{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:07:33Z","timestamp":1791950853243,"version":"4.3.4"},"reference-count":129,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,12,5]],"date-time":"2023-12-05T00:00:00Z","timestamp":1701734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Hypothermia is a widespread condition all over the world, with a high risk of mortality in pre-hospital and in-hospital settings when it is not promptly and adequately treated. In this review, we aim to describe the main specificities of the diagnosis and treatment of hypothermia through consideration of the physiological changes that occur in hypothermic patients. Hypothermia can occur due to unfavorable environmental conditions as well as internal causes, such as pathological states that result in reduced heat production, increased heat loss or ineffectiveness of the thermal regulation system. The consequences of hypothermia affect several systems in the body\u2014the cardiovascular system, the central and peripheral nervous systems, the respiratory system, the endocrine system and the gastrointestinal system\u2014but also kidney function, electrolyte balance and coagulation. Once hypothermia is recognized, prompt treatment, focused on restoring body temperature and supporting vital functions, is fundamental in order to avert preventable death. It is important to also denote the fact that CPR has specificities related to the unique profile of hypothermic patients.<\/jats:p>","DOI":"10.3390\/jpm13121690","type":"journal-article","created":{"date-parts":[[2023,12,5]],"date-time":"2023-12-05T08:09:17Z","timestamp":1701763757000},"page":"1690","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Hypothermia: Beyond the Narrative Review\u2014The Point of View of Emergency Physicians and Medico-Legal Considerations"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8679-5435","authenticated-orcid":false,"given":"Gabriele","family":"Savioli","sequence":"first","affiliation":[{"name":"Emergency Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5460-4625","authenticated-orcid":false,"given":"Iride Francesca","family":"Ceresa","sequence":"additional","affiliation":[{"name":"Emergency Department and Internal Medicine, Istituti Clinici di Pavia e Vigevano, Gruppo San Donato, 27029 Vigevano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5618-7404","authenticated-orcid":false,"given":"Gaia","family":"Bavestrello Piccini","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Universit\u00e9 Libre de Bruxelles, 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Gri","sequence":"additional","affiliation":[{"name":"Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell\u2019Ospedale Maggiore, 3, 20162 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Nardone","sequence":"additional","affiliation":[{"name":"Emergency Department, Ospedale Civile, 27058 Voghera, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"La Russa","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Saviano","sequence":"additional","affiliation":[{"name":"Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5703-8737","authenticated-orcid":false,"given":"Andrea","family":"Piccioni","sequence":"additional","affiliation":[{"name":"Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3422-2747","authenticated-orcid":false,"given":"Giovanni","family":"Ricevuti","sequence":"additional","affiliation":[{"name":"Department of Drug Science, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Esposito","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Unit, ICS Maugeri, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,5]]},"reference":[{"key":"ref_1","unstructured":"(2023, August 15). Hypothermia: Background, Pathophysiology, Etiology. Available online: https:\/\/emedicine.medscape.com\/article\/770542-overview."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1067\/j.cpsurg.2014.07.005","article-title":"In brief: Hypothermia","volume":"51","author":"Petrone","year":"2014","journal-title":"Curr. Probl. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1136\/bmj.332.7543.706","article-title":"Accidental shypothermia","volume":"332","author":"Epstein","year":"2006","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"258","DOI":"10.15585\/mmwr.mm7007a6","article-title":"QuickStats: Death Rates* Attributed to Excessive Cold or Hypothermia\u2020 Among Persons Aged \u226515 Years, by Urban-Rural Status\u00a7 and Age Group\u2014National Vital Statistics System, United States, 2019","volume":"70","author":"Spencer","year":"2021","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"van Veelen, M.J., and Brodmann Maeder, M. (2021). Hypothermia in Trauma. