Management of Pediatric Hypothermia and Peripheral Cold Injuries in the Emergency Department

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Publication Date: January 2019 (Volume 16, Number 1)

CME: This issue includes 4 AMA PRA Category 1 Credits™; 4 ACEP Category I credits; 4 AAP Prescribed credits; and 4 AOA Category 2-A or 2-B CME credits. CME expires 01/01/2022.

Authors

Ashish Shah, MD

Pediatric Emergency Medicine Fellow, Cincinnati Children’s Hospital, Cincinnati, OH

Manu Madhok, MD

Pediatric Emergency Medicine Attending Physician, Children's Minnesota, Minneapolis, MN

Peer Reviewers

Theodore E. Macnow, MD

Assistant Professor of Pediatrics, University of Massachusetts Medical School; Attending Physician, Pediatric Emergency Medicine Division, UMass Memorial Children’s Medical Center, Worcester, MA

Hiromi Yoshida, MD,MBA

Clinical Assistant Professor, Pediatric Emergency Medicine, University of Washington, Seattle, WA

Abstract

Hypothermia occurs when the core body temperature falls below 35ºC (95ºF) due to primary exposure (eg, environmental exposure) or secondary to other pathologies. Infants, children, and adolescents are at higher risk for primary cold injuries due to a combination of physiologic and cognitive factors, but quick rewarming and appropriate disposition can result in survival and improved neurological outcomes. Treatment for cold injuries is guided by severity and can include passive or active measures. This issue reviews the stages of hypothermia and offers recommendations for emergent management of pediatric patients with hypothermia; guidance is also provided for the identification and management of frostnip and frostbite.

Excerpt From This Issue

An EMS call comes in to your ED: “7-year-old girl drowning in a frozen lake. ETA now.” EMS personnel then rush into the trauma bay with CPR in progress. The paramedic reports that the girl had wandered away from her family, who found her 90 minutes later on the bank of a nearly frozen lake. The girl had no pulses on EMS arrival, so they started CPR and brought her straight to the ED. On examination, she is in wet clothing, has no signs of trauma, is pulseless, and has an initial rectal temperature of 23.8ºC (74.8ºF). As you prepare for intubation and continue CPR, you try to control your racing mind and prioritize. What are the best ways to rewarm this patient? What lab tests should you be ordering? Does she need ECMO?

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