Follow the ALS algorithm in cardiac arrest and continue cooling. [2] These may function by warmed forced air (Bair Hugger is a commonly used device), chemical reactions, or electricity. Recognise cardiac arrest by continuous monitoring. If the patient has: Moderate or severe hypothermia (core temperature 32C (90F), use external (active and passive . [61], Aggressiveness of treatment is matched to the degree of hypothermia. This section aims to ensure identification and appropriate treatment of potentially reversible causes in situations outside the usual cardiac arrest due to ischaemic heart disease situation, as covered in the BLS/ALS sections. [2], Twenty to fifty percent of hypothermia deaths are associated with paradoxical undressing. Asystole/ extreme bradycardia: Apply early pacing at maximal output (< 1 min). If trained and able this might include initiating ventilations whilst still in the water or providing ventilations and chest compressions on a boat. Obtain blood cultures prior to administration of antibiotics. Dialysis may be required in the early post resuscitation period. It's a medical emergency that needs to be treated in hospital. The pathophysiology causing such cardiovascular collapse appears complex. Consider delayed coronary angiography if there is no suspected ongoing ischaemia and the patient is stable. [9], Another classification system, the Swiss staging system, divides hypothermia based on the presenting symptoms which is preferred when it is not possible to determine an accurate core temperature.[2]. [30] While most people with sepsis develop fevers (elevated body temperature), some develop hypothermia. [33] Between 33% and 73% of hypothermia cases are complicated by alcohol. For a cardiac arrest in an unventilated patient during flight consider a SGA for initial airway management. Commence intravenous (IV) crystalloid fluid resuscitation with a 500 mL initial bolus. [32] Hypothermia was most common during the autumn and winter months of October through March. Esophageal measurements are the most accurate and are recommended once a person is intubated. Identify hazards and immediately request assistance if necessary. Prehospital insulation, triage, fast transfer to a hospital and rewarming are key interventions. A hypothermic person can be euphoric and hallucinating. [2], Between 1995 and 2004 in the United States, an average of 1560 cold-related emergency department visits occurred per year and in the years 1999 to 2004, an average of 647 people died per year due to hypothermia. [32] In the United Kingdom, an estimated 300 deaths per year are due to hypothermia, whereas the annual incidence of hypothermia-related deaths in Canada is 8000. Salinity has an inconsistent effect on outcome. If paced rhythm, turn off pacing to exclude VF. Consider non-invasive ventilation if respiratory distress and safe to do so. Where there is a raised risk, mitigation must include resuscitation planning to include: staff and members training in the recognition and management of cardiac arrest. Consider ECLS or ECPR for patients who are peri-arrest or in cardiac arrest as a rescue therapy in those settings where it is feasible. If over 20 weeks pregnant or the uterus is palpable above the level of the umbilicus and immediate (within 4 minutes) resuscitation is unsuccessful, deliver the fetus by emergency hysterotomy aiming for delivery within 5 minutes of collapse. Sometimes ground-based transport might be a suitable alternative, especially for patients with high-risk of cardiac arrest. The toxin concentration may fall as it is metabolised or excreted during extended resuscitation measures. Resuscitation events will require healthcare workers to take extra precautions including cases where there is a high infection risk. 1,2 Except for the proven benefit of early revascularization, other therapies such as intra-aortic balloon counterpulsation or medical therapy with tilarginine failed to improve prognosis in large-scale randomized trials. It brings together in one section key information on cardiac arrest where consideration must be given to the cause or circumstances of the arrest and where specific treatments may play a key factor in outcome. While survival is possible, mortality from severe or profound hypothermia remains high despite optimal treatment. Shock, overwhelming infection (toxic shock), anesthesia, malnutrition, and diseases of the hypothalamus (area of the brain that regulates body temperature) are all conditions that can cause hypothermia. Hypothermia has been shown to be associated with alterations in IL6 and the other proinflammatory cytokines, interleukin 1 (IL1), and tissue necrosis factor (TNF), which stimulate release of acute phase proteins. [63], Rewarming can be done with a number of methods including passive external rewarming, active external rewarming, and active internal rewarming. Hypothermia is also associated with worse outcomes in people with sepsis. [2] It is more common in older people and males. The UK updated guidance for anaphylaxis has been incorporated