Cardiac Arrest – Hypothermia

Last Updated on by FRCEM Intermediate


<30 severe
30-32 moderate
32-35 mild

How is CPR different in hypothermia?

  • careful intubation and movement
  • check signs of life for 1 minute
  • hold drugs until above 30 degrees then double the interval between doses
  • 3 shocks below 30 degrees and then focus on rewarming

How should we rewarm?

  • ambient room temp
  • blankets
  • forced air blanket


  • Warm (40-46c) humidified oxygen
  • Warm Intravenous fluid
  • Gastric,bladder/pleural/peritoneal irrigation with warmed fluids (at 40c)
  • Extracorporal rewarming (cardiopulmonary bypass)

What are the ECG changes in hypothermia?

  • bradycardia
  • AF
  • J waves
  • ST/T changes
  • QRS broadening

How should we manage frost bite?

  • don’t rewarm until in a definitive environment. Refreezing of something partially thawed a disaster warm (37-39) water
  • give NSAID
  • allow to dry in air, don’t towel
  • avoid early debridement and allow to naturally separate
  • thrombolysis has been done early in severe cases

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