Materiały źródłowe

• #1 Hypothermia Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/condition/hypothermia

  Severe hypothermia is a life-threatening condition. If you or someone you care for has symptoms of hypothermia, give first aid to warm them up and call 911 immediately. […] For mild hypothermia, warming up may be enough. Get out of the cold and remove wet clothing and replace it with dry, warm clothing and blankets. Give the person something warm to drink, but DO NOT give alcohol. Other techniques include using hot water bottles filled with warm water, warm (not hot) baths, or heat packs placed under the arms and on the chest, neck, and groin. […] At the hospital, the medical team will use heated IV (intravenous) fluids. The person may be wrapped with blankets in a warm room or put into a large tub of warm water. Warm humidified air may also be used. […] Severe or complicated cases of hypothermia may need IV drug therapy.

• #1 Hypothermia – Wikipedia

  https://en.wikipedia.org/wiki/Hypothermia

  Hypothermia is defined as a body core temperature below 35.0 C (95.0 F) in humans. […] The treatment of mild hypothermia involves warm drinks, warm clothing, and voluntary physical activity. […] In those with moderate hypothermia, heating blankets and warmed intravenous fluids are recommended. […] People with moderate or severe hypothermia should be moved gently. […] In severe hypothermia, extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass may be useful. […] In those without a pulse, cardiopulmonary resuscitation (CPR) is indicated along with the above measures. […] Rewarming is typically continued until a person’s temperature is greater than 32 C (90 F). […] If there is no improvement at this point or the blood potassium level is greater than 12 millimoles per litre at any time, resuscitation may be discontinued.

• #1 Hypothermia: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hypothermia-pro

  Hypothermia is usually caused by accidental exposure but may be caused or aggravated by underlying medical conditions or may be deliberate as part of patient therapy. […] Hypothermia with intracorporeal temperature monitoring may be used for hypoxic perinatal brain injury. […] May be used in the post-resuscitation period, in traumatic brain injury with high intracranial pressure, in the perioperative setting during various surgical procedures (eg, vascular surgery for spinal cord protection and overall neuroprotection) and for various other indications. […] This is directed at re-warming, careful patient monitoring and treatment of complications such as cardiac arrhythmias. […] The patient is given warmed, humidified oxygen, and heated intravenous saline, and is surrounded by warmed blankets or heat lamps.

• #1 Hypothermia: First aid

  https://www.mayoclinic.org/first-aid/first-aid-hypothermia/basics/art-20056624

  Hypothermia happens when the body loses heat faster than it can produce heat and the body temperature falls below 95 degrees Fahrenheit (35 degrees Celsius). Left untreated, it can be life-threatening. […] To help someone with hypothermia, take these steps immediately: Gently move the person out of the cold. If going indoors isn’t possible, protect the person from the wind, especially around the neck and head. Insulate the individual from the cold ground, such as by laying a blanket underneath the person. Gently remove wet clothing. Replace wet things with warm, dry coats or blankets. If further warming is needed, do so gradually and focus on the center of the body. For example, apply warm, dry compresses to the neck, chest and groin. The CDC says that another option is using an electric blanket, if available. If a hot water bottle or chemical hot pack is used, first wrap it in a towel before applying. Offer the person warm, sweet, nonalcoholic drinks. Begin CPR if the person shows no signs of life, such as breathing, coughing or movement.

• #1 Hypothermia: First aid

  https://www.mayoclinic.org/first-aid/first-aid-hypothermia/basics/art-20056624

  Do not rewarm the person too quickly, such as with a heating lamp or hot bath. Don’t attempt to warm the arms and legs. Heating or massaging the limbs can stress the heart and lungs. Don’t give the person alcohol or cigarettes. Alcohol hinders the rewarming process, and tobacco products interfere with circulation that is needed for rewarming.

• #1 Diagnosis and Treatment of Hypothermia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2325.html

  A more recent article on hypothermia and cold weather injuries is available. […] Management depends on the degree of hypothermia present. Treatment modalities range from noninvasive, passive external warming techniques (e.g., removal of cold, wet clothing; movement to a warm environment) to active external rewarming (e.g., insulation with warm blankets) to active core rewarming (e.g., warmed intravenous fluid infusions, heated humidified oxygen, body cavity lavage, and extracorporeal blood warming). […] Mild to moderate hypothermia is treated easily with supportive care in most clinical settings and has good patient outcomes. The treatment of severe hypothermia is more complex, and outcomes depend heavily on clinical resources. […] Forced-air warming systems are an efficient method of initiating heat transfer during active external warming.

• #1

  https://wms.org/magazine/magazine/1350/Thermodynamics—Hypothermia/default.aspx

  The Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update provide an excellent evidence-based summary of the management of hypothermia. This clinical practice guideline recommends giving high-carbohydrate liquids and foods to any patient who is alert and shivering and is not at risk for aspiration. […] The oral treatment of cold stress and mild hypothermia is an important way in which the progression of hypothermia may be avoided. This is done in two ways, providing hydration and calories to fuel shivering thermogenesis. […] Although hydration is needed to facilitate heat redistribution and reverse cold-induced blood viscosity, water provides no calories for thermogenesis. […] The bottom line for the alert hypothermia patient able to protect their airway: (1) let them shiver, (2) remove wet clothes and provide insulation so they can keep this heat, (3) provide hydration, and (4) the caloric content, particularly those from carbohydrates, is more important than the temperature of the drink. Hot drinks are not likely to significantly raise a patients core temperature.

