Hypothermia


Article Author:
Hieu Duong


Article Editor:
Gaurav Patel


Editors In Chief:
Chaddie Doerr


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes


Updated:
8/23/2019 12:34:22 PM

Introduction

The definition of hypothermia is an involuntary drop in body temperature below 35C. Accidental hypothermia is not limited to regions or times of severe cold and can occur in milder climates.[1] Symptoms will vary depending on the severity of hypothermia. Severity is defined based on core temperature as mild (32 to 35 C), moderate (28 to 32 C), and severe (under 28 C), with some experts also categorizing certain individuals with profound (less than 24 C) hypothermia. More severe symptoms, morbidity, and mortality are associated with worsening degrees of hypothermia.[2]

Etiology

Hypothermia takes place when the body dissipates more heat than it absorbs or creates, leaving the body unable to generate sufficient heat to maintain homeostasis and proper bodily function. While the underlying cause of accidental hypothermia is excessive cold stress and inadequate heat generation from the body (thermogenesis), other factors increase the risk of developing hypothermia. Functional central and peripheral nervous systems, along with proper behavioral adaptation, are important components.[3]

Extremes of age, hypoglycemia, malnutrition, and endocrine disorder are examples of heat production inadequacy. Skin disorders (psoriasis and burns) and improper peripheral vasodilation from peripheral dysfunction (peripheral neuropathies and spinal cord injuries) exacerbate heat loss. Cerebrovascular accidents, neurodegenerative disorders, and drug abuse may disrupt the hypothalamic thermoregulation function. In addition to organic causes, an impaired behavioral response to cold stress may result in hypothermia for individuals with dementia, drug abuse disorder, or psychiatric condition. Situational circumstances from lack of shelter or clothing may occur in the homeless.[4][5][3][2] 

 Hypothermia may also be due to drugs like general anesthetics, beta-blockers, meperidine, clonidine, neuroleptics, and alcohol.

Epidemiology

Each year there are approximately 700 to 1500 patients in the United States who have hypothermia noted on their death certificate.[4] Adults between the ages of 30 to 49 are more likely affected, with men being ten times more likely than women. However, the true incidence of hypothermia is relatively unknown. Even with supportive in-hospital care, the mortality of those with moderate to severe hypothermia still approaches 50 percent.[4]

Pathophysiology

Core temperature is a balance between heat produced by the body, and heat lost to the surrounding environment. The normal average temperature of an individual is 37+/-0.5 C.  Heat loss occurs through four mechanisms: radiation, conduction, convection, and evaporation. Radiation occurs when electromagnetic energy transfers between each other. Conduction occurs when heat gets transferred between two objects that are in contact with one another. Convection is heat loss that occurs when air molecules move past an object.  Evaporation is an endothermic reaction that causes a liquid to form a gas. While radiation is the most common form of heat loss, the most common mechanism of developing accidental hypothermia is by convective heat loss to cold air and when in cold water or wet clothing via immersion or excessive sweating.[6][2]  

Body temperature regulation is by the hypothalamus and gets maintained by a variety of autonomic mechanisms. The hypothalamus receives input from central and peripheral thermal receptors. In response to increased cold stress, the hypothalamus will work to raise its metabolic heat production through a variety of mechanisms. Initial muscle tone and basal metabolic rate increase, which can double heat production.  Shivering can also increase the heat production rate 2 to 5 times from baseline.  There will also be an increase in thyroid, catecholamine, and adrenal activity.  The body will also try to avoid further heat loss through sympathetically mediated cold-induced vasoconstriction of peripheral vessels where cooling and heat loss are often the greatest. Additional heat production results from behavioral changes such as adding more clothing, seeking shelter, starting a fire, and exercising.[1][3]

The body initially increases metabolism, ventilation, and cardiac output in an effort to maintain bodily function during drops in temperature. Eventually, the heat loss overwhelms the body and shivering ceases. Multiple organ systems, including neurologic, metabolic, and cardiac, will stop functioning and ultimately lead to death.[7]

