Home
Cold Injuries Print E-mail
Written by Budgie   
Friday, 26 June 2009
The State of Alaska Cold Injuries Guidelines have been developed for use by prehospital, clinic
and hospital personnel dealing with cold injuries in Alaska. The guidelines are not absolute rules,
governing the treatment of hypothermia, cold water near drowning, frostbite and avalanche
burial. COLD INJURIES GUIDELINES
INTRODUCTION
The State of Alaska Cold Injuries Guidelines have been developed for use by prehospital, clinic
and hospital personnel dealing with cold injuries in Alaska. The guidelines are not absolute rules,
governing the treatment of hypothermia, cold water near drowning, frostbite and avalanche
burial.
Readers should note that these guidelines are primarily designed to be used in EMS education
and as a reference for the treatment of cold injuries and for use in assisting in the development of
local standing orders. In the absence of standing orders, they may be used to guide the treatment
of cold injuries until communication with a physician is established.
These guidelines are not intended to serve as a comprehensive teaching document on coldrelated
illnesses and injuries. Consequently, those teaching the treatment of cold injuries must be
prepared to elaborate on pathophysiology and treatment.
The 2003 version of the Alaska Cold Injuries Guidelines was developed at the Southeast Region
EMS Council, Inc. Environmental Injuries Conference in Sitka in April, 2002. This conference
brought together many of the world’s experts in treating hypothermia, frostbite, cold water near
drowning, and avalanche. The criteria for the recommendations contained within this document
are a combination of evidence-based medicine, clinical experience, experimental data and,
extrapolation when no direct evidence could be found.
Michael Copass, MD Co-
Moderator
Director of Emergency Services, Harborview Hospital
Capt. Martin J. Nemiroff, MD
Co-Moderator
USCG/USPHS (Ret.)
Warren D. Bowman, MD National Medical Director Emeritus for the National Ski Patrol
Gordon Giesbrecht, PhD Professor of Thermophysiology at the University of Manitoba,
Winnipeg
Murray Hamlet, DVM US Army (Ret.)
Robert Janik, MICP EMS Training Coordinator, Southeast Region EMS Council, Inc.
Evan Lloyd, MD Consultant Anaesthetist (ret.)
RAdm. William Mills, MD Orthopedic Surgery, USNR (Ret.)
Peter Tikuisis, PhD Scientist, Defense and Civil Institute of Environmental Medicine,
Toronto, Ontario
Ken Zafren, MD, FACEP State EMS Medical Director, Alaska
Attending Physician, Alaska Native Medical Center
Clinical Faculty, Emergency Medicine Division, Stanford
University Medical Center, California
Revised 1/2005 -4-
HYPOTHERMIA
General Points
A. The evaluation and treatment of hypothermia whether wet or dry, on land or water, are
similar. Specific differences are covered in the following pages.
B. The patient with severe hypothermia must be handled very gently. The cold heart is very
prone to spontaneous ventricular fibrillation due to any disturbance or movement. Even
cautious movement of the patient may induce ventricular fibrillation.
C. In the cold patient, a core temperature is one of the vital signs. In terms of the ABC's,
think:
A-Airway
B-Breathing
C-Circulation
D-Diagnosis (Degrees)
D. In the cold patient, body core temperature becomes an important sign. While obtaining a
body core temperature is important and useful for assessing and treating hypothermia,
there is tremendous variability in individual physiologic responses at specific
temperatures and a low reading thermometer may not always be available. Therefore,
these guidelines are not solely based on the patient's measured temperature. Core
temperature1 is best measured with an esophageal probe, if one is available and personnel
have been trained in its insertion and use. If esophageal temperature monitoring is not
available or appropriate, epitympanic or rectal temperature should be used.
E. Assessment of temperature:
1. The simplest assessment of a patient's body temperature may be performed by
placing an ungloved hand against the skin of the patient's arm pit (axilla), back, or
chest. If the skin feels warm, hypothermia is unlikely. This method, however,
does not provide a reliable estimate of the patient's core temperature.
2. Patients with cold skin should have a core temperature taken with a low reading
thermometer. Household thermometers are useless in this setting. Low reading
thermometers should be capable of measuring temperatures as low as 70°F (21
oC).
