Handle patient gently
V-fib may be induced by rough handling of patient due to irritable myocardium (anecdotal)<unk>  causes leftward shift of oxyhemoglobin dissociation curve
Intubation
Intubate gently
if RSI is given medications may act at a slower rate
Patients are also hypovolemic since<unk>  causes impaired renal concentrating ability, in turn causing cold diuresis
Patients are prone to rhabdomyolysis and will need hydration
Intravascular volume is lost due to extravascular shift
NS preferred over LR as cold liver poorly metabolizes LR
Only perform if patient  truly does not have a pulse (unnecessary CPR may lead to V-fib)
Spend 30-45s attempting to detect respiratory activity and pulse before starting CPR
May occur spontaneously if temperature <30°C (86°F)
Rewarming is treatment of choice
Most dysrhythmias (e.g. sinus brady, a-fib/flutter) require no other therapy
Activity of antiarrhythmics is unpredictable in<unk> <unk>  heart is relatively resistant to atropine, pacing, and countershock
Ventricular tachycardia or Ventricular fibrillation are most common
May be refractory to therapy until patient is rewarmed
Attempt defibrillation
Value of deferring repeat defibrillation until a target temperature is reached is uncertain
Reasonable to perform further defibrillation attempts concurrent with rewarming
May be refractory to therapy until patient is rewarmed
Attempt defibrillation
Value of deferring repeat defibrillation until a target temperature is reached is uncertain
Reasonable to perform further defibrillation attempts concurrent with rewarming
Give if suspect sepsis (e.g.<unk>  fails to correct with rewarming measures)
Consider if Wernicke disease is possible cause of<unk>  (e.g. alcoholic patient)
Consider if patient has history of adrenal suppression or insufficiency
100mg Hydrocortisone
100mg Hydrocortisone
Consider if any suspicion for hypothyroidism/myxedema coma
Could cause dysrhythmia or cardiac ischemia if not in myxedema coma
Hyperglycemia common in<unk> :
Stimulates catecholamine induced glycogenolysis
Inhibits insulin release and uptake by cell membranes
Rebound hypoglycemia during rewarming can occur if clinicians too aggressively deliver exogenous insulin
Stimulates catecholamine induced glycogenolysis
Inhibits insulin release and uptake by cell membranes
Accidental hypothermia
Generalized
Malignant hyperthermia
Hypothermia
Traumatic asphyxia
Freezing
Lightning injuries
Frostbite