Too Cold, Too Hot: Temperature Emergencies

• Hypothermia: handle gently and rewarm passively plus actively; keep CPR going ('not dead until warm and dead'); withhold epi until >30 °C and double the interval at 30–35 °C.
• Heat stroke: start evaporative/ice-pack cooling immediately, targeting <39 °C within 30 min; antipyretics are useless (different mechanism).
• Malignant hyperthermia: dantrolene 2.5 mg/kg repeated, stop the trigger, cool; EMHG 2024 update adds activated-charcoal circuit filters, explicit hyperkalemia management, and stopping active cooling at 38.5 °C.
• NMS: stop the dopamine blocker, give dantrolene/bromocriptine, cool, admit to ICU.

Heat stroke / severe hyperthermia

First tests: Core temperature, Blood glucose, Sodium, potassium, bicarbonate, urea and creatinine, Liver biochemistry, Creatine kinase, PT/INR, aPTT and fibrinogen, Full blood count.

Only if indicated: Arterial blood gas.

Repeat monitoring: Sodium, potassium, bicarbonate, urea and creatinine.

Accidental hypothermia

First tests: Core temperature, 12-lead ECG, Blood glucose, Sodium, potassium, bicarbonate, urea and creatinine, Arterial blood gas.

Only if indicated: PT/INR, aPTT and fibrinogen, Creatine kinase, Cause-directed endocrine, infection or toxicology tests.

Repeat monitoring: Core temperature.

• Fever/Hyperthermia Workup