• #1 Hypothermia Treatment & Management: Prehospital Care, Emergency Department Care, Complications

  https://emedicine.medscape.com/article/770542-treatment

  Prehospital management focuses on preventing further heat loss, rewarming the body core temperature, and avoiding precipitating ventricular fibrillation or another malignant cardiac rhythm. This should be the preeminent concern. […] To prevent cardiac dysrhythmia with continued hypothermia, rescuers or paramedics should attempt rewarming in the field. […] Generally, defibrillation is ineffective at hypothermic core temperatures and when equipment for heroic attempts at resuscitation is unavailable. […] Patients with respiratory failure should be endotracheally intubated and placed on a mechanical ventilator. […] Profound hypothermia is a true emergency, warranting the same resource-intensive resuscitation as myocardial infarction. […] Initiate warmed, humidified oxygen; provide heated intravenous saline; and place warmed blankets or heat lamps around a hypothermic patient.

• #1 Hypothermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/hypothermia

  Treatment for mild hypothermia is passive rewarming, using a warm environment and insulating blankets. […] Severe hypothermia requires active rewarming of both the body surface (eg, with forced-air warming systems, radiant sources) and the core (eg, with warm air inhalation, heated infusion and lavage, extracorporeal blood rewarming). […] The first priority is to prevent further heat loss by removing wet clothing and insulating the patient. Subsequent measures depend on how severe hypothermia is and whether cardiovascular instability is present. […] Fluid resuscitation is essential because patients are typically hypovolemic. Administer 500 cc to 2 L of 0.9% saline solution (20 mL/kg for children) IV; if possible, heat the solution to 40 to 42 C. More fluid is given as needed to maintain perfusion.

• #1 Diagnosis and Treatment of Hypothermia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2325.html

  Extracorporeal blood warming is the most effective method for active core rewarming and increases core temperature by 1C (1.8F) to 2C (3.6F) every three to five minutes. […] In general, steroid supplementation should not be given empirically to all patients. […] Most other dysrhythmias do not require specific treatment and will resolve spontaneously with rewarming. […] The most effective method of active core rewarming is extracorporeal blood warming, accomplished by cardiopulmonary bypass, arteriovenous rewarming, venovenous rewarming, or hemodialysis. […] Active core rewarming also can be accomplished by warm lavage of several body cavities. […] The lowest initial temperature recorded in a child who survived from hypothermia was 14.2C (57.6F), and in an adult was 13.7C (56.7F).

• #1 Hypothermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/hypothermia

  With moderate to severe hypothermia, the core temperature must be stabilized before rewarming the extremities to prevent sudden cardiovascular collapse (rewarming collapse) when the peripheral vasculature dilates. […] In mild hypothermia (temperature 32 to 35 C) with intact thermoregulation (indicated by shivering), wrapping the patient in heated blankets and providing warm fluids to drink are adequate. […] Active rewarming is required if patients have any of the following: Temperature 32 C, Cardiovascular instability, Hormone insufficiency (such as hypoadrenalism or hypothyroidism), Hypothermia secondary to trauma, Hypothermia secondary to toxins, Predisposing disorders. […] For moderate hypothermia (body temperature at the warmer end of the range, 28 to 32 C), external rewarming with forced hot air enclosures may be used.

• #1 Diagnosis and Treatment of Hypothermia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2325.html

  Resuscitation should not be discontinued, even in a patient who appears to be dead, until the core body temperature is greater than 30C to 32C (89.6F) and still no signs of life are apparent. […] Hypothermia is a devastating and potentially avoidable condition, making education and preparation the cornerstones of prevention.

• #1 Hypothermia: Symptoms, treatment, stages, and more

  https://www.medicalnewstoday.com/articles/182197

  Treatment depends on the degree of hypothermia, but the aim is to make the person warmer. It involves first aid and clinical treatment. […] Anyone with symptoms of hypothermia needs immediate medical attention. Until help arrives, the CDC recommends: moving the person to a warm, dry place, if possible, or sheltering them from the elements; taking off any wet clothing; covering the person with an electric blanket, if available, or dry layers of towels, clothing, or blankets; making skin-to-skin contact with another individual; having the person drink a warm beverage, excluding alcohol, if they are not unconscious; avoiding moving or jostling the person, as doing so can trigger a fatal heart rhythm abnormality. […] If someone has severe hypothermia, they may be unconscious. They may also appear not to have a pulse or be breathing. If this occurs, a bystander should perform CPR and continue it until help arrives. Sometimes people with hypothermia who appear to be dead can resuscitate.

• #1 Hypothermia Treatment & Management: Prehospital Care, Emergency Department Care, Complications

  https://emedicine.medscape.com/article/770542-treatment

  Debate centers on interventions for patients who are worsening, are comatose, have nonperfusing rhythms, or appear dead. […] An optimal warming strategy is elusive. […] For simplicity, aggressive rewarming methods can be categorized as slow, moderate, or rapid. […] Ventricular fibrillation should be treated immediately with defibrillation, despite the fact that most other dysrhythmias will correct with warming alone. […] Cardiothoracic bypass has been used successfully to treat cases of hypothermia presenting in cardiac arrest. […] If bypass is unavailable or delayed, 2 previously described methods of internal rewarming are available: heated thoracic lavage and arteriovenous (AV) heated countercurrent exchange. […] Hypotension should be addressed with volume resuscitation; inotropic agents, such as dopamine, should be avoided unless the hypotension is refractory to intravenous fluids due to the possible cardiac stimulation/ectopy that pressors may induce.

