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Think about:

Any modifications that are needed within your sub heading

Consider best practice vs reality

Think what we, as Paramedics, can do and think outside the box for other interventions

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Defibrillation is less effective in hypothermia. For ventricular fibrillation/ventricular tachycardia (VF/VT) defibrillation may be tried up to three times but is then not tried until the temperature reaches 30°C.

Do not try pacing unless bradycardia persists when normothermia is reached. Sinus bradycardia may be a physiological response and is not treated specifically.

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HEMS often performs interventions that are typically only available in a hospital setting and are not within the scope of a standard paramedic team. These might include:

Pre-hospital anaesthesia and advanced airway management, which may be needed to secure the airway without causing a fatal arrhythmia.

Administration of advanced medications, such as inotropic support to assist a failing heart, which are not carried by most ground units.

Point-of-care diagnostics for blood gas analysis and electrolyte levels, though this is not universally available.

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More advanced warming equipment i.e bear hugger

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Patients should be moved from the cold environment and wet or cold clothes should be removed. They can then be covered by a blanket and have their head covered to reduce heat loss.

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Modifications - changing the environment, making it warm and that being a priority as there is a lack of circulation. Delay defibrillation: If ventricular fibrillation (VF) persists after three shocks in a patient with a core temperature below 30, delay further shocks until core temperature is less than 30. This is because myocardium is cold and is resistant to it. 

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Modifications - changing the environment, making it warm and that being a priority as there is a lack of circulation. Delay defibrillation: If ventricular fibrillation (VF) persists after three shocks in a patient with a core temperature below 30, delay further shocks until core temperature is less than 30. This is because myocardium is cold and is resistant to it. 

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Drug intervals - half the dose or double the time 

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Drug intervals - half the dose or double the time 

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Heat packs, heat lamps, bair hugger to warm patient would be best to rewarm patient but this is likely to not be available prehospitally.

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Modifications to assessing signs of Life in hypothermia

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Modifications to assessing signs of Life in hypothermia

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In severe hypothermia, (30°C), Vital signs can be extremely slow, faint, or difficult to detect.

Modifications: Checking for breathing and carotid pulse for up to 60 seconds before deciding that cardiac arrest has occurred

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Halving the dose / doubling the interval- takes longer to metabolise and circulate

Harder to cannulate- peripheral vasoconstriction, if cant cannulate IO, however cannulation preferred if possible

Palpate gentle- due to rough handling can stimulate myocardium, increased risk of VF

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Environmental factors - dangerous or difficult surrounding might delay or rush checking for signs of life.

Family/members of the public - May interrupt or distract causing the para to feel rushed or lose focus

Unclear hierarchy - cause confusion and unclear communication

Pressure - people may feel rushed to declare death

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Assess for cardiac activity for full minute - use of ultrasound?

low flow state

Obtain core temperautre - oesophageal probe pls (if possible, or bladder/rectal)

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In hypothermia, the chest wall and heart muscle are stiffer and less responsive, making defibrillation less effective. This increases the impedance of the chest wall

Repeated defibrillation attempts can cause myocardial injury, and some evidence suggests a risk of inducing VF again after successful rewarming resuscitation.