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18168719"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1097\/00005373-198709000-00010","article-title":"Incidence and effect of hypothermia in seriously injured patients","volume":"27","author":"Luna","year":"1987","journal-title":"J. Trauma"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/10903127.2019.1599474","article-title":"Predictors of Hypothermia upon Trauma Center Arrival in Severe Trauma Patients Transported to Hospital via EMS","volume":"24","author":"Forristal","year":"2020","journal-title":"Prehosp. Emerg. Care"},{"key":"ref_8","first-page":"141","article-title":"Hypothermia-related deaths\u2014Wisconsin, 2014, and United States, 2003\u20132013","volume":"64","author":"Meiman","year":"2015","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/1757-7241-22-6","article-title":"Accidental Cold-Related Injury Leading to Hospitalization in Northern Sweden: An Eight-Year Retrospective Analysis","volume":"22","author":"Johansson","year":"2014","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1136\/bmj.311.7007.725","article-title":"Urban hypothermia in the west of Scotland. West of Scotland Accident and Emergency Trainees Research Group","volume":"311","author":"Hislop","year":"1995","journal-title":"BMJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"789","DOI":"10.5603\/KP.2015.0171","article-title":"Management of hypothermia\u2014Severe Accidental Hypothermia Centre in Krakow","volume":"73","author":"Darocha","year":"2015","journal-title":"Kardiol. Pol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1067\/j.cpsurg.2014.07.004","article-title":"Management of accidental hypothermia and cold injury","volume":"51","author":"Petrone","year":"2014","journal-title":"Curr. Probl. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.autneu.2016.01.001","article-title":"Thermoregulatory disorders and illness related to heat and cold stress","volume":"196","author":"Cheshire","year":"2016","journal-title":"Auton. Neurosci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S186","DOI":"10.1097\/CCM.0b013e3181aa5241","article-title":"Mechanisms of action, physiological effects, and complications of hypothermia","volume":"37","author":"Polderman","year":"2009","journal-title":"Crit. Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"640","DOI":"10.4085\/1062-6050-43.6.640","article-title":"National Athletic Trainers\u2019 Association Position Statement: Environmental Cold Injuries","volume":"43","author":"Cappaert","year":"2008","journal-title":"J. Athl. Train."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.suc.2006.10.003","article-title":"Environmental Cold-Induced Injury","volume":"87","author":"Jurkovich","year":"2007","journal-title":"Surg. Clin. N. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.emc.2004.01.002","article-title":"Hypothermia and localized cold injuries","volume":"22","author":"Ulrich","year":"2004","journal-title":"Emerg. Med. Clin. N. Am."},{"key":"ref_18","first-page":"733","article-title":"Cold stress, near drowning and accidental hypothermia: A review","volume":"71","author":"Giesbrecht","year":"2000","journal-title":"Aviat. Space Environ. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1089\/152702903321489031","article-title":"The Medical On-site Treatment of Hypothermia: ICAR-MEDCOM Recommendation","volume":"4","author":"Durrer","year":"2003","journal-title":"High Alt. Med. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1615\/JLongTermEffMedImplants.v15.i1.80","article-title":"Cold injuries","volume":"15","author":"Long","year":"2005","journal-title":"J. Long Term Eff. Med. Implant."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.injury.2012.12.027","article-title":"Clinical and translational aspects of hypothermia in major trauma patients: From pathophysiology to prevention, prognosis and potential preservation","volume":"45","year":"2014","journal-title":"Injury"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1152\/jappl.1987.63.3.1246","article-title":"Effects of hyperthermia and hypothermia on oxygen extraction by tissues during hypovolemia","volume":"63","author":"Schumacker","year":"1987","journal-title":"J. Appl. Physiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"808025","DOI":"10.3389\/fmed.2021.808025","article-title":"Effects of Carbon Dioxide and Temperature on the Oxygen-Hemoglobin Dissociation Curve of Human Blood: Implications for Avalanche Victims","volume":"8","author":"Woyke","year":"2022","journal-title":"Front. