Hypothermia in children: Management
- Howard M Corneli, MD
Howard M Corneli, MD
- Professor of Pediatrics
- University of Utah School of Medicine
- Robert G Bolte, MD
Robert G Bolte, MD
- Professor of Pediatrics
- University of Utah School of Medicine
- Section Editor
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Although generally harmful, severe hypothermia may also provide cerebral protection against anoxia, allowing cases of remarkable survival after cardiac arrest [1-5]. Successful resuscitation of the hypothermic child requires rapid attention to supportive care (airway, breathing, circulation), assessment and treatment of injury or medical conditions, and rewarming interventions directed by the severity of hypothermia and the presence or absence of circulation (table 1).
This article discusses the treatment of unintentional hypothermia in children. The clinical manifestation of hypothermia in children, neonatal hypothermia, and frostbite are discussed separately. (See "Hypothermia in children: Clinical manifestations and diagnosis" and "Short-term complications of the premature infant", section on 'Hypothermia' and "Frostbite".)
DEFINITION OF HYPOTHERMIA
Hypothermia is defined as a core body temperature below 35ºC (95ºF). The stage of hypothermia, defined by core temperature, has a large impact on both recognition and treatment. The most commonly used definitions found in the literature are as follows [6-9]:
●Mild – Core temperature 32 to 35°C (90 to 95°F)
●Moderate – Core temperature 28 to 32°C (82 to 90°F)
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- DEFINITION OF HYPOTHERMIA
- INITIAL MANAGEMENT
- Core temperature measurement
- Prehospital rescue and triage
- - Prehospital declaration of death
- Prehospital patient care and transport
- Initial hospital care
- Rewarming techniques
- - Passive rewarming
- - Active external rewarming
- - Active internal rewarming
- TREATMENT OF MILD HYPOTHERMIA
- TREATMENT OF MODERATE OR SEVERE HYPOTHERMIA
- Supportive care
- - Airway and breathing
- - Chest compressions
- - Vascular access and intravenous fluid therapy
- - Glucose homeostasis
- Perfusing bradycardic rhythms
- Nonperfusing cardiac rhythms
- - Ventricular arrhythmias with hypothermia
- - Asystole or pulseless electrical activity
- - Duration of resuscitation
- - Withholding resuscitation
- Choosing rewarming methods
- - Moderate hypothermia with intact circulation
- - Severe hypothermia with intact circulation
- - Severe hypothermia with absent circulation
- - Failure to rewarm
- Post-resuscitation care
- PREDICTION OF NEUROLOGIC OUTCOME
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- General treatment
- Pediatric advanced life support