Patient is a 40 year old, avid ice fisherman from Minnesota. He's been very upset by how warm the winter has been this year because the lakes haven't frozen over and he hasn't been able to ice fish. After a week long cold spell, he decided "you know what, it's probably safe out on the ice now". He couldn’t be more wrong. After getting about 10 feet out onto the lake, he fell through. He was in the water for about 5 minutes before he was able to pull himself out and walk back his car. Someone saw this happen and called paramedics who arrived and noticed that the man was slurring his speech and was slightly confused.  His temperature at the time was 30 C (91.4 F) and HR 29. He was transported to the ED where he continues to exhibit lethargy and shivering. Which of the following is true?

A. Pacing is indicated for this patient

B. Elevation of the J point is prognostic for mortality

C. Hypothermia causes shortened QT intervals on EKG

D. In severe hypothermia, extremities should be warmed first because they aren't as well perfused as the trunk

E. Allow up to 1 minute for pulse check before defibrillation


  1. Danzl DF, Pozos RS. Accidental hypothermia. N Engl J Med 1994; 331:1756.

  2. Delaney KA, Vassallo SU, Larkin GL, Goldfrank LR. Rewarming rates in urban patients with hypothermia: prediction of underlying infection. Acad Emerg Med 2006; 13:913.

  3. Graham CA, McNaughton GW, Wyatt JP. The electrocardiogram in hypothermia. Wilderness Environ Med 2001; 12:232.

  4. Gentilello LM. Advances in the management of hypothermia. Surg Clin North Am 1995; 75:243.

  5. Giesbrecht GG. Cold stress, near drowning and accidental hypothermia: a review. Aviat Space Environ Med 2000; 71:733.

  6. Harchelroad F. Acute thermoregulatory disorders. Clin Geriatr Med 1993; 9:621.

  7. Jolly BT, Ghezzi KT. Accidental hypothermia. Emerg Med Clin North Am 1992; 10:311.

  8. Truhlář A, Deakin CD, Soar J, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148.

  9. Walpoth BH, Walpoth-Aslan BN, Mattle HP, et al. Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med 1997; 337:1500.

Blake Briggs