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Severe Hypothermia and Active Rewarming Protocols

Cardiac arrhythmia risk increases at core body temperature less than 28°C; ECMO-assisted active internal warming saves lives in selected cases.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Severe Hypothermia and Active Rewarming Protocols?

Hypothermia is defined as a drop in core body temperature below 35°C. It is classified as mild (32-35°C), moderate (28-32°C), and severe (less than 28°C). Cold environment, water immersion, alcohol, and old age are leading causes.

Clinically, mild hypothermia presents with shivering and decreased consciousness; moderate hypothermia features bradycardia-arrhythmia; severe hypothermia presents with coma, paradoxical undressing, 'Osborn (J) wave', and ventricular fibrillation are prominent.

Rewarming strategy is planned according to temperature; passive external (blanket), active external (Bair Hugger, warming blanket), active internal (warmed IV fluid, air, lavage), ECMO or cardiopulmonary bypass is applied in the most severe cases.

Symptoms

Shivering, tachycardia (mild stage)
Confusion, ataxia, dysarthria
Bradycardia and hypotension
Respiratory depression
Loss of consciousness
Osborn (J) wave on ECG
Ventricular fibrillation
Pseudo-rigor mortis

Risk Factors

Prolonged cold weather exposure
Falling into cold water
Alcohol or substance intoxication
Old age and homelessness
Hypothyroidism, adrenal insufficiency
Sepsis
Trauma and injury
Sedative and neuroleptic medications

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Every suspected hypothermia must be evaluated
  • Altered consciousness and cold environment
  • Bradycardia and hypothermia
  • After cold water rescue
  • Confusion and low temperature in elderly
  • History of alcohol and outdoor exposure

Treatment Methods

01
Removal of wet clothing
02
Passive external warming (blanket)
03
Active external warming (Bair Hugger)
04
Warmed IV fluid (40-42°C)
05
Ventilation with warmed air
06
Bladder/gastric lavage with warm fluid
07
ECMO or cardiopulmonary bypass (less than 28°C)
08
Prolonged CPR (potentially reversible)
09
Defibrillation effective after 30°C

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.