• #1 Overview of Therapeutic Hypothermia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3519955/

  Therapeutic Hypothermia has proven neuroprotective effects in global cerebral ischemia. Indications for hypothermia induction include cardiac arrest and neonatal asphyxia. The two general methods of induced hypothermia are either surface cooling or endovascular cooling. Hypothermia should be induced as early as possible to achieve maximum neuroprotection and edema blocking effect. The optimum method of cooling is yet to be determined but a multimodal approach is necessary to address three phases of cooling: induction, maintenance, and re-warm. Hypothermia treatment can help provide neuroprotection in cases of anoxic brain injury and global brain ischemia, hence its application in cardiac arrest patients and neonatal hypoxic-ischemic encephalopathy. The treatment effectiveness in other neurological injuries such as stroke and traumatic brain injury is not established firmly. Hypothermia should be induced as early as possible to achieve maximum neuroprotection and edema blocking effect. Controversy remains, however, regarding the therapeutic window for hypothermia and the optimum cooling duration. In regards to cooling duration, animal models suggest longer hypothermia treatment offered better neuroprotection. Longer duration of hypothermia treatment, however, was associated with more adverse effects suggesting treatment should be limited to 24 hours. Hypothermia improves neurologic outcome and decreases mortality in patients with global cerebral ischemia, such as cardiac arrest patients and infants with hypoxic-ischemic encephalopathy. To provide effective treatment, optimal induction and safe rewarming methods need to be determined. Hypothermia has not been proven to show benefit in patients with stroke and traumatic brain injury. Therefore, hypothermia should only be used in randomized controlled trials in this patient population.

• #1 Hypothermia Therapy (Neonatal Cooling) | Treatment for HIE

  https://hiehelpcenter.org/treatment/hypothermia-therapy/

  Hypothermia therapy is one established treatment that can minimize permanent brain damage from hypoxic-ischemic encephalopathy (HIE). However, it must be given very shortly after birth/the oxygen-depriving incident in order to be effective (ideally within six hours). […] Hypothermia therapy involves cooling the baby down to a temperature below homeostasis to allow the brain to recover from a hypoxic-ischemic injury. Typically, the target temperature is about 33.5 degrees Celsius (92.3 degrees Fahrenheit) (1). […] If your baby was diagnosed with hypoxic-ischemic encephalopathy (HIE), doctors have to begin hypothermia therapy very shortly after the oxygen deprivation occurred. Hypothermia therapy should ideally be commenced within six hours of birth, under certain circumstances, this may be done within 12 hours (2).

• #1 Therapeutic Hypothermia | Baptist Health

  https://www.baptist-health.com/services/heart-health/cardiology-services/interventional-cardiology/therapeutic-hypothermia/

  What is Therapeutic Hypothermia? […] Therapeutic hypothermia is a type of treatment used in patients who experience sudden cardiac arrest—lowering the body temperature immediately after cardiac arrest allows healthcare providers to reduce the probability of injury and long-term brain damage. […] During therapeutic hypothermia, a sedative is administered to induce sleep and keep the body from shivering. The patient’s heart rate, blood pressure, and other vital signs will be closely monitored during the procedure. Using cooling blankets, ice packs, or internal cooling methods, the patient’s body temperature will be brought down as quickly as possible to around 89°F to 93°F. After 12 to 24 hours, the medical team will gradually rewarm the body until a healthy temperature is reached. Since the body does not always respond to treatment right away, healthcare providers often wait 3 days after the procedure to examine the effect cardiac arrest may have had on the brain. This procedure does not guarantee that the patient will regain brain function.

• #1 Targeted temperature management – Wikipedia

  https://en.wikipedia.org/wiki/Targeted_temperature_management

  Targeted temperature management may be used in the following conditions: […] The 2013 ILCOR and 2010 American Heart Association guidelines support the use of cooling following resuscitation from cardiac arrest. […] A recent Cochrane Review summarized available evidence on the topic and found that targeted temperature management around 33 C may increase the chance to prevent brain damage after cardiac arrest by 40%. […] Hypothermia therapy for neonatal encephalopathy has been proven to improve outcomes for newborn infants affected by perinatal hypoxia-ischemia, hypoxic ischemic encephalopathy or birth asphyxia. […] Targeted temperature management is used during open-heart surgery because it decreases the metabolic needs of the brain, heart, and other organs, reducing the risk of damage to them.

• #1 Targeted temperature management – Wikipedia

  https://en.wikipedia.org/wiki/Targeted_temperature_management

  Possible complications may include: infection, bleeding, dysrhythmias and high blood sugar. […] Targeted temperature management should be started as soon as possible. The goal temperature should be reached before 8 hours. […] When body temperature drops below a certain threshold—typically around 36 C (97 F)—people may begin to shiver. […] Cooling catheters are inserted into a femoral vein. Cooled saline solution is circulated through either a metal coated tube or a balloon in the catheter. […] Transnasal evaporative cooling is a method of inducing the hypothermia process and provides a means of continuous cooling of a person throughout the early stages of targeted temperature management and during movement throughout the hospital environment. […] With these technologies, cold water circulates through a blanket, or torso wraparound vest and leg wraps.

