53
moderate heat to the chest and armpits is indicated. Place external heat sources, such as
heat packs etc., over a thin layer of clothing as indicated above.
Warmed and humidified supplemental oxygen may be administered. This is
unlikely to significantly heat the body core; however, improvement in cardiovascular and
mental function has been reported with this treatment likely due to rewarming of the
brainstem via heat transfer form the upper airways.
Do not give a patient with impaired consciousness any warm drinks as this may
cause burns and/or choking. Aggressive rewarming, such as warm water immersion,
should never be attempted as this may cause ventricular fibrillation. Do not rub the
extremities under any condition as rubbing produces little frictional heat, but damages the
skin and underlying tissue (especially if it is frozen).
D) Cardiopulmonary Resuscitation: A cold, rigid, apparently pulseless and breathless
patient is not necessarily a dead patient. A cold patient with no detectable pulse should
not necessarily be given chest compressions. Apparent pulselessness may be caused by
hypothermia and the resulting tissue rigidity in combination with a very slow heart rate.
Under these conditions chest compressions may trigger ventricular fibrillation, and will
not be effective in someone dead from the cold.
Check for breathing and pulse for a full minute, because vital signs in
hypothermia may be present but very slow and faint. If you fail to detect cardiac acivity
or respiration, initiate rescue breathing immediately. This should continue for 3 minutes
as improved oxygenation may strengthen cardiac activity and make it detectable. The
patient needs oxygen and there is no danger to the patient from rescue breathing. If bag
and mask are used (with ambient air or compressed oxygen), care should be taken not to
hyperventilate the patient as the heart is more susceptible to fibrillation during periods of
hypocarbia. After 3 minutes of rescue breathing, another 60 seconds should be taken to
detect cardiac activity and respiration. If the patient is still pulseless and breathless, chest
compressions could be initiated.
Do not initiate chest compressions in a patient who has been submerged in cold
water for more than 1 hour; has a core temperature of less than 10º C; has obvious fatal
injuries; is frozen (e.g. ice formation in the airway); has a chest wall that is so stiff that
compressions are impossible; or if the rescuers are exhausted or in danger.
(Recommendation Category 1A) Reference: State of Alaska Cold Injuries Guidelines,
Revised 11/2003-1.
Defibrillation is rarely effective if the core temperature is below 30° C.
(Recommendation Category 1A) Reference: Danzl DF. Accidental hypothermia, p.152.
In: Auerbach PS, ed. Wilderness Medicine, 4
th
Ed. St. Louis: Mosby, Inc. 2001.
In the patient who is not breathing and has no pulse, the clinical decisions are based on
access to transportation:
·
If transportation is available within 3 hours, begin ventilation (intubate if
possible), protect from further cooling, and do not start chest compressions. Wait
for the rescue crew. Starting chest compressions might precipitate ventricular
fibrillation in a patient who actually has a weak pulse which is difficult to detect,