3. Axillary and oral measurements are poor measures of core temperature, but may
be used to rule out a diagnosis of hypothermia. Esophageal monitoring is the
preferred method of monitoring temperature in hypothermic patients.
Epitympanic devices2, which differs from the tympanic devices used in many
1 Information about specific temperature measuring devices can be found on the CHEMS website:
www.chems.alaska.gov/EMS/coldinjuries/equip.htm
2 Epitympanic temperature probes contain a wire which measures the temperature of the air in the ear canal (the
Revised 1/2005 -5-
clinics, is second in order of preference. Rectal temperature lags significantly
behind core temperature, but may be useful if esophageal or epitympanic
temperature is not available. It is acknowledged that other methods of estimating
the core temperature exist. Use of techniques other than esophageal
measurements should be evaluated for their accuracy and practicality in the field.
The decision to use a methodology other than esophageal temperatures should be
made in consultation with the service’s physician medical director.
CAUTION: Electronic thermometers may not be accurate if they are used in the
cold. Cold shortens battery life, care must be taken that you have an alternate,
non-battery dependent thermometer.
F. The hypothermic patient should be assessed carefully for coexisting injuries and illnesses.
The signs and symptoms of hypothermia may be mimicked by alcohol, diabetes, altitude
sickness, overdose, exhaustion, and other conditions. As a result, a thorough assessment
of the patient is imperative. Associated significant illness or injury may exacerbate
hypothermia.
G. If there is a fracture/dislocation associated with frostbite, the limb should be aligned in a
neutral position (“make limbs look like limbs”) and splinted. Use caution to prevent
additional injuries to frostbitten tissues. Splints should not be constrictive or restrict
blood flow into the limb.
H. Make every attempt to warm oxygen and fluids (both oral and IV) used for a hypothermic
patient to at least the core temperature of the patient. (These fluids may be carried under
the rescuers’ jackets). Fluids are given for volume expansion, not to warm the patient. If
fluid resuscitation is required, give a bolus (rather than as a continuous infusion), then
saline lock the IV. Additional boluses can be given as needed.
I. Since cold skin is easily injured, avoid direct application of hot objects or excessive
pressure (e.g. uninsulated hot water bottles, BP cuffs, etc.).
J. Chemical heat packs are ineffective in warming a patient. If the patient does not have
frostbitten hands and feet, chemical hand warmers may be helpful in preventing further
injury during transportation. Care should be taken with some chemical heat packs that
may not have much total heat capacity but may burn the skin (i.e., surface temperature
above 122 °F (50 °C).
K. Assume that the hypothermic patient can be resuscitated even if they appear to be beyond
help because of skin color, pupil dilation, and depressed vital signs. Patients suffering
from severe hypothermia have been resuscitated. It is also wise to be cautious about what
is said during the resuscitation. Seemingly unconscious patients frequently remember
what was said and done.
probe blocks outside air from entering the ear canal) which is very close to the temperature of the brain. Regular
tympanic thermometers use infrared technology which is less accurate.
Revised 1/2005 -6-
L. Severe cold injuries are encountered relatively infrequently. Consequently, it is
necessary that responders preplan the management of these conditions and that they are
familiar with the appropriate equipment.
M. The inside of the ambulance and any rooms where hypothermia patients are treated
should be warm enough to prevent further heat loss, ideally above 80° F (27° C).
N. Rescuers should follow state law and local standing orders. Generally, CPR should not be
initiated if the patient:
·  has been submerged in cold water for more than 1 hour;
·  has a core temperature of less than 50° F (10° C);
·  has obvious fatal injuries, e.g. decapitation;
·  is frozen, e.g. ice formation in the airway;
·  has a chest wall that is so stiff that compressions are impossible;
·  rescuers are exhausted or in danger; or if
·  if definitive care is available within three hours.
O. An initial check for cardiac activity (or pulse) should be continued for 60 seconds when
assessing a hypothermic patient or a patient who has been removed from cold water.
P. If the patient is not breathing and has no signs of circulation, give 3 minutes of
ventilation. This may improve previously undetectable cardiovascular activity (i.e.,
increased pulse rate and/or increased blood pressure).
Q. Cardiac activity (or pulse) should then be checked again for 60 seconds before assuming
no cardiac activity.