History and Physical

Those suffering from accidental hypothermia will typically have a history of cold exposure. Obtaining a core temperature is essential to diagnose and manage hypothermia effectively. Oral temperature is only useful to rule out hypothermia as most commercially available thermometers cannot read under 35 C. Tympanic thermometers are also unreliable. Epitympanic thermometers, when used correctly, reflect the carotid artery temperature and can be reasonably reliable. Both rectal and bladder temperature measurements are reasonable in conscious individuals with mild to moderate hypothermia but should not appropriatein critical patients during rewarming as they lag behind true core temperature. Neither are appropriate in the pre-hospital setting as doing so may further expose the patient and cause further drops in temperature. Esophageal temperature measurement is the most accurate when done correctly with the probe in the lower third of the esophagus; this should only be performed in patients with an advanced airway in place.[1] Given the difficulty to get an immediate, reliable temperature in a pre-hospital setting, it is crucial to know the clinical findings associated with the stages of hypothermia so that appropriate treatment can initiate immediately.[6]

Mild Hypothermia 32 to 35 C:  Presentation can often be subtle with vague symptoms such as hunger, nausea, fatigue, shivering, and pale-dry skin. Often, they will have increased muscle tone, increased blood pressure, tachycardia, and tachypnea from the body’s attempts to promote thermogenesis. Patients are frequently shivering, but if energy stores have been depleted, they may not be shivering meaning you cannot rely on this finding. They will often have a decline in cognitive abilities, memory, and judgment with some experiencing ataxia and dysarthria.  The patient may experience “cold diuresis” due to peripheral vasoconstriction leading to increased diuresis and volume depletion.[1]

Moderate Hypothermia 28 to 32 C: The patient will continue to have cognitive decline and be lethargic. Increased CNS depression may lead to hyporeflexia with pupils less responsive and dilated. They may become hypotensive with bradycardia and bradypnea. Shivering typically ceases between 30 to 32 C and paradoxical undressing may be observed.  Susceptibility to dysrhythmias increases with atrial fibrillation being the most common.[7]

Severe Hypothermia, less than 28 C: Cerebral blood flow continues to decline until patients become unresponsive. Blood pressure, heart rate, and cardiac output continue to decrease. Increased susceptibility to atrial and junctional dysrhythmias is present. Pulmonary congestion, extreme oliguria, and areflexia may occur. Ultimately, cardiorespiratory failure results.[8]

All patients with suspected hypothermia should have a complete physical exam to exclude local cold-induced injuries and to assess for signs of trauma or other illness that may have caused their exposure to the cold. Also, be aware of vital signs inconsistent with the degree of hypothermia as this may be the only clue to an alternate diagnosis such as hypothyroidism, adrenal insufficiency, sepsis, hypoglycemia, carbon monoxide poisoning, alcohol abuse, malnutrition, unintentional/intentional overdose.[4]

Evaluation

As with all potentially unstable patients, the initial focus of the clinician should remain on assessing the patients ABCs. Once the ABCs have been evaluated and managed, the patient should be exposed to remove all clothing. Warm blankets should then be placed over the patient once he/she is fully exposed. Standard laboratory evaluation should include finger-stick glucose, complete blood count, a metabolic panel with basic serum electrolytes, BUN, and creatinine. One may expect increased hemoglobin and hematocrit in hypothermic patients due to cold diuresis from impaired secretion of antidiuretic hormone. Electrolyte reassessment approximately every 4 hours is the recommended procedure when resuscitating the moderate to severely hypothermic patient. Glucose also does not follow a specific pattern but maybe the earliest clue for a patient in DKA.[4]

In moderate to severely hypothermic patients in whom invasive procedures may be necessary, it is reasonable to obtain a coagulation panel to rule out coagulopathy. However, coagulation studies generally require blood warmed to 37 C, so it does not accurately reflect actual function. Fibrinogen should also be checked to rule out disseminated intravascular coagulation. Serum lactate, creatinine kinase, troponin, TSH, cortisol, toxicology screen, fibrinogen, lipase, magnesium, and any other labs deemed necessary may be necessary under the right clinical settings.[3][8] 

Imaging should be dictated by clinical scenario as some patients may have experienced trauma, cerebrovascular accident, or other events that led to prolonged cold exposure. If obtaining a chest X-ray, it is not uncommon for severely hypothermic patients to show signs of pulmonary edema. Bedside ultrasound can be used to confirm cardiac activity and volume status. Head CT may be beneficial individuals whose mental status is not consistent with measured core temperature or if there is a concern for trauma.[8] 

Due to the different dysthymias that often present in hypothermic patients, an ECG is necessary. Hypothermia can cause slowed impulse conduction through potassium channels resulting in prolonged ECG intervals. There may also be an elevated J point that can produce an Osborne or J wave. The height of this wave is proportional to the degree of hypothermia and is most common in the precordial leads. Any dysrhythmia is possible with atrial fibrillation being the most common.  Those with more moderate to severe hypothermia will likely exhibit bradycardia and are at increased risk for ventricular arrhythmias.[4][5]

