Objectives Review the pathophysiology of cold injuries Review the stages of hypothermia Review treatment of hypothermia frostbite and frostnip in the prehospital setting Case Study Your next call on this sofar uneventful New Years Eve is to Death Valley AKA The Bottoms where a pe ID: 1048673
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1. COLD EMERGENCIESBRRRRRR….
2. Objectives Review the pathophysiology of cold injuriesReview the stages of hypothermiaReview treatment of hypothermia, frostbite, and frostnip in the pre-hospital setting
3. 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?
4. Hypothalmus – the Human Thermostat
5. Normal Temperature Regulation
6. Human Specific Responses
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8. What prevents us from adapting?AlcoholMalnutritionDrugsAge (young and old)Comorbid diseaseUnpreparedness
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12. Cold Water Immersion
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14. The ECG of Hypothermia
15. Osborne J Waves
16. Treatment of HypothermiaRemove wet clothingPassive WarmingWarm airWarm blanketsActive rewarmingWarmed IV fluidsWarmed oral fluids when alert, oriented, and able to maintain gag reflex
17. Cardiac Arrest in Hypothermia‘They ain’t dead until they’re warm and dead!’ExceptionsUnder water greater than 1 hourFrozen bodyOther reason to not attemptPulse check for 60 secondsStandard CPR, remember, drugs won’t work as well until rewarming occurs
18. FrostbiteThe Cold version of burnsIsolated cold injury to a body partThree degrees (just like burns)
19. Superficial Frostbite
20. Severe Frostbite
21. Severe Frostbite
22. TreatmentRewarmingAvoid refreezing at all costs, even if delaying rewarming.PAIN CONTROL!Morphine 4-8mg IVFentanyl 25-50mcgTreat as needed for generalized hypothermia
23. Trench Foot
24. 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 EMSKeep the feet dry!Treatment is dry, clean, warm feetMay require wound care if severe