Emergencies – HypothermiaSECTION: 13.25
Strength of Evidence Level: 3__RN__LPN/LVN__HHA
PURPOSE:
To identify patients with hypothermia and prevent further decrease in core body temperature.
CONSIDERATIONS:
1.Identifiable signs of hypothermia are:
a.Confusion.
b.Disorientation.
c.Slurred speech.
d.Low blood pressure.
e.Weak pulse.
f.Trembling on one side of body.
g.Does not feel the cold.
h.Hard to arouse.
i.Shallow, weak breathing.
j.Puffy face, waxy, oddly pink at times.
k.Muscle tightening.
l.Difficulty in moving.
2.Those most at risk are the elderly, very young and already ill individuals.
3.Specific situations and disorders predispose anyone to accidental hypothermia.
a.Individuals with decreased ability to produce body heat.
Examples: malnutrition, hypothyroidism, Parkinson's disease.
b.Individuals with increased heat loss.
Examples: prolonged exposure to cold, acute ethanol intoxication.
c.Individuals with impaired thermoregulation.
Examples: brain damage, central nervous system, depression (drugs).
4.Moderate to severe hypothermia is defined as a core body temperature of 89.6 degrees Fahrenheit (32 degrees Celsius) to 77 degrees Fahrenheit (25 degrees Celsius); mild hypothermia is 89.6-95 degrees Fahrenheit (32-35 degrees Celsius).
[Note: Temperature below 34 degrees Celsius cannot be measured with an ordinary thermometer.]
5.Patients in deep hypothermia may not exhibit detectable signs of life. However, warming procedure is indicated.
6. Assessing vital signs may be difficult to assess because tissues conduct sound poorly at low temperatures.
7.Special precautions, such as extreme caution when moving victim, are required for moderate to severe hypothermia to minimize cardiac dysrhythmias.
8. A frostbitten area should not be actively warmed if there is any chance of refreezing or if the victim is close to a medical facility.
EQUIPMENT:
Blankets
PROCEDURE:
1.Adhere to Standard Precautions.
2.Observe patient and environment to identify signs of hypothermia.
3.Take vital signs. Before starting cardiopulmonary resuscitation (CPR), check victim’s pulse for up to 1 minute.
4.Initiate CPR, if indicated.
5.Obtain immediate emergency medical care.
6.Move into a warm environment. Remove cold or wet clothing.
7.Never rub the injured area; this aggravates tissue damage.
8.Wrap patient in blankets, handling gently to minimize cardiac dysrhythmia.
9.Active re-warming should be used only when the victim is far from a medical facility.
[Note: Hot water bottles, heating pads (if the victim is dry) or other heat sources can help re-warm the body. Apply heat sources only to the trunk, at the armpits and groin. Keep a barrier between the heat source and victim to avoid burning. DONOT warm victim too quickly; rapid re-warming can cause dangerous heart rhythms. If victim is fully conscious may give hot, nonalcoholic, non-caffeinated liquids.]
10.Continue observing patient and warming procedure until medical assistance is obtained.
AFTER CARE:
- Document in patient's record:
a.Incident, degree of injury and environment.
b.Estimated length of time exposed to cold environment.
c.Treatment provided.
d.Patient's response to treatment.
- Medical assistance obtained.