›Immediate stabilization workflow
›Cardiac monitor
›Core temperature measurement if moderate or severe suspected
›Oxygen for hypoxemia
›Two large bore IV access
›Point of care glucose with immediate correction if low
›Remove wet clothing
›Insulation and active external warming initiation if not severe
Rewarming strategy selection
›Rewarming approach by severity
›Mild hypothermia
›Passive external rewarming
›Warm environment
›Warm oral fluids if alert and low aspiration risk
›Moderate hypothermia
›Active external rewarming
›Forced air warming blanket
›Warm IV fluids
›Active core rewarming options if not improving
›Severe hypothermia
›Active core rewarming
›Warm humidified oxygen
›Warm IV fluids
›Consider extracorporeal rewarming if instability
Hypothermic cardiac arrest modifications
›Resuscitation principles
›Continue CPR until rewarmed
›Defibrillation attempts
›Up to 3 shocks if VF or pulseless VT
›Additional shocks after core temperature rises
›Medication dosing modifications
›Withhold vasoactive drugs if core temperature less than 30 C local protocol dependent
›Dose interval extension if core temperature 30 C to 35 C local protocol dependent
›Extracorporeal life support consideration
›Persistent arrest with potentially reversible hypothermia
›Use HOPE score if available
›Perfusion support and metabolic correction
›Warm isotonic crystalloid
›Hypoglycemia correction
›Dextrose IV
›Repeat glucose checks
›Electrolyte correction caution
›Potassium shifts during rewarming
›Avoid overly rapid correction without trend
Frostbite and local cold injury treatment
›Frostbite management essentials
›Rapid rewarming in circulating water 37 C to 39 C if refreezing risk absent
›Avoid refreezing after rewarming
›Analgesia
›Ibuprofen dosing
›400 mg to 600 mg PO every 6 hours
›Maximum 2400 mg per day
›Blister management local protocol dependent
›Tetanus update if indicated
›Thrombolysis consideration for deep frostbite local protocol dependent
›Early presentation within hours
›Bleeding risk assessment
›Harm avoidance
›No rubbing or massage of frostbitten tissue
›No dry heat directly on numb tissue
›No refreezing after thaw
›Avoid rough handling of severe hypothermia patient
Monitoring and reassessment loop
›Trend based reassessment
›Core temperature every 15 to 30 minutes until stable
›ECG rhythm continuous
›Vital signs every 5 to 15 minutes if moderate or severe
›Glucose recheck every 30 to 60 minutes if corrected
›Electrolytes and acid base repeat based on severity and rewarming rate