Hypothermia/Cold Exposure

Question 1

Hypothermia is insidious and rarely occurs in…?

Answer 1

Isolation. If pt in a group, assess other members of the group for hypothermia also.

Question 2

At what temperature is arrhythmia in hypothermia associated with?

Answer 2

Temperatures below 33 degrees.

Question 3

Which arrhythmias typically resolve on rewarming? When are antiarrhythmics indicated in these pts?

Answer 3

Atrial arrhythmias, bradycardias or AV blocks.

Antiarrhythmics only indicated if decompensation occurring.

Question 4

At what temperature are defibrillation and cardioactive drugs not functional?

Answer 4

30 degrees.

Question 5

Hypothermic VF may spontaneously resolve…

Answer 5

on rewarming.

Question 6

What measure is made for accommodating prolonged onset and durations of drugs in hypothermic pts?

Answer 6

Doubled intervals between drug doses.

Question 7

Why is gentle handling important in hypothermic pts?

Answer 7

To avoid arrhythmias.

Question 8

List the 8 points of General Care for the hypothermic pt.

Answer 8

1. Shelter from wind in heated environment
2. Remove all damp or wet clothing
3. Gently dry pt with towels/blankets
4. Wrap in warm sheet/blanket - cocoon.
5. Cover head with a towel/blanket - hood.
6. Use thermal/space blankets above and below the pt if available.
7. Only warm frostbite if there is no chance of re-freezing prior to arrival at hospital.
8. Assess BGL if ALOC.

Question 9

How should Normal Saline be administered in hypothermia?

Answer 9

Where indicated, warm fluid between 37 - 42 degrees (normothermic) to avoid worsening hypothermia.

Question 10

Under the hypothermia guidelines, define mild, moderate and severe hypothermic temperatures.

Answer 10

Mild - 32 to 35 degrees
Moderate - 28 to 32 degrees
Severe <28 degrees

Question 11

If pt not in cardiac arrest and moderate/severe hypothermia present. what is the management?

Answer 11

Warmed fluids 10ml/kg IV

Rpt. normal saline 10ml/kg (max. 40ml/kg) to maintain perfusion.

Question 12

If the pt is in cardiac arrest and hypothermia is present, at what temperature does management change and how?

Answer 12

<30 degrees.
Double interval in Adrenaline and Amiodarone doses.
>3 shocks unlikely to be effective, consider mCPR and AAV. If not available, continue DCCS.

Question 13

What is the target temperature for the ambulance compartment for patients with/at risk of hypothermia?

Answer 13

24 degrees or higher.

Question 14

What should be done for the patient in wet clothes and dry clothes?

Answer 14

Remove wet clothing, dry the pt and then provide thermal protection. If dry clothes, leave on and only remove to assess injuries.

Question 15

What is the management for a hypothermic patient <35 degrees?

Answer 15

Protect from heat loss by:

1. Use ambulance heater, keep doors closed.
2. Remove wet clothing
3. Cover pt above and below with a blanket roll

Question 16

What is the heat management of the Major Trauma patient, regardless of temp?

Answer 16

1. Ambulance heater, keep doors closed
2. Remove wet clothes
3. Minimise scene time
4. Cover with blanket roll

Question 17

When does temperature management become a priority in the major trauma patient?

Answer 17

If temp <35, intubated or haemorrhagic shock.