Accidental Hypothermia: An Evidence-Based Approach (Trauma CME)
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Accidental Hypothermia: An Evidence-Based Approach (Trauma CME)

January 2009

Abstract

From Florida to Alaska, hypothermia is prevalent in every emergency department (ED) regardless of location or time of year. In the United States, there are more than 650 deaths per year from primary hypothermia with 66% of the deaths occurring in men. Beyond that, there are an unknown number of deaths where hypothermia is a secondary or contributing cause.1

Hypothermia occurs in a wide variety of environmental settings and is complicated by multiple patient co-morbidities. It does not have to be a subzero night in Wyoming to encounter severely hypothermic patients. The homeless, intoxicated patient in Miami is also at risk for accidental hypothermia. The states with the highest hypothermia-related death rates are those with milder climates that experience rapid temperature changes (eg, North Carolina and South Carolina) and western states that have high elevations and considerable changes in nighttime temperatures.2

The best strategy to manage the hypothermic patient must be individually tailored and varies depending on the resources available. However, there are basic principles that apply to all hypothermic patients. Some hypothermic patients can make seemingly miraculous recoveries and must be treated very differently than their normothermic counterparts. The adage that "a person is not dead until he is warm and dead" is corroborated by the fact that the lowest initial temperature recorded in a child who survived from hypothermia was 14.2°C (57.6°F),3 and the lowest recorded temperature in an adult was 13.7°C (56.7°F).4

This issue of Emergency Medicine Practice reviews the evidence and current understanding of the pathophysiology, clinical assessment, and treatment options for maximizing outcomes in accidental hypothermia.
 
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