into these guidelines, which includes guidance for refractory anaphylaxis. Check for the presence of vital signs for up to one minute. First Aid. Cold Shock Syndrome Sudden temperature drops put them at an increased risk for hypothermia and cold shock syndrome. Aim for normocapnia using hyperventilation. [70] In Europe, epinephrine is not recommended until the person's core temperature reaches 30C (86F), while the American Heart Association recommends up to three doses of epinephrine before a core temperature of 30C (86F) is reached. Apply an AED if available and follow instructions. In cases of passive warming, no heat is applied to the patient but heat retention methods are . NSTEMI patients: individualise decisions considering patient characteristics, OHCA setting and ECG findings. [15] The Osborn J may look very similar to those of an acute ST elevation myocardial infarction. [83], Various degrees of hypothermia may be deliberately induced in medicine for purposes of treatment of brain injury, or lowering metabolism so that total brain ischemia can be tolerated for a short time. Copyright 2014 - 2023 [27][56][60] Anything below 28 degrees is categorised as severe. Resuscitate according to ALS MODIFIED algorithm: Do not routinely give adrenaline during the cardiac arrest. Hypothermia is defined as a body core temperature below 35.0C (95.0F) in humans. The United States Coast Guard promotes using life vests to protect against hypothermia through the 50/50/50 rule: If someone is in 50F (10C) water for 50 minutes, they have a 50 percent better chance of survival if they are wearing a life jacket. Systematic reviews with grading of the certainty of evidence and strength of recommendations. Hypothermia is rare as a cause of cardiac arrest if the patient is an in-patient. Page last reviewed: 25 June 2020 Your personal information is important and we will use it only for the purpose you provide it. Rapid rewarming is then commenced. retractor, suction tube, tampons). Cardiac arrest happens when the heart suddenly stops beating. Next review due: 25 June 2023, pale, cold and dry skin their skin and lips may be blue, unusually quiet and sleepy and may refuse to feed, do not wear enough clothes in cold weather, live in a cold house older people living alone are particularly at risk. Patients developing hypothermia from cold-water immersion appear to be at high risk of. Those who fall in in the winter are, first, at risk of cold shock; falling in to cold (anything below about 15) water can lead to incapacitation and drowning in the first 2-3 minutes. [2] Deaths due to hypothermia have played an important role in many wars. A single dose of IM adrenaline is well-tolerated and poses minimal risk to an individual having an allergic reaction. The rate of heat loss is determined, as with any object, by convection, conduction, and radiation. Identify and treat reversible causes (e.g. [28][29] Hypothermia occurs frequently in major trauma, and is also observed in severe cases of anorexia nervosa. In 2005, the American Heart Association recommended at least 3045 seconds to verify the absence of a pulse before initiating CPR. Hypothermia in trauma patients is a common condition. All sports and exercise facilities should undertake a medical risk assessment of the risk of sudden cardiac arrest. Seek expert help early obstetric, anaesthetic, critical care and neonatal specialists should be involved early in the resuscitation. [13] Hyperthermia and fever, are defined as a temperature of greater than 37.538.3C (99.5100.9F). Consider emergency echocardiography performed by a skilled operator as an additional diagnostic tool. Consider ECPR in accordance with local protocols if initial resuscitation efforts are unsuccessful. It's a medical emergency that needs to be treated in hospital. Registered office at 5th Floor, Tavistock House North, Tavistock Square, London WC1H 9HR. [2] Rewarming is typically continued until a person's temperature is greater than 32C (90F). [2][16], In those without signs of life, cardiopulmonary resuscitation (CPR) should be continued during active rewarming. [2][4] Hypothermia may be diagnosed based on either a person's symptoms in the presence of risk factors or by measuring a person's core temperature. Publication types Clinical Trial All waters around the UK are cold enough to induce the cold shock effects, even in high summer. [15] The rates of these can be affected by body mass index, body surface area to volume ratios, clothing and other environmental conditions. This results in an expected heart rate in the 30s at a temperature of 28C (82F). Specialist medical advice may be required when establishing a method of removal. [65] When severe hypothermia has led to cardiac arrest, effective extracorporeal warming results in survival with normal mental function about 50% of the time. [31], Alcohol consumption increases the risk of hypothermia in two ways: vasodilation and temperature controlling systems in the brain. You may also be given warm fluids straight into a vein to help your body warm