Hypothermia Follow-up

  • Author: Jamie Alison Edelstein, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 27, 2011
 

Further Inpatient Care

Medical complications from hypothermia often result and necessitate admission to the hospital in moderate and severe hypothermia. Severely hypothermic patients should be admitted to an intensive care unit where their respiratory and cardiac function and temperature may be closely monitored.

Acute pulmonary edema should be treated with oxygen, empirical antibiotics for aspiration pneumonia, and diuretics as necessary.

Frostbite and other localized cold injuries result in deep tissue damage. Surgical exploration and debridement may be necessary. Affected body parts may have to be amputated if gangrene develops. Such a procedure is usually performed at some delayed time interval once a line of demarkation has declared itself days to weeks later.

The development of rhabdomyolysis should be monitored.

Next

Deterrence/Prevention

  • Preparation is key to avoiding accidental hypothermia.
  • Appropriate cold weather clothing and survival bags are a necessity if walking or climbing in a cold climate.
  • Persons should avoid alcohol if anticipating exposure to cold because alcohol can disrupt temperature homeostasis by causing vasodilation.
  • Individuals should remain alert to early symptoms and initiate preventive measures (eg, drinking warm fluids).
  • Adequate heat in the home should be maintained.
  • Patients should be referred to a social service agency for help with adequate housing, heat, and/or clothing.
Previous
Next

Complications

Complications of hypothermia

  • Cardiac arrhythmias at temperatures below 30-32°C
  • Infection
  • Pulmonary edema
  • Bleeding diathesis
  • Bladder atony
  • Electrolyte (hyperkalemia, hypoglycemia), hematocrit, coagulation study abnormalities

Complications of treatment of hypothermia

  • Rewarming shock, or hypotension secondary to marked vasodilatation of rewarming
  • Rewarming acidosis due to recirculation of pooled lactic acid in the peripheral circulation
  • Rewarming electrolyte disturbances, in particular hypocalcemia and hypomagnesemia, indicate a poor prognosis
  • Aspiration pneumonia
  • Pulmonary edema
  • Pancreatitis
  • Burns to cold and vasoconstricted skin secondary to application of hot water bottles and heating pads
  • Neutropenia, thrombocytopenia, and infection
  • Iatrogenic hyperthermia
  • Peritonitis
  • GI bleeding
  • Intravascular thrombosis
  • Gangrene
  • Compartment syndrome
Previous
Next

Prognosis

  • The risk of morbidity and mortality depends on the severity of the degree of hypothermia and the underlying cause.
  • Recovery is usually complete for previously healthy individuals with mild or moderate hypothermia (mortality rate < 5%).
  • The mortality rate for patients with severe hypothermia, especially with preexisting illness, may be higher than 50%.
Previous
Next

Patient Education

Previous
 
Contributor Information and Disclosures
Author

Jamie Alison Edelstein, MD  Staff Physician, Department of Emergency Medicine, State University of New York, Kings County Hospital Center

Disclosure: Nothing to disclose.

Coauthor(s)

James Li, MD  Former Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Board of Directors, Remote Medicine

Disclosure: Nothing to disclose.

Mark A Silverberg, MD, MMB, FACEP  Assistant Professor, Associate Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate Medical Center

Mark A Silverberg, MD, MMB, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Wyatt Decker, MD  Vice President and Chief Executive Officer, Mayo Clinic Campus, Arizona

Wyatt Decker, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Dan Danzl, MD  Chair, Professor, Department of Emergency Medicine, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

James Steven Walker, DO, MS  Clinical Professor of Surgery, Department of Surgery, University of Oklahoma College of Medicine

James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References
  1. Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med. Jul 2009;37(7 Suppl):S186-202. [Medline].

  2. Long WB 3rd, Edlich RF, Winters KL, Britt LD. Cold injuries. J Long Term Eff Med Implants. 2005;15(1):67-78. [Medline].

