Hypothermia

Meet the patient

A 67-year-old man is brought to a regional emergency department by ambulance after being found collapsed in a Tasmanian national park in winter, having been missing for 18 hours in wet clothing at 2 degrees ambient. On arrival he is unconscious (GCS 8), pale and cold. Heart rate 42 in sinus bradycardia, blood pressure 78 over 44, respiratory rate 8 and shallow. A low-reading bladder probe records a core of 28.2 degrees. The ECG shows sinus bradycardia with prominent Osborne J waves and a prolonged QT. Capillary glucose is 3.1. The nearest ECMO-capable centre is 90 minutes away.[1]

Three questions decide the next hour, and they are the three that decide every hypothermia: how cold is he really? (a low-reading probe is the only instrument that finds the severe case), which rung of the rewarming ladder? (active internal for HT III, with ECMO on the horizon), and what must I not do? (rough-handle him — a cold myocardium fibrillates with a single jolt).[1]

References13Show ledgerHide ledger

1. [1]Brown DJA, Brugger H, Boyd J, Paal P. Accidental hypothermia N Engl J Med, 2012.PMID 23150960
2. [2]Dow J, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update Wilderness Environ Med, 2019.PMID 31740369
3. [3]Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances Resuscitation, 2021.PMID 33773826
4. [4]Wanscher M, Agersnap L, Ravn J, et al. Outcome of accidental hypothermia with or without circulatory arrest: experience from the Danish Præstø Fjord boating accident Resuscitation, 2012.PMID 22634431
5. [5]Pasquier M, Hugli O, Paal P, et al. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: An external validation of the HOPE score Resuscitation, 2019.PMID 30940473
6. [6]Paal P, Pasquier M, Darocha T, Lechner R, Kosinski S, Wallner B, Zafren K, Brugger H. Accidental Hypothermia: 2021 Update Int J Environ Res Public Health, 2022.PMID 35010760
7. [7]Pasquier M, Hugli O, Paal P, Darocha T, Blancher M, Husby P, Silfvast T, Carron PN. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score Resuscitation, 2018.PMID 29481910
8. [8]Lott C, et al. European Resuscitation Council Guidelines 2025 Special Circumstances in Resuscitation Resuscitation, 2025.PMID 41117569
9. [9]Musi ME, et al. Clinical staging of accidental hypothermia: The Revised Swiss System Resuscitation, 2021.PMID 33675869
10. [10]Reed RL 2nd, et al. The disparity between hypothermic coagulopathy and clotting studies J Trauma, 1992.PMID 1404519
11. [11]Eastwood GM, et al. A pilot assessment of alpha-stat vs pH-stat arterial blood gas analysis after cardiac arrest J Crit Care, 2015.PMID 25449882
12. [12]Australian and New Zealand Committee on Resuscitation Guideline 11.10 Resuscitation in Special Circumstances ANZCOR, 2026.Source
13. [13]Australian and New Zealand Committee on Resuscitation Guideline 9.3.3 First Aid Management of Hypothermia and Cold-Related Injuries ANZCOR, 2026.Source