Transcript Document 7194106

Drill of the Month
Developed by Gloria Bizjak
Recognizing and Managing Cold
Emergencies:
Frostbite and Hypothermia
Recognizing and Managing Cold
Emergencies: Frostbite and
Hypothermia
Student Performance Objective:
Given information, resources, and opportunity for
discussion and practice, EMTs will be able to:
• Describe types of frostbite and hypothermia
• Describe signs and symptoms
• Demonstrate patient assessment and care
EMTs will follow acceptable Maryland medical
practice and Maryland Medical Protocols for
Emergency Medical Providers.
Drill of the Month
2
Altered Mental Status: Assessing
and Managing Seizure Patients
Overview
 Frostbite description and classifications
 Frostbite signs and symptoms
 Frostbite assessment and emergency care
 Hypothermia description and classifications
 Hypothermia signs and symptoms
 Hypothermia assessment and emergency care
 Practice assessment and care
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Frostbite

Description
– Freezing of a distal or small body part from
prolonged cold exposure
 Cold air
 Contact with a cold object
 Wind and/or water chill
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Frostbite

Description
– Local cooling injuries to extremities
 Feet and toes
 Hands and fingers
 Face: nose and cheeks
 Ears
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Frostbite

Description
– Known by several names

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
Frostnip
Immersion foot (trench foot): Injury to skin,
blood vessels, and nerves of the feet from
continuous immersion in water, even in above
freezing conditions
Chilblains (pernio): Inflammation of the hands
and feet from repeated exposure to cold and
moisture
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Frostbite

Description
– A result of prolonged cold exposure,
outdoors as well as indoors, constricting
blood vessels in the extremities, which
diverts warm blood flow and oxygen to
central vital organs

Constriction cycles with dilation to preserve
functions of extremities
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Frostbite

Description
– As the body temperature continues to drop,
the brain permanently constricts vessels in
extremities to maintain warmth in vital
organs: frostbite begins
– Cell death due to exposure


Ice crystals form in the space outside cells
Cells become dehydrated
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Frostbite

Description
– Cell deterioration from of lack of oxygen and
water




Lining of blood vessels is damaged
Blood leaks from vessels on rewarming
Small clots form causing blood flow problems and
inflammation
Inflammation causes further tissue damage
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Frostbite

Classifications
– Superficial (early stage)
 Blood flow is restricted to body parts
 Body parts freeze
 Ice crystals form inside tissues
– Deep (late stage)
 Gangrene sets in due to cell dehydration and
oxygen loss
 The part may have to be amputated, even after
months of trying to heal
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Frostbite Signs and Symptoms

Superficial (early stage)
– Patient may complain of burning, numbness,
tingling, itching, or cold in affected areas
– Affected part first appears red, then turns
mottled, bluish, white, or grey as the flesh
continues to freeze
– Dark skin: the skin color lightens, then
blanches and will quickly turn bluish or grey
– Skin feels frozen/stiff/rigid; has some pliability
when pressed
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Frostbite Signs and Symptoms

Deep (late stage)
– Patient may complain of decreased sensation,
then lose all sensation or feeling
– Affected part swells, develops blood-filled
blisters over white/yellowish waxy-looking
skin
– Skin feels hard with no pliability when pressed
– Affected part may appear black
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Frostbite Signs and Symptoms

Deep (late stage)
– On rewarming
 Affected part turns purplish-blue
 Painful aching as blood flow returns to tissues
 Throbbing begins in 2 – 3 days; may last months
 Part may never heal and may require amputation
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Frostbite Assessment and Care

Assessment: Perform General Patient Care
(Maryland Protocols)
– Size up the scene; gather info on approach
– Perform initial assessment
 Superficial
– Look for color changes: light skin reddens; dark skin
lightens; both blanch followed by color changes
– Feel area for pliability
– Ask patient how it feels: patient may report numbness,
tingling, burning, etc.
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Frostbite Assessment and Care

Assessment: Perform General Patient Care
(Maryland Protocols)
– Size up the scene; gather info on approach
– Perform initial assessment
 Deep
– Check skin appearance: white, waxy skin turns mottled
or blotchy, then to grayish yellow to grayish blue
– Look for swelling and blistering
– Gently palpate: Does surface feel frozen w/no pliability in
underlying tissue? Do not squeeze affected part
– Ask patient how it feels
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Frostbite Assessment and Care