  3. Sessler DI. Thermoregulatory defense mechanisms. Crit Care Med. Jul 2009;37(7 Suppl):S203-10. [Medline].

  4. McCullough L, Arora S. Diagnosis and treatment of hypothermia. Am Fam Physician. Dec 15 2004;70(12):2325-32. [Medline].

  5. Laniewicz M, Lyn-Kew K, Silbergleit R. Rapid endovascular warming for profound hypothermia. Ann Emerg Med. Feb 2008;51(2):160-3. [Medline].

  6. Abella BS, Rhee JW, Huang KN, Vanden Hoek TL, Becker LB. Induced hypothermia is underused after resuscitation from cardiac arrest: a current practice survey. Resuscitation. Feb 2005;64(2):181-6. [Medline].

  7. Alam HB, Rhee P, Honma K, et al. Does the rate of rewarming from profound hypothermic arrest influence the outcome in a swine model of lethal hemorrhage?. J Trauma. Jan 2006;60(1):134-46. [Medline].

  8. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. Feb 21 2002;346(8):557-63. [Medline]. [Full Text].

  9. Biancolini CA, Del Bosco CG, Jorge MA, Poderoso JJ, Capdevila AA. Active core rewarming in neurologic, hypothermic patients: effects on oxygen-related variables. Crit Care Med. Aug 1993;21(8):1164-8. [Medline].

  10. Biem J, Koehncke N, Classen D, Dosman J. Out of the cold: management of hypothermia and frostbite. CMAJ. Feb 4 2003;168(3):305-11. [Medline].

  11. Britt LD, Dascombe WH, Rodriguez A. New horizons in management of hypothermia and frostbite injury. Surg Clin North Am. Apr 1991;71(2):345-70. [Medline].

  12. Brunette DD, Sterner S, Robinson EP, Ruiz E. Comparison of gastric lavage and thoracic cavity lavage in the treatment of severe hypothermia in dogs. Ann Emerg Med. Nov 1987;16(11):1222-7. [Medline].

  13. Buckley JJ, Bosch OK, Bacaner MB. Prevention of ventricular fibrillation during hypothermia with bretylium tosylate. Anesth Analg. Jul-Aug 1971;50(4):587-93. [Medline].

  14. Casas F, Alam H, Reeves A, Chen Z, Smith WA. A portable cardiopulmonary bypass/extracorporeal membrane oxygenation system for the induction and reversal of profound hypothermia: feasibility study in a Swine model of lethal injuries. Artif Organs. Jul 2005;29(7):557-63. [Medline].

  15. Centers for Disease Control and Prevention (CDC). Hypothermia-related deaths--United States, 2003-2004. MMWR Morb Mortal Wkly Rep. Feb 25 2005;54(7):173-5. [Medline].

  16. Danzl DF, Pozos RS. Accidental hypothermia. N Engl J Med. Dec 29 1994;331(26):1756-60. [Medline].

  17. Danzl DF, Pozos RS, Auerbach PS, et al. Multicenter hypothermia survey. Ann Emerg Med. Sep 1987;16(9):1042-55. [Medline].

  18. Danzl DF, Pozos RS, Hamlet MP. Accidental hypothermia. In: Wilderness Medicine. 51-103.

  19. [Guideline] ECC Committee, Subcommittees and Task Forces of the American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. Dec 13 2005;112(24 Suppl):IV1-203. [Medline].

  20. Elbaz G, Etzion O, Delgado J, Porath A, Talmor D, Novack V. Hypothermia in a desert climate: severity score and mortality prediction. Am J Emerg Med. Jul 2008;26(6):683-8. [Medline].

  21. Fildes J, Sheaff C, Barrett J. Very hot intravenous fluid in the treatment of hypothermia. J Trauma. Nov 1993;35(5):683-6; discussion 686-7. [Medline].

  22. Gentilello LM, Cobean RA, Offner PJ, Soderberg RW, Jurkovich GJ. Continuous arteriovenous rewarming: rapid reversal of hypothermia in critically ill patients. J Trauma. Mar 1992;32(3):316-25; discussion 325-7. [Medline].