Treatment / Management

The management and treatment of accidental hypothermia revolve around the prevention of further heat loss and the initiation of rewarming. However, initial steps are always to evaluate and support airway, breathing, and circulation. Wet clothing should be removed and replaced with dry clothing or insulation as soon as possible to prevent further heat loss.[9]

Once able, one should then attempt to determine the degree of hypothermia based on history, mental status, physical exam, and core temperature measurement. If there is suspicion for moderate or severe hypothermia, especially in those with a decreased level of consciousness or in those have an irregular or faint pulse, extra care should be taken not to move or jostle the patient too much as it may precipitate cardiac collapse from a fatal arrhythmia due to increased cardiac irritability. Comorbid medical conditions and trauma that may also have occurred merit considerations and appropriate treatment.[10]

Rewarming of hypothermic patients involves passive external rewarming, active external rewarming, active internal rewarming, or a combination of these techniques. The treatment of choice for mild hypothermia is passive external rewarming. After removal of wet clothing, additional layers of insulation are placed on the patient with the goal to prevent heat loss and promote retention of heat produced by patients. Shivering allows the body to spontaneously produce up to a 5-fold increase of heat as compared to baseline. However, the success of this method requires adequate glucose stores so that a patient can produce heat. Given that at this point many will have depleted energy reserves (more so in elderly, young, and malnourished), it is appropriate to supply glucose to these individuals, orally when possible. In individuals with mild hypothermia, it is recommended to warm them at 0.5 to 2 C per hour. Vigorous shivering, however, can be problematic in people with limited cardiopulmonary reserve as it requires an increase in the consumption of oxygen. Furthermore, patients with more severe hypothermia may fail to respond to passive techniques, so it is appropriate to progress to active external rewarming techniques.[8]

Active external rewarming is necessary for moderate to severe hypothermia and in some cases of mild hypothermia not responding to standard measures. A heated air unit can decrease heat loss and transfer heat through convection. Water immersion is an alternative, but it is more cumbersome and harder to monitor. Immersion of extremities in warm water (44 to 45 C) requires great care and attention, as efforts to rewarm patients may precipitate increases CV load and collapse as peripheral vasodilation this may lead to an after-drop cooling of core temperature from sudden return of cold blood from the extremities.[8]

Despite active external rewarming, some patients may require more invasive methods ranging from airway rewarming with humidified air to full cardiopulmonary bypass. Most patients will be started on warm intravenous fluids of 40 to 42 C as they are readily available and safe, as well as humidified air. Lavage of body cavities such as stomach, bladder, colon, peritoneal and pleura with warm fluid, though invasive, can be considered. Pleural and peritoneal lavages are preferable due to the larger mucosal surface area. Pleural lavage involves placing one thoracostomy tube between the second and third anterior intercostal space in the midclavicular line and the second thoracostomy tube between the fifth and sixth intercostal space at the posterior axillary line. Warm fluid infusion will begin at the anterior tube and drain through the more posterior tube. Peritoneal lavage involves the placement of two or more catheters in the peritoneal cavity, which allows for the diagnostic of occult abdominal trauma and rewarming peritoneal cavity. Extracorporeal rewarming techniques allow for even faster rewarming.[5][7]

Extracorporeal methods, including hemodialysis, continuous arteriovenous rewarming, cardiopulmonary bypass, and extracorporeal membrane oxygenation (ECMO). Hemodialysis is the most accessible and can raise the core temperature 2 to 3 C per hour. In arteriovenous rewarming, the patient’s blood pressure creates movements of blood from the femoral artery through a countercurrent fluid rewarmer and into the contralateral femoral vein. It is capable of raising the temperature by 4.5 C per hour. However, hemodialysis and AV rewarming require the patient to have adequate blood pressure. Cardiopulmonary bypass surgery and venoarterial ECMO is the most effective but highly invasive method of rewarming a patient. These methods are only for hypothermic patients in cardiac arrest; those patients refractory to other rewarming techniques, and hemodynamically unstable patients. It is capable of raising core temperature by 7 to 10 C per hour. It is an ideal option for cardiac arrest, as it simultaneously provides rewarming, oxygenation, and circulatory support. However, it is not readily available and requires systemic anticoagulation.[1][4][8]

