ICU · Resuscitation

Hypothermia and environmental emergencies

Also known as Accidental hypothermia · Swiss staging system · ECMO rewarming · Osborn (J) waves · Drowning and near-drowning

Accidental hypothermia is a core temperature below 35C. Swiss staging: HT I (35-32C, conscious, shivering), HT II (32-28C, altered consciousness, no shivering), HT III (28-24C, unconscious), HT IV (24-13.7C, apparent death), HT V (<13.7C, cardiac arrest). Management: active rewarming (forced air, warm IV fluids) for HT I-II. HT III-IV: active internal rewarming (warm lavage, ECMO/extracorporeal). HT V (cardiac arrest): full cardiopulmonary bypass or VA-ECMO — rewarm to 32C before declaring death ('no one is dead until warm and dead'). Key ECG: Osborn (J) waves. Arrhythmias: avoid adrenaline/antiarrhythmics until rewarm to 30C. Near-drowning: lung-protective ventilation and supportive care, primary lung injury from submersion.

Checked against its sources on 14 Oct 2026