  23. Hall KN, Syverud SA. Closed thoracic cavity lavage in the treatment of severe hypothermia in human beings. Ann Emerg Med. Feb 1990;19(2):204-6. [Medline].

  24. Headdon WG, Wilson PM, Dalton HR. The management of accidental hypothermia. BMJ. Jun 10 2009;338:b2085. [Medline].

  25. Jurkovich GJ. Environmental cold-induced injury. Surg Clin North Am. Feb 2007;87(1):247-67, viii. [Medline].

  26. Kanzenbach TL, Dexter WW. Cold injuries. Protecting your patients from the dangers of hypothermia and frostbite. Postgrad Med. Jan 1999;105(1):72-8. [Medline].

  27. Keatinge WR. Hypothermia: dead or alive?. BMJ. Jan 5 1991;302(6767):3-4. [Medline].

  28. Ko CS, Alex J, Jeffries S, Parmar JM. Dead? Or just cold: profoundly hypothermic patient with no signs of life. Emerg Med J. Sep 2002;19(5):478-9. [Medline]. [Full Text].

  29. Launay JC, Savourey G. Cold adaptations. Ind Health. Jul 2009;47(3):221-7. [Medline].

  30. Mechem CC. Accidental Hypothermia. www.uptodate.com.

  31. Murphy K, Nowak RM, Tomlanovich MC. Use of bretylium tosylate as prophylaxis and treatment in hypothermic ventricular fibrillation in the canine model. Ann Emerg Med. Oct 1986;15(10):1160-6. [Medline].

  32. Plaisier BR. Thoracic lavage in accidental hypothermia with cardiac arrest--report of a case and review of the literature. Resuscitation. Jul 2005;66(1):99-104. [Medline].

  33. Romet TT, Hoskin RW. Temperature and metabolic responses to inhalation and bath rewarming protocols. Aviat Space Environ Med. Jul 1988;59(7):630-4. [Medline].

  34. Savard GK, Cooper KE, Veale WL, Malkinson TJ. Peripheral blood flow during rewarming from mild hypothermia in humans. J Appl Physiol. Jan 1985;58(1):4-13. [Medline].

  35. Schewe JC, Heister U, Fischer M, Hoeft A. [Accidental urban hypothermia. Severe hypothermia of 20.7 degrees C]. Anaesthesist. Oct 2005;54(10):1005-11. [Medline].

  36. Spencer SM, Roeseler J, Verschuren F, Reynaert M, Thys F. Metabolism study in an 88-year-old woman with severe hypothermia during rewarming procedures. Am J Emerg Med. Oct 2007;25(8):986.e1-3. [Medline].

  37. Ulrich AS, Rathlev NK. Hypothermia and localized cold injuries. Emerg Med Clin North Am. May 2004;22(2):281-98. [Medline].

  38. Vachiery JL, Reuse C, Blecic S, Contempre B, Vincent JL. Bretylium tosylate versus lidocaine in experimental cardiac arrest. Am J Emerg Med. Nov 1990;8(6):492-5. [Medline].

  39. Walpoth BH, Walpoth-Aslan BN, Mattle HP, et al. Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med. Nov 20 1997;337(21):1500-5. [Medline].

  40. Webb P. Afterdrop of body temperature during rewarming: an alternative explanation. J Appl Physiol. Feb 1986;60(2):385-90. [Medline].

  41. Wilkerson JA. Hypothermia, Frostbite, and other Cold Injuries. 1986.

  42. Windsor JS, Firth PG, Grocott MP, Rodway GW, Montgomery HE. Mountain mortality: a review of deaths that occur during recreational activities in the mountains. Postgrad Med J. Jun 2009;85(1004):316-21. [Medline].

  43. Zachary L, Kucan JO, Robson MC, Frank DH. Accidental hypothermia treated with rapid rewarming by immersion. Ann Plast Surg. Sep 1982;9(3):238-41. [Medline].

Previous
Next
 
Osborne (J) waves (V3) in a patient with a rectal core temperature of 26.7°C (80.1°F). ECG courtesy of Heather Murphy-Lavoie of Charity Hospital, New Orleans.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.