• #1 Accidental hypothermia in adults: Management – UpToDate

  https://www.uptodate.com/contents/accidental-hypothermia-in-adults-management

  Accidental hypothermia in adults: Management […] The management of hypothermia requires prevention of further heat loss, resuscitation, rewarming, and treatment of complications. Complete neurologic recovery in patients with hypothermia and cardiac arrest despite prolonged resuscitation has been well documented. […] A table and algorithm outlining the emergency management of hypothermia in adults are provided (table 1 and algorithm 1). […] The management of accidental hypothermia will be discussed here.

• #1 Care for the Cold: Assessment and Treatment of Accidental Hypothermia – Clinical Advisor

  https://www.clinicaladvisor.com/features/care-for-the-cold-assessment-and-treatment-of-accidental-hypothermia/

  The neuroprotective effects of hypothermia, and the treatments currently available for rewarming, give patients an excellent chance of neurologically intact survival despite prolonged cardiac arrest times. […] However, with many patients having recovered from severe hypothermia, early recognition and prompt treatment is paramount. […] Effective diagnosis and management of hypothermia depend upon the use of a low-reading thermometer to determine core temperature; many standard thermometers read only to a minimum of 34 C (93 F) and are therefore unsuitable. […] The International Commission for Mountain Emergency Medicine developed a clinical staging system for accidental hypothermia intended to help rescuers in the field estimate severity of hypothermia by observing clinical signs if core body temperature cannot be readily measured. […] The system is helpful for understanding the physiologic effects of hypothermia on the body and the expected clinical manifestations per stage.

• #1 Targeted Temperature Management (Therapeutic Hypothermia): Practice Essentials, Overview, Pathophysiology

  https://emedicine.medscape.com/article/812407-overview

  It is reasonable to maintain TTM for at least 24 hours (class IIa, level of evidence: C-EO). […] Routine prehospital cooling of patients with ROSC with intravenous (IV) rapid infusion is not advised (class III: no benefit; level of evidence A). […] It is reasonable to prevent fever in comatose patients after TTM (class IIb, level of evidence C-LD). […] Hemodynamically stable patients with spontaneous mild hypothermia (33C) after resuscitation from cardiac arrest should not be actively rewarmed. […] Provide all adults who do not follow post-ROSC commands, irrespective of arrest location or presenting rhythm, with treatment that includes a deliberate strategy for temperature control (class I, level of evidence: B-R). […] During postarrest temperature control, select and maintain a constant temperature between 32C and 37.5C (class I, level of evidence: B-NR).

• #2 How to Treat Hypothermia at Home? – BuzzRx

  https://www.buzzrx.com/blog/how-to-treat-hypothermia-at-home

  Hypothermia is an emergency medical condition in which the body loses heat faster than it can produce heat, resulting in a lower-than-normal body temperature. It is a serious and life-threatening condition that requires immediate medical attention. Without medical treatment, severe hypothermia can lead to multiple organ failure, including heart failure and even death. […] If you suspect hypothermia, seek immediate medical care. Call 911 or emergency services. Hypothermia is a medical emergency. Even moderate hypothermia can be fatal if left untreated. While you wait for medical help to arrive, offer first aid and warm the person. […] Mild hypothermia is treated with heated blankets and a warm drink. For moderate to severe hypothermia, doctors may do the following to raise body temperature: Rewarm the blood by drawing it out, warming it, and sending it back to the body using a hemodialysis machine. Give warm salt water intravenously to help with blood rewarming. Use humidified oxygen with a mask or breathing tube to rewarm the airways. Rewarm the abdominal cavity or lung area using a warm salt water solution introduced through catheters.

• #2 Diagnosis and Treatment of Hypothermia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2325.html

  A more recent article on hypothermia and cold weather injuries is available. […] Management depends on the degree of hypothermia present. Treatment modalities range from noninvasive, passive external warming techniques (e.g., removal of cold, wet clothing; movement to a warm environment) to active external rewarming (e.g., insulation with warm blankets) to active core rewarming (e.g., warmed intravenous fluid infusions, heated humidified oxygen, body cavity lavage, and extracorporeal blood warming). […] Mild to moderate hypothermia is treated easily with supportive care in most clinical settings and has good patient outcomes. The treatment of severe hypothermia is more complex, and outcomes depend heavily on clinical resources. […] Forced-air warming systems are an efficient method of initiating heat transfer during active external warming.

• #2 Accidental hypothermia in adults: Management – UpToDate

  https://www.uptodate.com/contents/accidental-hypothermia-in-adults-management

  Accidental hypothermia in adults: Management […] The management of hypothermia requires prevention of further heat loss, resuscitation, rewarming, and treatment of complications. Complete neurologic recovery in patients with hypothermia and cardiac arrest despite prolonged resuscitation has been well documented. […] A table and algorithm outlining the emergency management of hypothermia in adults are provided (table 1 and algorithm 1). […] The management of accidental hypothermia will be discussed here.

