2. Cold Water Near Drowning
Drowning - Lungs fill with Water (aka
Pulmonary Aspiration
Near Drowning - Survival of up to 24
hours after a drowning episode.
(Warm and Dead - 30 Degrees C)
Hypothermia (Hypo- Low, Therme -Heat)
“A Dangerous Loss of Heat”
3. Cold Water Submersion
Adults - Asphyxiation and Immediate
Hypothermia
RAPID CORE COOLING - LOW BOD
Children - Cool More Rapidly
Heart to 7 BPM Epiglotis Closes
MAMMALIAN DIVING REFLEX 30 MIN.
4. FORCES IN THERMAL
REGULATION IN COLD
THIS IS A BALANCE BETWEEN THE COLD
CHALLENGE AND YOUR ABILITY TO
PRODUCE OR RETAIN HEAT.
THE COLD CHALLENGE -- The environment
working to take heat away from the body.
HEAT RETENTION -- The body’s ability to
retain heat.
HEAT PRODUCTION -- The body’s ability to
produce heat
5. Your Body’s Reaction to a
Cold Challenge
1. The Cold Response
2. Mild Hypothermia
3. Severe Hypothermia
6. The Cold Response
The body’s normal physiological response
to a cold challenge
ASSESSMENT
Blood is shunted from the periphery to the core.
Mild shivering: if exercise is not adequate for heat
production
A normal level of consciousness
Fine motor function may be impaired.
Increased urination causing a loss of fluid
7. The Cold Response
TREATMENT
Add more clothing layers (Heat Retention)
Increase fluid/fuel intake (Heat Production)
Increase exercise (Heat Production)
THE BOTTOM LINE -- EASILY DEALT WITH IF
RECOGNIZED EARLY. EMS INVOLVEMENT OR SAR IS
TO EDUCATE, EDUCATE, EDUCATE.
8. MILD HYPOTHERMIA
THE BODY’S ABILITY TO COMPENSATE FOR
THE COLD CHALLENGE IS OVERWHELMED
The onset of mild hypothermia is a field emergency,
indicating a significant drop in core temperature has
already occurred.
9. MILD HYPOTHERMIA
ASSESSMENT
Mental status changes: irritable, lethargic, mild
confusion (may appear drunk)
Shivering may be present
Loss of fine motor function
Shell to core shunting
Core temp. Less than 90 degrees F, 32 deg. C
Other VS within normal parameters
10. MILD HYPOTHERMIA
Treatment
Shelter from wind
and moisture
Remove wet clothes
:replace with dry.
Body to body contact
may be helpful
Insulate from the
ground or snow
Use a vapor barrier
over clothing to cut
evaporative heat loss
Take in fluids (warm
drinks)
Take in Calories
Exercise to increase
heat production once
above completed.
11. SEVERE HYPOTHERMIA
This is a true medical emergency.
The patient has lost all ability to fight the
cold challenge. Rescue efforts should be
directed to gentle rapid transport and
preventing further heat loss.
12. SEVERE HYPOTHERMIA
ASSESSMENT
Significant decrease in LOC
Shell to core effect is extreme
Core temperature less than 90 degrees F
No shivering
“Metabolic Icebox” effect. VS depressed
or unobtainable. Pupils dialated with CA
13. SEVERE HYPOTHERMIA
Treatment
Nothing by mouth
Airway to be open
Slow Mouth to Mouth
CPR
6-12 Breaths/Min.
40-60
Comp./Min.
Primary/Secondary
Injury Mgmt.
Reduce further heat
loss.
Package for rapid
transport accordingly
Handle gently
Prevent exercise
Avoid shell rewarming
Evacuate flat.
14. SEVERE HYPOTHERMIA
Treatment Concerns and Upgrades
Warmed, Humidified Oxygen (Rescue Air
RES-Q-AIR 9”x3”x2” weight 4.5 $1600
Flex Disks Thermo Pads. CORE AREA
ONLY
No Drugs -- Pooling Shock
Protocols EMS Academy Kyle Thornton
State of Alaska EMT I,II,III
JAMA October 28, 1992
