

Patients with mild to moderate hypothermia (95 F to 89.9 F or 35 C to 32.16 C) and no other injuries or problems require less drastic methods to rewarm. Patients whose body temperature normalizes by gradually rewarming in a warm, dry room with towels and blankets, usually do not need admission to the hospital. However, those with more severe hypothermia may need to be observed in the hospital.

Ideally, treatment will allow the body to return to its normal temperature. At normal temperature, the symptoms of hypothermia should gradually disappear. Consequently, the saying in most emergency departments that treat hypothermic patients is that "the hypothermic patient is not dead until they are warm and dead."

Medically Reviewed by a Doctor on 2/27/2014

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