• #2 Hypothermia: Symptoms, Causes, and Treatment | Red Cross

  https://www.redcross.org/take-a-class/resources/learn-first-aid/hypothermia?srsltid=AfmBOorfXu-pO5nOUb56BdyRaSyySJCycHeZ9k5Ewz_flgLUfre8MlmB

  Rewarm the person slowly. […] Rapid rewarming can lead to dangerous heart rhythms. […] Move the person to a warmer place. […] Remove wet clothes. […] Dry the person. […] Help the person put on dry clothing, including hat, gloves and socks, if available. […] Wrap the person in dry blankets and plastic sheeting, if available. […] Cover the persons head. […] Position the person as appropriate near a heat source or apply heating pads or hot water bottles filled with warm water to the body (if far from medical care). […] Wrap heating pads or hot water bottles in thin, dry cloths to protect the persons skin. […] Offer small sips of a warm, non-caffeinated liquid if alert and can swallow. Examples include broth, warm water. […] Continue checking them as appropriate to determine if additional care is needed.

• #2 Hypothermia – Wikipedia

  https://en.wikipedia.org/wiki/Hypothermia

  The UK National Health Service advises against putting a person in a hot bath, massaging their arms and legs, using a heating pad, or giving them alcohol. […] Rewarming can be done with a number of methods including passive external rewarming, active external rewarming, and active internal rewarming. […] Active core rewarming involves the use of intravenous warmed fluids, irrigation of body cavities with warmed fluids (the chest or abdomen), use of warm humidified inhaled air, or use of extracorporeal rewarming such as via a heart lung machine or extracorporeal membrane oxygenation (ECMO). […] When severe hypothermia has led to cardiac arrest, effective extracorporeal warming results in survival with normal mental function about 50% of the time.

• #2 Hypothermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/hypothermia

  Treatment for mild hypothermia is passive rewarming, using a warm environment and insulating blankets. […] Severe hypothermia requires active rewarming of both the body surface (eg, with forced-air warming systems, radiant sources) and the core (eg, with warm air inhalation, heated infusion and lavage, extracorporeal blood rewarming). […] The first priority is to prevent further heat loss by removing wet clothing and insulating the patient. Subsequent measures depend on how severe hypothermia is and whether cardiovascular instability is present. […] Fluid resuscitation is essential because patients are typically hypovolemic. Administer 500 cc to 2 L of 0.9% saline solution (20 mL/kg for children) IV; if possible, heat the solution to 40 to 42 C. More fluid is given as needed to maintain perfusion.

• #2 Hypothermia Treatment & Management: Prehospital Care, Emergency Department Care, Complications

  https://emedicine.medscape.com/article/770542-treatment

  Debate centers on interventions for patients who are worsening, are comatose, have nonperfusing rhythms, or appear dead. […] An optimal warming strategy is elusive. […] For simplicity, aggressive rewarming methods can be categorized as slow, moderate, or rapid. […] Ventricular fibrillation should be treated immediately with defibrillation, despite the fact that most other dysrhythmias will correct with warming alone. […] Cardiothoracic bypass has been used successfully to treat cases of hypothermia presenting in cardiac arrest. […] If bypass is unavailable or delayed, 2 previously described methods of internal rewarming are available: heated thoracic lavage and arteriovenous (AV) heated countercurrent exchange. […] Hypotension should be addressed with volume resuscitation; inotropic agents, such as dopamine, should be avoided unless the hypotension is refractory to intravenous fluids due to the possible cardiac stimulation/ectopy that pressors may induce.

• #2 Hypothermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/hypothermia

  For severe hypothermia (body temperatures 28 C), core rewarming is required, particularly for those with low blood pressure or cardiac arrest. […] Core rewarming options include Inhalation, IV infusion, Lavage, Extracorporeal core rewarming (ECR). […] Providing heated (40 to 45 C), humidified oxygen via face mask or endotracheal tube eliminates respiratory heat loss and can add 1 to 2 C/hour to the rewarming rate. […] Patients with a nonperfusing rhythm (ventricular fibrillation or asystole) require CPR with chest compressions and endotracheal intubation. Successful defibrillation is difficult if body temperature is low; 1 attempt at maximum energy setting for the defibrillator (200 J for biphasic and 360 J for monophasic) may be made but, if ineffective, further attempts are generally deferred until the temperature reaches 30 C. […] Advanced cardiac life-support medications (eg, antiarrhythmics, vasopressors, inotropes) are usually not given until the temperature reaches 30 C.

• #2 Hypothermia Treatment & Management: Prehospital Care, Emergency Department Care, Complications

  https://emedicine.medscape.com/article/770542-treatment

  A reasonable approach is to initiate resuscitation on all hypothermic patients unless a patient presents with a frozen chest or other obvious nonsurvivable injuries. […] Medical complications from hypothermia often result and necessitate admission to the hospital in moderate and severe hypothermia. […] The development of rhabdomyolysis should be monitored.

