Hypothermia: Beyond the Narrative Review—The Point of View of Emergency Physicians and Medico-Legal Considerations

Abstract

Hypothermia is a widespread condition all over the world, with a high risk of mortality in pre-hospital and in-hospital settings when it is not promptly and adequately treated. In this review, we aim to describe the main specificities of the diagnosis and treatment of hypothermia through consideration of the physiological changes that occur in hypothermic patients. Hypothermia can occur due to unfavorable environmental conditions as well as internal causes, such as pathological states that result in reduced heat production, increased heat loss or ineffectiveness of the thermal regulation system. The consequences of hypothermia affect several systems in the body—the cardiovascular system, the central and peripheral nervous systems, the respiratory system, the endocrine system and the gastrointestinal system—but also kidney function, electrolyte balance and coagulation. Once hypothermia is recognized, prompt treatment, focused on restoring body temperature and supporting vital functions, is fundamental in order to avert preventable death. It is important to also denote the fact that CPR has specificities related to the unique profile of hypothermic patients.

A retrospective data analysis on prevalence and risk factors for hypothermia among sick neonates at presentation to the neonatal intensive care unit of the Tamale Teaching Hospital

“…Lunze et al in their systematic review found global case fatality rates associated with neonatal hypothermia ranging from 8.5% to as high as 52% [ 3 ] while another study in Malawi recorded a higher rate of mortality associated with hypothermia [ 23 ]. Although it is difficult to document the direct contribution of hypothermia to deaths in these patients, it is well known that hypothermia can alter general metabolism in the neonate, predispose to hypoglycemia, increase oxygen consumption at the initial stages, depresses respiration, and have adverse effects on the functions of the central nervous system [ 7 , 24 ].…”