In the patient who is not breathing and has no signs of circulation, the clinical decisions
are based on access to cardiac monitoring and definitive care.3
·  If cardiac monitor is not available and definitive care is available within 3 hours,
continue ventilation (intubate if possible), protect from further cooling, and do not
start chest compressions. Wait for rescue crew. Starting chest compressions
might precipitate vent ricular fibrillation in a patient who actually has a weak pulse
which is difficult to detect, but which might be providing adequate perfusion. If
chest compressions cause ventricular fibrillation, this perfusion will be lost.
·  If cardiac monitor is not ava ilable and definitive care is not available within 3
hours, continue ventilation (intubate if possible), start chest compressions and
perform for 30 minutes while attempting to rewarm the patient. If this is
unsuccessful in restoring spontaneous circulation, EMTs, Paramedics, Physician
Assistants and Physicians may pronounce the patient dead.
·  If cardiac monitoring is available, follow the appropriate guidelines. AED
3 Definitive care is rendered in a medical facility or by an advanced level EMS provider. It requires appropriate
temperature measuring devices (esophageal or epitympanic), cardiac monitoring capability, and the ability to
initiate active patient rewarming. Active rewarming includes forced air warming, plumbed (water-filled)
blankets, the Charcoal Heatpac, etc. (see chart on page 26). Chemical heat packs are NOT effective for patient
rewarming.
Revised 1/2005 -7-
guidelines are found on page 7, ‘S.’ Manual defibrillator guidelines are found in
the EMT-III/Paramedic Section on pages 21-22.
·  CPR, while litter bearing, is not effective and should not be attempted.
R. In the State of Alaska, legislation (AS 18.08.089) has empowered EMTs, paramedics and
physician assistants to declare death in the field following 30 minutes of properly
performed advanced life support (ALS), even when the patient is hypothermic. If ALS is
not available, current law requires EMTs to perform 60 minutes of cardiopulmonary
resuscitation in conjunction with rewarming techniques on hypothermic patients prior to
the declaration of death in the field. Please note that this legislation does not authorize
Emergency Trauma Technicians and the general public to pronounce a patient dead.4
S. An Automated External Defibrillator (AED) may be helpful to ascertain the presence or
absence of ventricular fibrillation (cardiac activity). On AEDs, which do not display a
tracing, the signal to shock means that the cardiac rhythm is either ventricular fibrillation
or ventricular tachycardia. The signal not to shock may mean that the patient is in
asystole or has a cardiac rhythm which would not benefit from defibrillation; this
includes pulseless electrical activity.
T. When moving hypothermic patients by helicopter, care must be taken to protect the
patient from additional exposure to cold due to the increased windchill caused by
rotorwash. Rotorwash can be minimized if the helicopter shuts down while loading and
unloading. If this is unsafe from an aviation standpoint, the patient must be packaged
carefully to avoid any additional loss of heat or skin exposure that can cause or worsen
frostbite and hypothermia.
4 AS 08.18.089 (d) (3) (B) defines “properly administered resuscitation efforts” as “when a person authorized to
perform advanced cardiac life support techniques is not available and the patient is hypothermic, at least 60
minutes of cardiopulmonary resuscitation properly performed in conjunction with rewarming techniques as
described in the current State of Alaska Hypothermia and Cold Water Near-Drowning Guidelines” NOTE: If a
physician is available for consultation by radio or telephone, it is the physician, not the EMT, MICP, or PA who is
pronouncing the patient and this statute does not apply.
