Cold Weather Emergencies: Hypothermia Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute Region 8 CE March 2012

Learning Objectives Cognitive 1. Describe the various emergencies as they relate to the cold weather 2. Discuss the assessment process for a patient found in a cold environment 3. Describe the treatment for patients who are suffering from hypothermia Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Learning Objectives Psychomotor 1. Demonstrate the appropriate treatment for a patient suffering from a cold weather related emergency 2. Demonstrate the safety EMS providers should take when working in a cold weather environment Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Introduction Cold weather emergencies generally occur during certain times each year Hypothermia can occur anytime the body temperature decreases below 98 degrees EMS providers should review and update their knowledge to prepare for cold weather situations Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Scene Safety Consider length of time providers and the patients are exposed to cold weather elements Prepare to keep warm throughout emergency Determine resources needed to keep patient warm Request resources to decrease time patient and crew is exposed to cold Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Responder Precautions Maintain situational awareness for personal safety Watch for early signs of hypothermia Dress for weather Prepared for extended exposure Work in shifts Have extra dry clothes Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Cold Weather Dangers Hypothermia Frost nip Frostbite Complicates assessment Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Risk Factors Cool temperatures Wind chill Age Injuries Chronic illness Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Q4.09 – October 2009Cold Weather Emergencies © Copyright 2006 JSL Communications LLC

Risk Factors (continued) Improper clothing Moisture Fatigue Dehydration Alcohol Poisoning / overdose Medications Antidepressants Antipyretics, phenothiazines Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Assessment Check responsiveness and mental status Evaluate ABCDE Maintain and treat any airway problems Initiate breathing adjuncts as needed Provide adequate circulatory support Determine disability Expose patient and cover to maintain temperature Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Assessment (continued) Secondary Assessment Assess for underlying medical conditions or injuries Treat priority injuries Determine degree of hypothermia Mild Moderate Severe Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Regulating Heat Production Muscular Baseline muscular activity Exertion Shivering Metabolic Processing of food and nutrients Carbohydrates (sugars and starches) Fats Proteins Glycogen Endocrine Role of hormones in basal metabolic rate

Regulating Heat Loss Heat lost through skin, lungs, excretions Skin most important Major sources of heat loss Radiation Conduction Convection Evaporation Respiration

Hypothermia A condition in which an organism's temperature drops below that required for normal metabolism and bodily functions Mild Core temperature greater than 90° F (32° C) with s/s of hypothermia Severe Core temperature below 90° F (32° C) with s/s of hypothermia Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Mild Hypothermia Shivering Vasoconstriction No complex actions Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Moderate Hypothermia Lost fine motor skills Uncontrollable shivering Slurred speech Altered mental status Irrational behavior Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Severe Hypothermia Shivering stops Fetal position Muscle rigidity Pale skin Dilated pupils Decreased pulse & respiratory rates Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Eminent Death Erratic, shallow breathing Semi-conscious Cardiac arrhythmias Ventricular Fibrillation Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

J Wave ECG Pathognomonic J waves (Osborn waves) Eventual onset of bradycardia Ventricular fibrillation probable below 86º F

Q4.09 – October 2009Cold Weather Emergencies © Copyright 2006 JSL Communi cations LLC moderate hypothermia (temp 30°C) severe hypothermia (temp < 27°C)

Q4.09 – October 2009Cold Weather Emergencies

Frost Nip Skin turning white and waxy Top layer hard and rubbery Deeper tissue still soft Numbness Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Frost Nip Care Gently re-warm with warm air Place against body DO NOT rub Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Frostbite White, wooden-feeling skin Can include freezing muscle or bone Small areas – attempt re-warming Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Frostbite Q4.09 – October 2009Cold Weather Emergencies © Copyright 2006 JSL Communications LLC Gangrenous necrosis 6 wks after frostbite injury

Frostbite Care Deep frostbite includes freezing muscle and/or bone Deep frostbite – DO NOT re-warm Hypothermia care is first priority Re-warm area after core is 96° No alcohol / tobacco Follow protocols Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Emergency Care Identify underlying medical conditions Assess for trauma Re-warming considerations Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Emergency Care Patient requires re-warming to determine mental state Remove wet clothing Move to warmer environment Apply hot packs Warmed, humidified oxygen Stabilize injuries if needed Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

LOC Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Q4.09 – October 2009Cold Weather Emergencies © Copyright 2006 JSL Communications LLC

Drug of the Month… Nitrous Oxide Action Indication Contraindication Adverse Reaction Adult Dose Pediatric Dose Q4.09 – October 2009Cold Weather Emergencies © Copyright 2006 JSL Communi cations LLC

Summary Be familiar with the subtle signs of cold emergencies and evaluate for hypothermia Determine if any underlying medical or traumatic situation is complicating the present condition and treat appropriately Q4.09 – October 2009Cold Weather Emergencies © Copyright 2009 Health & Safety Institute

Q4.09 – October 2009Cold Weather Emergencies © Copyright 2006 JSL Communi cations LLC