2. Fluid replacement with careful monitoring.

3. Rewarming — All hypothermic patients with no evidence of other fatal disease should be assumed fully recoverable. In the event of cardiac arrest full resuscitation should continue until the patient is normothermic (ventricular fibrillation is resistant to defibrillation between 28 and 30°C). The technique used for rewarming depends on the core temperature (measured with a low reading rectal thermometer) and the clinical circumstance.

Rapid central rewarming

In cases where the temperature is <28°C (<33°C with acute exposure hypothermia), or where there is cardiac arrest, rapid rewarming may be achieved by peritoneal dialysis, gastric or bladder lavage with warmed fluids. These techniques may achieve rewarming rates of 1-5°C/h. Active surface rewarming with a heated blanket or warm air blanket can achieve rates of 1-7°C/h and is less invasive. Haemodynamic changes may be dramatic during active rewarming, requiring careful monitoring and support. If extracorporeal rewarming is available, rates of 3-15°C/h may be achieved with the addition of cardiovascular support.

Spontaneous rewarming

Spontaneous rewarming proceeds at a rate inversely proportional to the duration of hypothermia. With good insulation (space blanket), rewarming rates of 0.1-0.7°C/h can be achieved. Core temperature may fall during spontaneous rewarming as cold blood is returned from the periphery to the central circulation.

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