Atrial arrhythmias appear – usually innocent and revert when rewarmed
Ventricular arrythmias (including VF)
Fixed dilated pupils
Temperature of the coldest known survivor
Hypothermia in Resuscitation
Hypothermia substantially reduces effectiveness of defibrillation and resuscitation drugs. It is reasonable to attempt defibrillation, but if unsuccessful, continue cardiac compression until core temperature is > 30°C, when defibrillation / drugs are more likely to be effective.
Drugs are generally withheld until core temperature is >30°C, as accumulation may occur while cold, with resultant toxicity when rewarmed.
Never diagnose death and thus stop resuscitation until the patient is rewarmed to at least 32°C or cannot be rewarmed despite active measures.
Monitor core temperature
Monitor heart rate and rhythm
Check electrolytes and glucose
Actively rewarm to 32oC, then allow passive rewarming. Once above the fibrillation threshold (32oC) there is no urgency in rewarming
Mild brain hypothermia may limit reperfusion injury
Avoid hyperthermia (keep temperature < 36.5oC)
Never diagnose death and thus stop resuscitation until the patient is rewarmed to at least 32°C, or cannot be rewarmed despite active measures
Beware: rewarming may lead to vasodilation and hypotension (so-called “after shock“), which can contribute significantly to mortality
Beware: Peripheral rewarming and vasodilation can result in cold, acidotic blood being shunted to the core, with a drop in core temperature (so-called “after drop“) and an increased risk of arrhythmias
Hypokalaemia is common, even in the presence of marked acidosis
Check blood gases, potassium, glucose, and haematocrit with every few degrees of warming
External rewarming (for temperature > 32°C)
Passive external rewarming:
Remove wet clothes, dry patient
Cover with sheet of foil/space blankets
Active external rewarming (truncal areas only):
Warm air system e.g. Bair Hugger
Active core rewarming (for temperature < 32°C)
Warm IV fluids to 39°C with blood warmer (slow) – start with pre-warmed IV 0.9% saline at 40ºC
Gastric or bladder lavage with 0.9% saline at 40°C
Peritoneal lavage with potassium-free dialysate or 0.9% saline at 40°C. Use 20 mL/kg cycled every 15 minutes
Ventilation with humidified gas heated to 42°C
Pleural or pericardial lavage
Haemodialysis, extra-corporeal blood warming
Routine nursing care.
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