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Triage and immediate risks
Immediate stabilization priorities
Airway patency
Aspiration risk with altered mental status
Intubation readiness for HT III or HT IV
Breathing adequacy
Hypoventilation risk with CNS depression
Warmed humidified oxygen if available
Circulation threats
Ventricular fibrillation trigger risk with rough handling
Hypovolemic component from cold diuresis
Gentle handling and minimal movement
Avoid unnecessary procedures before warming in severe hypothermia
Horizontal positioning during transfers
Core temperature confirmation strategy
Esophageal temperature probe for intubated patients
Distal esophagus placement
Continuous temperature trending
Rectal and bladder temperature limitations
Lag behind core temperature during rewarming
Misleading in rapidly changing temperature states
Tympanic and oral temperature unreliability
Environmental artifact risk
Low reading floor limitations
Monitoring and targets
Monitoring essentials
Cardiac monitor with rhythm vigilance
Bradyarrhythmia predominance
Atrial fibrillation common in moderate to severe hypothermia
Continuous pulse oximetry
Low perfusion artifact risk
Consider waveform quality over numeric value
Noninvasive blood pressure cycling
Peripheral vasoconstriction artifact risk
Consider arterial line for unstable severe hypothermia
End tidal CO2 if intubated
CPR quality marker in arrest
Ventilation adequacy marker during rewarming
Hemodynamic and physiologic targets
Oxygen saturation target 92-96%
Avoid hyperoxia after ROSC if applicable
Titrate to perfusion and waveform reliability
Glucose target 4-10 mmol/L
Hypoglycemia as cause and complication
Hyperglycemia stress response consideration
Rewarming rate goals by severity
Mild hypothermia gradual external rewarming
Moderate to severe active rewarming with continuous monitoring
Resuscitation bay triggers
Core temperature below 28°C
Dysrhythmia risk escalation
Shivering cessation suggests moderate to severe staging
Hypotension refractory to warmed fluids
Shock and occult sepsis consideration
ECLS pathway consideration in severe cases
Cardiac arrest or peri-arrest rhythm
ECLS capable center activation
Prolonged resuscitation planning
Key concepts
Condition framing
Accidental hypothermia definition
Core temperature 35°C or lower
Net heat loss exceeding heat production
Clinical staging emphasis
Swiss staging based on consciousness and shivering when core temperature unavailable
Stage and temperature match imperfect in real-world cases
Cardiac arrest reversibility
Potential for neurologically intact survival after prolonged arrest with ECLS rewarming
Termination decisions delayed until rewarming and reversible causes addressed
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