General supportive care for severe hypothermia consists of an intensive care level management of multisystem dysfunction. Because an individual's metabolic rate falls sharply during hypothermia, drugs have little effect. However, as the body core temperature returns toward normal, drugs may be rapidly absorbed and distributed. Hypoglycemia should be anticipated because reduced caloric intake often contributes to the development of hypothermia.
Re-warming techniques include passive techniques to active core re-warming. The first step in treating a conscious elderly person with hypothermia is to remove the person from the cold environment. This includes the removal of any wet garments, as these will inhibit warming by absorbing heat intended for the patient. The patient should then be covered with insulating materials, such as dry blankets or sweaters, and placed in a warm environment. If the patient is unable to ambulate, additional insulating material should be place at contact points between the patient and solid surfaces. Administration of "warmed" not "hot" beverages will reduce the chance of burns and help enhance a return to normal temperature.
When an unconscious elderly hypothermia victim is found, "911" should be instituted immediately. Due to slowed metabolic and physiologic processes it may not be possible to detect pulse, respirations or blood pressure. However, no hypothermia victim should be considered dead until the body is brought back to normal temperature and resuscitation is attempted.
It is important to recall that the heart is more irritable when cold and that the cold cardiovascular system is less able to react to change. Therefore, every attempt should be made to minimize stress during transport. Hypothermia induced cardiac irritability can result in serious dysrhythmias. When possible, transport should be undertaken with resuscitation equipment (defibrillator) and medically trained personnel available. Because the cold cardiovascular system is less able to compensate for blood pressure variation, patients should be transported horizontally to avoid orthostatic hypotension.
Arrhythmia, shock and dehydration from fluid shifts are common consequences of hypothermia. Intravenous access should be considered for all hypothermia victims.
Active external re-warming techniques may be used to restore body temperature to normal. These techniques include immersion in temperature controlled water and use of radiant heat sources, such as an electric blanket, warming pad, hot water bottle and warm air sources. Such external warming devices must be used with care due to:
Active core re-warming techniques are invasive and aggressive forms of therapy that many elderly people may not tolerate well. Such techniques include: using an intragastric balloon, colonic irrigation with warmed fluids, hemodialysis, peritoneal dialysis, extracorporeal blood warming and inhalation re-warming.
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