2-17 HYPOTHERMIA

Significant hypothermia occurs when a patient’s trunk feels cool to the touch and shivering is absent. This increases the likelihood of fatal dysrhythmias.  Hypothermia may occur in relatively warm weather with prolonged exposure.

• Mild:  Conscious with an intact shivering mechanism, may be confused. Still able to rewarm themselves with shivering.
• Moderate/Severe: Depressed LOC or coma, often with some degree of rigidity.  Cold skin at the trunk with absence of shivering. Requires assistance to rewarm.
• Hypothermic cardiac arrest: Requires active rewarming and ACLS intervention

All patients with decreased LOC or cardiac arrest secondary to hypothermia should be transported to the closest hospital with Cardiopulmonary bypass capability (Aurora BayCare Medical Center, Bellin Hospital or St. Vincent Hospital)

EMR - Emergency Medical Responder

1. Ensure patent airway and apply oxygen.
2. Perform a pulse check. Remember that the patient may be bradycardic, so pulse should be measured for 45-60 seconds  
   1. Do not perform CPR in the presence of any pulse.
   2. Handle the patient gently to avoid development of V-fib.
   3. If pulse is absent, initiate CPR.  The heart will not restart until rewarmed.
   4. Place Non-visualized airway (Combitube) gently if trained to do so, and ventilate 12/min.
3. Assess for trauma or medical conditions and refer to appropriate protocol.
4. Remove from cold environment
5. Remove all of the patient’s clothing once inside warm environment and cover with blankets, including patient’s head.
6. Apply warm packs to central pulse points (groin, axilla and neck).  Do not apply directly to skin, as may cause thermal burns.
7. Note: AED is not effective in hypothermic cardiac arrest and should not be used.

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Consider ALS intercept
2. Perform glucometry and follow hypoglycemia protocol if indicated.
3. Apply cardiac monitor if trained to do so.  Print rhythm strip for reference.
4. Obtain 12-lead EKG for reference if trained to do so.
5. Consult Medical Control on all hypothermic patients in arrest for consideration of transport and other orders.
6. Transport the patient rapidly but smoothly.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Establish IV access.
2. Consult Medical Control for fluid orders.
   1. If IV fluids are administered, warmed IV fluids are preferred.

Intermediate - Perform/Confirm All Above Interventions

1. Bradycardia will respond to rewarming. Atropine is not effective and should not be used.
2. Pulseless VT/VF
   1. May defibrillate once
   2. May Administer 1 round of ACLS medications (Epi 1 mg IV/IO/ET, Amiodarone (Cordarone) 300 mg IV/IO)
   3. Further treatment requires rewarming
   4. Transport with CPR
   5. Consult Medical Control for further ACLS guidelines
3. IO access as indicated

Paramedic - Perform/Confirm All Above Interventions