Severe Hypothermia Copy

Severe Hypothermia Copy

Severe hypothermia exists when we lose enough heat to cause severe mental status changes—basically unconsciousness.

Prevention

Patients in severe hypothermia had to progress through mild hypothermia to get here. Prevention steps are the same. Keep the patient hydrated, fed, and protected from the environment before this becomes a problem.

Signs and Symptoms

A patient in severe hypothermia will have a seriously altered mental status. The patient will no longer be shivering as they are out of fuel and blood has most moved to the core.

Pulse and respirations will be very difficult to obtain. Their core temperature will be below 90degrees F.

Also, these patients will be fragile—they have what is called “cardiac irritability” which means moving (rough handling or even rolling) them could trigger a lethal heart rhythm that would require CPR/AED.

Treatment

This condition is very difficult, if not impossible, to treat in the field. The ideal treatment is to warm the patient from the inside first slowly. This treatment is best accomplished in a warm, controlled environment with a lot of equipment

The best way to rewarm severe hypothermia in the field is to perform rescue breathing. We exhale warm, humid air that goes to the very center of the body. We can also place warming bottles at the groin, armpits, and neck.

Patients cannot maintain good perfusion pressure, so they need to be transported as horizontally as possible. They should be packaged in a manner that traps any radiated heat from the patient and keeps it close to the body, and also protects them from the environment. The packaging should prevent any moisture from the body from degrading any of the insulation materials.

You can build a “Hypo Wrap” for a patient using a few simple materials. At a minimum, you will need a large tarp, sleeping bag (or blanket), large garbage bags, and an insulating pad.

  1. Lay the tarp on the ground spread out.
  2. Place the insulating pad on the tarp, offset to one side by about a third.
  3. Open the sleeping bag and place it over the insulating pad in such a way that you will be able to cover the patient.
  4. Remove any wet clothing from the patient—replace with dry if possible.
  5. Encase the patient in the garbage bags (cut out holes for the head and arms). You may want to consider some kind of adult diaper or absorbent material to manage body wastes). Put some kind of hat on the patient’s head to trap heat.
  6. Place the patient in a sleeping bag on top of an insulating pad, and close the sleeping bag.
  7. Pad void spaces of the patient (behind the knees, small of the back, under the neck).
  8. Wrap the tarp around the patient:
  9. Fold the section below the feet up and over the patient’s feet.
  10. Fold the tarp above the patient’s head at an angle toward the shoulders (you do not want to smother the patient).
  11. Fold the short edge of the tarp over the patient.
  12. Bring the long edge over the patient—this provides a continuous surface over the top of the patient and prevents rain or snow from getting to the body.

“After drop” is a condition in which the core temperature continues to drop once the rewarding process begins. Cold blood from the extremities returns to the core after the body vasodilates. This cold fluid can cause the patient’s temperature to drop again for a short time. Ultimately this doesn’t have any long-term effect on the patient though they might have a brief period where mental status appears to get worse.

References

https://www.ci.unalaska.ak.us/sites/default/files/fileattachments/Public%20Safety/page/586/2014_ak_cold_injuries_final_.pdf