Revised 1/2005 -8-
Classifications of Level of Hypothermia
Classifications Core temp Patient’s ability to
rewarm without
external heat source
Clinical Presentation
Normal
Above 95 oF
(35 oC)
Cold sensation
shivering
Mild 95-90 oF
(35-32 oC)
Good Physical
impairment
·  Fine
motor
·  Gross
motor
Mental
impairment
·  Complex
·  Simple
Moderate 90-82 oF
(32-28 oC)
Limited Below 86 oF (30 oC) degrees
shivering stops
loss of consciousness
Below 82 oF
(28 oC)
Unable Rigidity
Vital signs reduced or absent
Severe risk of mechanicallystimulated
ventricular fibrillation
(VF) (rough handling)
Severe
Below 77 oF
(25oC)
Unable Spontaneous ventricular
fibrillation (VF)
Cardiac arrest
Bold text shows the major thresholds between stages of hypothermia
Revised 1/2005 -9-
HYPOTHERMIA
General Public
A. Assessment of Patient
1. Mild Hypothermia: A patient who is cold and has the following signs is
considered to have mild hypothermia:
a. Alert
b. Vital signs not depressed
c. Vigorous shivering
2. Moderate or Severe Hypothermia – consistent with a temperature below 90 oF (32
oC). A patient who is cold and has any of the following signs or symptoms is
considered to have moderate to severe hypothermia:
a. Depressed vital signs, such as a slow pulse and/or slow respiration.
b. Altered level of consciousness, including slurred speech, staggering gait,
decreased mental skills, or the lack of response to verbal or painful
stimuli.
c. No shivering in spite of being very cold. (Note: This sign is potentially
unreliable and may be altered by alcohol intoxication.)
B. Basic Treatment for Hypothermia
1. Prevent further heat loss:
a. Insulate from the ground;
b. Protect from the wind, eliminate evaporative heat loss by removing wet
clothing (once the patient has adequate shelter);
c. Insulate the patient, including the head and neck;
d. Cover the patient with a vapor barrier (such as a blue tarp, a large piece of
plastic, large garbage bags, etc.); and
e. Move the patient to a warm environment.
2. Activate the emergency medical services system to provide transport to a medical
facility.
3. Do not give alcohol or permit patient to use tobacco.
Revised 1/2005 -10-
C. Treatment for Mild Hypothermia
1. Treat the patient as outlined in Section B.
2. If there is no way to get to a medical facility, or if it will take more than 30
minutes for the patient to arrive at a medical facility, rewarm the patient with one
or more of the following methods:
a. Vigorous shivering is a very important method for increasing heat
production. Shivering should be fueled by calorie replacement with fluid
containing sugars (sugar content is more important than hot drinks);
b. Do not allow the patient to drink liquid s unless the patient is capable of
swallowing and protecting the airway.
c. Apply heat to areas of high surface heat transfer including the underarms,
sides of the chest wall, the neck and groin;
d. Place the patient in a sleeping bag and provide close skin-to-skin contact
with a warm body. The patient should not be placed in a sleeping bag with
another individual who is hypothermic. This method may not speed core
warming in a vigorously shivering patient but will slowly warm a nonshivering
patient;
e. Consider a warm shower or a warm bath for the patient, if he or she is
alert and mobile; and
f. Mild exercise, such as walking or stepping up and down on an object, will
produce heat and may be helpful. This should only be conducted after the
patient is dry, has had calorie replacement, and has been stable for at least
30 minutes.
D. Treatment for Moderate to Severe Hypothermia with Signs of Life (Pulse or
Respirations):
1. Treat patients who are hypothermic very gently (do not rub or manipulate
extremities, or attempt to remove wet clothes without cutting them off).
2. Treat the patient as outlined in sections B and C above with the following
exceptions:
a. Do not allow the patient to sit or stand until rewarmed (do not put in
shower or bath).
b. Do not give the patient oral fluids or food.
c. Do not attempt to increase heat production through exercise, including
walking.
3. Reassess the patient's physical status periodically.
4. Transfer to a medical facility as soon as possible.
E. Treatment for Severe Hypothermia with No Life Signs:
1. Treat the patient as outlined in Section B. Handle very carefully.
2. Check for respiration and signs of circulation (e.g. coughing, movement) for 60
seconds. If the patient is not breathing and does not have signs of circulation,
Revised 1/2005 -11-
give 3 minutes of ventilation. Recheck for respiration and signs of circulation for
a further 60 seconds. If the patient still is not breathing and does not have signs of
circulation and there are no contraindications as listed Appendix C, continue
ventilations. Start chest compressions only if the patient will not receive definitive
care within 3 hours (see Q page 6).
