Clinical Practice Guidelines:
Environmental/Hypothermia
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Date
February, 2015
Purpose
Scope
To ensure consistent management of patients with Hypothermia.
Applies to all QAS clinical staff.
Author
Clinical Quality & Patient Safety Unit, QAS
Review date
February, 2017
URL
https://ambulance.qld.gov.au/clinical.html
This work is licensed under the Creative Commons
Attribution-NonCommercial-NoDerivatives 4.0
International License. To view a copy of this license,
visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Hypothermia
February, 2015
Hypothermia is defined as a core body temperature of < 35°C and is caused by excessive cold stress and/or inadequate body heat production.[1]
Clinical features
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Early compensatory mechanisms include shivering, increasing muscle tone, peripheral vasoconstriction, increased respiratory rate and cardiac output. When these mechanisms no longer compensate for heat loss, body temperature falls.[1,2,3]
Despite Queensland’s climate, hypothermia can occur in any season or setting.[4]
Signs and symptoms depend on the underlying aetiology and core temperature.[5]
• Mild ( 35–32°C ) – vasoconstriction, apathy/lethargy,
ataxia, tachycardia, tachypnoea and normotension.
• Moderate ( 32–28°C ) – confusion, delirium, ALOC,
hypotension, bradycardia and muscle rigidity.
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Causes of hypothermia can be classified under three (3 ) broad headings:
Increased heat loss
• vasodilation
• environmental
• trauma
• loss of skin integrity e.g. burns
• Severe (< 28°C ) – stupor, coma, diminished or absent signs of life, dilated pupils, reduced/
absent reflexes and apnoea. Dysrhythmias including SB, slow AF (may present with J-wave), VF and finally asystole.
The patient can also develop:
UNCONTROLLED WHEN PRINTED
• blunted catecholamine release
• Hypo/hyperglycaemia
• neuropathy
Decreased heat production
• Hypo/hyperkalaemia
• coagulopathy/disseminated intravascular
coagulation/thromboembolic disorders
• age
• endocrine disorders
• rhabdomyolysis.
• nutritional deficits
• immobility
UNCONTROLLED WHEN PRINTED
CNS dysfunction
Risk Assessment
• trauma
• CVA
• Not applicable
• hypoxaemia
• malignancy
• encephalopathy.
Figure 2.14
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CPG: Paramedic Safety
Additional information
CPG: Standard Cares
• Ensure treatable underlying conditions (e.g. overdose,
hypoglycaemia, seizure and/or trauma) are managed concurrently.
Manage as per:
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• In the pre-hospital setting it is difficult to accurately measure core temperature (tympanic
thermometers lack accuracy at temperature extremes).
Signs of life?
Y
•
Minimise patient movement
•
Prevent further heat loss
N
• CPG: Resuscitation (age specific)
• CPG: Resuscitation – Special circumstances
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• Move hypothermic patients carefully and gently as they are at an increased risk of developing VF (impaired conduction system).[5]
- gently remove wet clothes (should be cut off rather than stripped off).
- ensure patient is dry
•
Commence rewarming
- cover with blankets and consider warming blanket
Note: Officers are only to
perform procedures for which they have received
specific training and
authorisation by the QAS.
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- warm/heat ambulance
Consider:
• Oxygen
• LMA/ETT
• 12-Lead ECG
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• IV fluid
• BGL
• Serial temperature monitoring
• Treat concurrent conditions
Transport to hospital
Pre-notify as appropriate
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