EMS Hypothermia
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Transcript EMS Hypothermia
COLD EMERGENCIES
BRRRRRR….
Objectives
Review the pathophysiology of cold injuries
Review the stages of hypothermia
Review treatment of hypothermia, frostbite, and frostnip
in the pre-hospital setting
Case Study
Your next call on this so-far uneventful New Year’s Eve
is to Death Valley (AKA: The Bottoms) where a person
is found on the ground. On arrival, you try to turn the
patient around, but he is stuck to the ground by ice that
formed between concrete and his body.
Can you just get back into your almost-warm rig and
leave him to the Coroner?
How long do you have to check for a pulse?
What can cause him to lose body heat faster than
normal?
Hypothalmus – the Human
Thermostat
Normal Temperature
Regulation
Human Specific Responses
What prevents us from
adapting?
Alcohol
Malnutrition
Drugs
Age (young and old)
Comorbid disease
Unpreparedness
Cold Water Immersion
Cold Water Immersion Chart/Hypothermia Table
Water
Temperature
in Degrees F
(Degrees C)
32.5 (0.3)
Loss of
Dexterity
(with no
protective
clothing)
Under 2 min.
32.5 to 40 (0.3
Under 3 min.
to 4.5)
Exhaustion or
Unconsciousness
Expected
Time of
Survival
Recommended Paddling
Clothing
Always wear a PFD!!
Under 15 min.
Drysuit with neoprene wetsuit
& fleece under layers,
Under 15 to
neoprene booties, or mukluks,
45 min.
neoprene cap covering ears &
gloves/mitts.
15 to 30 min.
30 to 90
min.
Drysuit with neoprene wetsuit
& fleece under layers,
neoprene booties or mukluks,
neoprene cap covering ears &
gloves/mitts.
40 to 50 (4.5 to
Under 5 min.
10)
30 to 60 min.
1 to 3 hrs.
Drysuit with neoprene wetsuit
& fleece or polypro layers,
neoprene booties or mukluks,
neoprene cap covering ears &
gloves.
50 to 60 (10 to
10 to 15 min.
15.5)
1 to 2 hrs.
1 to 6 hrs.
Drysuit with polypro or
fleece layers or 3mm wetsuit
plus drytop, neoprene booties,
cap
60 to 70 (15.5
to 21)
2 to 7 hrs.
2-3mm Wetsuit or Shortie
2 to 40 hrs. with light paddling top,
paddling shoes, hat
70 to 80 (21 to
1 to 2 hrs.
26.5)
2 to 12 hrs.
3 hrs. to
indefinite
1-1.5mm Shortie wetsuit,
hydroskin or light paddling
top, paddling shoes, hat
Over 80 (Over
2 to 12 hrs.
26.5)
Indefinite
Indefinite
Swimsuit, paddling shoes, hat
•
30 to 40 min.
The effects are not the same for everyone. Use this table as a basic guideline for various water
temperatures. If water/weather conditions are rough and/or paddlers are inexperienced,
clothing one or two levels more protective should strongly be considered.
Original chart provided to University of Sea Kayaking by Shawn Baker and modified by Scott Shea
for the Maine Association of Sea Kayak Guides and Instructors.
The ECG of Hypothermia
Osborne J Waves
Treatment of Hypothermia
Remove wet clothing
Passive Warming
Warm air
Warm blankets
Active rewarming
Warmed IV fluids
Warmed oral fluids when alert, oriented, and able to
maintain gag reflex
Cardiac Arrest in Hypothermia
‘They ain’t dead until they’re warm and dead!’
Exceptions
Under water greater than 1 hour
Frozen body
Other reason to not attempt
Pulse check for 60 seconds
Standard CPR, remember, drugs won’t work as well
until rewarming occurs
Frostbite
The Cold version of burns
Isolated cold injury to a body part
Three degrees (just like burns)
Superficial Frostbite
Severe Frostbite
Severe Frostbite
Treatment
Rewarming
Avoid refreezing at all costs, even if delaying rewarming.
PAIN CONTROL!
Morphine 4-8mg IV
Fentanyl 25-50mcg
Treat as needed for generalized hypothermia
Trench Foot
Trench Foot
Exposure to cold (not freezing), damp conditions
Causes a decrease in circulation and soft tissue
damage
High rates seen in WWI
Can also see it in prolonged ops in EMS
Keep the feet dry!
Treatment is dry, clean, warm feet
May require wound care if severe