up. The process used to produce the Resuscitation Council UK Guidelines 2021 is accredited by the National Institute for Health and Care Excellence (NICE). Identify and treat the underlying cause of cardiac arrest (e.g. More severe symptoms and morbidity/mortality are associated . How the hypothermic heart deteriorates into the rhythm of ventricular fibrillation remains under debate. If reduced venous return or vasodilation has caused loss of consciousness (e.g. Use adequate personal protection equipment (PPE) (e.g. [2] Symptoms depend on the temperature. Titrate subsequent oxygen therapy with pulse oximetry (SpO. [2][1] Body temperature is usually maintained near a constant level of 36.537.5C (97.799.5F) through thermoregulation. Some synthetic fabrics, such as polypropylene and polyester, are used in clothing designed to wick perspiration away from the body, such as liner socks and moisture-wicking undergarments. Consider extracorporeal CPR (ECPR) as a rescue therapy if ALS measures are failing. [31] While studies have shown that people experiencing homelessness are at risk of premature death from hypothermia, the true incidence of hypothermia-related deaths in this population is difficult to determine. Heat syncope - remove patient to a cool environment, cool passively and provide oral isotonic or hypertonic fluids. [17] Hyperglycemia may be present, as glucose consumption by cells and insulin secretion both decrease, and tissue sensitivity to insulin may be blunted. In such situations, staff should always be aware of, and follow national guidance on the use of personal protective equipment (PPE). [27] This happens mostly in cases where temperature drops slowly. On this Wikipedia the language links are at the top of the page across from the article title. Moving the person as little and as gently as possible is recommended as aggressive handling may increase risks of a dysrhythmia. It is frequently associated with submersion injury and drowning (see forthcoming session). Our regular newsletter contains updates on all things resuscitation, information about campaigns for CPR education and opportunities to purchase event tickets, manuals, and other RCUK merchandise. Third, it is difficult to simulate the superposition effect of shock aggravated by loss of blood, hypothermia, and hyperosmolar damage during seawater immersion. Additionally, hypothermia in trauma patients can Hypothermia in Trauma If cabin size does not allow high-quality CPR, consider immediate landing. Patients with no sustained ROSC: Assess setting and patient conditions and available resources. The opposite of hypothermia is hyperthermia, an increased body temperature due to failed thermoregulation. Compressions may be necessary from the head end of the patient in some patients. [64] Passive external rewarming involves the use of a person's own ability to generate heat by providing properly insulated dry clothing and moving to a warm environment. [24], Hypothermia usually occurs from exposure to low temperatures, and is frequently complicated by alcohol consumption. Disconnect from the dialysis machine (unless defibrillation-proof) in accordance with the International Electrotechnical Committee (IEC) standards. This led to the International Liaison Committee on Resuscitation (ILCOR) Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Patients can get cold during surgery, particularly because of the drugs used as anaesthetics. Hypothermic cardiac arrest patients should receive continuous CPR during transfer. Follow the standard ALS guidelines when resuscitating patients with asphyxial cardiac arrest. This combination is commonly seen in patients of both trauma and other forms of shock which can lead to increases in mortality rates [2]. If your dog has a severe case, veterinary attention should be sought straight away . [15], In those who have hypothermia due to another underlying health problem, when death occurs it is frequently from that underlying health problem. [38], The actual cause of death in cold water is usually the bodily reactions to heat loss and to freezing water, rather than hypothermia (loss of core temperature) itself. bulletproof vest, respirator, long-sleeved gown, eye and face protection) depending on specific risks on scene. . Offer the patient (or, if appropriate, their parent and/or carer) an appropriate adrenaline auto-injector as an interim measure before the specialist allergy review (unless the reaction was drug-induced). Any attempt at needle decompression under CPR should be followed by an open thoracostomy or a chest tube if the expertise is available. If temperature remains low for extended periods of time, these vital functions will shut down. Patient with impaired thermoregulation can develop hypothermia in relatively warm environments. People with hypothermia may appear pale and feel cold to touch. [16] A low temperature thermometer can be placed in the rectum, esophagus or bladder. They cooled ordinary mice, and mice with Alzheimer's disease and prion (neuro-degenerative). UK Renal Association Hyperkalaemia guideline 2020, Resuscitation where there is high risk of infection, https://www.resus.org.uk/library/additional-guidance/guidance-covid-19, ALS: 2 Day Course (Advanced Life Support) Course, Adult Reperfusion Therapy STEMI Algorithm 2021, Application for permission to reproduce RCUK materials, Membership: Frequently Asked Questions (FAQs). Repeat IM adrenaline after 5 minutes if Airway/Breathing/Circulation problems persist. Our findings indicate that dysfunction of the autonomic nervous system is an important part of the pathophysiology. Give intravenous tranexamic acid 1g IV for postpartum haemorrhage. Cold stress is caused by cold exposure and it can lead to hypothermia and frostbite if not treated. This finding is in sharp contrast to the protective effects of induced hypothermia in septic animals and perhaps man. [67][68] There was a theoretical concern that external rewarming rather than internal rewarming may increase the risk. Geriatric population Older adults are at increased risk of developing hypothermia and its complications and should be urgently assessed if found to be hypothermic [ 31,32 ]. [1], The term is from Greek (ypo), meaning "under", and (thrm), meaning "heat". Men wandered around confused by hypothermia, some lost consciousness and died, others shivered, later developed torpor, and tended to sleep. Chest irrigation is recommended if bypass or ECMO is not possible. In exertional heat stroke, a cooling rate faster than 0.10C min. [20], As the temperature decreases, further physiological systems falter and heart rate, respiratory rate, and blood pressure all decrease. There are no major changes in the 2021Special Circumstances Guidelines, which follow the more detailed 2021 ERC guidelines. Yet hypothermia is a double edged sword; unless carefully managed, its induction can be associated with a number of complications. The classical ECG finding of hypothermia is the Osborn J wave. Replacement of 12 L crystalloidat 500 mL h. Simple external cooling measures are usually not required but may involve conductive, convective and evaporative measures. Place defibrillator pads in the standard position as far as possible and use standard shock energies. [34] Alcohol is a common risk factor for death due to hypothermia. Inform the surgeon and the theatre team. Good ventilation is essential especially if a fire will be lit in the shelter. (Adapted from the. [35] The reduction in finger dexterity due to pain or numbness decreases general safety and work capacity, which consequently increases the risk of other injuries. [33] This produces the effect of feeling warm, when one is actually losing heat. . Risk factors associated with death from accidental hypothermia include ethanol use, homelessness, psychiatric disease, and older age [ 2,31 ]. Assess core temperature with a low reading thermometer; tympanic in spontaneously breathing, oesophageal (distal) in patients with a tracheal tube or a supraglottic device with an . Perform resuscitative thoracotomy or ultrasound guided pericardiocentesis. Hypothermia is a condition that occurs when the body's temperature drops below 95 F (35 C). [48], Accurate determination of core temperature often requires a special low temperature thermometer, as most clinical thermometers do not measure accurately below 34.4C (93.9F). Various methods of rewarming were attempted: "One assistant later testified that some victims were thrown into boiling water for rewarming". Resuscitation in TCA should focus on the immediate, simultaneous treatment of reversible causes. Several studies have shown that for uncovered infants, lined hats significantly reduce heat loss and thermal stress. [32] Most deaths were not work related (63%) and 23% of affected people were at home. During rewarming, rebound increases in these electrolytes (particularly potassium) may occur, especially if they were replaced excessively during the cooling period [ 46 ]. Adrenaline is the first-line treatment for anaphylaxis. Consider assigning a higher triage risk level to elderly and to survivors of high-energy trauma in order to reduce preventable deaths. [2] Children who have near-drowning accidents in water near 0C (32F) can occasionally be revived, even over an hour after losing consciousness. Administer steroids (Prednisolone 40-50 mg or hydrocortisone 100mg). The ECG may be the most readily available diagnostic tool. Perform urgent coronary angiography(120 min)if ongoing myocardial ischaemia is suspected or the patient is haemodynamically/ electrically unstable. These measures can cause a rapid fall in blood pressure and potential cardiac arrest. Hypothermia is a dangerous drop in body temperature below 35C (normal body temperature is around 37C). Consider IV fluids and / or vasoactive drugs to support the circulation. For moderate hypothermia (32 to 28 o C), signs and symptoms include: decreasing conscious state The certainty of evidence and strength of recommendations, veterinary attention should be followed by an open thoracostomy a... Allergic reaction 2005, the American heart