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/j.1478-5153.2006.00177.x","article-title":"Correcting arterial blood gases for temperature: (When) is it clinically significant?","volume":"11","author":"Bisson","year":"2006","journal-title":"Nurs. Crit. Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"149","DOI":"10.3109\/00365519009087504","article-title":"The oxyhemoglobin dissociation curve before, during and after cardiac surgery","volume":"50","author":"Coetzee","year":"1990","journal-title":"Scand. J. Clin. Lab. Investig."},{"key":"ref_26","first-page":"1","article-title":"Heat illness in the emergency department: Keeping your cool","volume":"16","author":"Santelli","year":"2014","journal-title":"Emerg. Med. Pract."},{"key":"ref_27","first-page":"111","article-title":"Treating heat-related illness in the elderly","volume":"33","year":"2004","journal-title":"Emerg. Med. Serv."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1146\/annurev-physiol-020518-114546","article-title":"Central Mechanisms for Thermoregulation","volume":"81","author":"Morrison","year":"2019","journal-title":"Annu. Rev. Physiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/B978-0-444-63912-7.00001-1","article-title":"The thermoregulation system and how it works","volume":"156","author":"Romanovsky","year":"2018","journal-title":"Handb. Clin. Neurol."},{"key":"ref_30","unstructured":"Osilla, E.V., Marsidi, J.L., and Sharma, S. (2023, August 15). Physiology, Temperature Regulation, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK507838\/."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1016\/j.emc.2013.07.012","article-title":"Heat-related illness","volume":"31","author":"Atha","year":"2013","journal-title":"Emerg. Med. Clin. N. Am."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"(2023, August 17). Severe Recurrent Hypothermia in an Elderly Patient with Refractory Mania Associated with Atypical Antipsychotic, Valproic Acid and Oxcarbazepine Therapy|BMJ Case Reports. Available online: https:\/\/casereports.bmj.com\/content\/2017\/bcr-2017-222462.","DOI":"10.1136\/bcr-2017-222462"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1080\/23328940.2018.1516100","article-title":"Fever, hypothermia, and mortality in sepsis","volume":"6","author":"Rumbus","year":"2018","journal-title":"Temperature"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1136\/bmj.1.5435.619","article-title":"Cardiovascular, Metabolic, and Ther Moregulatory Disturbances in Patients with Erythrodermic Skin Diseases","volume":"1","author":"Fox","year":"1965","journal-title":"Br. Med. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1001\/archderm.1978.01640200092043","article-title":"Hypothermia and Generalized Skin Disease","volume":"114","author":"Cucinell","year":"1978","journal-title":"Arch. Dermatol."},{"key":"ref_36","first-page":"142","article-title":"Hypothermia in patients with exfoliative dermatitis","volume":"40","author":"Krook","year":"1960","journal-title":"Acta Derm. Venereol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/0163-7258(83)90018-9","article-title":"Effects of ethanol on thermoregulation","volume":"23","author":"Kalant","year":"1983","journal-title":"Pharmacol. Ther."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1111\/j.1530-0277.2007.00341.x","article-title":"Differential Expression of Ethanol-Induced Hypothermia in Adolescent and Adult Rats Induced by Pretest Familiarization to the Handling\/Injection Procedure","volume":"31","author":"Ristuccia","year":"2007","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1056\/NEJMra1114208","article-title":"Accidental hypothermia","volume":"367","author":"Brown","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1152\/physrev.00038.2020","article-title":"Exercise under heat stress: Thermoregulation, hydration, performance implications, and mitigation strategies","volume":"101","author":"Eijsvogels","year":"2021","journal-title":"Physiol. Rev."},{"key":"ref_41","first-page":"305","article-title":"Out of the cold: Management of hypothermia and frostbite","volume":"168","author":"Biem","year":"2003","journal-title":"CMAJ"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/S0020-1383(03)00309-7","article-title":"Hypothermia in the trauma patient","volume":"35","author":"Tsuei","year":"2004","journal-title":"Injury"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.resuscitation.2010.10.016","article-title":"The incidence and significance of accidental hypothermia in major trauma\u2014A prospective observational study","volume":"82","author":"Ireland","year":"2011","journal-title":"Resuscitation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1056\/NEJM199412293312607","article-title":"Accidental hypothermia","volume":"331","author":"Danzl","year":"1994","journal-title":"N. Engl. J. