Hypothermia

• Hypothermia = when the core* body temperature drops below 35° ​
  • Note that the core body temperature is most accurately measured via invasive (in-hospital only) means. The tympanic site is not considered a true core measurement and is unreliable. However, this may be all that is available to you, and therefore what you work with​
• Hypothermic arrest = Death due to extreme cold conditions​
  • The key being Hypothermia as the CAUSE for the cardiac arrest

When determining whether or not to leave early it is important to determine if the patient is in cardiac arrest from primary hypothermia or from a secondary cause (i.e., Shoveling snow while outside due to a possible ischemic event)​

• Suspected primary hypothermia: leave early​
• Suspected secondary non-reversible cause: stay on scene for resuscitation

Why Leave Early?

In short: Rewarming!​

• The quicker a hypothermic arrest is re-warmed, the better the chance of good neurologic survival​
  • Hospital management includes invasive and non-invasive warming strategies​

Note: You may use rewarming strategies available to you (environmental controls or service-specific equipment) as long as it does not delay transport to hospital

​Are There Any Other Differences in Resuscitation aside from Leaving Early?

In short: NO​

• There have been myths debunked regarding withholding defibrillation and cardiac medications in the hypothermic arrested patient​
  • AHA recommends continuing defibrillation (as needed) and other cardiac resuscitation medications as you would any other medical cardiac arrest

Bottom Line: Continue treatment per the Medical Cardiac Arrest medical directive and consider transport after the 1st analysis

 

Summary:

• When you suspect a patient has arrested from hypothermia (e.g. low temperature reading and cold environment that upon exposure could produce cardiac arrest) consider transporting after 1 analysis​
  • These patients benefit from being rapidly rewarmed including via invasive means which can only occur in-hospital​
• Aside from leaving early, continue your standard treatment per the Medical Cardiac Arrest Medical Directive 

No additional resources available for this #SWORBHPTip.