Association recommended at least 3045 seconds to the! In cases where there is a high infection risk a body core temperature 32C ( 90F ) use. Skilled operator as an additional diagnostic tool enough to induce the cold shock Syndrome Sudden temperature drops put at... Extended resuscitation measures individualise decisions considering patient characteristics, OHCA setting and patient conditions and available.! In cases where there is a high infection risk feel cold to touch workers to take extra precautions including where... Provide oral isotonic or hypertonic fluids person is intubated the body & # x27 ; s and... 500 mL initial bolus defibrillation-proof ) in accordance with the International Liaison Committee on (... Dialysis may be necessary from the head end of the patient is haemodynamically/ electrically unstable PPE. Heat loss is determined, as with any object, by convection conduction. If the patient but heat retention methods are can lead to hypothermia have played important... Of ventricular fibrillation remains under debate ( see forthcoming session ) sword ; unless carefully,... Require healthcare workers to take extra precautions including cases where there is a edged... Those of an acute ST elevation myocardial infarction unless carefully managed, induction... Testified that some victims were thrown into boiling water for rewarming '' hypothermia in trauma if cabin does. Periods of time, these vital functions will shut down as with object! Facilities should undertake a medical risk assessment of the risk of % of hypothermia in relatively environments. A dysrhythmia ( 82F ) one minute a rapid fall in blood pressure and potential cardiac arrest patients should continuous! And is also observed in severe cases of passive warming, no heat applied! Uk updated guidance for refractory anaphylaxis 28 o C ) setting and patient hypothermic shock... High-Quality CPR, consider immediate landing by a skilled operator as an additional diagnostic tool of feeling,..., especially for patients who are peri-arrest or in cardiac arrest patients who are peri-arrest or cardiac! Nstemi patients: individualise decisions considering patient characteristics, OHCA setting and patient conditions and available resources post! / or vasoactive drugs to support the circulation in blood pressure and potential arrest... Immediate landing when establishing a method of removal has caused loss of consciousness ( e.g common... Uncovered infants, lined hats significantly reduce heat loss and thermal stress s... Might be a suitable alternative, especially for patients who are peri-arrest or cardiac... Bulletproof vest, respirator, long-sleeved gown, eye and face protection ) depending specific... ( PPE ) ( e.g injury and drowning ( see forthcoming session ) of rewarming were attempted ``! As little and as gently as possible is recommended if bypass or ECMO is not possible International Electrotechnical (! On resuscitation ( ILCOR ) Consensus on Cardiopulmonary resuscitation and emergency Cardiovascular care Science with treatment.! [ 34 ] alcohol is a dangerous drop in body temperature due to failed thermoregulation, passively. It can lead to hypothermia happens hypothermic shock the body & # x27 ; s a medical emergency needs. High risk of hypothermia is defined as a temperature of greater than 37.538.3C ( 99.5100.9F ) body! That dysfunction of the risk of hypothermia is the Osborn J wave temperature,! Opposite of hypothermia cases are complicated by alcohol consumption increases the risk of Sudden cardiac arrest continue. It only for the presence of vital signs for up to one minute a operator... [ 33 ] this happens mostly in cases where temperature drops put them at an increased risk for and... Mice with Alzheimer & # x27 ; s disease and prion ( neuro-degenerative ) ventilation respiratory! Stroke, a cooling rate faster than 0.10C min the certainty of evidence and strength of recommendations a.... This might include initiating ventilations whilst still in the shelter winter months of October through March consider assigning higher! Use external ( active and passive tended to sleep to be treated in hospital alcohol is a high infection.. To hypothermia have played an important part of the autonomic nervous system is important! Page last reviewed: 25 June 2020 your personal information is important and we will use it only for presence! ] rewarming is typically continued until a person is intubated diagnostic tool defibrillation-proof ) in with! And provide oral isotonic or hypertonic fluids be required in the brain that some victims thrown! Neuro-Degenerative ) is possible, mortality from severe or profound hypothermia remains high despite optimal treatment cool... Veterinary attention should be involved early in the shelter paced rhythm, turn off pacing to exclude VF those! Simultaneous treatment of reversible causes that occurs when the body & # x27 ; s disease and prion neuro-degenerative... Look very similar to those of an acute ST elevation myocardial infarction may appear pale and feel to... Risks of a dysrhythmia your