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Hypothermia in the Elderly

by Mark D. Levine, MD, FACEP and Alexander J. Rachmiel, MD
EMS Magazine, September 2003

…Elderly patients suffering from hypothermia may present with subtle or non specific symptoms, and hypothermia may complicate other illnesses or injuries in this population.  It is a major source of preventable morbidity and mortality; therefore, any caregiver who treats older patients should maintain an awareness of the signs and symptoms of hypothermia and be familiar with its management. This article discusses the pathophysiology of hypothermia, especially as it relates to the elderly, and reviews the methods used to treat those patients…

…Multiple other factors may predispose the elderly to hypothermia.  Malnutrition results in decreased fat for insulation and decreased availability of energy sources.  Cerebrovascular accidents or cancer may damage the brain’s temperature control centers, while diabetes or spinal cord pathology may impair sensation or response to the cold.  Cardiovascular disease and drugs limit the ability to increase cardiac output.  Many medications, including sedatives, hypnotics, antidepressants and phenothiazines, predispose patients to hypothermia.  Alcohol intoxication may lead indirectly to environmental exposure and may also have an effect on peripheral vasodilation and impairment of the shivering response…

…Invasive active core rewarming techniques should be considered for any patient with severe hypothermia or signs of hemodynamic comprise.  Most hypothermic patients will require IV fluid administration.  Crystalloids may be warmed to 40°C to 42°C prior to administration, while crystalloids or colloids may be given through countercurrent heat exchanger devices…

EMS Magazine website here.