Management before hospital admission

The patient should be removed from the cold environment as rapidly as possible, dressed in dry clothes, and covered with insulating blankets or sleeping bags. Frozen or potentially frozen extremities should not be rubbed to avoid secondary injuries and necrosis, but should be protected from further trauma. The diagnosis of hypothermia can be confirmed using a tympanic thermometer.

Warm drinks, but not alcohol, can be given to the conscious patient with stable hemodynamic parameters. Humidified and warmed oxygen should be delivered by face mask. Endotracheal intubation for apnea or low respiratory rate (2-4 breaths/min) should be performed without delaying hospital admission. Insertion of a catheter into a peripheral vein is difficult due to the intense venoconstriction, and central access may be necessary. Hypoglycemia should be suspected in a comatose person in whom hypothermia is obviously not due to an accident, and glucose should be administered intravenously.

The patient should be moved and transported gently since at 28 °C there is danger of inducing ventricular fibrillation simply by movement. In severe hypothermia, the pulse may be very weak and difficult to sense and the respiratory rate slow; cardiocirculatory arrest may develop at any time. Cardiopulmonary resuscitation should be initiated in all situations even if there is a risk of transforming a slow cardiac rhythm or ventricular tachycardia into ventricular fibrillation. It should be continued until hospital admission. Patients with moderate and severe hypothermia should be transferred directly to a hospital with appropriate rewarming facilities.

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