Differential Diagnosis

Primary hypothermia

Secondary Hypothermia

  • Central failure
    • Cerebrovascular accident
    • CNS trauma
    • Hypothalamic dysfunction
    • Metabolic failure
    • Toxins
    • Pharmacologic effects
  • Peripheral failure
    • Acute spinal cord transection
    • Neuropathy
  • Endocrinologic failure
    • Alcoholic or diabetic ketoacidosis
    • Hypoadrenalism
    • Hypopituitarism
    • Lactic acidosis
  • Insufficient energy
    • Hypoglycemia
    • Malnutrition
  • Neuromuscular compromise
    • Extreme ages with inactivity
    • Impaired shivering
  • Dermatologic
    • Burns
    • Medication and toxins
  • Iatrogenic cause
    • Emergency childbirth
    • Cold infusion
    • Heat-stroke treatment
  • Other[11]
    • Carcinomatosis
    • Cardiopulmonary disease
    • Major infection
    • Multisystem trauma
    • Shock

Prognosis

Severe hypothermia can be lethal; however, the prognosis may be favorable depending on the scenario. Patients with primary hypothermia and cardiac stability that receive proper treatment with active external and minimal invasive rewarming techniques have a survival rate of approximately 100% with full neurological recovery. For those patients that suffer cardiac arrest who then receive extracorporeal rewarming, the survival rate approaches 50%. Full recovery might be possible in cardiac arrest with extracorporeal rewarming if there were no preceding hypoxia, serious underlying disease, or trauma. Full neurological recovery has been witnessed in accidental hypothermia of up to 14 C.[11]

Complications

Depending on the severity of hypothermia, the following may result[7]:

  • Cold diuresis
  • Rhabdomyolysis
  • Aspiration
  • Hyperkalemia
  • Frostbite
  • Acute kidney injury
  • Pulmonary edema
  • Ataxia
  • Arrhythmia (A. fibrillation, ventricular arrhythmia, PEA)
  • Coma
  • Pancreatitis
  • Death

Deterrence and Patient Education

Hypothermia occurs when your body can no longer produce enough heat to overcome cold exposure. Hypothermia is an extremely dangerous entity that has the potential to lead to death if not treated quickly. Luckily, hypothermia is avoidable. Individuals should not stay outside for too long if the weather is cold, and if outside during such arduous climate, proper clothing is critical. If your clothes are wet, quickly change out of them.

Certain patient populations are at a higher risk of developing hypothermia. Infants and young children are at increased risk due to their underdeveloped bodies and their inability to communicate reliably. On the other end of the age spectrum, the elderly are also at higher risk, as they tend to have multiple comorbidities. Physical and cognitive limitations could prevent them from seeking warmer environments in certain situations.

Pearls and Other Issues

  • Most commercial thermometers are only able to read down to 34 C, so a special low-reading thermometer is required to assess the exact level of hypothermia.
  • The esophageal thermometer is the most accurate way to determine a patient’s temperature.
  • Rectal temperatures take up to 1 hour to adjust for changes in core temperature.
  • The pulse oximeter may be inaccurate if placed on the fingers due to peripheral vasoconstriction during hypothermia.
  • Patients with hyperkalemia may not show normal ECG changes associated with elevated potassium.
  • The coagulation panel performed in the lab may not accurately represent actual coagulopathy in a hypothermic patient as it is normally warmed to 37c before being run.
  • J waves are associated with hypothermia, subarachnoid hemorrhage, ACS, and normal variant.
  • ECMO and cardiopulmonary bypass are the most invasive but effective way to rewarming an unstable patient.
  • If central access is necessary, a femoral CVL is preferred due to less irritation of myocardium and risk of dysrhythmia.
  • If the patient fails to rewarm despite appropriate rewarming techniques, secondary hypothermia such as hypoglycemia, infection, hypothyroidism, and adrenal insufficiency merit investigation.

Enhancing Healthcare Team Outcomes

Hypothermia is potentially lethal if not quickly recognized and treated. The majority of patients first present to the emergency department, and the triage nurse should promptly accept the patient and inform the emergency department physicians. In general, treating patients with hypothermia requires an interprofessional team of healthcare professionals.

EMS personnel provide the initial encounter and resuscitation effort. They will remove wet clothing and initiate external passive rewarming. After reaching the hospital, nurses and emergency room physicians will work together to further warm the patient with external and internal invasive rewarming methods.

Hypothermic patients are prone to many complications and require admission to the ICU, where there will be continuous monitoring by the nurses. The pulmonologist and cardiologist should be involved if the patient has pulmonary edema or aspiration pneumonia. Since frostbite is a common outcome, wound care must take part in therapy. Regular debridement of the wound may be necessary. Blood work requires monitoring for rhabdomyolysis. Nursing must remain in attendance constantly and report any deterioration in condition to the physician staff, as well as administering fluids and any medications.