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1007\/s00101-007-1219-4","article-title":"Hyperthermia and hypothermia. Effects on the cardiovascular system","volume":"56","author":"Deussen","year":"2007","journal-title":"Anaesthesist"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/0306-4565(84)90003-2","article-title":"The Effect of Hypothermia on the Cardiovascular System and the Pressor Actions of Angiotensin II","volume":"9","author":"Brooks","year":"1984","journal-title":"J. Therm. Biol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1093\/cvr\/cvz309","article-title":"Moderate but not severe hypothermia causes pro-arrhythmic changes in cardiac electrophysiology","volume":"116","author":"Dietrichs","year":"2020","journal-title":"Cardiovasc. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1172\/JCI102071","article-title":"The cardiovascular effects of acutely induced hypothermia","volume":"28","author":"Prec","year":"1949","journal-title":"J. Clin. Investig."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1161\/01.RES.10.2.148","article-title":"Mechanism of Ventricular Fibrillation in Hypothermia","volume":"10","author":"Covino","year":"1962","journal-title":"Circ. Res."},{"key":"ref_50","first-page":"71","article-title":"Cardiac electrophysiology during hypothermia. Implications for medical treatment","volume":"50","author":"Tande","year":"1991","journal-title":"Arctic Med. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1034\/j.1399-6576.2001.045004421.x","article-title":"Effects of dopamine on porcine myocardial action potentials and contractions at 37 degrees C and 32 degrees C","volume":"45","author":"Roscher","year":"2001","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/S0003-4975(01)03273-8","article-title":"Effect of hypothermia on cerebral blood flow and metabolism in the pig","volume":"73","author":"Ehrlich","year":"2002","journal-title":"Ann. Thorac. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1016\/S0003-4975(99)00441-5","article-title":"Cerebral metabolic suppression during hypothermic circulatory arrest in humans","volume":"67","author":"McCullough","year":"1999","journal-title":"Ann. Thorac. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1161\/01.STR.27.5.919","article-title":"Effect of Mild Hypothermia on Cerebral Energy Metabolism During the Evolution of Hypoxic-Ischemic Brain Damage in the Immature Rat","volume":"27","author":"Yager","year":"1996","journal-title":"Stroke"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1097\/01.WCB.0000066287.21705.21","article-title":"Effects of Hypothermia on Energy Metabolism in Mammalian Central Nervous System","volume":"23","author":"Erecinska","year":"2003","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/j.1440-1681.1998.tb02197.x","article-title":"Experimental Biology 1997 Symposium on Neurobiology of Thermoregulation: Role of Stress: Hypothermia and physiological control: The respiratory system","volume":"25","author":"Frappell","year":"1998","journal-title":"Clin. Exp. Pharmacol. Physiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1152\/ajplegacy.1941.132.3.685","article-title":"Respiratory and metabolic effects of hypothermia","volume":"132","author":"Dill","year":"1941","journal-title":"Am. J. Physiol. Leg. Content"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e15139","DOI":"10.14814\/phy2.15139","article-title":"Changes in breathing pattern during severe hypothermia and autoresuscitation from hypothermic respiratory arrest in anesthetized mice","volume":"9","author":"Taiji","year":"2021","journal-title":"Physiol. Rep."