The Wilderness Emergency Medical Services Institute
ADVANCED TREATMENT OF HYPOTHERMIA
Additional Guidelines for Medical care:
Establish a CVP Line as soon as possible. Do not insert the
catheter into the heart as it may cause ventricular fibrillation.
A Swanz_Ganz with thermistor tip will allow core temperature readings.
Try to hold the CVP at 5 to 10 cm. H2O.
Draw blood for CBC, electrolytes, glucose, Arterial Blood Gases,
remember to tell lab to correct results for patient's temperature.
Repeat ABGs and Lytes q. 15 - 20 minutes x 1 hour, then prn.
Monitor closely for 24 hours. Also, consider platelet count,
prothrombin, firbrinogen, BUN, amylase, calcium, creatnine. Chest
and skull X-rays after rewarming. Serum or urine osmolality.
Take cervical spine X-rays STAT if any possibility of spinal
cord injury.
Remember that hypothermia gives you time to plan out a course
of action. Once you begin, changes will be fast and furious.
Have all necessary equipment ready before you start.
Expect volume depletion, diuresis, acidosis, hyperkalemia,
hyperglycemia (BS up to 400 mg./dl. not unlikely), hypoglycemia
during or after rewarming.
Expect ECG changes:
J-wave or Osborne wave - a positive deflection in the S-T segment.
Lengthening of all intervals - RR, PR, QRS and ST.
Correct acidosis cautiously - as the patient rewarms, he will
revert to normal spontaneously. Too much correction will result
in boomerang alkalosis.
Pneumonia is the most common complication, followed by renal
failure. G.I. bleeding is also common. Consider antibiotics,
Cimetidene.
External rewarming methods such as warm gas inhalation, warm
IV fluids, hot enemas, etc. have proved ineffective when used
alone, but can be used in conjucntion with other methods.
Cardiopulmonary Bypass and Femorla A-V Shunt can also be
used if available.
Remember the rule, "Never dead until warm and dead."
References:
Williams, Toni, ed., Manual of U.S. Cave Rescue Techniques, NCRC, 1981.
Bangs, Cameron C. et al, Help for the Victim of Hypothermia, Patient Care, Dec. 15, 1977.
Bangs, Cameron C., Early Recognition and Treatment of Chronic Cold Injuries, unpublished paper, date unknown.
Bangs, Cameron C., Hypothermia and Cold Injury, Off Belay, Oct, 1976.
