With the arctic blast sweeping through the country, the incidence of patients with severe hypothermia is likely to increase. So what do you do when you’re sitting in the cardiac room and EMS brings in a patient with a very low core temp? Lets review the techniques of rewarming that should be in your arsenal.
Passive rewarming – This includes the obvious such as stripping off all clothes and covering with warm blankets or other types of insulation. Keeping the room temp on the warmer side is also recommended but sometimes is not possible. This method relies on the patient creating some heat with shivering and increased metabolism and is not always successful.
Active external rewarming – This includes adding heating pads and bear huggers which are present in our EDs. This also includes warm baths and forced warm air which are not available to us currently. This can be effective for mild to moderate and even some cases of severe hypothermia
Active internal rewarming – More aggressive techniques for severe hypothermia refractory to less invasive techniques. This involves:
- Warm IV fluids
- Warm O2
- Bladder irrigation with foley and warm solution
- Unilateral/bilateral chest tubes for pleural irrigation with warm solution (one placed anterior and high and the other posterior and low on same side)
- Peritoneal irrigation with warm solution
The last option is ECMO which can warm blood directly but can be difficult to attain if not available in house.
Bottom Line: Expose, rewarm externally, rewarm internally, ECMO as last resort.