Transcript As Cold As Ice

~Cold As Ice~
Case Studies in
Hypothermia
Brian A. Donaldson
Operations Supervisor
Western Eagle County Ambulance District
Eagle, Colorado 81631
[email protected]
970.390.5373
-Revised 2006-
Ground Rules
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Please place all electronic quiet / vibrate
mode, or turn them off if possible.
Be an active participant…..you don’t want
to listen to me for an hour!
If you are easily offended…..please locate
the emergency exit nearest your seat.
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Relax and enjoy yourself!
One Final
Ground Rule
What Happens in St. George
Stays in St. George !
Learning Objectives
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Identify the definition of Hypothermia
Identify signs & symptoms commonly
associated with Hypothermia
Identify appropriate management of the
Hypothermic patient
What Is Hypothermia?
A failure in thermoregulation
resulting in a core body temperature
of less than 97 F.
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Classification of
Hypothermia
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Mild
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Moderate
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97 – 95 degrees F
90 – 95 degrees F
Severe
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75 – 90 degrees F
You Can’t Fix Stupid
How Is Heat Lost?
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Conduction
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Convection
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8%
Dissipation of Heat into the Surrounding Air
Evaporation
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2%
In Contact with a Cooler Object
30%
Transformation of Perspiration and Saliva into Vapor
Radiation
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60%
Transfer of Heat via Electromagnetic Waves
Watch for the “Umbles”
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Stumbles
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Fumbles
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Mumbles
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Grumbles
Mild Hypothermia
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95 – 97 degrees F
Sensation of Being Cold
 Formation of “Goose Bumps”
 Mild – Severe Shivering
 Lack of Sensation in Hands
 Unable to Perform Complex Tasks with Hands
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Moderate Hypothermia
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93 – 95 degrees F
Intense Shivering
 Obvious Muscle Incoordination
 Movement Becomes Slow & Labored
 Stumbling Gait Begins
 Alert with Mild Disorientation
 Unable to Successfully Complete
Standardized Field Sobriety Testing
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Moderate Hypothermia
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90 – 93 degrees F
Violent Shivering
 Speaking Becomes Difficult
 Thought Processes Slow
 Amnesia Begins
 Gross Muscle Movement Slow
 Inability to Use Hands
 Obvious Stumbling Gait
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Severe Hypothermia
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86 - 90 degrees F
Shivering Stops
 Exposed Skin Becomes Cyanotic
 Profound Muscle Incoordination
 Unable to Walk
 Confused with Irrational Behavior
 May be Able to Maintain Sitting or Standing
Position
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Severe Hypothermia
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82 - 86 degrees F
Muscles Become Rigid
 Poorly Responsive to Stimuli
 Bradycardia
 Bradypnea
 Increased Risk of Ventricular Fibrillation
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Severe Hypothermia
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78 - 82 degrees F
Unresponsive
 Loss of Palpable Pulses
 Irregular Respiratory Patterns
 Irregular Heart Rhythm
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Severe Hypothermia
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75 - 78 degrees F
Profound Pulmonary Edema
 Cardio-Respiratory Failure
 Death is Assured…May Occur at Higher Core
Body Temperatures
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Hypothermia Treatment
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Remove from Cold Environment
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Place in Warm Environment
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Remove Wet / Cold Clothing
Administer Warmed Humidified Oxygen
(105 degrees F)
Hypothermia Treatment
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Administer Warm IV Fluids
(105 degrees F)
Hot Packs to Neck, Axillae & Groin
Neonatal Transport Pack under Torso
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Burrito Wrap
A Little Cold Weather Humor
Case Study #1
You and an engine
company are dispatched
to a local nursing home,
near the lake, following
a manpower request
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The time is 0915 hrs
It is the middle of April
Case Study #1
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You arrive at 0920 hrs and are assigned a 1000
ft expanse of lakeshore to search for a missing
76 year old male
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You are advised the male has been missing
since 0630 hrs and is an Alzhiemers patient
You and your partner begin to search your
assigned area and find the patient at 0957 hrs
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Case Study #1
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The patient is supine with his torso on the riprap and his lower extremities submerged in the
water
The patient has a 2” laceration on the forehead,
an avulsed ® ear, and visible lacerations on
both forearms with no active bleeding from any
of the wounds
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The patient is poorly responsive to painful
stimuli
Case Study #1
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What are some special considerations for
this patient?
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What additional information concerning
this patient would you like to obtain?
What is your differential field diagnosis?
What is your care plan for this patient?
Special Considerations from
Case #1
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Under 32 degrees F
Exhaustion or Unresponsiveness <15 minute
 Survival <45 minutes
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32.5 – 40 degrees F
Exhaustion or Unresponsiveness 15 – 30 min
 Survival 30 – 90 min
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40 – 50 degrees F
Exhaustion or Unresponsiveness 30 – 60 min
 Survival 1 – 3 hours
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Special Considerations from
Case #1
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50 – 60 degrees F
Exhaustion or Unresponsiveness 1 – 2 hours
 Survival 1 – 6 hours
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60 – 70 degrees F
Exhaustion or Unresponsiveness 2 – 7 hours
 Survival 2 – 40 hours
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70 – 80 degrees F
Exhaustion or Unresponsiveness 3 – 12 hours
 Survival 3 hours - Indefinite
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Hoping for a Little
Hypothermia
Case Study #2
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You and an engine
company are
dispatched to an
outdoor fall
The time is 0533 hrs
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It is early January
Case Study #2
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You arrive on scene at 0556 hrs
Law enforcement is already on scene and
states the patient was found by the paper
delivery boy shortly before your dispatch
The patient appears to be a 60+ yoa female
The patient is cyanotic, cold to the touch and
without detectable cardio-respiratory effort
Case Study #2
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What are some special considerations for
this patient?
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What additional information concerning
this patient would you like to obtain?
What is your differential field diagnosis?
What is your care plan for this patient?
Special Considerations from
Case #2
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Hypothermia protects against the effects
of cardio-pulmonary arrest
 Hypothermic patients may have
functional cardiac activity without
palpable pulses in the field (decreased
pulse pressure, bradycardia,
environment)
 Physical stimuli may cause ventricular
fibrillation (jostling, chest compressions,
intubation)
Special Considerations from
Case #2
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Cardiac tissue is resistant to defibrillation
and antidysrhythmic medications in
severe hypothermia – withhold until core
body temperature is at least 86 degrees F
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The hypothermic patient is not dead
until they are warm and dead
Case Study #3
You and an engine
company are dispatched
to the local Job Corps
Center for an
unresponsive male
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The time is 0310 hrs
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It is March
Case Study #3
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You arrive to find security with an 18 yoa male
patient supine on a concrete walkway in a
remote part of the campus
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The patient is pale, cool and dry
The patient has a slow weak radial pulse with
slow shallow respirations
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Your patient responds minimally to painful
stimuli and you detect an odor of alcoholic
beverage about your patient
Case Study #3
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What are some special considerations for
this patient?
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What additional information concerning
this patient would you like to obtain?
What is your differential field diagnosis?
What is your care plan for this patient?
Special Considerations from
Case #3
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Alcoholic beverage consumption increases
peripheral vasodilation and thus cutaneous
circulation by up to 10X
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Consider poly drug usage with alcohol
intoxication
Consider blood glucose abnormalities with
altered mental states and with alcoholic
beverage consumption
Thoughts on Hypothermia
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Often times it is not an isolated
event
Does not require “Cold” ambient
temperatures to occur
Be calm & gentle…this is the one
instance where time waits for us
Thank You for Your
Attention!
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Questions?
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Comments?
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Dirty Jokes?
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Rude Gestures?