Chart — Emergency Nursing
Hypothermia Severity Stages Chart
Hypothermia worsens in a recognizable sequence — and the counterintuitive turning point is when shivering stops. That’s deterioration, not recovery. Match the stage to the rewarming method.
Educational use only. Temperature thresholds vary slightly by source. Severe hypothermia needs careful, monitored core rewarming; continue resuscitation until rewarmed. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Stages Side by Side
| Feature | Mild | Moderate | Severe |
|---|---|---|---|
| Core temperature | 32–35°C (90–95°F) | 28–32°C (82–90°F) | < 28°C (82°F) |
| Shivering | Present (vigorous) | CEASES | Absent |
| Mental status | Alert; clumsy, slurred speech, withdrawn | Declining LOC, confusion, drowsiness | Stupor → coma; may appear dead |
| Cardiovascular | Tachycardia, vasoconstriction, hypertension | Bradycardia, hypotension, J wave | Profound bradycardia/hypotension, VF/asystole risk |
| Rewarming | Passive external (remove wet clothes, blankets, warm room) | Active external + warmed IV fluids/O₂ | Active internal/core (lavage, ECMO/bypass); core before periphery |
Exam Traps
- ✦Shivering STOPPING signals moderate-to-severe hypothermia — worse, not better.
- ✦The J (Osborn) wave is the classic ECG finding; the cold heart fibrillates easily — handle gently.
- ✦Rewarm the CORE before the periphery to limit afterdrop.
- ✦Severe hypothermia can mimic death — 'not dead until warm and dead'; keep resuscitating.
- ✦Use a low-reading core thermometer; standard ones don't read low enough.
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with Emergency Nurses Association (ENA) · AHA ACLS / PALS Guidelines · Advanced Trauma Life Support (ATLS). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →