Hypothermia

Question 1

Describe how defibrillation of hypothermic patients in cardiac arrest differs from standard treatment:

Answer 1

Analyze once only and Shock if indicated

Question 2

Severely hypothermic patients should receive gentle handling because rough handling may cause __________

Answer 2

Ventricular fibrillation

While incidents of cardiac disrythmia have been reported anecdotally the cause is not understood. It may be related to vigorous handling of the patient during extrication or egress from the scene but there is no convincing evidence to substantiate or refute this concern. Careful handling of the patient is warranted but the need for immediate transport to hospital should never be delayed for fear of inducing ventricular fibrillation.

Question 3

Describe features of severe hypothermia that distinguish it from moderate hypothermia:

Answer 3

patients will have a significantly lower level of consciousness with no response to pain, display an absence of reflexes and have severely diminished cardiac output. Ventricular fibrillation risk increases as the temperature drops and becomes most significant below 28 degrees.

Question 4

While a history of environmental exposure may trigger an assessment for the presence of hypothermia, be aware that patients with the following medical conditions may be at risk of hypothermia in an atypical environment: (list up to 6)

Answer 4

• Behavioural/psychiatric problem
• Seizure
• ETOH intoxication / Drug overdose
• CVA
• Diabetic emergency
• Frail elderly patients “ found down” at their home

Question 5

Hypothermic patients without a pulse _____ (should / should not) be transported to hospital while receiving CPR

Answer 5

should

hypothermia is considered a treatable cause of cardiac arrest.

Question 6

Hypothermic patients should have pulse and breathing checked for _____ seconds

Answer 6

30-45 seconds

Question 7

Suspicion of hypothermia may mask an underlying medical cause of ALOC. Asessment of the hypothermic patient should therefor include checking _________

Answer 7

blood glucose

Question 8

Severely hypothermic patients should be warmed in the prehospital setting using _______ (active / passive) methods.

Answer 8

passive

For severe cases, re-warming in the pre-hospital setting is problematic and in most cases should be limited to passive re-warming, including removal of wet clothing and use of blankets to limit further cooling. Warm heat packs have limited utility in severe hypothermia and care must be taken not to induce thermal injury in the skin.

Question 9

Effectively determining core body temperature for a hypothermic patient in the prehospital setting is likely __________ (possible/not possible).

Answer 9

not possible

Esophageal temperature monitoring is considered the gold standard but is not widely available. Rectal temperature is another option using a low reading thermometer but is difficult to obtain in the field setting. Tympanic assessment of temperature is unreliable, especially in hypothermia and should not be used for decision making

Question 10

Careful handling of severely hypothermic patients is warranted and ______ (should/should not) delay immediate transport to the hospital

Answer 10

should not

Question 11

List signs of mild hypothermia:

Answer 11

peripheral vasoconstriction, shivering, hypertension and tachycardia