IBCC Episode 65 - Hypothermia

Hypothermia requires immediate clinical recognition and structured management, as it often signals underlying systemic issues like sepsis, adrenal insufficiency, or metabolic derangements. Core temperature measurement is essential, as standard thermometers frequently fail to detect readings below 34°C. Resuscitation of pulseless patients necessitates modified ACLS protocols, prioritizing rapid re-warming—ideally via ECMO or cardiopulmonary bypass—over repetitive epinephrine administration or defibrillation. For patients with pulses, management focuses on aggressive external warming, such as forced-air systems or commercial devices, while avoiding cold fluid boluses that exacerbate hypotension. Clinicians should maintain a low threshold for empirical treatment of potential endocrine causes like myxedema coma or adrenal insufficiency when the etiology remains unclear. Monitoring for complications like rhabdomyolysis, cold diuresis, and rebound hyperkalemia is critical throughout the re-warming process to ensure patient stability and prevent secondary injury.