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1152\/ajplegacy.1953.173.1.100","article-title":"Blood Volume in the Hypothermic Dog","volume":"173","author":"Hegnauer","year":"1953","journal-title":"Am. J. Physiol. Content"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1111\/j.1749-6632.1959.tb49220.x","article-title":"The effect of hypothermia on renal function and renal damage from ischemia","volume":"80","author":"Moyer","year":"1959","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/0002-9149(63)90259-5","article-title":"Acid-base and electrolyte disturbances in hypothermia","volume":"12","author":"Rosenfeld","year":"1963","journal-title":"Am. J. Cardiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.resuscitation.2021.03.013","article-title":"Elevated risk of venous thromboembolism in patients undergoing therapeutic hypothermia after cardiac arrest","volume":"162","author":"Sharma","year":"2021","journal-title":"Resuscitation"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"A20","DOI":"10.1186\/cc11278","article-title":"Hypothermia and coagulation","volume":"16","author":"Polderman","year":"2012","journal-title":"Crit. Care"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"9564","DOI":"10.21037\/apm-21-1925","article-title":"The effects of hypothermia in thrombosis: A systematic review and meta-analysis","volume":"10","author":"Li","year":"2021","journal-title":"Ann. Palliat. Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s12959-014-0031-z","article-title":"Hypothermia: Effects on platelet function and hemostasis","volume":"12","author":"Stevens","year":"2014","journal-title":"Thromb. J."},{"key":"ref_66","first-page":"682","article-title":"Accidental hypothermia","volume":"368","author":"Paal","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1097\/00003246-199210000-00007","article-title":"Effect of hypothermia on the coagulation cascade","volume":"20","author":"Rohrer","year":"1992","journal-title":"Crit. Care Med."},{"key":"ref_68","unstructured":"Watts, D.D. (2023, August 15). Hypothermic Coagulopathy in Trauma: Effect of Varying Levels of Hypothermia on Enzyme Speed, Platelet Function and Fibrinolytic Activity. Available online: https:\/\/archive.hshsl.umaryland.edu\/handle\/10713\/1405."},{"key":"ref_69","first-page":"202","article-title":"Coagulopathy by Hypothermia and Acidosis: Mechanisms of Thrombin Generation and Fibrinogen Availability","volume":"67","author":"Martini","year":"2009","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1097\/00005373-199805000-00017","article-title":"Hypothermic Coagulopathy in Trauma: Effect of Varying Levels of Hypothermia on Enzyme Speed, Platelet Function, and Fibrinolytic Activity","volume":"44","author":"Watts","year":"1998","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1042\/cs0610463","article-title":"Hypoglycaemia, Hypothermia and Shivering in Man","volume":"61","author":"Gale","year":"1981","journal-title":"Clin. Sci."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.annemergmed.2011.11.015","article-title":"Respiratory Failure and Spontaneous Hypoglycemia During Noninvasive Rewarming From 24.7 \u00b0C (76.5 \u00b0F) Core Body Temperature After Prolonged Avalanche Burial","volume":"60","author":"Strapazzon","year":"2012","journal-title":"Ann. Emerg. Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1136\/bmj.1.5908.614","article-title":"Hypothermia, thrombosis, and acute pancreatitis","volume":"1","author":"Savides","year":"1974","journal-title":"Br. Med. J."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1249\/01.mss.0000241641.75101.64","article-title":"American College of Sports Medicine position stand: Prevention of cold injuries during exercise","volume":"38","author":"Castellani","year":"2006","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1136\/bmj.4.5895.757","article-title":"Acute Pancreatitis and Diabetic Ketoacidosis in Accidental Hypothermia and Hypothermic Myxoedema","volume":"4","author":"Maclean","year":"1973","journal-title":"BMJ"},{"key":"ref_76","unstructured":"Buchanan, J.T., and Thurman, J. (2023, August 15). EMS Management of Traumatic and Medical Disorders in a Wilderness Environment, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK553188\/."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1016\/j.wem.2019.10.002","article-title":"Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update","volume":"30","author":"Dow","year":"2019","journal-title":"Wilderness Environ. Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s40560-021-00558-4","article-title":"Insight into the use of tympanic temperature during target temperature management in emergency and critical care: A scoping review","volume":"9","author":"Micarelli","year":"2021","journal-title":"J. Intensiv. Care"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1136\/emj.2009.090464","article-title":"Tympanic temperature during therapeutic hypothermia","volume":"28","author":"Hasper","year":"2010","journal-title":"Emerg. Med. J."