Cold Weather Emergencies.ppt for the patient in distress in cold climates

encountering patients having cold related EMS complicaitons

1. Recognizing and Managing
Cold Emergencies:
Frostbite and Hypothermia

2. Altered Mental Status: Assessing
and Managing
Overview
Frostbite description and classifications
Frostbite signs and symptoms
Frostbite assessment and emergency care
Hypothermia description and classifications
Hypothermia signs and symptoms
Hypothermia assessment and emergency care
Practice assessment and care 2

3. Frostbite
Description
Freezing of a distal or small
body part from prolonged cold
exposure
Cold air
Contact with a cold object
Wind and/or water chill
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4. Frostbite
Description
Local cooling injuries to extremities
Feet and toes
Hands and fingers
Face: nose and cheeks
Ears
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5. Frostbite
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Known by several names
Frostnip

6. Frostbite
Drill of the Month 6
Immersion foot (trench foot): Injury to skin, blood
vessels, and nerves of the feet from continuous
immersion in water, even in above freezing
conditions
Chilblains (pernio): Inflammation of the hands and
feet from repeated exposure to cold and moisture

7. Frostbite
A result of prolonged cold exposure,
outdoors as well as indoors,
constricting blood vessels in the
extremities, which diverts warm blood
flow and oxygen to central vital organs
Constriction cycles with dilation to
preserve functions of extremities
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8. Frostbite
As the body temperature continues to drop,
the brain permanently constricts vessels in
extremities to maintain warmth in vital
organs: frostbite begins
Cell death due to exposure
Ice crystals form in the space outside cells
Cells become dehydrated
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9. Frostbite
Cell deterioration from of lack of oxygen and
water
Lining of blood vessels is damaged
Blood leaks from vessels on rewarming
Small clots form causing blood flow problems
and inflammation
Inflammation causes further tissue damage
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10. Clasifications
Drill of the Month 10

11. Frostbite
Classifications
Superficial (early stage)
Blood flow is restricted to body parts
Body parts freeze
Ice crystals form inside tissues
Deep (late stage)
Gangrene sets in due to cell dehydration and oxygen loss
The part may have to be amputated, even after months of
trying to heal
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12. Frostbite Signs and Symptoms
Superficial (early stage)
Patient may complain of burning, numbness, tingling,
itching, or cold in affected areas
Affected part first appears red, then turns mottled,
bluish, white, or grey as the flesh continues to freeze
Dark skin: the skin color lightens, then blanches and
will quickly turn bluish or grey
Skin feels frozen/stiff/rigid; has some pliability when
pressed
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13. Frostbite Signs and Symptoms
Deep (late stage)
Patient may complain of decreased
sensation, then lose all sensation or feeling
Affected part swells, develops blood-filled
blisters over white/yellowish waxy-looking skin
Skin feels hard with no pliability when pressed
Affected part may appear black
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14. Frostbite Signs and Symptoms
Deep (late stage)
On rewarming
Affected part turns purplish-blue
Painful aching as blood flow returns to tissues
Throbbing begins in 2 –3 days; may last months
Part may never heal and may require amputation
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15. Frostbite Assessment and Care
Assessment: Perform General Patient
Care
Size up the scene; gather info on approach
Perform initial assessment
Superficial
Look for color changes: light skin reddens; dark skin lightens; both
blanch followed by color changes
Feel area for pliability
Ask patient how it feels: patient may report numbness, tingling, burning,
etc.
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16. Frostbite Assessment and Care
Assessment: Perform General Patient
Care Size up the scene; gather info on
approach
Perform initial assessment
Deep
Check skin appearance: white, waxy skin turns mottled
or blotchy, then to grayish yellow to grayish blue
Look for swelling and blistering
Gently palpate: Does surface feel frozen w/no pliability in
underlying tissue? Do not squeeze affected part
Ask patient how it feels
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17. Frostbite Assessment and Care
Assessment: Perform General Patient
Care Perform focused history and physical
exam
Follow treatment protocols
Communicate with hospital or other response
personnel
Disposition: determine priority and mode of
transport 17

