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