Hypothermia - Protocol for ED

CORE TEMP < 34º

INITIAL THERAPY

 • Remove wet garments

 • Avoid rough movements and excess activity

 • Continuous core temp monitoring (rectal or esophageal probe)

 • Cardiac monitoring

 • Ventilate with warm humidified O2 (42-46º)

 • Cover with BAIR Hugger

INVESTIGATIONS

 • Stat POCT Glucose

 • CBC, Chem 7, INR, Ca, Mg, P04, LFTs, alb, Lipase, CK

 • ECG

 • ABG

 • Chest Xray

MILD-MODERATE HYPOTHERMIA (30-34ºC)

 • Infuse Normal Saline 1000 cc bolus (large bore IV)

 • Rapid - Level 1 fluid warmer 

 • Slow - Hot Line fluid warmer

 • Warmed bladder lavage (use Normal Saline)

SEVERE HYPOTHERMIA (<30ºC)

Perfusing Rhythm

 • Intubate

 • Page Staff Cardiac Surgeon and ICU

 • Consider inotropic support with epinephrine

 • Consider paralysis to suppress shivering

 • If hemodialysis considered, page Staff Nephrologist

Non-Perfusing Rhythm

 • Intubate

 • Consider inotropic support

 • Page Staff Cardiac Surgeon to request mechanical circulatory support: ECMO/CPB

 • Continue CPR

 • Max 3 shocks for ventricular arrhythmias

 • Max 3 doses of epinephrine IV until temp is > 29ºC (consider doubling interval between doses)



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