Pediatric Hypothermia

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A 2 year old child is hospitalized for exposure. Rectal temp is 30C. The most appropriate method of rewarming is:

a. apply radiant heat
b. increase ambient temp to 28C
c. use a heating blanket at 39C
d. warm and humidify inspired gas
e. warm IV fluids to 37C

Please discuss.

Source: ITE 1991 Book A Q 76

a) not a very precise answer
b) maybe
c) maybe
d) not very effective nor practical
e) you don't have a lot of fluid to play with in a 2 y/o and 37C is too low

so b or c but "As the core reaches temperatures of 31°C or below, the body loses its ability to generate heat by shivering" so b not usefull

i'd say c

"Moderate rewarming methods provide heat at approximately 3°C/h. Methods include warmed gastric lavage (2.8°C/h), intravenous solutions heated to 65°C (2.9°C/h), and peritoneal lavage with 45°C fluid at 4 L/h (70 kcal/h or 3°C/h).
Rapid rewarming methods provide heat at levels higher than 100 kcal/h.
Methods include thoracic lavage at 500 mL/min (6.1°C/h), cardiopulmonary bypass (400 kcal/h or 18°C/h), thoracic lavage at 2 L/min (19.7°C/h), and warm-water immersion (1500 kcal/h).
In comparison, endogenous shivering provides rewarming at a rate of 300 kcal/h.
No noninvasive technique rewarms as rapidly as full-body immersion in warm water. Known as the Hubbard tank technique, immersion has successfully rewarmed humans with severe hypothermia.
Unfortunately, patients who require rapid rewarming in the emergency department also need cardiac monitoring and intravenous therapy, both of which are difficult to manage under water.
Defibrillation also is difficult; however, defibrillation likely is futile once a patient's core temperature falls below 30°C."

dhb, I would have said C too (or maybe A, since those heat lamps they use on kids is very effective).

But the answers for the ITE are published, and they say the answer is D.

The question was published in 1991, a long time ago. Hopefully, the answer they gave is no longer true, because it's not what I have been taught.

I just wanted to see if anyone actually agrees with their answer.

in my residency in the mid-80's, they taught that warm humidified air was good for re-warming; that idea was disproved in the 90's, i think;

The point for the warm air method might have been that rewarming occurs from the core of the body to the periphery that way. Some of the other methods would cause peripheral vasodilation before rewarming the core, causing more of the cold blood to circulate at once and increase the risk of arrhythmias. Is that wrong?

Originally Posted by Freibi

The point for the warm air method might have been that rewarming occurs from the core of the body to the periphery that way. Some of the other methods would cause peripheral vasodilation before rewarming the core, causing more of the cold blood to circulate at once and increase the risk of arrhythmias. Is that wrong?

Plausible, but are there any studies, animal or human, showing that warming the skin will open up the constricted peripheral arteries, without a signal, neural or hormonal, from the central core.