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1136\/adc.80.3.262","article-title":"Tympanic membrane temperature as a measure of core temperature","volume":"80","author":"Childs","year":"1999","journal-title":"Arch. Dis. Child."},{"key":"ref_81","unstructured":"Duong, H., and Patel, G. (2023, August 17). Hypothermia, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK545239\/."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1097\/00005373-199209000-00022","article-title":"The disparity between hypothermic coagulopathy and clotting studies","volume":"33","author":"Reed","year":"1992","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1089\/ther.2013.0003","article-title":"Electrocardiographic Changes in Hypothermia: A Review","volume":"3","author":"Chhabra","year":"2013","journal-title":"Ther. Hypothermia Temp. Manag."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"73","DOI":"10.7812\/TPP\/10-087","article-title":"ECG Diagnosis: Hypothermia","volume":"14","author":"Levis","year":"2010","journal-title":"Perm. J."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1111\/j.1553-2712.1999.tb00114.x","article-title":"A prospective evaluation of the electrocardiographic mani-festations of hypothermia","volume":"6","author":"Vassallo","year":"1999","journal-title":"Acad. Emerg. Med."},{"key":"ref_86","first-page":"328","article-title":"Hypothermic lung edema after accidental hypothermia with out of hospital cardiac arrest","volume":"7","author":"Su","year":"2015","journal-title":"Heart Lung Vessel."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1378\/chest.103.3.971","article-title":"Noncardiogenic Pulmonary Edema Associated with Accidental Hypothermia","volume":"103","author":"Morales","year":"1993","journal-title":"Chest"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/S0003-4975(00)01592-7","article-title":"Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials","volume":"71","author":"Stecker","year":"2001","journal-title":"Ann. Thorac. Surg."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"98","DOI":"10.4103\/JETS.JETS_55_20","article-title":"Major Trauma in Elderly Patients: Worse Mortality and Outcomes in an Italian Trauma Center","volume":"14","author":"Savioli","year":"2021","journal-title":"J. Emerg. Trauma Shock"},{"key":"ref_90","first-page":"e52","article-title":"Outcomes of Crowding in Emergency Departments; a Systematic Review","volume":"7","author":"Rasouli","year":"2019","journal-title":"Arch. Acad. Emerg. Med."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Darraj, A., Hudays, A., Hazazi, A., Hobani, A., and Alghamdi, A. (2023). The Association between Emergency Department Overcrowding and Delay in Treatment: A Systematic Review. Healthcare, 11.","DOI":"10.3390\/healthcare11030385"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/TME.0b013e318207e86a","article-title":"The effect of emergency department crowding on patient outcomes: A literature review","volume":"33","author":"Johnson","year":"2011","journal-title":"Adv. Emerg. Nurs. J."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Savioli, G., Ceresa, I.F., Gri, N., Piccini, G.B., Longhitano, Y., Zanza, C., Piccioni, A., Esposito, C., Ricevuti, G., and Bressan, M.A. (2022). Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions. J. Pers. Med., 12.","DOI":"10.3390\/jpm12020279"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/s11739-021-02732-w","article-title":"How the coronavirus disease 2019 pandemic changed the patterns of healthcare utilization by geriatric patients and the crowding: A call to action for effective solutions to the access block","volume":"17","author":"Savioli","year":"2022","journal-title":"Intern. Emerg. Med."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Wu, L., Chen, X., Khalemsky, A., Li, D., Zoubeidi, T., Lauque, D., Alsabri, M., Boudi, Z., Kumar, V.A., and Paxton, J. (2023). The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine Learning: An Observational Cohort Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12144750"},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Savioli, G., Ceresa, I.F., Manzoni, F., Ricevuti, G., Bressan, M.A., and Oddone, E. (2020). Role of a Brief Intensive Observation Area with a Dedicated Team of Doctors in the Management of Acute Heart Failure Patients: A Retrospective Observational Study. Medicina, 56.","DOI":"10.3390\/medicina56050251"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"87","DOI":"10.36150\/2499-6564-446","article-title":"Brief intensive observation areas in the management of acute heart failure in elderly patients leading to high stabilisation rate and less admissions","volume":"69","author":"Savioli","year":"2021","journal-title":"J. Gerontol. Geriatr."