Severe Hypothermia

Definition and Epidemiology

2 Topics

The Body’s Core Temperature

The Most Vulnerable

Pathophysiology

4 Topics

Initial Physiological Changes

Conduction Abnormalities

Clinical Assessment

4 Topics

Primary or Secondary Problem?

Checking Cardiac Output

Core Temperature

3 Topics

Blood Gas Analysis

Management of Hypothermic Patients in Actual or Impending Arrest

2 Topics

Changes to Standard Advanced Life Support

6 Topics

Passive Measures

Active Measures: Cardiopulmonary Bypass

Active Measures: Alternatives to Cardiopulmonary Bypass

Re-Warming Rates

Target Temperature

Re-Warming Shock

2 Topics

Morbidity and Mortality

1 Topic

Severe Hypothermia

Severe Hypothermia

Severe Hypothermia Severe Hypothermia

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Question 1 of 10

1. Question
1 point(s)
Which one or more of the following physiological changes occurs in hypothermia?
- Depressed myocardial contractility
- Leftwards shift of the oxygen dissociation curve
- Vasodilatation
- Ventilation-perfusion mismatch
- Developing alkalosis
Question 2 of 10

2. Question
1 point(s)
In hypothermia, which one of the following deviations from standard advanced life saving (ALS) protocol is correct?
- No more than three attempts at defibrillation should be made when core temperature is less than 30°C
- Intubation should be avoided as it risks precipitating ventricular fibrillation
- Drugs should not be given until core temperature reaches 32°C
- Therapeutic hypothermia should be avoided following hypothermic cardiac arrest
Question 3 of 10

3. Question
1 point(s)
Which one of the following statements regarding chest compressions in hypothermic cardiac arrest is correct?
- The chest compression rate should be reduced to 60/minute
- Chest compressions may well be harder because of increased chest wall rigidity
- There is no role for mechanical compression devices
- Chest compressions should be avoided until absence of cardiac output has been determined by Doppler techniques, if the appropriate equipment is available
Question 4 of 10

4. Question
1 point(s)
Which one of the following statements regarding ventilation in hypothermic cardiac arrest is correct?
- The patient should be hyperventilated to help correct the metabolic acidosis that occurs in hypothermia
- Target CO2 should be within the normal range as shown by arterial blood corrected to the patient's current temperature
- A lower rate of ventilation is required to maintain normocapnia
- The patient should be hyperventilated to maximise cerebral perfusion during cardiopulmonary resuscitation (CPR)
- Inspired oxygen concentration should be adjusted to avoid hyperoxia
Question 5 of 10

5. Question
1 point(s)
Which one of the following statements regarding measurement of temperature during the management of hypothermic cardiac arrest is correct?
- A rectally placed temperature probe is the gold-standard
- Tympanic thermometers are inaccurate below 32oC
- Vascular temperature probes are not recommended because of the risk or precipitating arrhythmias during placement
- A skin surface temperature sensor placed in the axilla will provide accurate guidance on re-warming rates
- Oesophageal temperature probes are reliable, accurate and recommended
Question 6 of 10

6. Question
1 point(s)
Which one of the following statements regarding hypothermic peri-arrest and cardiac arrest situations is true?
- Sinus bradycardia should be aggressively treated to improve tissue oxygen perfusion
- Malignant arrhythmias are unlikely to be a result of hypothermia if the core temperature is above 32°C
- The absence of J waves on the ECG effectively rules out hypothermia as the cause of any malignant arrhythmias
- Fluid replacement must be cautious as renal vasoconstriction results in fluid retention
Question 7 of 10

7. Question
1 point(s)
Which one of the following is typical of severe hypothermia?
- Thrombocytopaenia
- Reduced haematocrit
- Hyperkalaemia
- Normal clotting
- Reduced creatinine
Question 8 of 10

8. Question
1 point(s)
Which one of the following estimated rates of re-warming is correct?
- Peritoneal lavage: 5-7°C/hour
- Inhalation of warmed air: 3-4°C/hour
- Haemofiltration: 4-6°C/hour
- Cardiopulmonary bypass (CPB): 7-10°C/hour
- External forced-heated air: 4-6°C/hour
Question 9 of 10

9. Question
1 point(s)
Which one of the following statements regarding cardiopulmonary bypass (CPB) in hypothermia is true?
- CPB should only be started for patients in cardiac arrest
- CPB should not be started if the patient's peripheries are frozen
- Femoro-femoral bypass if preferable to aorto-right atrial bypass
- The CPB equipment should always be brought to the patient if it is available within the institution
- Rhabdomyolysis with hyperkalaemia is a contraindication to CPB
Question 10 of 10

10. Question
1 point(s)
Which one of the following is a reliable marker of futility in primary hypothermic cardiac arrest?
- A K+ of >10 mmol/L
- Frozen peripheries
- Fixed dilated pupils
- Failure to achieve defibrillation after 3 shocks
- Core temperature <20oC

5 Comments

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Navin Leanage January 25, 2021 at 5:48 pm

Very good and useful

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wildek May 10, 2021 at 10:24 am

Very comprehensive module

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Dr. Tariq Mehmood Juno August 27, 2021 at 2:18 am

great stuff, cleared lot of quarries, comprehensive revision for the topic.

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Dr Smita Tyagi April 26, 2022 at 4:39 pm

Very well written module covering all aspects

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Dr Zahid Mehmood February 2, 2023 at 7:40 pm

Excellent topic, we should be prepared as we can have a primary hypothermia leading to cardiac arrest .

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