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Dow J, Giesbrecht GG, Danzl DF, Brugger H, Sagalyn EB, Walpoth B, Auerbach PS, McIntosh SE, Némethy M, McDevitt M, Schoene RB, Rodway GW, Hackett PH, Zafren K, Bennett BL, Grissom CK. Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update. Wilderness Environ Med 2019; 30:S47-S69. [PMID: 31740369 DOI: 10.1016/j.wem.2019.10.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 01/16/2023]
Abstract
To provide guidance to clinicians, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and a balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is the 2019 update of the Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2014 Update.
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Affiliation(s)
- Jennifer Dow
- Alaska Regional Hospital Anchorage, Anchorage, AK; National Park Service: Alaska Region, Anchorage, AK.
| | - Gordon G Giesbrecht
- Faculty of Kinesiology and Recreation Management, Departments of Anesthesia and Emergency Medicine, University of Manitoba, Winnipeg, Canada
| | - Daniel F Danzl
- Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, KY
| | - Hermann Brugger
- International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Bolzano, Italy; Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | | | - Beat Walpoth
- Service of Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Paul S Auerbach
- Departments of Emergency Medicine and Surgery, Stanford University School of Medicine, Stanford, CA
| | - Scott E McIntosh
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT
| | | | | | | | - George W Rodway
- School of Nursing, University of California, Davis, Sacramento, CA
| | - Peter H Hackett
- Division of Emergency Medicine, Altitude Research Center, University of Colorado School of Medicine, Denver, CO; Institute for Altitude Medicine, Telluride, CO
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Bolzano, Italy; Departments of Emergency Medicine and Surgery, Stanford University School of Medicine, Stanford, CA
| | - Brad L Bennett
- Military & Emergency Medicine Department, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Colin K Grissom
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City, UT
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Abstract
Accidental hypothermia is an unintentional drop in core temperature to 35°C or below. Core temperature is best measured by esophageal probe. If core temperature cannot be measured, the degree should be estimated using clinical signs. Treatment is to protect from further heat loss, minimize afterdrop, and prevent cardiovascular collapse during rescue and resuscitation. The patient should be handled gently, kept horizontal, insulated, and actively rewarmed. Active rewarming is also beneficial in mild hypothermia but passive rewarming usually suffices. Cardiopulmonary resuscitation should be performed if there are no contraindications to resuscitation. CPR may be delayed or intermittent.
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Affiliation(s)
- Ken Zafren
- Alaska Department of Health and Social Services, State of Alaska, Juneau, AK, USA; International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Zürich, Switzerland; Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA, USA; Alaska Native Medical Center, Anchorage, AK, USA.
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Zafren K, Giesbrecht GG, Danzl DF, Brugger H, Sagalyn EB, Walpoth B, Weiss EA, Auerbach PS, McIntosh SE, Némethy M, McDevitt M, Dow J, Schoene RB, Rodway GW, Hackett PH, Bennett BL, Grissom CK. Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update. Wilderness Environ Med 2015; 25:S66-85. [PMID: 25498264 DOI: 10.1016/j.wem.2014.10.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia published in Wilderness & Environmental Medicine 2014;25(4):425-445.
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Affiliation(s)
- Ken Zafren
- Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA; International Commission for Mountain Emergency Medicine (ICAR MEDCOM) (Dr Zafren).
| | - Gordon G Giesbrecht
- Faculty of Kinesiology and Recreation Management, Departments of Anesthesia and Emergency Medicine, University of Manitoba, Winnipeg, Canada (Dr Giesbrecht)
| | - Daniel F Danzl
- Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, KY (Dr Danzl)
| | - Hermann Brugger
- International Commission for Mountain Emergency Medicine (ICAR MEDCOM) (Dr Zafren); European Academy Institute of Mountain Emergency Medicine, Bolzano, Italy (Dr Brugger)
| | - Emily B Sagalyn
- University of Nevada School of Medicine, Reno, NV (Dr Sagalyn)
| | - Beat Walpoth
- Service of Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland (Dr Walpoth)
| | - Eric A Weiss
- Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA; Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA (Drs Weiss and Auerbach)
| | - Paul S Auerbach
- Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA; Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA (Drs Weiss and Auerbach)
| | - Scott E McIntosh
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs McIntosh, Némethy, and McDevitt)
| | - Mária Némethy
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs McIntosh, Némethy, and McDevitt)
| | - Marion McDevitt
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs McIntosh, Némethy, and McDevitt)
| | - Jennifer Dow
- Alaska Regional Hospital, Anchorage, AK; Denali National Park and Preserve, AK (Dr Dow)
| | | | - George W Rodway
- Division of Health Sciences, University of Nevada, Reno, NV (Dr Rodway)
| | - Peter H Hackett
- Division of Emergency Medicine, Altitude Research Center, University of Colorado School of Medicine, Denver, CO; Institute for Altitude Medicine, Telluride, CO (Dr Hackett)
| | - Brad L Bennett
- Military & Emergency Medicine Department, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences Bethesda, MD (Dr Bennett)
| | - Colin K Grissom
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City, UT (Dr Grissom)
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Zafren K, Giesbrecht GG, Danzl DF, Brugger H, Sagalyn EB, Walpoth B, Weiss EA, Auerbach PS, McIntosh SE, Némethy M, McDevitt M, Dow J, Schoene RB, Rodway GW, Hackett PH, Bennett BL, Grissom CK. Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia. Wilderness Environ Med 2014; 25:425-45. [PMID: 25443771 DOI: 10.1016/j.wem.2014.09.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/05/2014] [Accepted: 09/08/2014] [Indexed: 01/04/2023]
Abstract
To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations.