3. Use mouth-to-mask breathing.
4. Reassess the patient's physical status periodically.
5. Transfer to a medical facility as soon as possible.
Revised 1/2005 -12-
HYPOTHERMIA:
First Responder/Emergency Medical Technician-I5
A. Assessment of Patient
1. Mild Hypothermia: A patient who is cold and has the following signs is
considered to have mild hypothermia:
a. Alert
b. Vital signs not depressed
c. Vigorous shivering
2. Moderate or Severe Hypothermia – consistent with a temperature below 90 oF (32
oC). A patient who is cold and has any of the following signs or symptoms is
considered to have moderate to severe hypothermia:
a. Depressed vital signs, such as a slow pulse and/or slow respiration.
b. Altered level of consciousness, including slurred speech, staggering gait,
decreased mental skills, or the lack of response to verbal or painful
stimuli.
c. No shivering in spite of being very cold. (Note: This sign is potentially
unreliable and may be altered by alcohol intoxication.)
B. Basic Treatment for Hypothermia
1. Prevent further heat loss:
a. Insulate from the ground;
b. Protect from the wind, eliminate evaporative heat loss by removing wet
clothing (once the patient has adequate shelter);
c. Insulate the patient, including the head and neck;
d. Cover the patient with a vapor barrier (such as a blue tarp, a large piece of
plastic, large garbage bags etc.); and
e. Move the patient to a warm environment.
2. Activate the emergency medical services system to provide transport to a medical
facility.
3. Do not give alcohol or permit patient to use tobacco.
4. Oxygen should be administered, if available. Oxygen should be heated to a
maximum of 108°F (42°C) and humidified if possible. Heating oxygen without
humidification is not an effective warming technique.
5. Splinting should be performed, when indicated, in an anatomically neutral
5 Community Health Aides should use the protocols for their level of EMS certification. CHAs who are not
certified as EMTs should use the EMT-I protocols for cold injuries.
Revised 1/2005 -13-
position if possible with caution to prevent additional injuries to frostbitten
tissues.
C. Treatment for Mild Hypothermia
1. Treat the patient as outlined in Section B.
2. If there is no way to get to a medical facility, or if it will take more than 30
minutes for the patient to arrive at a medical facility, rewarm the patient with one
or more of the following methods:
a. Vigorous shivering is a very important method for increasing heat
production. Shivering should be fueled by calorie replacement with fluid
containing sugars (sugar content is more important than hot drinks);
b. Do not allow the patient to drink liquids unless the patient is capable of
swallowing and protecting the airway.
c. Apply heat to areas of high surface heat transfer including the underarms,
sides of the chest wall, the neck and groin;
d. Place the patient in a sleeping bag and provide close skin-to-skin contact
with a warm body. The patient should not be placed in a sleeping bag with
another individual who is hypothermic. This method may not speed core
warming in a vigorously shivering patient but will slowly warm a nonshivering
patient;
e. Consider a warm shower or a warm bath for the patient, if he or she is
alert and mobile; and
f. Mild exercise, such as walking or stepping up and down on an object, will
produce heat and may be helpful. This should only be conducted after the
patient is dry, has had calorie replacement, and has been stable for at least
30 minutes.
D. Treatment for Moderate to Severe Hypothermia with Signs of Life (Pulse or
Respirations):
1. Treat patients who are hypothermic very gently (do not rub or manipulate
extremities, or attempt to remove wet clothes without cutting them off).
2. Obtain a core temperature as trained and authorized.
3. Treat the patient as outlined in sections B and C above with the following
exceptions:
a. Do not allow the patient to sit or stand until rewarmed (do not put in
shower or bath).
b. Do not give the patient oral fluids or food.
c. Do not attempt to increase heat production through exercise, including
walking.
4. Reassess the patient's physical status periodically.
5. Transfer to a medical facility as soon as possible.
E. Treatment for Severe Hypothermia with No Life Signs:
Revised 1/2005 -14-
1. Treat the patient as outlined in Section B. Handle ve ry carefully.
2. Check for respiration and signs of circulation for 60 seconds. If the patient is not
breathing and has no signs of circulation, give 3 minutes of ventilation. Recheck
for respiration and signs of circulation for a further 60 seconds. If the patient still
is not breathing and has no signs of circulation and there are no contraindications
as listed in Appendix C, continue ventilations. Start chest compressions only if the
patient will not receive definitive care within 3 hours (see Q, page 6).
