eMedicine Specialties > Emergency Medicine > Environmental
Hypothermia: Follow-up
Updated: Oct 29, 2009
Follow-up
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.
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.
Complications
- Complications of hypothermia
- Cardiac arrhythmias at temperatures below 30-32°C
- Infection
- Aspiration pneumonia
- Pulmonary edema
- Pancreatitis
- Bleeding diathesis
- Bladder atony
- Frostbite
- 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
- Ventricular fibrillation
- Peritonitis
- GI bleeding
- Acute tubular necrosis
- Intravascular thrombosis
- Metabolic acidosis
- Rhabdomyolysis
- Gangrene
- Compartment syndrome
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%.
Patient Education
- For excellent patient education resources, visit eMedicine's Environmental Exposures and Injuries Center. Also, see eMedicine's patient education articles Hypothermia and Wilderness: Hypothermia.
Miscellaneous
Medicolegal Pitfalls
- The major medical/legal pitfall is misdiagnosis by failing to check or document a patient's core temperature.
- Treating a patient for hypothermia but failing to treat for a secondary cause or an underlying comorbid condition, such as sepsis or drug overdose, is another potential pitfall.
- Always consider the possibility of trauma, especially to the head and abdomen, in patients with severe hypothermia who are unable to give a reliable history.
Special Concerns
- Controversy surrounds the issue of pronouncing death in a hypothermic patient.
- A reasonable approach is to initiate resuscitation on all hypothermic patients unless a patient presents with a frozen chest or other obvious nonsurvivable injuries. A patient can be warmed aggressively and resuscitated until the core temperature rises above 32°C. At that juncture, if no signs of life are present and the patient is not responding to advanced cardiac life support measures, termination of resuscitation may be indicated.
- Individual clinical judgment is paramount in these settings, and variables, such as the patient's age and any comorbid conditions, must be taken into account. Serum potassium levels may be useful in determining when to cease resuscitation; patients with potassium levels of 10 mmol/L or higher have very poor outcomes. However, the recovery rate is based on retrospective or observational studies in survivors after potassium levels greater than 10 have been reported.
- Clearly, profound hypothermia can mimic clinical death. However, patients with profound hypothermia can be resuscitated successfully with good neurologic outcomes. The adage that "a patient is not dead until they are warm and dead" is of some use.
- Spending prolonged periods to bring a patient with no signs of life to a normal body temperature can, in some instances, be unwarranted. If a patient's chest is frozen, resuscitative efforts are not necessary.
More on Hypothermia |
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| Differential Diagnoses & Workup: Hypothermia |
| Treatment & Medication: Hypothermia |
 Follow-up: Hypothermia |
| Multimedia: Hypothermia |
| References |
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Further Reading
Keywords
hypothermia, environmental exposure, accidental hypothermia, intentional hypothermia, primary hypothermia, secondary hypothermia, atrial arrhythmia, ventricular arrhythmia, ventricular fibrillation, core temperature drop, decreased heat production, increased heat loss, impaired thermoregulation, mild hypothermia, moderate hypothermia, severe hypothermia
