Hypothermia (cont.)

Usually the diagnosis of hypothermia is evident because of circumstances. The patient is found outside in the cold, and either the patient or a companion can explain the situation. Sometimes, it is less apparent, especially if the patient is found indoors and is confused.

The body core temperature needs to be measured; this may be done with a special rectal thermometer that is designed for very low readings or with a bladder catheter equipped with a temperature probe. Oral or ear temperatures are not accurate in very cold patients.

Aside from diagnosing hypothermia, the underlying cause needs to be ascertained. While some causes may be readily apparent, there may be confounding factors. Intoxicated patients may have fallen and sustained a head injury. The elderly patient may have diabetes and have a low blood sugar. While it is important to treat the low temperature, the individual medical history of the patient needs to be considered and appropriate diagnostic tests performed to rule out any associated injuries or conditions.

Care for the hypothermic patient begins when the person is found.

• First aid should be initiated.
  
  
• The patient should be removed from the cold environment and placed in a warm shelter away from the wind. Wet clothing should be removed and replaced with a warm, dry covering including head covering.
  
  
• Emergency medical services should be activated (call 911 if available) as soon as possible.
  
  
• The patient's breathing should be monitored, and if it becomes dangerously slow or stops, CPR should be initiated.
  
  
• Rough handling or jerking of the patient should be minimized if the person is lethargic or unconscious. This may cause an irritable heart to develop electrical abnormalities such as ventricular fibrillation.
  
  
• Rewarming should be started by applying warm compresses to the chest, neck, and groin. Hot water should not be used. Because there may be associated frostbite, direct heat should not be applied to the body. Instead, warm blankets and body to body contact may be needed as a first aid measure.
  
  
• The severity of hypothermia and the patient's mental status and ability to function will determine what further treatment is necessary. Passive rewarming with warm clothing in a warm environment may be all that is required for a conscious person who is shivering.
  
  
• Active rewarming may be considered for those who are colder, showing signs of confusion, or have other medical conditions that need attention. Warmed intravenous fluids, warming blankets, and warmed humidified air may be provided in the hospital.
  
  
• More aggressive core rewarming may include infusing warm fluids into the stomach or bladder, irrigating warm solutions into the chest or abdominal cavity, and in some situations, placing the patient on dialysis or heart bypass to rewarm the body.

Each of the above options needs to be specifically tailored to the patient's situation and presentation.

One axiom that continues to be followed in emergency medical care is that a patient is not dead until they are "warm and dead." Vital signs like breathing, heartbeat, and blood pressure may be difficult to detect in a severely hypothermic patient, and often efforts are made to try prolonged resuscitation until the patient is warmed. Occasional stories are reported in the press about patients, especially children, who have been resuscitated from severe hypothermia due to immersion in cold water.

Source: MedicineNet.com
http://www.medicinenet.com/hypothermia/article.htm