3. Use mouth-to-mask breathing or bag-valve-mask (BVM) with oxygen when
giving ventilations. Care must be taken not to hyperventilate the patient as
hypocarbia can reduce the threshold for ventricular fibrillation in the cold heart.
·  When using a BVM, ventilate the hypothermic patient at 6 breaths per minute
(half the normal rate).
·  When using mouth-to-mask ventilations to the hypothermic patient, give 12
breaths per minute.
4. If the rescuers are authorized to use an automated external defibrillator and the
device states that shocks are indicated, one set of three stacked shocks should be
delivered. If the core temperature of the patient cannot be determined or is above
86 °F (30 oC), treat the patient as if normothermic. If the patient's core
temperature is below 86 °F (30 oC), discontinue use of the AED after the initial
three shocks until the patient’s core temperature has reached 86 °F (30 oC).
5. If CPR has been provided in conjunction with rewarming techniques for more
than 30 minutes without the return of spontaneous pulse or respiration, contact the
base physician for recommendations. If contact with a physician is not possible,
Emergency Medical Technicians may consider terminating the resuscitation in 60
minutes in accordance with AS 18.08.089 and local protocols (see page 6,
General Point Q).
Revised 1/2005 -15-
HYPOTHERMIA
Emergency Medical Technician-II
A. Assessment of Patient
1. Mild Hypothermia: A patient who is cold and has the following signs is
considered to have mild hypothermia:
a. Alert
b. Vital signs not depressed
c. Vigorous shivering
2. Moderate or Severe Hypothermia – consistent with a temperature below 90 oF (32
oC). A patient who is cold and has any of the following signs or symptoms is
considered to have moderate to severe hypothermia:
a. Depressed vital signs, such as a slow pulse and/or slow respiration.
b. Altered level of consciousness, including slurred speech, staggering gait,
decreased mental skills, or the lack of response to verbal or painful
stimuli.
c. No shivering in spite of being very cold. (Note: This sign is potentially
unreliable and may be altered by alcohol intoxication.)
B. Basic Treatment for Hypothermia
1. Prevent further heat loss:
a. Insulate from the ground;
b. Protect from the wind, eliminate evaporative heat loss by removing wet
clothing (once the patient has adequate shelter);
c. Insulate the patient, including the head and neck;
d. Cover the patient with a vapor barrier (such as a blue tarp, a large piece of
plastic, large garbage bags etc.); and
e. Move the patient to a warm environment.
2. Activate the emergency medical services system to provide transport to a medical
facility.
3. Do not give alcohol or permit patient to use tobacco.
4. Oxygen should be administered, if available. Oxygen should be heated to a
maximum of 108°F (42°C) and humidified if possible. Heating oxygen without
humidification is not an effective warming technique.
5. Splinting should be performed, when indicated, in an anatomically ne utral
position if possible with caution to prevent additional injuries to frostbitten
tissues.
6. IV Therapy
Revised 1/2005 -16-
a. Indications for IVs are the same for mildly hypothermic patients as they
are for normothermic patients.
b. Most hypothermic patients are volume depleted and may require
aggressive fluid resuscitation.
c. Do not delay transport, communications, or other therapy by taking a long
time to start an IV. IVs are difficult to start in cold patients.
d. The recommended fluid for volume replacement is no rmal saline. Bolus
therapy is preferred to continuous drip. Give the patient a 250 cc bolus
then either saline lock the IV (preferred) or decrease the fluid to TKO.
Additional boluses can be delivered as needed to replace volume losses.
Most hypothermic patients who don’t have contraindications (e.g.
pulmonary edema, near drowning) will usually require at least one liter of
fluids for volume replacement.
e. IVs should be heated to approximately 104° - 108° F (40o– 42° C), when
possible, but should be no colder than the patient’s core temperature.
7. Medications:
a. Indications for medications are the same for mildly hypothermic patients
as they are for normothermic patients.
b. Medications are inefficient and poorly metabolized in the moderate-toseverely
hypothermic patient. In addition, due to delayed metabolism,
medications given in normal therapeutic doses to severely hypothermic
patients can result in toxicity when the patient is rewarmed.