18. Frostbite Assessment and Care
Emergency care (adults or peds)
Remove patient from cold environment
Outside: Place patient in heated ambulance, wrap
in blankets
Inside: Turn up heat while working in patient’s
home, wrap in blankets, move to heated
ambulance
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19. Frostbite Assessment and Care
Emergency care (adults or peds)
Gently handle frostbitten areas
Do not rub affected areas
Ice crystals in tissues cause further damage
Wrap affected area gently, loosely with gauze
Patient may complain of tingling/burning these are normal
sensations
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20. Frostbite Assessment and Care
Emergency care (adults or peds)
If patient does not respond to simple treatment, begin
care for deep frostbite
Provide high-concentration oxygen
Provide rapid transport
If transport is delayed, re-warm affected part only on medical
direction
Do not allow patient to smoke or consume caffeine or alcohol
(vasoconstrictors, raise blood pressure)
Do not allow patient to use affected part or walk on affected
feet
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21. Frostbite Assessment and Care
Emergency care (adults or peds)
Maintain a warm environment: do not re-expose
patient to a cold environment
Reassess: recheck vital signs, recheck injury
treatments and medical status
Transport/transfer/transition patient and information
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22. Hypothermia
Description
Generalized body cooling as a result of
prolonged cold exposure
Reduces body heat
Prevents body from maintaining proper core body
temperature
Can be life-threatening
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23. Hypothermia
Description
Loss of body heat through several methods
Radiation: heat lost to environment from what body
gives off (radiates)
Conduction: heat lost by contact with or immersion in
cold water or snow
Convection: heat lost by cold water flow or air currents
Evaporation: heat lost through perspiration or wet skin
Respiration: heat lost through expired breaths—warm
air to cooler environment
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24. Hypothermia
Description
Abnormally low core body temperature
95°F or below
Life-threatening at 90°F and below
Core body measurements
Oral measurement: 96.8 to 98.6 °F (affected by liquid and
food intake and breathing)
Rectal temperature: 0.9 °F higher than oral
Axillary temperature: 0.9 °F lower than oral
Tympanic temperature: very close to oral measurement
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25. Hypothermia
Classifications: Mild to moderate —95°F to
90°F core body temperature: Caused by a cold
environment
Affects healthy individuals with prolonged exposure
Can quickly affect at-risk individuals
Patients with major trauma and shock, chronic illness,
circulatory disorders, infection, burns, and diabetes
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26. Hypothermia
Classifications: Mild to moderate —95°F to
90°F core body temperature: Caused by a cold
environment
Can quickly affect at-risk individuals
Elderly persons in an environment with cool ambient
temperature (low thermostat in winter), diet, illnesses,
medications, sedentary living
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27. Hypothermia
Classifications: Mild to moderate—95°F to
90°F core body temperature: Caused by a cold
environment
Can quickly affect at-risk individuals
Infants and children with their large skin surface to body
mass ratio, little fat, and small muscle mass (resulting in no
shivering, a typical early warning sign)
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28. Hypothermia
Classifications: Severe, or extreme
Body temperature below 90°F
Presents an unconscious cold patient in a cold
environment with no apparent vital signs (heart rate
<10 beats per minute)
Patients will not reach biological death for at least 30
minutes: resuscitate
Do not assume death based on body temperature and no
vital signs
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29. Hypothermia Signs and
Symptoms
General
Vary with patient factors, length of exposure
Shivering, becomes intense; ceases in severe hypothermia
Dizziness and confusion
Numbness, stiffness, rigidity in posture, weakness
Impaired judgment, speech, and vision, glassy stare
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30. Hypothermia Signs and
Symptoms
General
Vary with patient factors, length of exposure
Drowsiness, decrease in consciousness to unconsciousness
Cool abdominal skin temperature to your touch (back of your
hand)
Reddened skin turning to pale and cyanotic with prolonged
exposure (dark skin initially white turning cyanotic)
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31. Hypothermia Signs and
Symptoms
Specific
Mild to moderate (core body temperature 90 to 95°F
Shivering, which becomes intense (generates body heat
until muscles are fatigued)
Pulse and breathing rates and blood pressure initially
increase
Vital signs drop as body temperature drops
Apathy: patient becomes clumsy, apathetic, confused, and
has slurred speech (as if drunk) 31

32. Hypothermia Signs and
Symptoms
Specific
Severe (core body temperature less than
95°F)
Loss of consciousness
Shivering stops
Oxygen intake drops
Heart rhythm becomes irregular
Patient loses consciousness
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33. Hypothermia Signs and
Symptoms
Specific
Severe (core body temperature less than
95°F
Continued decrease of pulse and breathing rates
Appearance of death, close to death
No reflexes
Brain activity slows
Pupils dilate
Risk of lethal irregular heart rhythm increases
Patient appears dead at 82°F
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34. Hypothermia
Assessment and Emergency
Care
Assessment: Perform General Patient Care Size
up the scene and gather info on approach
Perform initial assessment
Assess mental status: check patient’s orientation to person,
place, time
Check airway, breathing, circulation
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35. Hypothermia
Assessment and Emergency
Care
Assessment: Consider the following
Air temperature, wind chill or water chill
Patient’s age
Clothing worn by patient
Patient’s general health, illnesses and medications, or
injuries
Activity at time of incident
Use of alcohol or drugs
Mental status and motor function, which decreases with
degree of hypothermia
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36. Hypothermia
Assessment and Emergency
Care
Assessment
Perform focused history and physical exam
Follow treatment protocols
Communicate with hospital or other response personnel
Disposition: determine priority and mode of transport
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37. Hypothermia
Assessment and Emergency
Care
Emergency care (adults or peds)
Quickly remove patient from cold environment
Handle gently—rough handling may cause cardiac
arrest
Resuscitate as necessary
Assess pulse for 30 –45 seconds
No pulse, start CPR
Prepare to use AED if indicated
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38. Hypothermia
Assessment and Emergency
Care
Emergency care (adults or peds)
Use passive rewarming methods to prevent further
heat loss
Remove wet or frozen clothing
Wrap patient in thermal blankets and other insulating material
Cover the patient’s head
Administer warmed oxygen, if possible/available
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39. Hypothermia
Assessment and Emergency
Care
Emergency care (adults or peds)
Maintain a warm environment: do not re-expose to
cold environment
Reassess patient
Recheck vital signs
Recheck injuries and treatment
Recheck medical status
Transport/transfer/transition patient and information
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