Heat And Cold Emergencies for EMS

Heat and Cold Emergencies Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org

Thermoregulation Homeostasis requires stable temperature ~98.6ºF Heat Production>Heat Loss Increased Body Temperature Heat Production>Heat Loss Increased Body Temperature

Thermoregulation Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org

Heat Loss
Conduction
Convection
Evaporation
Radiation
Breathing
Porter, Littleton and Parker EMS 303-765-6367, www.emsteam.org

Cold Related Injuries
Hypothermia
Nonfreezing (dry or wet foot)
- Chilblains
-Trench foot (“immersion foot”)
Freezing
-frostnip
-frostbite

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

Predisposing Factors to Hypothermia
Age
Medical condition
Submersion (heat loss in water is 32x greater)
Drugs and alcohol

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

Moderate Hypothermia 86-93 degrees F
Metabolism slows down
Shivering stops
Cardiac problems
Cold diuresis results

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!

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!”

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

Nonfreezing Cold Related Injuries
Pernio (Chilblain)
Prolonged exposure to dry/cold
Typically seen in mountain climber
Small, superficial, painful ulcerations
Re-warm, elevate, bandages

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”

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

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

Frostbite
Do NOT :
Allow refreezing
Massage injured part
Allow patient to smoke
Puncture or drain blebs

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

Body’s Response to Heat
Skin
Cardiovascular system
Respiratory system
Skeletal muscular system

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

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

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

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

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

Heat Stoke
TRUE MEDICAL EMERGENCY!
Irritability
Bizarre behavior
Hallucinations
Coma
Seizures!
Rapid bounding pulse
Dry skin

Heat Stroke Treatment
Ensure airway
Administer oxygen
Aggressively lower body temperature
Remove clothing
Cool with water soaked sheets
Treat seizures
Monitor vital en route

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Heat And Cold Emergencies for EMS

by Porter, Littleton, Parker Emergency Medical Services

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