COLD INJURIES

HYPOTHERMIA (low body temperature)

1. Begin emergency care

Treat the hypothermia patient very gently, to help prevent abnormal heart rhythm.

1.1 First, check ABC's: Airway, Breathing, Circulation. If you think there is no pulse, check carefully for 2 full minutes before starting CPR. Patients with hypothermia may have slow pulse/respirations. do NOT do chest compressions if patient with hypothermia has any pulse, even if it is very slow. If you are doing CPR, and patient does not improve, continue until your referral doctor tells you to stop. a patient with hypothermia can live after long periods of CPR, even though he may look dead. Control severe bleeding. Patient should lie down to prevent fainting or shock. 2. Prevent additional heat loss 2.1 Protect from the cold. Move patient to warm shelter as soon as possible. remove wet or cold clothing, dry the patient, and replace with dry clothing or coverings of some kind. 2.3 Place dry blankets or clothes over and under patient and around head. 3. Get history and examine quickly 3.1 History: What was the patient exposed to? what was the temperature outside? how fast was the wind blowing? how long was the patient exposed? What was the patient like when he was exposed? how was he dressed? was he wet? was he drinking alcohol or taking illegal ("street") drugs? Past health History: illnesses? what medicines is the patient taking now? 3.2 Exam: vital signs: P, R, BP. rectal temperature: use a special low reading thermometer. Do a body survey (p.9) to check for injuries and frostbite. be sure to treat serious injuries/wounds at this step. 4. Assessment 4.1 You r assessment should be: Hypothermia (low body temperature). 4.2 If you used a low reading thermometer, your specific assessment should be one of the following: Mild hypothermia: temperature 90-95F. Severe hypothermia: temperature less than 90F. 4.3 If you do NOT have a low-reading thermometer, consider that patient has severe hypothermia if he has any of the following: No shivering, in spite of being very cold. Mental changes; getting worse (such as being very sleepy, confused, or unconscious). Abnormal coordination, getting worse; (such as trouble walking, using hands, or talking). Severe illness or injury that may have allowed the hypothermia to develop. slow pulse and respirations. Feels cold and stiff. 5. Plan 5.1 Report to your referral doctor. Report NOW if temperature is less than 90F (severe hypothermia). While you are waiting to report, follow this plan. 5.2 Decide if you should rewarm or transport as follows: If temperature is 90-95F (mild hypothermia), rewarm. If temperature is less than 90F (severe hypothermia), and you can NOT reach a doctor, do the following: if you can transport the patient to the hospital within a half hour, transport and do NOT rewarm (at least 50% of patients with severe hypothermia will die with rewarming). if you can NOT transport the patient to the hospital within a half hour, begin to rewarm while someone arranges for transport. 5.3 Rewarming. Start to add heat slowly, bit by bit. Follow these guidelines: If severe hypothermia: watch patient closely. recheck vital signs (P, BP) at least every 15 minutes. Keep the room warm. If available, use clothes dryer to quickly warm up blankets or sleeping bag. Apply warm objects to the head, neck, chest, armpits and groin. Use: hot water bottles well-wrapped in towels with warm (NOT hot) water inside. warm rocks well-wrapped in towels. a warm body or two. They should get into a warm sleeping bag together, naked (at least from the waist up). Do NOT do the following things: do NOT try to warm the arms or legs. do NOT rub or massage the arms or legs. do NOT put patient in a shower or bath. Note that this is a change from previous recommendations. give warm fluids to drink, ONLY if patient: is wide awake and can swallow without choking. is getting better, and then stops shivering. Do NOT give alcohol or caffeine drinks (coffee, tea, hot chocolate). 5.4 Other Plan should include the following: Treat for frostbite and other problems/injuries as in this manual. If mild hypothermia: recheck as recommended by your referral doctor. when the time is right, talk about hypothermia prevention (which follows). If problem is related to alcohol or other drug abuse: remind patient kindly of this. talk with patient about the alcohol or drug problem following the plan on p.204. If severe hypothermia: transport to hospital as soon as possible. stay with patient. Hypothermia: General Information Hypothermia is a lowering of the body-s temperature below 95F. It can kill a person if it persists. Common reasons for the body to loose heat are: getting wet. being in a cool or windy place without proper clothing. Stages of hypothermia A person goes through stages as his temperature gets lower: Uncontrolled shivering, except in the very young, the old, or patients who abuse alcohol. Shivering stops as the body gets colder. As the brain also gets colder, patient may have: mental changes, such as poor judgment, fatigue, confusion. abnormal coordination, such as trouble walking, using hands or talking (slurred speech). Next, patient will get: weak or irregular pulse. decreased and shallow breathing. pupils that do not react well to light. Patient will eventually become unconscious and die if heat loss continues. Prevention of Hypothermia Give patient education. Get handouts from your referral hospital or other sources (many good ones are available). Include the following information: do not ignore shivering. It is a warning that the body is getting too cool. Be prepared for the weather: wear adequate clothing. avoid getting wet. Keep your energy up by eating and resting often. also encourage others to show films and give talks on outdoor safety. Plan ahead to treat hypothermia. Be sure to get a special low-reading thermometer from your referral hospital. Have hot water bottles and blankets handy.