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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