C. Treatment for Mild Hypothermia
1. Treat the patient as outlined in Section B.
2. If there is no way to get to a medical facility, or if it will take more than 30
minutes for the patient to arrive at a medical facility, rewarm the patient with one
or more of the following methods:
a. Vigorous shivering is a very important method for increasing heat
production. Shivering should be fueled by calorie replacement with fluid
containing sugars (sugar content is more important than hot drinks);
b. Do not allow the patient to drink liquids unless the patient is capable of
swallowing and protecting the airway.
c. Apply heat to areas of high surface heat transfer including the underarms,
sides of the chest wall, the neck and groin;
d. Place the patient in a sleeping bag and provide close skin-to-skin contact
with a warm body. The patient should not be placed in a sleeping bag with
another individual who is hypothermic. This method may not speed core
warming in a vigorously shivering patient but will slowly warm a nonshivering
patient;
e. Consider a warm shower or a warm bath for the patient, if he or she is
alert and mobile; and
Revised 1/2005 -17-
f. Mild exercise, such as walking or stepping up and down on an object, will
produce heat and may be helpful. This should only be conducted after the
patient is dry, has had calorie replacement, and has been stable for at least
30 minutes.
D. Treatment for Moderate to Severe Hypothermia with Signs of Life (Pulse or
Respirations):
1. Treat patients who are hypothermic very gently (do not rub or manipulate
extremities, or attempt to remove wet clothes without cutting them off).
2. Obtain a core temperature as trained and authorized.
3. Treat the patient as outlined in sections B and C above with the following
exceptions:
a. Do not allow the patient to sit or stand until rewarmed (do not put in
shower or bath).
b. Do not give the patient oral fluids or food.
c. Do not attempt to increase heat production through exercise, including
walking.
4. Reassess the patient's physical status periodically.
5. Transfer to a medical facility as soon as possible.
E. Treatment for Severe Hypothermia with No Life Signs:
1. Treat the patient as outlined in Section B. Handle very carefully.
2. Check for respirations and signs of circulation for at least 60 seconds. If the
patient is not breathing and has no signs of circula tion, give 3 minutes of
ventilation. Recheck for signs of circulation and respiration for a further 60
seconds. If the patient still is not breathing and has no signs of circulation and
there are no contraindications as listed in as listed Appendix C, continue
ventilations. Start chest compressions only if the patient will not receive definitive
care within 3 hours. (see P page 6).
3. Use mouth-to-mask breathing or bag-valve-mask (BVM) with oxygen when
giving ventilations. Care must be taken not to hyperve ntilate the patient as
hypocarbia can reduce the threshold for ventricular fibrillation in the cold heart.
·  When using a BVM, ventilate the hypothermic patient at 6 breaths per minute
(half the normal rate).
·  When using mouth-to-mask ventilations to the hypothermic patient, give 12
breaths per minute.
4. Advanced airway devices: The indications and contraindications for advanced
airway devices are the same in both the hypothermic and the warm patient. The
patient should be adequately ventilated and pre-oxygenated for 3 minutes prior to
the intubation attempt. Intubation should only be attempted under optimum
conditions by skilled personnel. Care should be taken to be extremely gentle and
avoid excessive movement during the procedure. Avoid hyperventilation in the
hypothermic patient.
Revised 1/2005 -18-
5. If the rescuers are authorized to use an automated external defibrillator and the
device states that shocks are indicated, one set of three stacked shocks should be
delivered. If the core temperature of the patient cannot be determined or is above
86 °F (30 oC), treat the patient as if normothermic. If the patient's core
temperature is below 86 °F (30 oC), discontinue use of the AED after the initial
three shocks until the patient’s core temperature has reached 86 °F (30 oC).
6. If CPR has been provided in conjunction with rewarming techniques for more
than 30 minutes without the return of spontaneous pulse or respiration, contact the
base physician for recommendations. If contact with a physician is not possible,
Emergency Medical Technicians may consider terminating the resuscitation in 60
minutes in accordance with AS 18.08.089 and local protocols (see page 6,
General Point Q).
Revised 1/2005 -19-
HYPOTHERMIA:
Emergency Medical Technician-III/Paramedic
A. Assessment of Patient
1. Mild Hypothermia: A patient who is cold and has the following signs is
considered to
 
< Prev   Next >
[ Back ]

Popular