Hs and Ts - Hypothermia | ACLS Certification Association

Hypothermia in ACLS: Stages, Red Flags, and Rewarming—What Every Provider Must Know

There are three main causes of hypothermia: extreme cold exposure, cold-water submersion, and cold exposure with thermoregulator issues (e.g., elderly, malnourished, polypharmacy, dementia, substance use). This video breaks down how to recognize each severity level and what to do next—from passive rewarming to ECMO.

Severity & Clinical Hallmarks
▪️Mild (34–36 °C): The patient shivers (their body is generating heat).
▪️Moderate (30–34 °C): Mental status declines; around 32–30 °C they lose the ability to shiver.
▪️Severe (less than 30 °C): Unconscious, no respirations, no pupil reflex; VF common; may appear lifeless.
▪️Profound (less than 20 °C): Essentially frozen—asystole on the monitor, no brain activity.

Treatment by Stage
▪️All cases: Start passive rewarming—move to a warm environment, remove cold/wet clothing; patient generates the heat (blankets are okay, but no added heat beyond environment).
▪️Moderate: Add active external warming with warm packs to groin, axillae, head—always use a barrier to prevent burns.
▪️Severe: Introduce active internal rewarming: warmed IV fluids, warmed humidified oxygen, gastric/rectal lavage; ECMO is an excellent option and provides rapid rewarming plus circulatory support.

Medication Warning
▪️less than 30 °C: Medications are ineffective—enzymes needed for drug activation and clearance don’t work well. Avoid dosing until the patient warms to safer thresholds.

ACLS Considerations
Begin BLS immediately. If the monitor shows VF and the temperature is unknown, deliver one shock; subsequent defibrillation may require rewarming to be effective.

💬 Your turn: What’s your protocol tip for preventing rewarming burns or managing drug decisions below 30 °C? Share it for learners who’ll see these patients during winter.

Here is some more information about ACLS Certification Association:

ACLS Certification Association prioritizes making life-saving education and medical certifications available in an easy-to-use online format. Our curriculum and testing materials are designed and peer-reviewed by our Medical Review Board utilizing the latest guidelines from ILCOR, the American Academy of Pediatrics, and the American Heart Association.

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Chapters
00:00 – Intro
00:35 – Why It Matters
01:10 – Definition
02:05 – Types
03:00 – Effects
04:10 – Cardiac Impact
05:05 – ACLS Points
06:00 – Rewarming
07:10 – Meds/Shocks
08:00 – Summary