Assessment: Perform General Patient Care
(Maryland Protocols)
– Perform focused history and physical exam
– Follow treatment protocols
– Communicate with hospital or other response
personnel
– Disposition: determine priority and mode of
transport
Drill of the Month
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Frostbite Assessment and Care

Emergency care (adults or peds)
– Remove patient from cold environment
 Outside: Place patient in heated ambulance, wrap
in blankets
 Inside: Turn up heat while working in patient’s
home, wrap in blankets, move to heated
ambulance
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Frostbite Assessment and Care

Emergency care (adults or peds)
– Gently handle frostbitten areas
 Do not rub affected areas
 Ice crystals in tissues cause further damage
– Wrap affected area gently, loosely with gauze
 Patient may complain of tingling/burning: these
are normal sensations
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Frostbite Assessment and Care

Emergency care (adults or peds)
– If patient does not respond to simple
treatment, begin care for deep frostbite
 Provide high-concentration oxygen
 Provide rapid transport
 If transport is delayed, re-warm affected part only
on medical direction
 Do not allow patient to smoke or consume caffeine
or alcohol (vasoconstrictors, raise blood pressure)
 Do not allow patient to use affected part or walk
on affected feet
Drill of the Month
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Frostbite Assessment and Care

Emergency care (adults or peds)
– Maintain a warm environment: do not reexpose patient to a cold environment
– Reassess: recheck vital signs, recheck injury
treatments and medical status
– Transport/transfer/transition patient and
information
Drill of the Month
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Hypothermia

Description
– Generalized body cooling as a result of
prolonged cold exposure
 Reduces body heat
 Prevents body from maintaining proper core body
temperature
 Can be life-threatening
Drill of the Month
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Hypothermia

Description
– Loss of body heat through several methods
 Radiation: heat lost to environment from what
body gives off (radiates)
 Conduction: heat lost by contact with or immersion
in cold water or snow
 Convection: heat lost by cold water flow or air
currents
 Evaporation: heat lost through perspiration or wet
skin
 Respiration: heat lost through expired breaths—
warm air to cooler environment
Drill of the Month
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Hypothermia

Description
– Abnormally low core body temperature


95°F or below
Life-threatening at 90°F and below
– Core body measurements
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Oral measurement: 96.8 to 98.6 °F (affected by
liquid and food intake and breathing)
Rectal temperature: 0.9 °F higher than oral
Axillary temperature: 0.9 °F lower than oral
Tympanic temperature: very close to oral
measurement
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Hypothermia

Classifications: Mild to moderate — 95°F
to 90°F core body temperater: Caused
by a cold environment
– Affects healthy individuals with prolonged
exposure
– Can quickly affect at-risk individuals

Patients with major trauma and shock, chronic
illness, circulatory disorders, infection, burns, and
diabetes
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Hypothermia

Classifications: Mild to moderate — 95°F
to 90°F core body temperature: Caused
by a cold environment
– Can quickly affect at-risk individuals

Elderly persons in an environment with cool
ambient temperature (low thermostat in winter),
diet, illnesses, medications, sedentary living
Drill of the Month
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Hypothermia

Classifications: Mild to moderate—95°F
to 90°F core body temperature: Caused
by a cold environment
– Can quickly affect at-risk individuals

Infants and children with their large skin surface
to body mass ratio, little fat, and small muscle
mass (resulting in no shivering, a typical early
warning sign)
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Hypothermia

Classifications: Severe, or extreme
– Body temperature below 90°F
– Presents an unconscious cold patient in a
cold environment with no apparent vital
signs (heart rate <10 beats per minute)
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Patients will not reach biological death for at
least 30 minutes: resuscitate
Do not assume death based on body
temperature and no vital signs
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Hypothermia Signs and Symptoms

General
– Vary with patient factors, length of exposure
 Shivering, becomes intense; ceases in severe
hypothermia
 Dizziness and confusion
 Numbness, stiffness, rigidity in posture, weakness
 Impaired judgment, speech, and vision, glassy
stare
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Hypothermia Signs and Symptoms

