Management of Hypothermia
| Problem | Comment/management |
|---|---|
| Deranged blood glucose | Treat hypoglycaemia Raised blood glucose (10–20 mmol/L) is common (due to insulin resistance) and should not be treated with insulin because of the risk of hypoglycaemia on rewarming. |
| Arrhythmias | Ventricular fibrillation may occur at core temperatures below 28–30°C. Precipitants include central vein cannulation, chest compression, endotracheal intubation and IV injection of epinephrine. DC countershock may not be effective until core temperature is >30°C. Continue cardiopulmonary resuscitation for longer than usual (as hypothermia protects the brain from ischaemic injury) Sinus bradycardia does not need treatment: temporary pacing is only indicated for complete heart block Atrial fibrillation and other supraventricular arrhythmias are common and usually resolve as core temperature returns to normal |
| Hypovolaemia/hypotension | Most hypothermic patients are volume depleted (due in part to cold-induced diuresis) If chest X-ray does not show pulmonary oedema, start an IV infusion of normal saline 1L over 4h via a warming coil; further fluid therapy should be guided by the blood pressure, central venous pressure and urine output. |
| Acute kidney Injury | Bladder catheter to monitor urine output. See Chapter 25. |
| Sepsis | Pneumonia is a common cause and complication of hypothermia: give co-amoxiclav 1.2g IV or cefotaxime 1g IV once blood cultures have been taken. Further doses need not be given until the core temperature is >32°C. |
| Cause of hypothermia | Hypothermia in the elderly is often the consequence of acute illness (e.g. pneumonia, stroke, myocardial infarction, fractured neck of femur). Consider poisoning with alcohol or psychotropic drugs if no other cause of hypothermia is evident. |