Hypothermia in adults: A strategy for detection and Tx
Whether hypothermia is a result of environmental exposure or illness, it's important to identify predictable patterns of physiologic response and focus on proper Tx.
PRACTICE RECOMMENDATIONS
› Measure the patient's temperature with a rectal thermometer capable of reading a temperature <35°C (<95°F) when hypothermia is suspected. C
› Begin prevention of further heat loss promptly for hypothermic patients who retain a perfusing rhythm. C
› Do not consider a patient dead until body temperature has normalized. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Prognosis varies with severity, the health of the patient
In healthy, mildly hypothermic patients, full recovery is common if heat loss is minimized and the cause is treated. Moderately hypothermic patients who receive proper care can also have a favorable result. Outcomes for severe hypothermia vary with duration, comorbidities, and severity of core body temperature loss.15
Immediate initiation of rewarming by pre-hospital providers improves outcomes, and higher mortality has been demonstrated with hospital admission temperatures <35°C (95°F).15 Almost 100% of primary hypothermia patients with cardiac stability who were treated using active external and minimally invasive rewarming techniques survived with an intact neurologic system.12 Fifty percent of patients who endured cardiac arrest or who were treated with extracorporeal rewarming had an intact neurologic system. In cardiac arrest cases without significant underlying disease or trauma, and in which hypoxia did not precede hypothermia, full recovery is possible (and has been observed).12
CASE
Mr. S was given a diagnosis of mild to moderate hypothermia and transferred to the nearest ED for further treatment. His age had put him at increased risk of hypothermia. The work-up included laboratory testing (CBC, chemistry panel, thyroid-stimulating hormone, urinalysis, and blood cultures), electrocardiography, chest radiography, and CT of the head.
The chest radiograph showed pneumonia. Based on the results of blood culture, bacterial infection (pneumonia) was determined to be the underlying cause of hypothermia. Mr. S was started on antibiotics.
CORRESPONDENCE
Natasha J. Pyzocha, DO, Bldg 1058, 1856 Irwin Dr, Fort Carson, CO 80913; natasha.j.pyzocha.mil@mail.mil.