General
– Vary with patient factors, length of exposure
 Drowsiness, decrease in consciousness to
unconsciousness
 Cool abdominal skin temperature to your touch
(back of your hand)
 Reddened skin turning to pale and cyanotic with
prolonged exposure (dark skin initially white
turning cyanotic)
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Hypothermia Signs and Symptoms

Specific
– Mild to moderate (core body temperature 90
to 95°F


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
Shivering, which becomes intense (generates
body heat until muscles are fatigued)
Pulse and breathing rates and blood pressure
initially increase
Vital signs drop as body temperature drops
Apathy: patient becomes clumsy, apathetic,
confused, and has slurred speech (as if drunk)
Drill of the Month
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Hypothermia Signs and Symptoms

Specific
– Severe (core body temperature less than
95°F)

Loss of consciousness
–
–
–
–
Shivering stops
Oxygen intake drops
Heart rhythm becomes irregular
Patient loses consciousness
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Hypothermia Signs and Symptoms

Specific
– Severe (core body temperature less than
95°F


Continued decrease of pulse and breathing rates
Appearance of death, close to death
–
–
–
–
–
No reflexes
Brain activity slows
Pupils dilate
Risk of lethal irregular heart rhythm increases
Patient appears dead at 82°F
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Hypothermia
Assessment and Emergency Care

Assessment: Perform General Patient Care
(Maryland Protocols)
– Size up the scene and gather info on
approach
– Perform initial assessment
 Assess mental status: check patient’s orientation to
person, place, time
 Check airway, breathing, circulation
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Hypothermia
Assessment and Emergency Care

Assessment: Consider the following
 Air temperature, wind chill or water chill
 Patient’s age
 Clothing worn by patient
 Patient’s general health, illnesses and medications,
or injuries
 Activity at time of incident
 Use of alcohol or drugs
 Mental status and motor function, which decreases
with degree of hypothermia
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Hypothermia
Assessment and Emergency Care

Assessment
– Perform focused history and physical exam
– Follow treatment protocols
– Communicate with hospital or other response
personnel
– Disposition: determine priority and mode of
transport
Drill of the Month
35
Hypothermia
Assessment and Emergency Care

Emergency care (adults or peds)
– Quickly remove patient from cold environment
– Handle gently—rough handling may cause
cardiac arrest
– Resuscitate as necessary
 Assess pulse for 30 – 45 seconds
 No pulse, start CPR
 Prepare to use AED if indicated
Drill of the Month
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Hypothermia
Assessment and Emergency Care

Emergency care (adults or peds)
– Use passive rewarming methods to prevent
further heat loss
 Remove wet or frozen clothing
 Wrap patient in thermal blankets and other
insulating material
 Cover the patient’s head
 Administer warmed oxygen, if possible/available
Drill of the Month
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Hypothermia
Assessment and Emergency Care

Emergency care (adults or peds)
– Maintain a warm environment: do not reexpose to cold environment
– Reassess patient
 Recheck vital signs
 Recheck injuries and treatment
 Recheck medical status
 Transport/transfer/transition patient and
information
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Practice

Demonstrate assessment and care of
patients exposed to cold environments
based on Maryland Medical Protocols
– General patient care steps for superficial and
deep frostbite patients
– General patient care steps for mild to
moderate hypothermia patients
– General patient care steps for severe
hypothermia patients, including resuscitation
and AED
Drill of the Month
39
Recognizing and Managing Cold
Emergencies: Frostbite and
Hypothermia
Student Performance Objective:
Given information, resources, and opportunity for
discussion and practice, EMTs will be able to:
• Describe types of frostbite and hypothermia
• Describe signs and symptoms
• Demonstrate patient assessment and care
EMTs will follow acceptable Maryland medical
practice and Maryland Medical Protocols for
Emergency Medical Providers.
Drill of the Month
40
Altered Mental Status: Assessing
and Managing Seizure Patients
Overview
 Frostbite description and classifications
 Frostbite signs and symptoms
 Frostbite assessment and emergency care
 Hypothermia description and classifications
 Hypothermia signs and symptoms
 Hypothermia assessment and emergency care
 Practice assessment and care
Drill of the Month
41