December Tip of the Month: Hypothermia Recognition and Management

As temperatures drop, hypothermia becomes a critical condition that paramedics must be prepared to identify and manage effectively. Hypothermia occurs when a patient's core body temperature falls below 35°C, leading to a progressive decline in physiological function. Recognizing and managing hypothermia promptly is vital to prevent further deterioration and ensure optimal patient outcomes. This month's tip focuses on hypothermia recognition and management, incorporating guidelines from the Basic Life Support Patient Care Standards (BLS-PCS) and the Advanced Life Support Patient Care Standards (ALS-PCS), along with best practices for managing these challenging cases.

Recognizing Hypothermia

Hypothermia presents along a spectrum, from mild to severe. In mild hypothermia (32–35°C), patients may exhibit shivering, tachycardia, tachypnea, and mild confusion. As the core temperature drops to moderate levels (28–32°C), shivering ceases, and symptoms such as bradycardia, hypotension, slurred speech, and impaired coordination become apparent. In severe hypothermia (<28°C), patients may present with profound bradycardia, fixed pupils, and an unresponsive state. Always consider environmental factors, medical history, and prolonged exposure to cold when assessing patients for hypothermia.

The BLS-PCS emphasizes the importance of protecting hypothermic patients from further heat loss. Remove wet clothing, insulate the patient with blankets, and minimize unnecessary movement to reduce the risk of cardiac arrhythmias. Assess the patient’s airway, breathing, and circulation, as hypothermia may mask the typical signs of clinical deterioration. Confirm and document core temperature if possible, utilizing available devices.

Managing Hypothermia

Paramedics should perform continuous monitoring for arrhythmias for hypothermic patients, and careful handling to prevent cardiac instability. Cardiac arrest management in hypothermic patients follows unique considerations. As hypothermia can prolong the viability of organs, resuscitation efforts should continue until the patient is rewarmed to at least 32°C unless obvious signs of irreversible death are present.

For patients in cardiac arrest, perform only one defibrillation attempt if the core temperature is below 30°C. Begin rewarming efforts while maintaining high-quality chest compressions and providing ventilatory support.

Recognizing Obvious Death in Hypothermic Patients

In hypothermic patients, distinguishing between a critical state and obvious death requires a cautious and systematic approach. Hypothermia slows metabolic processes, often mimicking death. Signs of obvious death include decapitation, rigor mortis, decomposition, or dependent lividity. For hypothermic patients, the principle of "not dead until warm and dead" generally applies. However, in cases where rewarming is not feasible or injuries are incompatible with life, obvious death can be confirmed following standard procedures. Refer to the BLS-PCS for specific criteria and consult with a base hospital physician as needed.

Key Takeaways

Hypothermia requires swift identification, protection from further heat loss, and evidence-based management. Leveraging guidelines from the BLS-PCS and ALS-PCS ensures appropriate care. Always maintain a high index of suspicion and follow best practices to provide optimal support for hypothermic patients. By staying vigilant and informed, paramedics can play a vital role in improving outcomes for those affected by the cold this winter season.

For further review on Hypothermia, please follow this link to watch a video with Dr. Jon Smith.

Hypothermia Video – December Tip of the Month

Stay warm, stay safe, and continue delivering excellent care!