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COLD EMERGENCIES

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.

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COLD EMERGENCIES

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  1. COLD EMERGENCIES BRRRRRR….

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

  3. 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?

  4. Hypothalmus – the Human Thermostat

  5. Normal Temperature Regulation

  6. Human Specific Responses

  7. What prevents us from adapting? • Alcohol • Malnutrition • Drugs • Age (young and old) • Comorbid disease • Unpreparedness

  8. Cold Water Immersion

  9. The ECG of Hypothermia

  10. Osborne J Waves

  11. 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

  12. 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

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

  14. Superficial Frostbite

  15. Severe Frostbite

  16. Severe Frostbite

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

  18. Trench Foot

  19. 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

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