Burr.....It’s getting cold out thereAn overview of cold emergencies

and the treatment of them

David B. Aber, NREMT-P

Myths about cold emergencies

• It is very hard to break off a body part!!!!

• If they are frozen….The whole “Warm and Dead” is out the door.

• Homeless + Pulseless + Apenic does not =

“BUMCICLE”

What we will cover

• Hypothermia• Frostbite• Treatments• Other goodies

Hypothermia

• Hypothermia is a condition in which an organism's temperature drops below that required for normal metabolism

• But, when the body is exposed to cold, its internal mechanisms may be unable to replenish the heat that is being lost to the organism’s surroundings

Risk Factors

• Age– Old or young

• Preexisting medical conditions– Anything that affects thermoregulation

• Medications– Sedative Hypnotics (Valium)

• Alcohol

US Geography / US Weather / Delaware Weather / New Castle Jan Feb MarApr MayJun Jul Aug Sep Oct NovDecAvg. High 38° 41° 52° 62° 72° 81° 85° 84° 77° 66° 55° 44°Avg. Low 22° 24° 34° 41° 52° 61° 67° 65° 58° 45° 37° 27°

US Geography / US Weather / Delaware Weather / New Castle Jan Feb MarApr MayJun Jul Aug Sep Oct NovDecAvg. High 38° 41° 52° 62° 72° 81° 85° 84° 77° 66° 55° 44°Avg. Low 22° 24° 34° 41° 52° 61° 67° 65° 58° 45° 37° 27°

US Geography / US Weather / Delaware Weather / New Castle Jan Feb Mar Apr Nov DecAvg. High 38° 41° 52° 62° 55° 44°Avg. Low 22° 24° 34° 41° 37° 27°

US Geography / US Weather / Delaware Weather / New Castle Jan Feb Mar Apr Nov DecAvg. High 38° 41° 52° 62° 55° 44°Avg. Low 22° 24° 34° 41° 37° 27°

Stage 1

• Body temperature drops 2-4°F• Shivering begins • Unable to perform complex tasks with hands• Goose bumps form

– Why?

• Stage 1Stage 2– If patient cannot touch pinky finger to thumb

Stage 2

• Body temperature drops 4-8°F• Shivering becomes violent• Increased respirations• Confusion• Extremity cyanosis/Core paleness

Stage 3

• Body temperature drops to 89.6°F• Shivering stops• Slowing of speech• Below 89°F cellular metabolism stops

– Blisters start to form– Terminal Burrowing

• We will cover this later

Frostbite

• 3 Degrees as well– 1st Frostnip

• Not uncommon. Skin firm

– 2nd Superficial• Tissue hard to frozen feeling. Blue/White. Blistering

– 3rd Deep Frostbite• White Blotchy/Blue Skin• Severe cases/old appear black• Amputation/Grafting

Frostbite

• Why don’t we thaw frozen parts– Danger of refreezing– Cellular crystals grow bigger

Cold water submersion

• Mammalian Dive Reflex• Length of time in water• Temperature of water

• Not dead til warm and dead• FROZEN IS FROZEN!!!!

LewesDE 32.5(01/31/2010 23:48 UTC)

JAN 37 FEB 36 MAR 41 APR 49 MAY 58 JUN 66 JULY 71 AUG 76 SEPT 73 OCT 65 NOV 58 DEC 44

In 1980, 16 shipwrecked Danish fishermen were hauled to safety after an hour and a half in the frigid North Sea. They then walked across the deck of the rescue ship, stepped below for a hot drink, and dropped dead, all 16 of them.

- Peter Stark, Outside Magazine, 1997

Terminal Burrowing

• Last stages of hypothermia• Patients last attempts to get warm• Indoors

– Closets, cupboards, any small enclosed space

• Outdoors– Pile of leaves, between rocks, or fallen trees

Paradoxical Undressing

• Phenomenon that causes patients to undress in the mid to late stages of hypothermia

• Not exactly sure why this happens – Malfunctioning hypothalamus– Sudden surge of blood making body feel hot

• Study showed that in non wilderness conditions this sometime leads police to think of sexual assault

– M. A. Rothschild et al., "Terminal burrowing behavior", p. 1

Trench Foot

• Nerve and tissue damage cause by cold and wet exposure

• Numbness, redness, cyanosis• Blisters, open sores, gangrene• 60°F or less• 12 hours exposure

http://www.myfootshop.com/images/medical/derm/immersion_foot_marked.jpghttp://www.myfootshop.com/images/medical/derm/immersion_foot_marked.jpg

Therapeutic Hypothermia

• Sometime called “induced hypothermia”• Post resuscitated cardiac arrest patients

– Delaware ALS and Hospitals are starting this

• Studies show reduced mortality of 35%• Studies ongoing regarding use in ischemic

strokes

Therapeutic Hypothermia

EMS Treatments

• Passive Rewarming• Using mainly the patients own body heat• Good for Mild Hypothermia

– Blankets – Unit Heat on high

• Remember the heat is for the patient

EMS Treatments

• Active Rewarming– Hot packs to groin, neck, armpits– Follow passive as well– Do not place Hot packs directly on frost bitten

areas

EMS Treatments

• Warm water• Local protocols• Just above normal body temp 100-105°F• Kept/monitor a constant temperature of

water

EMS TreatmentsBlanket Warmers

EMS Treatments Warmed Oxygen

• Tubing through heating vents

EMS TreatmentsWarmed Oxygen

• Use of hot packs

EMS TreatmentsWarmed Oxygen

*Commercial Wilderness device

Activation Time Temperature Oxygen Flow (liters)0 minutes 20° F 0 liters1 minute 74.6° F 8 liters5 minutes 82.3° F 8 liters10 minutes 88.1° F 8 liters

EMS TreatmentsWarmed IV Fluid

Secondary Illnesses

• Hot topic in EMS- CO– Economic classes

• Heating

– Power outages• Back up heat source

Secondary Illnesses

• CO produced by non-combusted fossil fuel– Gas Stoves– Furnaces– Wood burning fire places– Automobile

THANK YOU AND STAY WARM