Wilderness Medicine Updates

Author: Patrick Fink, MD

The podcast for medical providers at the edges, bringing you digestible updates at the growing edge of Wilderness Medicine, Wilderness EMS, Search and Rescue, and more. 
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Language: en-us

Genres: Health & Fitness, Medicine

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Ep. 31: Hypothermia Basics
Episode 21
Wednesday, 11 March, 2026

In this episode, Dr. Patrick Fink reviews accidental hypothermia for wilderness providers, building on Ep. 27 Thermoregulation, explaining physiologic changes as core temperature falls and why accurate core temperatures are difficult to obtain in the field. We learn the modified Swiss staging system (0–4) based on signs and symptoms and outlines field management: - 0 cold stress (shelter, dry/insulate, warm calories; avoid alcohol), - 1 mild hypothermia (ataxia/fine motor impairment; passive plus active external rewarming with a hypothermia wrap and heat near axilla/groin; frequent reassessment), - 2 moderate hypothermia (confusion/lethargy; active external rewarming, evaluate hypoglycemia, gentle handling and no exertion to avoid afterdrop, cardiac monitoring, expedite evacuation), - 3 severe hypothermia (unresponsive with vital signs; airway/ventilation support, extremely gentle transport)- 4 hypothermic cardiac arrest (60-second pulse check, CPR, limited shocks under 30°C, withhold epinephrine/amiodarone under 30°C, consider intermittent CPR per protocol, and note potassium’s role in termination decisions). We also briefly contrasts slow non-extracorporeal warming with ECMO/cardiopulmonary bypass, previewing a future episode on advanced care and the HOPE scoreLinksEpisode 27: ThermoregulationWMS 2019 Accidental Hypothermia GuidelineAHA Hypothermia GuidelinesEuropean Resuscitation Council Hypothermia AlgorithmChapters:00:00 Welcome and Overview00:48 Hypothermia Basics01:12 Cooling Physiology04:06 Severe Effects and Arrhythmias06:38 Field Temp Challenges07:41 Swiss Staging Intro08:35 Stage 0 Cold Stress11:40 Stage 1 Mild Hypothermia16:04 Stage 2 Moderate Hypothermia20:44 Afterdrop and Handling22:54 Stage 3 Severe Hypothermia27:00 Stage 4 Cardiac Arrest27:57 CPR Shocks and Drugs37:01 Advanced Rewarming ECMO43:26 Key Takeaways Summary46:57 Wrap Up and SupportAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wildernessmedicineupdates@gmail.com. You can pay us a compliment and share the show with a new listener on any popular platform here.