Accidental Hypothermia

An Evidence-Based Approach

Mulcahy, Allison R. MD
Watts, Melanie R. MD
Weingart, Scott MD
Jagoda, Andy MD, FACEP

Authors
Allison R. Mulcahy, MD Alameda County Medical Center/Highland Hospital, Oakland, CA
Melanie R. Watts, MD Alameda County Medical Center/Highland Hospital, Oakland, CA
Special Guest Editor
Scott Weingart, MD Assistant Professor of Emergency Medicine, Elmhurst Hospital Center, Mount Sinai School of Medicine, New York, NY
Peer Reviewers
Andy Jagoda, MD, FACEP Professor and Vice-Chair of Academic Affairs, Department of Emergency Medicine, Mount Sinai School of Medicine; Medical Director, Mount Sinai Hospital, New York, NY

Emergency Medicine Practice 11(1):p 1-24, January 2009.

Three physicians, 3 cities, 3 patients, 1 theme - and many questions:

Oakland, California:Change of shift on a busy, rainy Friday in January. A John Doe appearing to be in his 50's is brought in by EMS after being “found down” with obvious ethanol alcohol (ETOH) on board. He is intubated, pulseless, cold to touch, and CPR is in progress. While the ET tube placement is confirmed, the nurse places a Foley catheter and reports that his temperature is 25°C (77°F). When CPR is paused, the monitor shows ventricular fibrillation. A forced air warming device is requested STAT while the physician begins to think about the next steps. The hospital does not have cardiopulmonary bypass and the physician wonders, “Should ACLS guidelines be followed? Should the patient be transferred to a higher level facility? Is there a role for hemodialysis? Does this patient even have a chance of surviving?”

Jackson Hole, Wyoming:EMS calls in that they have a hypothermic, 30-year-old female who had probably gotten lost while backcountry skiing, though fortunately made it to a roadside before collapsing. It was unclear how long she had been down before she was found by a passing motorist. The medics report she is breathing and has a pulse but is unconscious; they have an estimated time of arrival (ETA) of 15 minutes. The paramedics request permission to intubate the patient. As the physician considers the wisdom of securing the airway in this patient, he quickly begins to think through the resources available to resuscitate such a critical patient … and what to do if this patient goes into cardiac arrest …

Jacksonville, Florida:An 80-year-old man is brought in from a skilled nursing facility with altered mental status. The core temperature measured via the Foley catheter is 32°C (89.6°F). Unsure of the patient's baseline or etiology of the hypothermia, the physician places a forced air rewarming device on the patient, administers warm humidified oxygen, and reflects, “Should I give the patient broad spectrum antibiotics or wait to see if his mental status improves? Should I give him steroids? How aggressively should I warm him?”