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Affiliation(s)
- Ken Zafren
- Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA (Drs Zafren, Weiss, and Auerbach); International Commission for Mountain Emergency Medicine (ICAR MEDCOM) (Drs Zafren and Brugger).
| | - Gordon G Giesbrecht
- Faculty of Kinesiology and Recreation Management, Departments of Anesthesia and Emergency Medicine, University of Manitoba, Winnipeg, Canada (Dr Giesbrecht)
| | - Daniel F Danzl
- Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, KY (Dr Danzl)
| | - Hermann Brugger
- International Commission for Mountain Emergency Medicine (ICAR MEDCOM) (Drs Zafren and Brugger); European Academy Institute of Mountain Emergency Medicine, Bolzano, Italy (Dr Brugger)
| | - Emily B Sagalyn
- University of Nevada School of Medicine, Reno, NV (Dr Sagalyn)
| | - Beat Walpoth
- Service of Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland (Dr Walpoth)
| | - Eric A Weiss
- Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA (Drs Zafren, Weiss, and Auerbach)
| | - Paul S Auerbach
- Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA (Drs Zafren, Weiss, and Auerbach)
| | - Scott E McIntosh
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs McIntosh, Némethy, and McDevitt)
| | - Mária Némethy
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs McIntosh, Némethy, and McDevitt)
| | - Marion McDevitt
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs McIntosh, Némethy, and McDevitt)
| | - Jennifer Dow
- Alaska Regional Hospital, Anchorage, AK (Dr Dow); Denali National Park and Preserve, AK (Dr Dow)
| | | | - George W Rodway
- Division of Health Sciences, University of Nevada, Reno, NV (Dr Rodway)
| | - Peter H Hackett
- Division of Emergency Medicine, Altitude Research Center, University of Colorado School of Medicine, Denver, CO (Dr Hackett); Institute for Altitude Medicine, Telluride, CO (Dr Hackett)
| | - Brad L Bennett
- Military & Emergency Medicine Department, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences Bethesda, MD (Dr Bennett)
| | - Colin K Grissom
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City, UT (Dr Grissom)
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Rein EB, Filtvedt M, Walløe L, Raeder JC. Hypothermia during laparotomy can be prevented by locally applied warm water and pulsating negative pressure. Br J Anaesth 2007; 98:331-6. [PMID: 17259258 DOI: 10.1093/bja/ael369] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Conflicting results have been obtained when using heat and constant negative pressure applied to the arm to induce re-warming in patients with mild hypothermia due to surgery. We hypothesized that pulsating negative pressure would increase skin blood flow and thus heat transfer. The purpose of this study was to compare a new method of applying heat and pulsating negative pressure to the skin with conventional forced-air warming for preventing perioperative hypothermia. METHODS Twenty patients undergoing prolonged laparotomy for gastric surgery were randomized into two groups. One group (SM) received hospital standard method: forced-air warming, 43 degrees C (Bair Hugger) on the thoracic and upper arm surface. The other group (NM) received the new method: warm water and pulsating negative pressure treatment applied in a transparent acrylic cylinder (50 x 16 cm) on one arm. The cylinder was circulated with water at 42.5 degrees C, leaving an air pocket inside the device. Pulsating pressure between 0 and -40 mm Hg was generated in the air pocket inside the cylinder. RESULTS Two groups of 10 patients were studied. Warming was started shortly after induction of general anaesthesia. The two methods performed similarly during the first 60 min, with a mean 0.7 degrees decrease in core temperature. The tympanic temperature curve in NM group then increased and returned to baseline (37 degrees C) by 120 min. The temperature of SM group increased more slowly, reaching 36 degrees C by 120 min (P < 0.05). CONCLUSION Warm water and pulsating negative pressure was significantly better at treating hypothermia during laparotomy than forced-air warming.
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Affiliation(s)
- E B Rein
- Department of Physiology, Institute of Basic Medical Sciences, University of Oslo, N-0317 Oslo, Norway.
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