Nephrologists, surgeons, and cardiology may be required if ECMO, hemodialysis, or cardiopulmonary bypass is needed.[8]

Hypothermia is a medical emergency and requires an interprofessional team approach, including physicians, specialists, specialty-trained nurses, and pharmacists, all collaborating across disciplines to achieve optimal patient results. [Level V]

For those who survive, education is necessary to prevent a repeat episode. These individuals should avoid alcohol, dress appropriately, and carry a survival bag with the essential equipment and material to protect the body. Only through an interprofessional team approach can be morbidity of hypothermia be lowered.

Outcomes

Patients who receive rapid resuscitation usually have good results but residual frostbite and muscle injury may be present. Outcomes are worst for the very young and elderly.


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Hypothermia - Questions

Take a quiz of the questions on this article.

Take Quiz
On a cold new year's day, paramedics are called to respond to an unresponsive, 48-year-old, alcoholic man. On arrival, bystanders are performing cardiopulmonary resuscitation after they were unable to palpate a pulse. The patient is immediately placed on the cardiac monitor, which revealed variable, wide QRS complexes. Paramedics resume cardiopulmonary resuscitation. Two rounds of defibrillation and 300 mg of amiodarone are given with minimal changes to the cardiac rhythm. Rectal temperature of 87.6°F (30.8°C) is measured. Which of the following is the next best step in the management of this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 59-year-old homeless man was brought in by paramedics after being found unconscious in Central Park on Christmas day. Patient medical history is unknown, but paramedics noted that the patient had an empty bottle of alcohol nearby. Patient’s initial vital signs included a heart rate of 130b/min, blood pressure of 115/76mmHG, respiratory rate of 14b/min, oxygen saturation of 96% on the nasal cannula, and temperature of 32 degrees Celsius. Paramedics hand you a rhythm strip with an irregular, irregular rhythm without any identifiable p waves. What is the next best step?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 60-year-old man with an unknown past medical history is brought into the emergency department after being found unconscious on a park bench. On examination, the patient is lethargic but arousable to sternal rub. Vital signs are blood pressure 100/60 mmHg, pulse 60 per minute, respiratory rate 24 per minute, and temperature 33 C. A detailed look shows a middle-aged gentleman with moist clothing that smells of alcohol. The wet clothing is removed, and the patient is started on warm IV fluids. After three hours, the patient's temperature remains at 33°C. Which of the following is the next best step in the management of this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 16-year-old boy fell through a frozen lake while ice skating. Luckily, his friends were able to pull him out of the water after being immersed for 15 minutes. On presentation, the patient is awake but drowsy. He is unable to perform fine motor skills and is not shivering. The patient's wet clothing is removed, and multiple warm blankets are placed on the patient. Which of the following is the next best step in the management of this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An obese 65-year-old female with a history of hypertension is brought in by paramedic for numbness of toes after being locked out of her house in the rain. On presentation, the patient is alert only to herself and shivering profusely on the stretcher. Her blood pressure is 134/82 mmHg, the temperature of 33 degrees Celsius, and a pulse is 66 beats per minute. The patient’s clothing is removed, and warm blankets are placed on the patient. The patient is noted to have bluish-gray toes bilaterally without capillary refill present or sensation to touch. Rewarming is initiated. What complication can result from the next management step?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 35-year-old male skier is brought into the emergency department by ski patrol after being found stranded on the side of a mountain. The patient reports that she was exploring the slopes but got lost after the sunset. His blood pressure is 110/60 mmHg, temperature of 33 degrees Celsius, and the pulse is 60 beats per minute. Examination shows a pale male wrapped in multiple layers of moist clothing and shivering vigorously. The physical examination is otherwise unremarkable. The patient changes into a gown and is given a heating blanket to warm up. Upon reevaluation, you note two full urinal bottle hanging on the railing of the bed. Which part of the body is most responsible for the increased in urination?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following patients is at greatest risk of postoperative hypothermia?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An 87-year-old male with a past medical history of Alzheimer, hypertension, and diabetes mellitus presents to the emergency department after being found roaming the streets in the rain. His blood pressure is 111/70 mmHg, temperature of 35 degrees Celsius, and a pulse is 70 beats per minute. Examination reveals a frail, mildly confused elderly man who is vigorously shaking in his wet clothes. Daughter reveals that the patient is at baseline mental status. Patient’s clothing is removed. Warm blankets are placed on the gentleman with the improvement of shivering. The patient now complaints of thirst. What is the next best step?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Why are the elderly more susceptible to the development of hypothermia?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 47-year-old male is brought to the emergency department after being found unconscious in the snow. His blood pressure is 90/55 mmHg, pulse is 56 beats per minute, respiratory rate is 13 breaths per minute, and a temperature of 31 degrees Celsius. He is semi-conscious and arousable to sternal pressure. The paramedic is only able to get interosseous cannulation in the left tibia after attempting for IV access multiple times. Central venous line placement is planned. Which of the following is the best possible site of central venous line placement in this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is not a risk factor for hypothermia?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
At which temperature would a hypothermic patient stop shivering?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 25-year-old female is found lying in the snow by ski-patrol after being reported missing by his family. The patient was discovered pulseless on initial examination with no apparent signs of trauma. Rescuers continued performing cardiopulmonary resuscitation until arrival to the hospital. The patient’s core temperature is 32°C in the emergency department. What should be performed next to determine if resuscitation should be continued?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 50-year-old man is brought into the emergency department. The patient had flu-like symptoms in the past few days. On physical examination, the patient is tachycardic, febrile, and tachypneic. The patient's past medical history is unremarkable. While admitted at the hospital, the patient was placed in a room with the air conditioner set at 55 degrees Fahrenheit. The next day the patient is found hypothermic with a new irregular irregular heart rhythm. Which conduction pathway in the heart is most likely affected?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 3-month-old newborn is brought into the emergency department after being found outside in the cold. The medical history of the newborn is unknown. On physical examination, the baby is crying vigorously and found to have a temperature of 98 Fahrenheit. The rest of the physical examination is unremarkable, including the lack of shivering. What mechanism in oxidative phosphorylation prevented the baby from becoming hypothermic?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which is least often seen secondary to cold stress in an infant?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An elderly man is brought into an emergency department in January. He was found outside of his house collapsed next to a snow shovel. On examination, his clothes are wet, cold, and the man is shivering vigorously. The wet clothes are removed, and the man is covered with warm blankets. What is the next best treatment option for this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 70-year-old male with a past medical history of Alzheimer disease, hypertension, and hyperlipidemia is brought in by paramedics after receiving a call from his wife about the patient being confused after locking himself out. His blood pressure is 110/60 mmHg, pulse 61/min, respiratory rate 13/min, and temperature 35 C. Examination reveals a thin man wrapped under multiple blankets with minimal shaking. The patient is alert and orient to person and place but is only able to identify himself on examination correctly. What is another side effect that is most commonly associated with the medication responsible for this patient’s presentation?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Hypothermia - References

