1. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 25 Cold-Related Emergencies

2. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 25.1 List and define the four mechanisms of heat loss. 25.2 List the signs and symptoms of cold exposure. 25.3 List the signs and symptoms of frostbite. 25.4 List and explain the two classifications of hypothermia. 25.5 List and explain the three categories of hypothermia related to severity. continued

3. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 25.6 Define afterdrop and explain how to prevent it. 25.7 Describe and demonstrate the assessment and emergency care of a patient with a cold injury. 25.8 Describe and demonstrate the assessment and emergency care of a patient with frostbite. continued

4. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 25.9 Describe and demonstrate the assessment and emergency care of an avalanche victim.

5. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Case Presentation Anatomy and Physiology Common Cold-Related Emergencies Rescuer Preparation for Cold Weather Rescue Case Update

6. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Assessment Management Evacuation and Transportation Case Disposition Chapter Summary continued

7. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation A cross-country skier falls through snow into a shallow creek. Uninjured, she extricates herself from the water, but gets wet up to her chest. She is shaking uncontrollably. She stops and drinks what is left in her thermos: hot chocolate and Schnapps. On a gondola, she is no longer shaking, appears sleepy, and closes her eyes. Her son is unable to wake her. You are at the off load ramp when the son yells out he needs your help. He briefs you while you conduct an initial assessment.

8. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Heat Loss: Four Mechanisms ◦ Conduction ◦ Convection ◦ Evaporation ◦ Radiation continued

9. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology continued

10. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Factors contributing to cold injury: ◦ Freezing temperatures ◦ High winds and high altitude ◦ Use of drugs ◦ Previous frostbite injury ◦ Over-exertion, producing fatigue and sweat continued

11. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Factors contributing to cold injury: ◦ Poor fitting, inadequate, or wet clothing ◦ Dehydration ◦ Impaired circulation ◦ Poor nutrition continued

12. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology

13. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Cold-Related Emergencies Frostnip and Frostbite ◦ Superficial (frostnip): no damage ◦ Partial thickness (frostbite): partial damage ◦ Full thickness (frostbite): severe damage; tissue death continued

14. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Cold-Related Emergencies Hypothermia ◦ Primary hypothermia: due to environmental exposure ◦ Secondary hypothermia: due to systemic disorders Afterdrop: continuous drop of body temp Windburn: irritation to the skin; resembles sunburn continued

15. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Cold-Related Emergencies

16. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Cold-Related Emergencies Copyright Tristan Roberson

17. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Rescuer Preparation for Cold Weather Rescue Do not become the victim! Be prepared ◦ Know your environment and be prepared. ◦ Bring adequate clothing for the environment; layer for insulation: inner (use synthetic "wicking" layers); outer shell layer. continued

18. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Rescuer Preparation for Cold Weather Rescue Be prepared ◦ Be attentive to yourself and companions. ◦ Maintain adequate nutrition and hydration. ◦ Stay dry. Pace yourself to avoid sweating and overexertion. Remove or add layers of clothing as appropriate. Keep feet dry. continued

19. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Rescuer Preparation for Cold Weather Rescue Be prepared ◦ Avoid tight and restrictive clothing and boots. ◦ Change socks often (at least daily, and never sleep wearing wet socks). ◦ Avoid alcohol, caffeine, and drugs because these will predispose you to cold injury. ◦ Do not tolerate numbness in feet or hands. continued

20. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Rescuer Preparation for Cold Weather Rescue Copyright Scott Smith

21. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Rescuer Preparation for Cold Weather Rescue Copyright Scott Smith

22. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Rescuer Preparation for Cold Weather Rescue Copyright Scott Smith

23. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update You move the patient inside the gondola base building where you have room to work on her. She appears dead. Her skin is pale and cold to the touch. Her clothes are wet. She is unresponsive. While assessing her ABCDs, you notice she is not breathing. She has a very slow pulse. There are no signs of trauma.

24. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Scene safety: Do not become a victim Assess ABCDs Look for signs of cold injury: ◦ Frostbite ◦ Hypothermia: mild, moderate, or severe continued

25. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment continued

26. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment DCAP-BTLS/SAMPLE Measuring core body temperature continued

27. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment

28. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Frostnip: seek shelter; warm the area Frostbite: warm the area rapidly ◦ Factors to consider: ◦ When to warm frostbitten tissue ◦ Where to warm the frostbitten body part ◦ How to warm the frostbitten body part continued

29. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY continued Management

30. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Hypothermia: prevent heat loss Warming methods: ◦ Passive: relies on the retention of the patient’s internal body heat (i.e., shivering) ◦ Active: application of a heat source Mild hypothermia: assist warming with heat application, warm high-energy drinks and food, mild exercise if patient can tolerate. continued

31. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Moderate-to-severe hypothermia: care is the same as in mild, but may need to move patient to a hospital. Treating other injuries/illnesses: use appropriate measures. Windburn: apply soothing, greasy ointments continued

32. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management

33. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY continued Management

34. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Evacuation and Transportation Patients who do not respond to warming: ◦ Evacuate ASAP; transport to a definitive care facility. ◦ Be as gentle as possible to avoid further damage. ◦ Continue to monitor vital signs, the skin underneath heat sources (for potential burns), and distal circulation (e.g., hands and feet).

35. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition She is severely hypothermic; you call 911. You ensure an open airway and use a bag-valve-mask device for rescue breathing. Wet clothes are removed. The patient is placed in a hypothermic wrap with warm blankets. Warm water bottles are placed in her axillae and groin area. The paramedics arrive to transport the patient. At the hospital the core temperature initially is 79°F (26°C). The patient goes into ventricular fibrillation. CPR is started. She has no response to initial defibrillation or the drugs given She is aggressively warmed and eventually her heart regains a normal rhythm.

36. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary The outdoor environment has many challenges. Weather changes, accidents, and poor planning can all be deadly. Frostbite has the potential to yield severe disability, but with quick identification and proper treatment, the severity can be minimized. As a responder we should always remember to avoid tight clothing and tight shoes. continued

37. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Hypothermia is a common cold injury that can affect anyone almost anywhere and can occur at temperatures well above freezing, especially when water and wind are factors. As core temperature drops, the body will attempt to generate heat through shivering. Avalanche victims can have a multitude of problems, asphyxiation being foremost. continued

38. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Once the patient is extricated, hypothermia and traumatic injuries must be addressed. They're not dead until they're warm and dead. Shivering ceases between 90°F. Handle suspected hypothermic patients gently. Mild hypothermia can be treated with passive warming. continued

39. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Remember... Moderate to severe hypothermia must be treated with active warming. A slow, perfusing pulse is enough to sustain a severely hypothermic patient Do not warm frostbite if it will be exposed to refreezing. Frostbite requires rapid warming.