Disease variant Mild / moderate hypothermia — passive & active external rewarming Severe hypothermia / cardiac arrest — advanced rewarming & PICU ▼
▶ Common pathogens (2) Classification (core temperature) (**Mild:** 32–35°C (90–95°F) · **Moderate:** 28–32°C (82–90°F) · **Severe:** <28°C (<82°F) — measure core temp rectal/esophageal/bladder; oral/tympanic unreliable when cold (ERC, AHA, WMS, AAP)) Initial assessment (ABCDE; mental status, perfusion; concurrent frostbite, trauma, drowning; ECG for Osborn (J) waves, bradycardia; check glucose; consider sepsis, toxins, endocrine (ERC, AHA, AAP, WMS)) First-line therapy Warmed IV fluids — moderate hypothermia Dextrose — hypoglycemia Warm isotonic crystalloid (38–42°C) • i.v. • 10–10 mg/kg/dose • 1×/day
Max 1000 mg/dose · Duration: PRN · 10–20 mL/kg warm (38–42°C) isotonic bolus if hypovolemic — repeat per perfusion; active external rewarming concurrently; avoid over-resuscitation (ERC 2021, WMS, AAP)
• **Passive rewarming:** remove wet clothing; dry and insulate; warm ambient environment — appropriate for **mild** hypothermia with intact thermoregulation (ERC, WMS, AAP). • **Active external rewarming:** forced-air warming, radiant heat, warm packs to trunk; warm bath **37–39°C** for moderate hypothermia when stable — **handle gently**; avoid rough movement (ERC, WMS, AAP). ▶ High-dose indications (3) • **Warm humidified O₂:** active internal rewarming adjunct for all moderate+ hypothermia (ERC, AHA). • **Monitoring:** continuous cardiac monitoring (arrhythmia risk); core temperature during rewarming; glucose; avoid over-warming (>38–39°C) (ERC, AHA, WMS). • **Concurrent conditions:** treat frostbite after core stabilization; drowning/submersion — continue resuscitation in severe hypothermia; see **Drowning** card cross-reference (ERC, AHA, AAP). Enter weight on Kids to calculate doses
▶ Alternative therapy Hospital admission + active internal rewarming • procedure
Duration: Inpatient · Admit moderate hypothermia, failed outpatient rewarming, arrhythmia, associated trauma/drowning/frostbite, electrolyte abnormalities (ERC, AHA, AAP, WMS)
▶ When preferred (5) • **Hospital admission:** moderate hypothermia; failed outpatient rewarming; persistent arrhythmia; associated trauma, drowning, or frostbite needing care; electrolyte/glucose abnormalities (ERC, AHA, AAP). • **Active internal rewarming:** warm humidified O₂; warmed IV fluids 38–42°C; body cavity lavage (peritoneal, pleural, gastric) for severe/refractory in hospital (ERC, AHA). • **Medications less effective** at low core temps — prioritize rewarming over repeated drug doses (ERC, AHA). • **ECG monitoring:** Osborn (J) waves, bradycardia, VF risk with rough handling — treat arrhythmias per PALS after rewarming when possible (ERC, AHA). • **Frostbite link:** if frostbite present, stabilize core temp first — see **Frostbite** card for local rewarming after patient is hemodynamically stable (WMS, ERC). Clinical notes • Classification: mild 32–35°C · moderate 28–32°C · severe <28°C — core temp rectal/esophageal/bladder (ERC, AHA, WMS). ▶ More notes (4) • Passive rewarming for mild; active external (forced-air, warm bath 37–39°C) for moderate — warm trunk, handle gently, avoid afterdrop (ERC, WMS, AAP). • Warm IV fluids 38–42°C for moderate+ with hypovolemia; warm humidified O₂ as adjunct (ERC, AHA). • Monitor: continuous cardiac monitoring, core temp, glucose, electrolytes; avoid over-warming >38–39°C (ERC, AHA). • Admit moderate hypothermia, arrhythmia, trauma/drowning/frostbite association, or failed outpatient rewarming (ERC, AAP, WMS). ▶ References & version (5) • ERC — Hypothermia guidelines (paediatric principles) (2021) • AHA — PALS hypothermia and resuscitation (2020) • AAP — Accidental hypothermia in children (2024) + 2 more • WMS — Wilderness Medical Society hypothermia guidelines (2019) • WHO — Cold exposure and hypothermia management (2022) MedBalans v1.0
Updated July 2026 · Review July 2027
