MedBalans

Accidental Hypothermia

Adults · emergency only · brief protocol

Algorithm

  1. Handle gently (risk of VF); ABC; remove wet clothing; insulate; core temperature if possible; ECG (Osborn J waves).
  2. Mild (~32–35 °C): passive external rewarming + warm environment; active external if needed.
  3. Moderate/severe: active external + internal rewarming (warm IV fluids, warm humidified oxygen, cavity lavage or ECMO/CPB for arrest/severe per protocol).
  4. ALS modifications: prolonged resuscitation may be warranted until rewarmed in selected accidental hypothermia without unsurvivable injury.
  5. Defibrillate VF up to 3 shocks then focus on rewarming if refractory while cold — follow local ERC special-circumstances protocol for drug timing.
  6. Treat hypoglycemia, trauma, intoxication; avoid rough movement.

Red flags

  • • Rough handling → VF
  • • Declaring death before rewarming in potentially reversible hypothermia
  • • Concomitant trauma / drowning
  • • Refractory VF while cold

Medications by step

Rewarming support

  • Warmed crystalloid · i.v.

    IV warmed fluids as bridge; not sole therapy in severe hypothermia

  • Glucose · i.v.

    Correct hypoglycemia

References

  • • ERC Guidelines 2025 — Special circumstances (hypothermia) (2025)

Updated: Июль 2026