FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- Keep hypothermic bradycardia distinct from the ordinary pediatric bradycardia algorithm.
- Severe heat illness requires prompt cooling and transport; do not wait for a precise temperature to recognize the listed clinical triggers.
Mild or moderate heat illness
- Move to shade or a cooler area with airflow. Use a fan when available and passive cooling such as cool wet towels or cold packs as tolerated.
- Encourage water or a balanced, non-caffeinated salt drink only when oral intake can be safely tolerated. Reassess mental status and perfusion for progression.
Severe hyperthermia
- Confusion or unconsciousness, hot dry skin, or hypotension activates the severe pathway. Contact base early for destination, with a pediatric-capable base preferred. Provide high-flow oxygen.
- For hypotension or poor perfusion, saline is 20 mL/kg IV/IO, maximum 250 mL, with base contact; may repeat twice for three total boluses.
- Use available active and passive cooling, including cold packs at the axillae, posterior neck, and groin with airflow. All pediatric hyperthermia patients require ALS escort.
Hypothermia with a pulse
- Remove wet clothing, conserve heat, and begin available warming. Monitor and document the rhythm.
- Expect a slow rate and weak pulse; SO-P-105 directs against trying to reverse hypothermic bradycardia in the field. Transport immediately to the nearest ERC.
Apparent arrest
- Check for a pulse for 30–45 seconds before starting CPR. If arrested, use the pediatric arrest pathway; assist ventilation without hyperventilating and continue warming.
- Do not pronounce in the field under this pathway. Contact base and provide ALS transport to the nearest appropriate ERC. Report exposure, warming/cooling measures, perfusion, rhythm, and fluids.
VISUAL FIELD REFERENCE
Pediatric temperature emergencies: keep the branches distinct
Pediatric · ALS
Use the mild/moderate heat-illness and full treatment sections below for additional care.
Severe hyperthermia
Confusion or unconsciousness, hot dry skin, or hypotension activates the severe pathway. Contact base early for destination, with a pediatric-capable base preferred. Provide high-flow oxygen.
Use available active and passive cooling, including cold packs at the axillae, posterior neck, and groin with airflow. All pediatric hyperthermia patients require ALS escort.
Hypothermia with a pulse
Remove wet clothing, conserve heat, and begin available warming. Monitor and document the rhythm.
Expect a slow rate and weak pulse; SO-P-105 directs against trying to reverse hypothermic bradycardia in the field. Transport immediately to the nearest ERC.
Hypothermic apparent arrest
Check for a pulse for 30–45 seconds before starting CPR. If arrested, use the pediatric arrest pathway; assist ventilation without hyperventilating and continue warming.
- Keep hypothermic bradycardia distinct from the ordinary pediatric bradycardia algorithm.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-P-105
UNDERSTAND THE CARE
Why the thermal context must remain explicit
Heat and cold exposure share the need for repeated assessment but lead to opposite environmental interventions. Record the exposure, clothing, intake and changes in consciousness and perfusion. Severe heat findings require prompt action even before a precise temperature is available.
Applying the guidance
For cold exposure, conserve heat and follow the deliberate pulse assessment if arrest is uncertain. Do not merge ordinary pediatric bradycardia treatment into the hypothermic-with-pulse branch. During transport, describe the warming or cooling already applied and the response, including fluids and rhythm changes.
Putting it together
Teaching example: a cold child has a very slow pulse. Communicate the cold-exposure context and use the thermal order, rather than applying the routine bradycardia pathway solely because of the rate.
Diagram text & teaching checkpoints
- Exposure
- Heat versus cold.
- Severity
- Consciousness, perfusion and breathing.
- Thermal action
- Cooling or warming under the matching branch.
- Ongoing care
- Reassessment, transport and required contact.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
A sweaty child can still have severe heat illness
Sweating does not exclude heat stroke. CDC/NIOSH includes profuse sweating as well as hot dry skin among possible findings. In a heat-exposed child, altered consciousness or poor perfusion should not be downgraded because the skin is wet.
Describe the change from the child’s normal interaction and the response to cooling. Continue the pediatric severe-heat pathway and its base-contact instructions when those clinical triggers apply.
Background: CDC/NIOSH heat-related illnesses; pediatric care remains governed by SO-P-105.