Last reviewed: 5 Nov 2021
Last updated: 01 Dec 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cold exposure and body temperature <35°C (<95°F)
  • cognitive impairment
  • shivering
  • frostbite

Other diagnostic factors

  • tachypnoea, tachycardia, hypertension
  • respiratory depression, bradycardia, hypotension
  • coma and apnoea
  • cold-induced diuresis

Risk factors

  • general anaesthetic use
  • older age
  • very young age
  • immobility
  • substance misuse
  • impaired cognition
  • hypothyroidism
  • stroke
  • Parkinson's disease
  • homelessness
  • gram-negative septicaemia
  • neuroleptic medication
  • beta-blocker medication
  • sedative hypnotic medication

Diagnostic investigations

1st investigations to order

  • core temperature measurement
  • 12-lead ECG
  • blood glucose
  • blood gas
  • serum urea, electrolytes, and creatinine
  • FBC
  • clotting screen
  • chest x-ray

Investigations to consider

  • serum creatine kinase
  • myoglobin levels
  • end-tidal CO₂
  • ultrasound

Treatment algorithm

Contributors

Expert advisers

Alexander Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd

Emergency Medicine Consultant

Barts Health NHS Trust

Physician Response Unit Consultant

London’s Air Ambulance

Royal London Hospital

London

UK

Disclosures

AA declares that he has no competing interests.

Melvyn Jenkins-Welch, MBBS, BSc, MSc, FRCA, FFICM

Consultant Critical Care Medicine

Cardiff and Vale ULHB

Cardiff

UK

Disclosures

MJW declares that he has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Emmanuel Atta Agaba, MD, FRCSEd, FACS

Attending Surgeon

Assistant Professor of Surgery

Montefiore Medical Center at Albert Einstein College of Medicine

Bronx

NY

Rafael Barrera, MD, FACP

Director

Surgical Intensive Care Unit

Long Island Jewish Medical Center

New Hyde Park

NY

Peer reviewers

Patrick Morgan, MBChB, FRCA, FFICM, Dip IMC RCSEd, DiMM

Consultant in Anaesthesia

North Bristol NHS Trust

Bristol

Pre-hospital and Retrieval Doctor

Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru

UK

Disclosures

PM is Medical Director, HM coastguard (UK). PM has been a medical expert witness in hypothermia, cold water-immersion and drowning. PM is a Research Associate/student at the Extreme Environments Laboratory, University of Portsmouth.

Editors

Annabel Sidwell,

Section Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

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