• #2 Treatment of Hypothermia – Medical care by the Rescuer, Transport Personnel and Hospital – International Life Saving Federation

  https://www.ilsf.org/library/treatment-of-hypothermia-medical-care-by-the-rescuer-transport-personnel-and-hospital/

  In treating and handling a hypothermal patient it is essential to handle the victim with utmost care and consideration as the heart is extremely susceptible to arrhythmias at subnormal temperatures. […] Patients suffering from cold who are still conscious are normally no problem to treat. Wet clothes should be removed and further heat loss prevented by wrapping the patient in insulated sheets or blankets. He can be treated at normal room temperature. The patients body temperature rises as a result of his own heat production. If possible the patient should be kept in an intensive care unit for observation. […] The patient must not be moved around or handled unnecessarily. Leave wet clothes on and prevent further heat loss by covering him carefully. Oxygen should be given from a mask if possible. No attempt must be made to warm the patient actively or revive him at the scene of the accident. Treatment requires the resources of hospital. A hypothermic patient shall not be declared dead, unless rewarming has been attempted without success. […] Treatment at hospital of the mild to moderate hypothermic patient usually only requires prewarmed, humid oxygen and intravenous (IV) infusion of glucose. Severe hypothermia needs more active treatment such as peritoneal lavage or probably best if possible heart-lung machine.

• #2 Hypothermia: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hypothermia-pro

  Aggressive management of temperature with faster rather than slow re-warming has been shown to improve the outcome. […] The patient should ideally be managed in a critical care setting. […] Cardiac drugs and defibrillation are not usually effective in the presence of acidosis, hypoxia and hypothermia. […] Cardiopulmonary bypass has been used in patients with severe hypothermia. […] Haemodialysis (HD) is a safe re-warming therapy for moderate and severe hypothermia in the absence of circulatory arrest. […] Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides an efficient re-warming method with complete cardiopulmonary support. […] Determination of death can be very difficult in the hypothermic patient.

• #2 Targeted temperature management – Wikipedia

  https://en.wikipedia.org/wiki/Targeted_temperature_management

  Targeted temperature management (TTM), previously known as therapeutic hypothermia or protective hypothermia, is an active treatment that tries to achieve and maintain a specific body temperature in a person for a specific duration of time in an effort to improve health outcomes during recovery after a period of stopped blood flow to the brain. This is done in an attempt to reduce the risk of tissue injury following lack of blood flow. […] Targeted temperature management improves survival and brain function following resuscitation from cardiac arrest. Evidence supports its use following certain types of cardiac arrest in which an individual does not regain consciousness. […] Targeted temperature management is thought to prevent brain injury by several methods, including decreasing the brain’s oxygen demand, reducing the production of neurotransmitters like glutamate, as well as reducing free radicals that might damage the brain.

• #2 Therapeutic Hypothermia | Sudden Cardiac Arrest Foundation

  https://www.sca-aware.org/about-sudden-cardiac-arrest/therapeutic-hypothermia

  One relatively new, promising treatment is the use of therapeutic hypothermia for comatose survivors of cardiac arrest. […] Hypothermia slows the body’s metabolism, reducing the cascade of undesirable events that can cause permanent brain damage associated with SCA. […] As a result of this work and subsequent studies verifying these findings, the American Heart Association in 2003 and again in 2005 issued guidelines recommending cooling comatose survivors of cardiac arrest caused by certain irregular heart rhythms known as ventricular tachycardia (VT) and ventricular fibrillation (VF). […] If you know someone who has remained comatose after surviving SCA, he may be a candidate for therapeutic hypothermia. […] The therapy typically will last for a maximum of 36 hours: 12 to 24 hours of cooling and up to 12 hours to rewarm slowly back to a normal body temperature of 98.6 (37C).

• #2 Therapeutic Hypothermia | Sudden Cardiac Arrest Foundation

  https://www.sca-aware.org/about-sudden-cardiac-arrest/therapeutic-hypothermia

  During the cooling process, the patient will require frequent blood samples to make sure s/he is tolerating the cooling procedure well. […] Two prospective randomized trials compared mild hypothermia (32-34 degrees Celsius) with normothermia in comatose SCA survivors. […] In a randomized trial of 273 survivors of sudden cardiac arrest, 75 of 136 patients (55%) treated with hypothermia had a favorable neurologic outcome as compared with 54 of 137 patients (39%) who maintained normothermia.

• #2 Therapeutic Hypothermia – What You Need to Know

  https://www.drugs.com/cg/therapeutic-hypothermia.html

  Healthcare providers will check the person’s blood pressure, heart rate, and breathing rate throughout the process. Monitors in the person’s esophagus, bladder, or rectum measure body temperature at all times. Healthcare providers will watch the person’s temperature closely so it does not go too low or too high. The person will start to shiver when the procedure begins. Shivering increases body temperature and decreases the benefits of therapeutic hypothermia. Healthcare providers will use medicines to stop the person from shivering. Healthcare providers may also use warm air in the room to help control shivering. […] Effects of medicines given to prevent shivering may last longer than expected. Therapeutic hypothermia may cool the person too fast or to a temperature that is too low. Cooling may cause the person’s blood pressure to become too high or too low. This can cause the heart to beat slowly or out of rhythm. Fluid loss from cooling can lead to dehydration or electrolyte (body chemical) levels that are out of balance. The medicines may prevent healthcare providers from realizing the person is having a seizure. Cardiac arrest is life-threatening. Low blood pressure, seizures, coma, or brain death cannot always be prevented, even with therapeutic hypothermia treatment.

