Hypothermia Management - Simplified Algorithm

FIRST: Scene Safety

STEP 1: Assess the Patient

Normal mental status?
├── YES → NOT HYPOTHERMIC → No action needed
└── NO ↓

Shivering?
├── NO → Shivering but functioning? 
│         ├── YES → MILD (35-32°C)
│         └── NO  → MILD (35-32°C)
└── YES ↓

Still shivering?
├── YES → MODERATE (32-28°C)
└── NO ↓

Conscious?
├── YES → MODERATE (32-28°C)
└── NO ↓

Signs of life / rhythm on ECG?
├── YES → SEVERE/PROFOUND (<28°C)
└── NO ↓

Lethal injury? Chest too stiff? Avalanche >35 min + airway blocked?
├── YES → DEATH - Do not resuscitate
└── NO → SEVERE/PROFOUND (<28°C) + CPR

STEP 2: Treat by Category

🟡 NOT HYPOTHERMIC (>35°C / Cold Stressed)

• Reduce heat loss, increase heat production

🟠 MILD (35-32°C)

• Insulate + vapor barrier, seek shelter
• Remove wet clothing only with shelter
• Measure temperature
• Passive warming + calorie support for shivering
• No standing/walking for 30 min
• Active warming is beneficial

🔴 MODERATE (32-28°C)

• Apply heat to upper torso (chest, axilla, back) - heat pads, forced air
• IV/IO access; saline boluses (40-42°C)
• IV/IO glucose
• Monitor continuously
• No standing or walking

🆘 SEVERE/PROFOUND (<28°C)

• Intubate or use supraglottic airway
• Lower anesthetic/paralytic drug doses; extend dosing intervals
• Ventilate at half the normal rate (with advanced airway)
• Supplemental O₂ (especially >2500m)
• Naso/orogastric tube if intubated

• Compressions at normal rate
• If <30°C: 1 shock max (VT/VF); warm 1-2°C before more shocks
• No vasopressors until ≥30°C (increase interval 30-35°C)
• CPR may be paused/intermittent if needed for evacuation
• No temperature cut-off for CPR
• Stop CPR if potassium >12
• Consider transcutaneous pacing if bradycardic + hypotensive

STEP 3: Transport

• Red banner at the top for scene safety
• Assessment flowchart on the left with yes/no decision points
• Color-coded treatment boxes (yellow → orange → red) by severity
• Transport guidance at the bottom