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Cold WeatherEmergencies: Hypothermia
Q4.09 – October 2009 Cold Weather Emergencies© Copyright 2009
Health & Safety Institute
Region 8 CEMarch 2012
Learning ObjectivesCognitive 1. Describe the various emergencies as
they relate to the cold weather2. 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 2009 Cold Weather Emergencies
© Copyright 2009 Health & Safety
Institute
Learning ObjectivesPsychomotor1. 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 2009 Cold Weather Emergencies© Copyright 2009
Health & Safety Institute
IntroductionCold 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 2009 Cold 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 2009 Cold 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 2009 Cold Weather Emergencies
© Copyright 2009 Health & Safety
Institute
Cold Weather DangersHypothermiaFrost nipFrostbiteComplicates assessment
Q4.09 – October 2009 Cold Weather Emergencies
© Copyright 2009 Health &
Safety Institute
Risk FactorsCool temperaturesWind chillAgeInjuriesChronic illness
Q4.09 – October 2009 Cold Weather Emergencies
© Copyright 2009 Health &
Safety Institute
Q4.09 – October 2009 Cold Weather Emergencies© Copyright 2006 JSL Communications LLC
Risk Factors (continued)
Improper clothingMoistureFatigueDehydrationAlcoholPoisoning / overdose Medications
AntidepressantsAntipyretics, phenothiazines
Q4.09 – October 2009 Cold 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 2009 Cold 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 2009 Cold Weather Emergencies
© Copyright 2009 Health &
Safety Institute
Regulating Heat ProductionMuscular
Baseline muscular activityExertionShivering
MetabolicProcessing of food and nutrients
Carbohydrates (sugars and starches) Fats Proteins
Glycogen
EndocrineRole of hormones in basal metabolic rate
Regulating Heat LossHeat lost through skin, lungs, excretions
Skin most importantMajor sources of heat loss
Radiation Conduction Convection Evaporation Respiration
HypothermiaA 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
SevereCore temperature below 90° F (32° C) with
s/s of hypothermia
Q4.09 – October 2009 Cold Weather Emergencies
© Copyright 2009 Health & Safety
Institute
Mild Hypothermia Shivering Vasoconstriction No complex actions
Q4.09 – October 2009 Cold 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 2009 Cold 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 2009 Cold Weather Emergencies
© Copyright
2009 Health &
Safety Institute
Eminent Death Erratic, shallow breathing Semi-conscious Cardiac arrhythmias Ventricular Fibrillation
Q4.09 – October 2009 Cold 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 2009 Cold Weather Emergencies
© Copyright 2006 JSL
Communications
LLC
moderate hypothermia (temp 30°C)
severe hypothermia (temp < 27°C)
Q4.09 – October 2009 Cold Weather Emergencies
Frost Nip Skin turning white and waxy Top layer hard and rubbery Deeper tissue still soft Numbness
Q4.09 – October 2009 Cold Weather Emergencies
© Copyright 2009 Health & Safety
Institute
Frost Nip Care Gently re-warm with warm airPlace against bodyDO NOT rub
Q4.09 – October 2009 Cold 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 2009 Cold Weather Emergencies
© Copyright 2009 Health & Safety
Institute
Frostbite
Q4.09 – October 2009 Cold Weather Emergencies
© Copyright 2006 JSL Communications
LLC
Gangrenous necrosis 6 wks after frostbite injury
Frostbite Care Deep frostbite includes freezing muscle
and/or boneDeep frostbite – DO NOT re-warm Hypothermia care is first priority
Re-warm area after core is 96°No alcohol / tobaccoFollow protocols
Q4.09 – October 2009 Cold Weather Emergencies
© Copyright 2009 Health &
Safety Institute
Emergency Care Identify underlying medical conditions Assess for trauma Re-warming considerations
Q4.09 – October 2009 Cold 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 2009 Cold Weather Emergencies
© Copyright 2009 Health &
Safety Institute
LOC
Q4.09 – October 2009 Cold Weather Emergencies
© Copyright 2009 Health &
Safety Institute
Q4.09 – October 2009 Cold Weather Emergencies
© Copyright 2006 JSL Communications
LLC
Drug of the Month…Nitrous OxideActionIndicationContraindicationAdverse ReactionAdult DosePediatric Dose
Q4.09 – October 2009 Cold Weather Emergencies
© Copyright 2006 JSL
Communications
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 2009 Cold Weather Emergencies
© Copyright
2009 Health &
Safety Institute
Q4.09 – October 2009 Cold Weather Emergencies
© Copyright 2006 JSL
Communications
LLC