COLD EMERGENCIES BRRRRRR Objectives Review the pathophysiology of

COLD EMERGENCIES BRRRRRR….

Objectives Review the pathophysiology of cold injuries Review the stages of hypothermia Review treatment of hypothermia, frostbite, and frostnip in the pre-hospital setting

Case Study Your 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? Alcohol Malnutrition Drugs Age (young and old) Comorbid disease Unpreparedness

Cold Water Immersion

The ECG of Hypothermia

Osborne J Waves

Treatment of Hypothermia Remove wet clothing Passive Warming Warm air Warm blankets Active rewarming Warmed IV fluids Warmed 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 hour Frozen body Other reason to not attempt Pulse check for 60 seconds Standard CPR, remember, drugs won’t work as well until rewarming occurs

Frostbite The Cold version of burns Isolated cold injury to a body part Three degrees (just like burns)

Superficial Frostbite

Severe Frostbite

Treatment Rewarming Avoid refreezing at all costs, even if delaying rewarming. PAIN CONTROL! Morphine 4 -8 mg IV Fentanyl 25 -50 mcg Treat as needed for generalized hypothermia

Trench Foot

Trench Foot Exposure to cold (not freezing), damp conditions Causes a decrease in circulation and soft tissue damage High rates seen in WWI Can also see it in prolonged ops in EMS Keep the feet dry! Treatment is dry, clean, warm feet May require wound care if severe