},{"key":"ref_98","first-page":"241","article-title":"Elderly patients with an atypical presentation of illness in the emergency department","volume":"75","author":"Hofman","year":"2017","journal-title":"Neth. J. Med."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.archger.2015.08.016","article-title":"Atypical presentations of older adults at the emergency department and associated factors","volume":"62","author":"Limpawattana","year":"2016","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1111\/echo.14395","article-title":"Right ventricular total isovolumic time: Reference value study","volume":"36","author":"Tavazzi","year":"2019","journal-title":"Echocardiography"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1093\/ehjci\/jeu274","article-title":"Reliability and feasibility of longitudinal AFI global and segmental strain compared with 2D left ventricular volumes and ejection fraction: Intra- and inter-operator, test\u2013retest, and inter-cycle reproducibility","volume":"16","author":"Barbier","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Savioli, G., Ceresa, I.F., Maggioni, P., Lava, M., Ricevuti, G., Manzoni, F., Oddone, E., and Bressan, M.A. (2020). Impact of ED Organization with a Holding Area and a Dedicated Team on the Adherence to International Guidelines for Patients with Acute Pulmonary Embolism: Experience of an Emergency Department Organized in Areas of Intensity of Care. Medicines, 7.","DOI":"10.3390\/medicines7100060"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"377","DOI":"10.2147\/OAEM.S267069","article-title":"Preparing for the Maximum Emergency with a Simulation: A Table-Top Test to Evaluate Bed Surge Capacity and Staff Compliance with Training","volume":"12","author":"Ceresa","year":"2020","journal-title":"Open Access Emerg. Med."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"72","DOI":"10.3810\/pgm.1999.01.490","article-title":"Cold injuries. Protecting your patients from the dangers of hypothermia and frostbite","volume":"105","author":"Kanzenbach","year":"1999","journal-title":"Postgrad. Med."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1136\/emj.2006.044404","article-title":"Is defibrillation effective in accidental severe hypothermia in adults?","volume":"24","author":"Clift","year":"2007","journal-title":"Emerg. Med. J."},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"American Heart Association (2005). Part 10.4: Hypothermia. Circulation, 112, IV-136\u2013IV-138.","DOI":"10.1161\/CIRCULATIONAHA.105.166566"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"A6","DOI":"10.1186\/cc11264","article-title":"Pharmacodynamics in hypothermia","volume":"16","author":"Tveita","year":"2012","journal-title":"Crit. Care"},{"key":"ref_108","first-page":"204","article-title":"The effect of hypothermia on the vasoconstriction and vasodilatation and concerned with vasoactive drugs","volume":"30","author":"Han","year":"2014","journal-title":"Zhongguo Ying Yong Sheng Li Xue Za Zhi"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.resuscitation.2021.02.011","article-title":"European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances","volume":"161","author":"Lott","year":"2021","journal-title":"Resuscitation"},{"key":"ref_110","first-page":"1","article-title":"Main Complications of Mild Induced Hypothermia after Cardiac Arrest: A Review Article","volume":"6","author":"Soleimanpour","year":"2014","journal-title":"J. Cardiovasc. Thorac. Res."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/S0022-5223(19)33737-7","article-title":"Deep hypothermia with circulatory arrest. Determinants of stroke and early mortality in 656 patients","volume":"106","author":"Svensson","year":"1993","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.jtcvs.2013.08.085","article-title":"Sequela-free long-term survival of a 65-year-old woman after 8 hours and 40 minutes of cardiac arrest from deep accidental hypothermia","volume":"147","author":"Meyer","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.annemergmed.2018.09.018","article-title":"Hypothermic Cardiac Arrest With Full Neurologic Recovery After Approximately Nine Hours of Cardiopulmonary Resuscitation: Management and Possible Complications","volume":"73","author":"Forti","year":"2019","journal-title":"Ann. Emerg. Med."