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

Points and Pearls Excerpt

• Pediatric patients are at higher risk for cold injury due to their smaller body mass-to-body surface area ratio and limited glycogen stores to support heat production, which can lead to metabolic acidosis, increased oxygen consumption, and brown fat breakdown in pediatric patients with cold stress.
• Always consider secondary hypothermia due to comorbid conditions (eg, sepsis, ingestion, dysautonomia, hypoglycemia).
• Consider using 2 or more sites of temperature measurement while rewarming a patient. Esophageal and nasopharyngeal probes may be the most reliable. If those are not available, bladder temperature measurements are more accurate than rectal temperatures.
• Assess central pulses in pediatric patients with hypothermia, as peripheral pulses may be undetectable due to peripheral vasoconstriction and bradycardia.

Hypothermia after prolonged submersion?
Read our award-winning issue of Emergency Medicine Practice: Drowning in the Adult Population: Emergency Department Resuscitation And Treatment

Most Important References

• Brown DJ, Brugger H, Boyd J, et al. Accidental hypothermia. N Engl J Med. 2012;367(20):1930-1938. (Review) DOI: http://dx.doi.org/10.1056/NEJMra1114208
• Corneli HM. Accidental hypothermia. Pediatr Emerg Care. 2012;28(5):475-480. (Review) DOI: http://dx.doi.org/10.1097/PEC.0b013e3182539098
• Zafren K, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update. Wilderness Environ Med. 2014;25(4 Suppl):S66-S85. (Review) DOI: http://dx.doi.org/10.1016/j.wem.2014.10.010
• Darocha T, Kosinski S, Jarosz A, et al. The chain of survival in hypothermic circulatory arrest: encouraging preliminary results when using early identification, risk stratification and extracorporeal rewarming. Scand J Trauma Resusc Emerg Med. 2016;24:85. (Prospective observational case series; 10 patients) DOI: http://dx.doi.org/10.1186/s13049-016-0281-9
• Skarda D, Barnhart D, Scaife E, et al. Extracorporeal cardiopulmonary resuscitation (EC-CPR) for hypothermic arrest in children: is meaningful survival a reasonable expectation? J Pediatr Surg. 2012;47(12):2239-2243. (Retrospective review; 9 patients) DOI: http://dx.doi.org/10.1016/j.jpedsurg.2012.09.014