• #2 Overview of Therapeutic Hypothermia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3519955/

  Therapeutic Hypothermia has proven neuroprotective effects in global cerebral ischemia. Indications for hypothermia induction include cardiac arrest and neonatal asphyxia. The two general methods of induced hypothermia are either surface cooling or endovascular cooling. Hypothermia should be induced as early as possible to achieve maximum neuroprotection and edema blocking effect. The optimum method of cooling is yet to be determined but a multimodal approach is necessary to address three phases of cooling: induction, maintenance, and re-warm. Hypothermia treatment can help provide neuroprotection in cases of anoxic brain injury and global brain ischemia, hence its application in cardiac arrest patients and neonatal hypoxic-ischemic encephalopathy. The treatment effectiveness in other neurological injuries such as stroke and traumatic brain injury is not established firmly. Hypothermia should be induced as early as possible to achieve maximum neuroprotection and edema blocking effect. Controversy remains, however, regarding the therapeutic window for hypothermia and the optimum cooling duration. In regards to cooling duration, animal models suggest longer hypothermia treatment offered better neuroprotection. Longer duration of hypothermia treatment, however, was associated with more adverse effects suggesting treatment should be limited to 24 hours. Hypothermia improves neurologic outcome and decreases mortality in patients with global cerebral ischemia, such as cardiac arrest patients and infants with hypoxic-ischemic encephalopathy. To provide effective treatment, optimal induction and safe rewarming methods need to be determined. Hypothermia has not been proven to show benefit in patients with stroke and traumatic brain injury. Therefore, hypothermia should only be used in randomized controlled trials in this patient population.

• #2 Targeted Temperature Management (Therapeutic Hypothermia): Practice Essentials, Overview, Pathophysiology

  https://emedicine.medscape.com/article/812407-overview

  After achieving the target temperature, it is reasonable to maintain temperature control for at least 24 hours (class IIa, level of evidence: B-NR). […] In patients unresponsive to verbal commands after initial temperature control, it may be reasonable to actively prevent pyrexia (class IIb level of evidence: C-LD). […] Do not routinely actively or passively rewarm patients with post-ROSC spontaneous hypothermia who are unresponsive to verbal commands faster than 0.5C per hour (class IIb, level of evidence C-EO). […] Routine use of rapid infusion of cold IV fluids is not recommended for prehospital post-ROSC cooling of patients (class III, level of evidence B-R). […] The goals of treatment include achieving the target temperature as quickly as possible; in most cases, this can be reached within 3-4 hours of initiating cooling.

• #3 Hypothermia and Frostbite | Winter Storm Safety | Red Cross

  https://www.redcross.org/get-help/how-to-prepare-for-emergencies/types-of-emergencies/winter-storm/hypothermia-and-frostbite.html?srsltid=AfmBOooD_CWe2todMw4xjzB9uHF5aJMyY8lKAFKLAK7uQ3sTyTBz61ui

  Frostbite and hypothermia are cold-related emergencies that may quickly become life or limb threatening. […] The goals of first aid are to restore normal body temperature and to care for any conditions while waiting for EMS personnel. […] What should you do if someone has hypothermia? CALL 9-1-1 or the local emergency number. Gently move the person to a warm place. Monitor breathing and circulation. Give rescue breathing and CPR if needed. Remove any wet clothing and dry the person. Warm the person slowly by wrapping in blankets or by putting dry clothing on the person. Hot water bottles and chemical hot packs may be used when first wrapped in a towel or blanket before applying. Do not warm the person too quickly, such as by immersing him or her in warm water. Warm the core first (trunk, abdomen), not the extremities (hands, feet).

• #3 Hypothermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/hypothermia

  With moderate to severe hypothermia, the core temperature must be stabilized before rewarming the extremities to prevent sudden cardiovascular collapse (rewarming collapse) when the peripheral vasculature dilates. […] In mild hypothermia (temperature 32 to 35 C) with intact thermoregulation (indicated by shivering), wrapping the patient in heated blankets and providing warm fluids to drink are adequate. […] Active rewarming is required if patients have any of the following: Temperature 32 C, Cardiovascular instability, Hormone insufficiency (such as hypoadrenalism or hypothyroidism), Hypothermia secondary to trauma, Hypothermia secondary to toxins, Predisposing disorders. […] For moderate hypothermia (body temperature at the warmer end of the range, 28 to 32 C), external rewarming with forced hot air enclosures may be used.

• #3 Hypothermia – Wikipedia

  https://en.wikipedia.org/wiki/Hypothermia

  Hypothermia is defined as a body core temperature below 35.0 C (95.0 F) in humans. […] The treatment of mild hypothermia involves warm drinks, warm clothing, and voluntary physical activity. […] In those with moderate hypothermia, heating blankets and warmed intravenous fluids are recommended. […] People with moderate or severe hypothermia should be moved gently. […] In severe hypothermia, extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass may be useful. […] In those without a pulse, cardiopulmonary resuscitation (CPR) is indicated along with the above measures. […] Rewarming is typically continued until a person’s temperature is greater than 32 C (90 F). […] If there is no improvement at this point or the blood potassium level is greater than 12 millimoles per litre at any time, resuscitation may be discontinued.

• #3 Hypothermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/hypothermia

  For severe hypothermia (body temperatures 28 C), core rewarming is required, particularly for those with low blood pressure or cardiac arrest. […] Core rewarming options include Inhalation, IV infusion, Lavage, Extracorporeal core rewarming (ECR). […] Providing heated (40 to 45 C), humidified oxygen via face mask or endotracheal tube eliminates respiratory heat loss and can add 1 to 2 C/hour to the rewarming rate. […] Patients with a nonperfusing rhythm (ventricular fibrillation or asystole) require CPR with chest compressions and endotracheal intubation. Successful defibrillation is difficult if body temperature is low; 1 attempt at maximum energy setting for the defibrillator (200 J for biphasic and 360 J for monophasic) may be made but, if ineffective, further attempts are generally deferred until the temperature reaches 30 C. […] Advanced cardiac life-support medications (eg, antiarrhythmics, vasopressors, inotropes) are usually not given until the temperature reaches 30 C.

