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Severe Hypothermia

Definition and Epidemiology

The Body’s Core Temperature

The Most Vulnerable

Pathophysiology

Initial Physiological Changes

Conduction Abnormalities

Clinical Assessment

Primary or Secondary Problem?

Checking Cardiac Output

Core Temperature

Blood Gas Analysis

Investigations – ECG

Management of Hypothermic Patients in Actual or Impending Arrest

Changes to Standard Advanced Life Support

Passive Measures

Active Measures: Cardiopulmonary Bypass

Active Measures: Alternatives to Cardiopulmonary Bypass

Re-Warming Rates

Target Temperature

Re-Warming Shock

Morbidity and Mortality

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
Correct Incorrect Correct answer

Leftwards shift of the oxygen dissociation curve
Correct Incorrect Correct answer

Vasodilatation
Correct Incorrect Correct answer

Ventilation-perfusion mismatch
Correct Incorrect Correct answer

Developing alkalosis
Correct Incorrect Correct answer
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
Correct Incorrect Correct answer

Intubation should be avoided as it risks precipitating ventricular fibrillation
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Drugs should not be given until core temperature reaches 32°C
Correct Incorrect Correct answer

Therapeutic hypothermia should be avoided following hypothermic cardiac arrest
Correct Incorrect Correct answer
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
Correct Incorrect Correct answer

Chest compressions may well be harder because of increased chest wall rigidity
Correct Incorrect Correct answer

There is no role for mechanical compression devices
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Chest compressions should be avoided until absence of cardiac output has been determined by Doppler techniques, if the appropriate equipment is available
Correct Incorrect Correct answer
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
Correct Incorrect Correct answer

Target CO2 should be within the normal range as shown by arterial blood corrected to the patient's current temperature
Correct Incorrect Correct answer

A lower rate of ventilation is required to maintain normocapnia
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The patient should be hyperventilated to maximise cerebral perfusion during cardiopulmonary resuscitation (CPR)
Correct Incorrect Correct answer

Inspired oxygen concentration should be adjusted to avoid hyperoxia
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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
Correct Incorrect Correct answer

Tympanic thermometers are inaccurate below 32oC
Correct Incorrect Correct answer

Vascular temperature probes are not recommended because of the risk or precipitating arrhythmias during placement
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A skin surface temperature sensor placed in the axilla will provide accurate guidance on re-warming rates
Correct Incorrect Correct answer

Oesophageal temperature probes are reliable, accurate and recommended
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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
Correct Incorrect Correct answer

Malignant arrhythmias are unlikely to be a result of hypothermia if the core temperature is above 32°C
Correct Incorrect Correct answer

The absence of J waves on the ECG effectively rules out hypothermia as the cause of any malignant arrhythmias
Correct Incorrect Correct answer

Fluid replacement must be cautious as renal vasoconstriction results in fluid retention
Correct Incorrect Correct answer
Question 7 of 10

7. Question
1 point(s)

Which one of the following is typical of severe hypothermia?

Thrombocytopaenia
Correct Incorrect Correct answer

Reduced haematocrit
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Hyperkalaemia
Correct Incorrect Correct answer

Normal clotting
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Reduced creatinine
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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
Correct Incorrect Correct answer

Inhalation of warmed air: 3-4°C/hour
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Haemofiltration: 4-6°C/hour
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Cardiopulmonary bypass (CPB): 7-10°C/hour
Correct Incorrect Correct answer

External forced-heated air: 4-6°C/hour
Correct Incorrect Correct answer
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
Correct Incorrect Correct answer

CPB should not be started if the patient's peripheries are frozen
Correct Incorrect Correct answer

Femoro-femoral bypass if preferable to aorto-right atrial bypass
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The CPB equipment should always be brought to the patient if it is available within the institution
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Rhabdomyolysis with hyperkalaemia is a contraindication to CPB
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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
Correct Incorrect Correct answer

Frozen peripheries
Correct Incorrect Correct answer

Fixed dilated pupils
Correct Incorrect Correct answer

Failure to achieve defibrillation after 3 shocks
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Core temperature <20oC
Correct Incorrect Correct answer

5 Comments

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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