Assessment of Patient

Severe Hypothermia: If the patient is cold and has any of the following signs or symptoms, he is considered to have severe hypothermia:

a. Temperature of 90O F (32.2O C) or less.

b. Depressed vital signs, such as a slow pulse and/or slow respiration.

c. Altered level of consciousness, including slurred speech, staggering gait, decreased mental skills, or the lack of response to verbal or painful stimuli.

d. No shivering in spite of being very cold. (Note: This sign is potentially unreliable and may be altered by alcohol intoxication.) Mild Hypothermia: If the patient is cold and does not have any of the above signs or symptoms, he is considered to have mild hypothermia.

Basic Treatment for Hypothermia

1. Prevent further heat loss. Insulate from the ground, protect from the wind, eliminate evaporative heat loss by removing wet clothing or by covering the patient with a vapor barrier (such as a plastic garbage bag), cover the head and neck and move the patient to a warm environment. Consider covering patient's mouth and nose with a light fabric to reduce heat loss through respirations.

2. Activate the emergency medical services system to provide transport to a medical facility.

3. Do not give alcohol.

Treatment for Mild Hypothermia

Treat the patient as outlined in Basic Treatment for Hypothermia. If there is no way to get to a medical facility, rewarm the patient gradually by:

a. Placing patient in as warm an environment as possible. b. Increasing heat production through exercise and calorie/ fluid replacement. This method of adding heat is particularly important when emergency care is not readily available as in remote or prolonged transport environment.

c. Rewarming passively through the application of insulated heat packs to high heat transfer/loss areas such as the head, neck, underarms, sides of the chest wall, and groin, and heavy insulation to prevent further heat loss.

d. Considering warm showers and warm bath if the patient is alert.

e. Placing patient in a sleeping bag and providing contact with a warm body. The patient should not be placed a sleeping bag with another individual who is hypothermic. This method should be considered a last resort since it may endanger the rescuer and is less efficient than other methods. Encourage the patient to drink warm fluids as soon as he, or she, is capable of swallowing and protecting his or her airway.

Treatment for Severe Hypothermia with Signs of Life (e.g. Pulse and Respirations Present)

Treat the patient as for Mild Hypothermia above with the following exceptions:

a. Do not put severely hypothermic patients in a shower or bath.

b. Do not give a patient oral fluids unless he or she is capable of swallowing and protecting his or her airway. Treat patients who are hypothermic very gently (do not rub or manipulate extremities).

Treatment for Severe Hypothermia with No Life Signs

1. Treat as above.

2. If no pulse (after checking for up to 45 seconds) and no respirations, start CPR.

3. Use mouth-to-mask breathing.

4. Reassess the patient's physical status periodically. Transfer to a medical facility as soon as possible.

- From the State of Alaska Cold Injuries and Cold Water

Near Drowning Guidelines (Rev 01/96).

Printed in “The Eddy Line”, February 2005

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