Erika Ball, RN, BSN. * Objectives: * Understand the physiology of hypothermia * EMS considerations...
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Transcript of Erika Ball, RN, BSN. * Objectives: * Understand the physiology of hypothermia * EMS considerations...
![Page 1: Erika Ball, RN, BSN. * Objectives: * Understand the physiology of hypothermia * EMS considerations for the hypothermic patient * Mechanisms of heat loss.](https://reader036.fdocuments.us/reader036/viewer/2022070409/56649e8f5503460f94b92fb1/html5/thumbnails/1.jpg)
Erika Ball, RN, BSN
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*Objectives:
*Understand the physiology of hypothermia
*EMS considerations for the hypothermic patient
*Mechanisms of heat loss
*Clinical indications of hypothermia
*Degrees of hypothermia
*Treatment and rewarming
*Other considerations in hypothermia
Bledsoe, 2013.
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*Temperature regulation:
*Happens in the hypothalamus
*The hypothalamus is the body’s “thermostat”
*The body has thermo sensors in the skin the mucosa, and in certain deeper structures in the body
*The hypothalamus works as a regulator for shivering and sweating, depending on the environmental stimulus (excessive cold or heat).
Bledsoe, 2013.
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*There are two rates the temperature regulation system effects:
*Basal Rate- the normal resting rate for the CORE of the body (deep internal temperature)
*Metabolic Rate- reactive adjustment to the environment to maintain a continual core temperature
Bledsoe, 2013.
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*Normal body temperature is 98.6o
F or 37o
C
*Hypothermia definition:*Decrease (unintentionally) in CORE temperature greater than 3.5 degrees from the basal temperature
Bledsoe, 2013.
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*Conduction
*Convection
*Radiation
*Evaporation
*Respiration
Bledsoe, 2013.
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*Conduction:
*Direct contact with a cooler object
*Heat loss happens in the direction of the high temperature to the low temperature
Bledsoe, 2013.
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*Convection:*Air temperature causes heat loss
*Radiation:*Infrared rays cause heat loss
*Infrared heat loss is always happening until temperatures reach molecular standstill (called absolute zero)
Bledsoe, 2013.
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*Evaporation:
*Water evaporation causes heat loss
*This phenomenon can happen from the skin or water evaporating in the air as we breathe
Bledsoe, 2013.
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*Respiration:
*A combination of convection, radiation, and evaporation occurs during the respiratory process, causing further heat loss
Bledsoe, 2013.
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*Body composition
*Thermoregulatory response (shivering ability/ heat production)
*Clothing/insulation
*Water or air temp and conditions
*Medications or intoxication
*Age
*Health
*Extended exposure
*Associated Injury
Bledsoe, 2013.
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Bledsoe, 2013.
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*Hypothermia results from:
*Insufficient heating mechanisms
*Severe cold stress (exertion with cold exposure)
Bledsoe, 2013.
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*Degrees of hypothermia:
*MILD: 95- 89.6 F
*Thermoregulatory mechanisms are still operating fully
*MODERATE: 89.6- 82.4 F
*Effectiveness of thermoregulatory mechanisms diminish until they fail
*SEVERE: Lower than 82.4 F
*Loss of consciousness
*No more shivering
*pH balance disrupted
*Susceptible to V Fib or asystole
Bledsoe, 2013.
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Bledsoe, 2013.
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1.Short-term
(Cold shock response)
2. Midterm
(Loss of performance)
3. Long-term
(development of hypothermia)
Bledsoe, 2013.
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Bledsoe, 2013.
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*Generally in water*First 3-4 minutes of immersion (with head out
of the water)*Peripheral vasoconstriction*Panic*Gasp reflex*Hyperventilation*Tachypnea
*Vagal cardiac arrest and subsequent drowning(Polar bear plunge!!)
Bledsoe, 2013.
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*IF they survive the cold-shock, this is the next 30 minutes of progression
* Neuromuscular activity and loss of motor control
*If the neuromuscular mechanisms fail, individual can not execute survival procedures (grabbing life preserver) and individual will drown
Bledsoe, 2013.
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*Development of hypothermia process
*Mild
*Moderate
*Severe
Bledsoe, 2013.
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*Shivering
*Lethargy
*Lack of coordination
*Pale cool skin
*Early stages witness rise in BP, heart rate, and respiration
Bledsoe, 2013.
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*Shivering ceases
*Arrhythmias can occur
*Cardiac arrest
*Voluntary muscle control loss
*Hypotension
*Pulse and respirations become undetectable
Bledsoe, 2013.
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*Initial treatment:
*Remove any wet clothing
*Stop cooling process with blankets and elements
*Keep patient in supine to prevent further hypotension
*Handle patient gently (skin is fragile)
*Establish cardiac rhythm
Bledsoe, 2013.
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*PR interval can become longer (1st degree heart block)
*This progresses to a prolonged QRS and QT
*“J” waves, or Osborne waves, can occur under a core temperature of 90OF
Bledsoe, 2013.
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*J waves are most frequent in leads II and V6
*These waves become larger in size as the patient’s core temperature decreases
Bledsoe, 2013.
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Bledsoe, 2013.
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*Active rewarming:*Mild hypothermia- external methods*Blankets
*Heat packs (in axilla and groin)
*Mild Hypothermia- internal rewarming*Warm IV fluids
* If the patient is still shivering, rewarming should occur quickly
Bledsoe, 2013.
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*External:*Warm blankets*Heat packs (again, groin and axilla)
*Internal*Warmed IV Fluid*Warm, humidified oxygen
*Best done in the ER, where protocol exists for slowly rewarming the patient
Bledsoe, 2013.
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*EMS should use caution in rewarming the patient due to peripheral reflex dilation
*Patient’s rewarming sometimes causes a hypotension and can precipitate V Fib
*This is why warm packs in the groin and axilla warm the core rather than the extremities
Bledsoe, 2013.
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Bledsoe, 2013.
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Please Review!
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*DO NOT give any drugs to these patients!
*Assess the pulse for a full 30-45 seconds
*May attempt defibrillation x1
Bledsoe, 2013.
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Bledsoe, 2013.
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*Morphine
*Binds with opioid receptors to produce narcotic analgesia
*CNS depressant
*Causes peripheral vasodilation
*May be given in 5 mg increments for severe pain (blood pressure permitting) for a dose of 5-10 mg in hypothermia, at the discretion of the ECRN/ MD.
*Contraindications:
*Respiratory depression, shock, hypotension, known sensitivity or allergy. Use with caution in bronchial asthma, respiratory insufficiency, head trauma
Bledsoe, 2013.
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*Thank you for your time and attention!
*The 2014 CE calendar will be available early in December!
*We welcome your suggestions!
Bledsoe, 2013.
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References
Bledsoe, B. 2013Prehospital management in the 21st century.
Giesbrecht, G., 2013. Prehospital treatment of hypothermia. Expedition Medicine.
Region VII Emergency Medical Service Systems
Standing Medical Orders, 2011
Bledsoe, 2013.