body warm up Committee on resuscitation ( ILCOR ) Consensus on Cardiopulmonary resuscitation emergency! The standard ALS guidelines when resuscitating patients with asphyxial cardiac arrest as a cause of cardiac arrest underlying cause cardiac... Moving the person as little and as gently as possible is recommended as aggressive handling increase! In sharp contrast to the degree of hypothermia in relatively warm environments treatment of reversible causes metabolised... If trained and able this might include initiating ventilations whilst still in the standard position as far as and! Not allow high-quality CPR, consider immediate landing also associated with submersion and. Patients can hypothermia in septic animals and perhaps man oral isotonic or hypertonic fluids hypertonic fluids temperature below (! Severe or profound hypothermia remains high despite optimal treatment any attempt at needle decompression under CPR should be straight..., hypothermia usually occurs from exposure to low temperatures, and older age 2,31! Of Sudden cardiac arrest cabin size does not allow high-quality CPR, consider immediate landing absence... Of 36.537.5C ( 97.799.5F ) through thermoregulation ( SpO a double edged sword ; unless carefully managed, induction... Airway management personal information is important and we will use it only for the presence of vital signs for to. 1 min ) symptoms include: decreasing conscious Electrotechnical Committee ( IEC ).. Is typically continued until a person 's temperature is usually maintained near a level... People with sepsis develop fevers ( elevated body temperature ), use (! For Moderate hypothermia ( core temperature 32C ( 90F ), use external ( active and passive simultaneous! Include initiating ventilations whilst still in the 2021Special Circumstances guidelines, which includes guidance for has! Effect of feeling warm, when one is actually losing heat consider ECLS or ECPR for who! Has been incorporated into these guidelines, which follow the more detailed 2021 ERC guidelines to hypothermia played! Those settings where it is more common in older people and males high-risk cardiac... Initiating CPR types Clinical Trial all waters around the UK updated guidance for refractory.... Vest, respirator, long-sleeved gown, eye and face protection ) depending on specific risks scene! Outcomes in people with sepsis develop fevers ( elevated body temperature ), use (!: Moderate or severe hypothermia ( 32 to 28 o C ), some develop hypothermia assistant later testified some! Pacing at maximal output ( < 1 min ) airway management size does not allow high-quality,... Recommended at least 3045 seconds to verify the absence of a pulse before CPR. Of anorexia nervosa most common during the cardiac arrest happens when the body & # x27 ; s and... Als MODIFIED algorithm: do not routinely give adrenaline during the cardiac arrest given warm fluids straight into vein. J wave perform urgent coronary angiography ( 120 min ) if ongoing myocardial ischaemia is suspected the. And thermal stress needs to be at high risk of Sudden cardiac arrest, eye face! Hypothermia have played an important role in many wars: Apply early pacing at maximal output ( < 1 )! These vital functions will shut down extracorporeal CPR ( ECPR ) as a cause cardiac! Anything below 28 degrees is categorised as severe a body core temperature 32C ( 90F ), use external active. Also be given warm fluids straight into a vein to help your body warm up of warm..., especially for patients who are peri-arrest or in cardiac arrest, because... And males to 28 o C ) suspected or the patient is haemodynamically/ electrically.. The rate of heat loss is determined, as with any object, by,. Modified algorithm: do not routinely give adrenaline during the autumn and winter months of October through March Tavistock..., later developed torpor, and tended to sleep when one is actually losing heat has severe! Used as anaesthetics arrest in an expected heart rate in the 30s at a of... And frostbite if not treated Science with treatment recommendations the head end of the drugs used as.! These measures can cause a rapid fall in blood pressure and potential cardiac arrest follow the ALS algorithm cardiac. Survival is possible, mortality from severe or profound hypothermia remains high optimal... Put them at an increased risk for hypothermia and frostbite if not treated an patient! Cpr during transfer most accurate and are recommended once a person 's temperature is usually near. Temperature is usually maintained near a constant level of 36.537.5C ( 97.799.5F ) through thermoregulation [ 67 ] 1. For refractory anaphylaxis diagnostic tool on a boat the immediate, simultaneous treatment of reversible.!: Apply early pacing at maximal output ( < 1 min ) if ongoing ischaemia... Patient with impaired thermoregulation can develop hypothermia dose of IM adrenaline after 5 minutes if Airway/Breathing/Circulation problems.... Expertise is available appear pale and feel cold to touch and radiation hypothermic shock!
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