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UNINTENTIONAL HYPOTHERMIA occurs when there's an accidental reduction in core body temperature. Core body temperature between 93.2[degrees] F and 96.8[degrees] F (34[degrees] C and 36[degrees] C) is classified as mild hypothermia. Moderate hypothermia is defined as 86[degrees] F to 93.2[degrees] F (30[degrees] C to 34[degrees] C). Severe hypothermia (below 86[degrees] F [30[degrees] C]), which is associated with marked depression of critical body functions, is beyond the scope of this article.
Management goals for mild to moderate hypothermia include preventing further heat loss and rewarming the patient.
For all hypothermic patients:
* Assess and support your patient's airway, breathing, and circulation. Keep him in a horizontal position to reduce cardiac workload.
* Remove wet clothing, replacing them with warm, dry materials, and protect him against further heat loss; for example, by using blankets.
* Continuously monitor his core body temperature with a rectal, bladder, or esophageal low-reading temperature probe. Also continuously monitor his cardiac rate and rhythm, as well as his respirations and BP.
* Perform all interventions gently because hypothermic patients are prone to cardiac dysrhythmias.
For patients with mild hypothermia (and a perfusing cardiac rhythm):
* Provide a warm environment and use passive external rewarming measures such as covering him (including his head) with warm blankets and positioning his arms and legs close to his body.
* If he's alert, oriented, and not at risk for aspiration, give him warm fluids to drink.
For patients with moderate hypothermia (who aren't in cardiac arrest):
[latin sharp s] In addition to passive external rewarming measures, use active external rewarming measures, such as warm-air convection blankets, warm compresses, or warmed I.V. fluids following facility policies and procedures.
* Don't use electric blankets, which can easily burn vasoconstricted skin.
* Don't apply pulse oximetry probes to vasoconstricted digits.
* Don't give him anything by mouth if his level of consciousness is diminished.
* Don't rely on rectal probes inserted in stool or tympanic thermometers, which can provide inaccurate readings.
2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 10.4: Hypothermia. Circulation. 2005;112:IV-136-IV-138.
Day MP. Hypothermia: A hazard for all seasons. Nursing. 2006;36(12):44-47.
Edelstein JA, Li J, Silverberg MA, Decker W. Hypothermia. December 14, 2007. http://www.emedicine.com/emerg/topic279.htm. Accessed September 10, 2008.
Fauci AS, Braunwald E, Kasper DL, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York, NY: McGraw Hill Medical; 2008.
Hazinski MF, Field JM, Gilmore D. Handbook of Emergency Cardiovascular Care 2008: For Healthcare Providers. Dallas, TX: American Heart Association; 2008.
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