Cold Injuries - Environmental

Question 1

Primary Survey

Answer 1

• Confirm there are no D-Spine precautions
• Assess lvl of consciousness (AVPU scale)
• Assess & manage ABC’s as required
• Assess circulation for up to 30-45 secs when determining a need for CPR
• Ventilate the non-breathing, severely hypothermic PT at a rate of 8-10 per min
• Complete RBS - expose & examine any injuries
• Consider PT’s position
• Remove from cold environment & all wet clothing
• In the even of cardiac arrest apply AED and analyze, defibrillate up to 3 times if needed then commence rapid transport to hospital, after 3 shocks do not pause CPR for analyzing or shocks

Question 2

Decision Point

Answer 2

Findings in unstable PT include:
- Moderate or severe hypothermia
- No distal circulation to injured limb
- Decreased LOC
- Signs & symptoms of shock

Question 3

Load & Transport

Answer 3

Transport PT in a cool environment (?). Monitor PT for signs of shivering as this can increase body temp (???? Did they copy paste from Heat injuries & forget to change the text????)

Question 4

Critical History

Answer 4

• Nature of the environment (temp, weather - rain, snow, sun, wind chill)
• Type and condition of PT’s clothing (e.g. wet, dry)
• Length of the PT’s exposure to elements and any shelter they had

Question 5

Patient History

Answer 5

SAMPLE & OPQRRRST

Question 6

Vital Signs

Answer 6

• Complete vitals q5 for unstable PT
• Complete vitals q15 for stable PT

Question 7

Protocol(s)

Answer 7

• Cardiac arrest protocol (if indicated)
• Pain management protocol (if indicated)

Question 8

Treatment - Frostbite

Answer 8

• Do not rub or massage frostbitten area
• Cover blisters w/ dry sterile dressing to protect area
• Place non-stick dressing between any affected digits
• Never re-warm area of late or deep frostbite

Question 9

Treatment - Mild Hypothermia

Answer 9

• Passive re-warming: move PT to heated area, remove wet clothes, and gently pat dry the skin, use warm blankets or reflective space blankets
• Consider giving PT small amounts of warm/hot liquids by mouth

Question 10

Treatment - Moderate Hypothermia

Answer 10

• Passive re-warming
• Active re-warming: place hot packs to re-warm “core” (chest, back, groin, neck & axilla regions)
• Recognize “uncontrolled shivering” & anticipate a decrease in mental status

Question 11

Treatment - Severe Hypothermia

Answer 11

• Use extreme care when handling PT
• Keep PT supine
• Assess circulation up to 60 secs when determining need for CPR
• Do NOT actively re-warm PT
• Maintain room temp in ambulance