References

Petrone P,Asensio JA,Marini CP, In brief: Hypothermia. Current problems in surgery. 2014 Oct;     [PubMed]
Kempainen RR,Brunette DD, The evaluation and management of accidental hypothermia. Respiratory care. 2004 Feb;     [PubMed]
Epstein E,Anna K, Accidental hypothermia. BMJ (Clinical research ed.). 2006 Mar 25;     [PubMed]
Petrone P,Asensio JA,Marini CP, Management of accidental hypothermia and cold injury. Current problems in surgery. 2014 Oct;     [PubMed]
Davis PR,Byers M, Accidental hypothermia. Journal of the Royal Army Medical Corps. 2005 Dec;     [PubMed]
Zafren K, Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia. Emergency medicine clinics of North America. 2017 May;     [PubMed]
Danzl DF,Pozos RS, Accidental hypothermia. The New England journal of medicine. 1994 Dec 29;     [PubMed]
Lloyd EL, Accidental hypothermia. Resuscitation. 1996 Sep;     [PubMed]
Haverkamp FJC,Giesbrecht GG,Tan ECTH, The prehospital management of hypothermia - An up-to-date overview. Injury. 2018 Feb;     [PubMed]
Lloyd EL, Treatment of accidental hypothermia with the Clinitron bed. Anaesthesia. 1987 Oct;     [PubMed]
Brown DJ,Brugger H,Boyd J,Paal P, Accidental hypothermia. The New England journal of medicine. 2012 Nov 15;     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Nurse-Child Health PN. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Nurse-Child Health PN, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Nurse-Child Health PN, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Nurse-Child Health PN. When it is time for the Nurse-Child Health PN board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Nurse-Child Health PN.