Cold Emergencies include conditions from mild frostbite to severe accidental hypothermia. Frostbite is defined as a localized injury resulting from freezing of body tissues and can be categorized from mild (frost-nip) to severe (deep frostbite). Hypothermia is the result of a decrease in heat production (often seen in patients with metabolic, neurologic and infectious illnesses), increased heat loss (traumatic, environmental and toxic), or a combination of the two factors. Hypothermia is defined as a core temperature below 95ºF (35ºC). Mild hypothermia often presents as altered mental status. Shivering may or may not be present. Moderate to severe hypothermia will not only have altered mental status, but may show decreased pulse, respiratory rate and blood pressure. Failure to recognize and properly treat hypothermia can lead to significant morbidity and mortality. REMEMBER: A patient in cardiopulmonary arrest with suspected severe hypothermia is not considered dead until all attempts at active re-warming have been completed in a hospital setting and resuscitation efforts remain unsuccessful.
ASSESSMENT / TREATMENT PRIORITIES
NOTE: Hypothermic patients must be handled gently as jarring movements may cause cardiac arrest.
1. Ensure scene safety and maintain appropriate body substance isolation precautions.
2. Maintain open airway and assist ventilations as needed. Assume spinal injury when appropriate and treat accordingly.
3. Administer oxygen using appropriate oxygen delivery device, as clinically indicated.
4. Determine patient’s hemodynamic stability and symptoms. Continually assess Level of Consciousness, ABCs and Vital Signs.
5. Obtain appropriate S-A-M-P-L-E history related to event.
6. Monitor and record vital signs and ECG.
7. Remove wet clothing (by cutting clothing to limit patient movement).
8. Prevent heat loss with use of blankets. If available, place heat sources at patient's neck, armpits, flanks and groin.
9. Handle patient gently. Do not allow patients to walk or exert themselves.
10. Do not allow patient to eat or drink stimulants.
11. Do not massage extremities.
12. Initiate transport as soon as possible, with or without ALS. Do not allow patients to exert themselves and properly secure to cot in position of comfort, or appropriate to treatment(s) required.