COLD EMERGENCIESBRRRRRR….
ObjectivesReview the pathophysiology of cold injuriesReview the stages of hypothermiaReview treatment of hypothermia, frostbite, and
frostnip in the pre-hospital setting
Case StudyYour 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?
AlcoholMalnutritionDrugsAge (young and old)Comorbid diseaseUnpreparedness
Cold Water Immersion
The ECG of Hypothermia
Osborne J Waves
Treatment of HypothermiaRemove wet clothingPassive Warming
Warm airWarm blankets
Active rewarmingWarmed IV fluidsWarmed 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 hourFrozen bodyOther reason to not attempt
Pulse check for 60 secondsStandard CPR, remember, drugs won’t work as
well until rewarming occurs
FrostbiteThe Cold version of burnsIsolated cold injury to a body partThree degrees (just like burns)
Superficial Frostbite
Severe Frostbite
Severe Frostbite
TreatmentRewarming
Avoid refreezing at all costs, even if delaying rewarming.
PAIN CONTROL!Morphine 4-8mg IVFentanyl 25-50mcg
Treat as needed for generalized hypothermia
Trench Foot
Trench FootExposure to cold (not freezing), damp conditionsCauses a decrease in circulation and soft tissue
damageHigh rates seen in WWICan also see it in prolonged ops in EMS
Keep the feet dry!Treatment is dry, clean, warm feet
May require wound care if severe