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"e167","DOI":"10.1097\/CCM.0b013e3182a643bc","article-title":"Neurologic Recovery From Profound Accidental Hypothermia After 5 Hours of Cardiopulmonary Resuscitation","volume":"42","author":"Boue","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/j.resuscitation.2014.04.029","article-title":"\u201cNobody is dead until warm and dead\u201d: Prolonged resuscitation is warranted in arrested hypothermic victims also in remote areas\u2014A retrospective study from northern Norway","volume":"85","author":"Hilmo","year":"2014","journal-title":"Resuscitation"},{"key":"ref_116","first-page":"184","article-title":"Degree of hypothermia in aortic arch surgery\u2014Optimal temperature for cerebral and spinal protection: Deep hypothermia remains the gold standard in the absence of randomized data","volume":"2","author":"Englum","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Paal, P., Pasquier, M., Darocha, T., Lechner, R., Kosinski, S., Wallner, B., Zafren, K., and Brugger, H. (2022). Accidental Hypothermia: 2021 Update. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19010501"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.resuscitation.2021.08.012","article-title":"Corrigendum to \u201cEuropean Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances\u201d [Resuscitation 161 (2021) 152\u2013219]","volume":"167","author":"Lott","year":"2021","journal-title":"Resuscitation"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1212\/01.CPJ.0000437350.47610.3a","article-title":"Diagnosis and management of periodic hypothermia","volume":"4","author":"Blondin","year":"2013","journal-title":"Neurol. Clin. Pract."},{"key":"ref_120","unstructured":"Patologia Forense\u2014Umani Ronchi, G., Bolino, G., Grande, A., and Marinelli, E. (2023, August 15). Gruppo Italiano di Patologia Forense. Available online: http:\/\/www.gipf.it\/2016\/10\/17\/patologia-forense-g-umani-ronchi-g-bolino-a-grande-e-marinelli\/."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1007\/s00414-014-0977-1","article-title":"Postmortem diagnosis of hypothermia","volume":"128","author":"Palmiere","year":"2014","journal-title":"Int. J. Legal Med."},{"key":"ref_122","doi-asserted-by":"crossref","unstructured":"Saukko, P., and Knight, B. (2015). Knight\u2019s Forensic Pathology, CRC Press. [4th ed.]. Available online: https:\/\/www.taylorfrancis.com\/books\/9781444165081.","DOI":"10.1201\/b13266"},{"key":"ref_123","unstructured":"(2023, August 15). Forensic Histopathology|SpringerLink. Available online: https:\/\/link.springer.com\/chapter\/10.1007\/978-1-59745-110-9_13."},{"key":"ref_124","unstructured":"Medicina Legale e Delle Assicurazioni (2023, August 15). PICCIN Nuova Libraria S.P.A. Available online: http:\/\/www.piccin.it\/es\/medicina-legale\/1933-medicina-legale-e-delle-assicurazioni-9788829923236.html."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/0300-9432(76)90059-5","article-title":"Necropsy findings in fatal hypothermia cases","volume":"8","author":"Hirvonen","year":"1976","journal-title":"Forensic Sci."},{"key":"ref_126","doi-asserted-by":"crossref","unstructured":"Sacco, M.A., Abenavoli, L., Juan, C., Ricci, P., and Aquila, I. (2022). Biological Mechanisms behind Wischnewsky Spots Finding on Gastric Mucosa: Autopsy Cases and Literature Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19063601"},{"key":"ref_127","first-page":"280","article-title":"Wischnewsky Spots in Fatal Hypothermia: Case Report","volume":"10","author":"Eren","year":"2015","journal-title":"Maedica"},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Hle\u0219cu, A.A., Grigora\u0219, A., Covatariu, G., Moscalu, M., and Amalinei, C. (2022). The Value of Myocardium and Kidney Histopathological and Immunohistochemical Findings in Accidental Hypothermia-Related Fatalities. Medicina, 58.","DOI":"10.3390\/medicina58111507"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1080\/20961790.2021.1886656","article-title":"Histopathological, histochemical and bio-chemical postmortem changes in induced fatal hypothermia in rats","volume":"7","author":"Ibrahim","year":"2022","journal-title":"Forensic Sci Res."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/12\/1690\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:33:35Z","timestamp":1760132015000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/12\/1690"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,5]]},"references-count":129,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["jpm13121690"],"URL":"https:\/\/doi.org\/10.3390\/jpm13121690","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,5]]}}}