Treatment of hypothermia

General supportive care for severe hypothermia consists of intensive management of multisystem dysfunction. Drugs have little effect because an individual's metabolic rate falls sharply during hypothermia. However, as the body core temperature returns toward normal, drugs may be rapidly absorbed and distributed. Hypoglycemia should be anticipated because reduced caloric intake often contributes to the development of hypothermia.

Re-warming techniques include passive techniques to active core re-warming.

The first step in treating a conscious elderly person with hypothermia is to remove the person from the cold environment. This includes the removal of any wet garments, as these will inhibit warming by absorbing heat intended for the patient. The patient should then be covered with insulating materials, such as dry blankets or sweaters, and placed in a warm environment. If the patient cannot ambulate, additional insulating material should be placed at contact points between the patient and solid surfaces. Administration of "warmed" not "hot" beverages will reduce the chance of burns and help enhance a return to normal temperature.

When an unconscious elderly hypothermia victim is found, "911" should be instituted immediately. Due to slowed metabolic and physiologic processes, it may not be possible to detect pulse, respirations or blood pressure. However, no hypothermia victim should be considered dead until the body returns to normal temperature and resuscitation is attempted.

It is important to recall that the heart is more irritable when cold and that the cold cardiovascular system is less able to react to change. Therefore, every attempt should be made to minimize stress during transport. Hypothermia-induced cardiac irritability can result in serious dysrhythmias. Transport should be undertaken with resuscitation equipment (defibrillator) and medically trained personnel available when possible. Because the cold cardiovascular system is less able to compensate for blood pressure variation, patients should be transported horizontally to avoid orthostatic hypotension.

Arrhythmia, shock and dehydration from fluid shifts are common consequences of hypothermia. Intravenous access should be considered for all hypothermia victims.

Active external re-warming techniques may be used to restore body temperature to normal. These techniques include immersion in temperature controlled water and use of radiant heat sources, such as an electric blanket, warming pad, hot water bottle and warm air sources. Such external warming devices must be used with care due to:

• An increased risk of burn trauma. The hypothermic patient will have decreased cutaneous perfusion since the body is attempting to shunt heat to its core. External radiant energy can therefore be retained and concentrated at the skin level.
• Shock from loss of peripheral vascular resistance can occur if the peripheral temperature is raised faster than the core temperature. When warmed the peripheral vasculature can dilate precipitating a drop in blood pressure.

Active core re-warming techniques are invasive and aggressive forms of therapy that many elderly people may not tolerate well. Such techniques include: using an intragastric balloon, colonic irrigation with warmed fluids, hemodialysis, peritoneal dialysis, extracorporeal blood warming and inhalation re-warming.

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