Heat And Cold Emergencies for EMS

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Basic prehospital lecture on heat and cold emergencies

Basic prehospital lecture on heat and cold emergencies

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  • 1. Heat and Cold Emergencies Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 2. Thermoregulation Homeostasis requires stable temperature ~98.6ºF Heat Production>Heat Loss Increased Body Temperature Heat Production>Heat Loss Increased Body Temperature
  • 3. Thermoregulation Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 4. Heat Loss
    • Conduction
    • Convection
    • Evaporation
    • Radiation
    • Breathing
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 5. Cold Related Injuries
    • Hypothermia
    • Nonfreezing (dry or wet foot)
    • - Chilblains
    • -Trench foot (“immersion foot”)
    • Freezing
    • -frostnip
    • -frostbite
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 6. Hypothermia An abnormal body temperature below 95 F, occurring when the amount of heat gained is less than the amount of heat given off. Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 7. Predisposing Factors to Hypothermia
    • Age
    • Medical condition
    • Submersion (heat loss in water is 32x greater)
    • Drugs and alcohol
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 8. Mild Hypothermia 93-96.8 degrees F
    • Peripheral vasoconstriction
    • HR, RR, BP all increase
    • Increased metabolic rate and shivering (until glucose is depleted)
    • Slurred speech
    • Failure of muscle coordination
    • Impaired judgment
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 9. Moderate Hypothermia 86-93 degrees F
    • Metabolism slows down
    • Shivering stops
    • Cardiac problems
    • Cold diuresis results
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 10. Severe Hypothermia Below 86 degrees F
    • Comatose
    • Areflexic
    • Profoundly depressed vital signs
    • Basil metabolic rate is 50% that of normal
    • Heart arrhythmias
    • Fixed and dilated pupils
    • They may look dead!
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 11. Treatment
    • Careful, gentle handling
    • Remove from the cold environment
    • Remove wet clothing
    • Prevent further heat loss
    • CPR if no pulse
    • Oxygen, bag valve if necessary
    • Re-warming techniques (heat to the head, neck, chest groin)
    • No alcoholic beverages or caffeine
    • “ No one is dead until warm and dead!”
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 12. Nonfreezing Cold Related Injuries
    • Trench Foot
    • Caused by exposure to cool wet conditions for 1-2 days
    • Resembles a partial thickness burn
    • Skin is pale, mottled, anesthetic
    • Gangrene may occur
    • Warm, dry, clean, wrap
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 13. Nonfreezing Cold Related Injuries
    • Pernio (Chilblain)
    • Prolonged exposure to dry/cold
    • Typically seen in mountain climber
    • Small, superficial, painful ulcerations
    • Re-warm, elevate, bandages
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 14. Freezing Injuries
    • Frostnip: skin is blanched/numb
    • Frostbite:
    • Superficial -skin is cold to the touch
    • -pale/gray/bloodless
    • -skin is soft and pliable
    • -blisters within 24-28 hours
    • Deep -skin is woody/stony
    • -deep purple/red skin
    • -may involve muscle, bone, tendon
    • -dark hemorrhagic blisters in 1-3 weeks
    • -”progressive dermal ischemia”
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 15. Predisposing Factors to Frostbite
    • Physiologic
    • -Dehydration
    • -Genetic
    • -Trauma
    • Mechanical
    • -Constrictive or wet clothing
    • -Inadequate insulation
    • Psychological
    • -Attitude
    • -Intoxicants
    • -Tobacco use
    • -Fatigue
    • Environmental
    • -Ambient temperature
    • -Humidity
    • -Wind chill factor
    • -Duration of exposure
    • -Altitude
    • Cardiovascular
    • -Hypotension
    • -Atherosclerosis
    • -Raynaud’s syndrome
    • -Cold-induced vasodilation
    • -Anemia
    • -Vasoconstrictors/vasodilators
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 16. Treatment
    • Frostnip:
    • -treat at the scene with rapid re-warming
    • -shelter from wind
    • -no rubbing or alcohol
    • -stay away from dry heat (campfire)
    • Frostbite:
    • -don’t re-warm if there is a potential for refreezing
    • -sterile dressing
    • -remove all jewelry
    • -in hospital re-warming with water at 100-105F
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 17. Frostbite
    • Do NOT :
      • Allow refreezing
      • Massage injured part
      • Allow patient to smoke
      • Puncture or drain blebs
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 18. Hyperthermia Abnormal elevation of body temperature, occurring when the amount of heat gained is greater than the amount of heat given off. Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 19. Body’s Response to Heat
    • Skin
    • Cardiovascular system
    • Respiratory system
    • Skeletal muscular system
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 20. Heat Related Emergencies Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org OFTEN NONE DRY, HOT BOUNDING DEEP, SHALLOW NO Heat Stroke SOMETIMES HEAVY COLD, CLAMMY WEAK RAPID, SHALLOW YES Heat Exhaustion SELDOM HEAVY NORMAL VARY VARY YES Heat Cramps Loss of responsiveness Sweat or Skin Moisture Skin Condition Pulse Rate Breathing Rates Muscle Cramps Heat Related condition
  • 21. Heat Cramps Painful contractions of the larger muscle groups of the body, usually calves and thighs, during or shortly after strenuous exercise.
    • Signs and Symptoms:
    • -normal body temperature
    • -no evidence of dehydration
    • -abdominal and leg pain
    • -nausea
    • Treatment:
    • - rest and oral/IV electrolyte replacement
    • -misdiagnosed rhabdomyolysis
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 22. Heat Exhaustion Volume depletion in the face of heat stress (@102 F)
    • SIGNS AND SYMPTOMS
    • Nausea/vomiting
    • Headache
    • Dizziness/ possible syncope
    • Actively sweating
    • Skin cool and pale
    • Usually conscious
    • but confused
    • TREATMENT
    • Shady place or AC room
    • Keep cool
    • Increase fluids
    • Cold wet towels
    • Fan
    • may require of up to 1-2L NS
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 23. Heat Stroke The body’s temperature regulating mechanisms have broken down.
    • Pathophysiology
      • Body heat accumulation leads to increased temperature above 106 0 F
      • Increased temperature damages hypothalamus:
        • Heat regulating mechanism failure occurs
        • 25 - 50% mortality
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 24. RISK GROUPS FOR HYPERTHERMIA?? Diabetics Age Environment Occupation Obesity Drugs and Alcohol Febrile Chronic diseases Psychological factors Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 25. Heat Stoke
    • TRUE MEDICAL EMERGENCY!
    • Irritability
    • Bizarre behavior
    • Hallucinations
    • Coma
    • Seizures!
    • Rapid bounding pulse
    • Dry skin
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org
  • 26. Heat Stroke Treatment
    • Ensure airway
    • Administer oxygen
    • Aggressively lower body temperature
    • Remove clothing
    • Cool with water soaked sheets
    • Treat seizures
    • Monitor vital en route
    Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org