MBBS OSCE · General Medicine
OSCE — Hypothermia
Eight-minute OSCE station on hypothermia: low-reading core temperature, Swiss HT I to IV (no HT V), modified ALS (three shocks then delay, adrenaline withheld below 30 C), HOPE triage, and secondary-cause search.
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Brief (to candidate)
You will assess a patient with a presentation consistent with hypothermia. You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.[5]
Clinical context
Accidental hypothermia is an unintentional core temperature below 35 C. Stage with ANZCOR bands (mild 32 to 35, moderate 28 to 32, severe below 28) and Swiss HT I to IV (no HT V). HT III is unconscious with vital signs below 28 C, not a 28-to-24 band. Handle gently. If VF persists after three shocks and the core is below 30 C, delay further shocks until above 30 C; withhold adrenaline below 30 C (6 to 10 minutes at 30 to 34 C). ECLS/ECMO for arrest. HOPE for ECLS triage. Always check glucose and a secondary cause.[5][3][8]
Candidate tasks
- Clarify onset, exposure, intoxication, trauma, and red-flag symptoms.
- State focused examination priorities (low-reading core site; one-minute life check; shivering as supportive not stage-defining).
- List first-line investigations and name HOPE (not a potassium-only cease rule).
- Give immediate resuscitation steps (gentle handling, wet clothes off, warmed fluid 38 to 42 C, glucose).
- Outline staged rewarming and modified ALS with numbers that are sourced.
- Name complications (afterdrop, rewarming shock, trauma triad) without unsourced magnitudes.
- Mention one special-population modifier (elderly high-risk below 32 C; child — do not apply adult HOPE; myxoedema — passive rewarming plus thyroid hormone and steroid).[5]
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Unintentional core below 35 C; low-reading thermometer |
| Staging | HT I to IV; no HT V; HT III is below 28 C with vital signs |
| Investigations | Glucose, ECG, potassium as a HOPE covariate, 37 C clotting trap |
| Emergency care | Gentle handling; one-minute life check; warmed IV 38 to 42 C |
| ALS | Three shocks then delay below 30 C; adrenaline withheld below 30 C |
| Safety | HOPE not a 32 C clock; avalanche 35 min + obstructed airway or K above 12 |
| Communication | Secondary-cause search and ECLS transfer criteria |
Model outline
Lead with unintentional core below 35 C and the Swiss stage. Resuscitate with gentle handling and only warmed fluid. Run modified ALS if arrested. Activate ECLS early for high-risk HT III and HT IV. Prognosticate with HOPE, not a 32 C or potassium-only indoor rule.[8]
References3ShowHide
- [5]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
- [3]Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances Resuscitation, 2021.PMID 33773826
- [8]Pasquier M, Rousson V, Darocha T, 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