• #3 Hypothermia Treatment & Management: Prehospital Care, Emergency Department Care, Complications

  https://emedicine.medscape.com/article/770542-treatment

  Prehospital management focuses on preventing further heat loss, rewarming the body core temperature, and avoiding precipitating ventricular fibrillation or another malignant cardiac rhythm. This should be the preeminent concern. […] To prevent cardiac dysrhythmia with continued hypothermia, rescuers or paramedics should attempt rewarming in the field. […] Generally, defibrillation is ineffective at hypothermic core temperatures and when equipment for heroic attempts at resuscitation is unavailable. […] Patients with respiratory failure should be endotracheally intubated and placed on a mechanical ventilator. […] Profound hypothermia is a true emergency, warranting the same resource-intensive resuscitation as myocardial infarction. […] Initiate warmed, humidified oxygen; provide heated intravenous saline; and place warmed blankets or heat lamps around a hypothermic patient.

• #3 Targeted Temperature Management (Therapeutic Hypothermia): Practice Essentials, Overview, Pathophysiology

  https://emedicine.medscape.com/article/812407-overview

  Targeted temperature management (TTM), previously known as mild therapeutic hypothermia, in selected patients surviving out-of-hospital sudden cardiac arrest (OHCA) can significantly improve rates of long-term neurologically intact survival, and it may prove to be one of the most important clinical advancements in the science of resuscitation. […] Induce hypothermia for unconscious adult patients with return of spontaneous circulation (ROSC) after OHCA when the initial rhythm was ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) (class I, level of evidence: B-R). […] Similar therapy may be beneficial for patients with non-VF/non-pVT (nonshockable) OHCA or with in-hospital arrest (class I, level of evidence: C-EO). […] The temperature should be maintained between 32C and 36C (class I, level of evidence: B-R).

• #3 Therapeutic Hypothermia – What You Need to Know

  https://www.drugs.com/cg/therapeutic-hypothermia.html

  Therapeutic hypothermia is a procedure used to cool a person’s body to a temperature that is lower than normal. The procedure is done after a cardiac arrest (when the heart stops) that happens outside of a healthcare setting. The unconscious person is cooled in the hospital after his or her breathing and heartbeat start again. […] Therapeutic hypothermia is done to reduce the risk of brain swelling, blood clots, and seizures after cardiac arrest. The procedure may help the person survive. […] The therapeutic hypothermia process often begins with an IV of cold liquid to cool the person’s body quickly. The person’s body is slowly warmed 12 to 24 hours later. Several methods may be used to keep body temperature at a cooled level: Ice packs, icy cold wet towels, or fans may be used. The ice packs are placed on the person’s neck, armpits, torso, and groin. A cooling blanket may be laid over the person’s body. Cool water runs through the cooling blanket. During endovascular cooling, a catheter is placed into a big vein in a person’s groin. The catheter cools the blood as it passes through the vein and over the catheter. During spinal cord perfusion, healthcare providers insert a constant flow of cooled saline into the spinal cord. The perfusion pump, suction device, and temperature probe keep the body at a constant temperature. It also keeps the spinal cord from swelling. An epidural heat exchanger is a machine attached to a cooling catheter that is in the epidural space. The epidural space contains cerebrospinal fluid. The machine sends cool water into and out of the cooling catheter. The fluid stays cooled and keeps the spinal cord from swelling.

• #3 Therapeutic Hypothermia | Baptist Health

  https://www.baptist-health.com/services/heart-health/cardiology-services/interventional-cardiology/therapeutic-hypothermia/

  Though the risks associated with therapeutic hypothermia rare, they include: Abnormal heart rhythm, Sepsis, Bleeding caused by an inability to form blood clots, Electrolyte and metabolic issues, Raised blood sugar levels, Imbalance of pH levels in the body. These risks vary based on age and underlying health conditions. Ask your healthcare provider about the risks that are specific to you.

• #3 Care for the Cold: Assessment and Treatment of Accidental Hypothermia – Clinical Advisor

  https://www.clinicaladvisor.com/features/care-for-the-cold-assessment-and-treatment-of-accidental-hypothermia/

  The neuroprotective effects of hypothermia, and the treatments currently available for rewarming, give patients an excellent chance of neurologically intact survival despite prolonged cardiac arrest times. […] However, with many patients having recovered from severe hypothermia, early recognition and prompt treatment is paramount. […] Effective diagnosis and management of hypothermia depend upon the use of a low-reading thermometer to determine core temperature; many standard thermometers read only to a minimum of 34 C (93 F) and are therefore unsuitable. […] The International Commission for Mountain Emergency Medicine developed a clinical staging system for accidental hypothermia intended to help rescuers in the field estimate severity of hypothermia by observing clinical signs if core body temperature cannot be readily measured. […] The system is helpful for understanding the physiologic effects of hypothermia on the body and the expected clinical manifestations per stage.

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