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Cold Emergencies

Cold Disorders:
Mild: CBT > 32.2 C or 90 F
Severe: CBT < 32.2 C or 90 F
Compensated: presence of signs and symptoms but with normal CBT
Hypothermia victims stop shivering at 90 degrees

Three primary causes:
Cold water immersion – principle cause of death in boating accidents. Any water less than 98.6. Acute onset, without rescue, chances are low
Cold weather exposure – close 2nd in occurrence, over minutes to hours
Urban hypothermia – debilitated, aged, intoxicated, or all three at once, lack proper thermoregulation, also babies. Chronic onset = hours to days

Signs and Symptoms:
Diminished coordination and psychomotor function Altered mentation
Cardiac irritability – A-FIB most common, brady down. V-Fib more common in rewarming
They’re not dead until they’re warm and dead

Treatment:
Remove from cold
Dry off and provide barriers/blankets, insulate
Handle gently, check pulse for 30-45 seconds, begin chest compressions/ventilation/AED as necessary. Cold hearts are resistant to shock (under 86)
Hi-flow O2, can be warm, moist
Warm fluids if conscious
IV of warm LR

Dress and care for frostbite – NEVER allow to refreeze Hot packs over carotids, head, lateral thorax and groin
Warm the core first, not extremities – there could be cold acidotic blood and waste in the extremities that will rush in “afterdrop phenomenon”

Frostbite: formation of ice crystals in the extremities

Trench foot: frostbite of feet from wet socks and boots

Treatment: rule out other significant injuries, raise core body temp before extremities, transport as soon as possible, protect the site and handle gently, do not break blisters, no smoking, no rubbing. Do not allow to refreeze.

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