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Cold Weather Emergencies

Cold Weather Emergencies. Presented by: Wade Scoles RRT, NREMT Staff Education Coordinator, NW MedStar. Emergency Vehicle Safety. Most serious injuries in ambulance crashes are unrestrained medical attendants in the rear compartment.

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Cold Weather Emergencies

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  1. Cold Weather Emergencies Presented by: Wade Scoles RRT, NREMT Staff Education Coordinator, NW MedStar

  2. Emergency Vehicle Safety • Most serious injuries in ambulance crashes are unrestrained medical attendants in the rear compartment. • You are 2.6 times more likely to be injured while running “code”.

  3. Cold Weather Assessment & Mngt • Exposing your patient • Bring them inside the ambulance • Keep them warm • Remove wet clothing • Cutting Coats & Snowsuits…

  4. Cold Weather Assessment & Mngt • Assessing skin color, temperature and perfusion • Normal cap refill of 2-3 seconds will be longer in cold weather due to vasoconstriction • Will not necessarily reflect hemodynamic status

  5. Patient #1 • Typical winter conditions (more than an inch of snowfall and temperatures that dip below 20 degrees) cause death rates from heart attacks to triple among men 35 to 49 years old. Video

  6. Patient #1 • 55 year old having chest pain while shoveling snow • Initial assessment: • Pale, diaphoretic, no resp. distress • Vital signs: • Pulse 110, RR 16, BP 158/90, SpO2 96%

  7. Patient #1 • Management: • Rapid transport, call for ALS if available • Monitor with AED, Oximetry • Oxygen • Nitroglycerin • Contraindicated if BP < 100 systolic • Aspirin

  8. Patient #1 • Why is shoveling a potentially dangerous activity? • Strenuous activity in cold weather • HR & BP increase • Body constricts vessels when exposed to the cold

  9. Patient #2 • Approximately 1,000 Americans fall through ice each year Video

  10. Patient #2 • 11 year old, cold water submersion • Pale, cold, unresponsive, not breathing • To resuscitate or not? • In the water 40-45 minutes • Water temp 33 degrees

  11. Patient #2 • Assessing hypothermic patients • Take extra time to assess pulse & RR in hypothermic patients • Allow for slow heart & respiratory rates • Don’t start chest compressions if severe hypothermic patient shows any signs of life

  12. Patient #2 • Management • Rapid transport, call for ALS if available • High quality BLS • Remove wet clothing • Begin active re-warming of truncal area while administering BLS • May attempt defibrillation once if AED says “Shock indicated”

  13. Patient #2 • Management • Withhold further defib or meds until body temp reaches >30°C (86°F) • Will need transport to facility capable of active internal rewarming for severe hypothermia

  14. Patient #2 • Sudden submersion into cold water triggers the Mammalian Dive Reflex • HR & RR slows and blood flow diverts from the extremities to the core • This slowing of metabolism and diversion of blood allows longer survival times. • How cold must the water be, to be “protective”? • <20° C (68 °F)

  15. Hypothermia Severity

  16. Patient #3

  17. Patient #3 • Nearby fishermen call 911 to report drunk, confused man wandering around the ice • Upon your arrival • Pt is confused, dizzy, vomiting and C/O headache • Vitals • Pulse 118, RR 24, BP 132/80, SpO2 97% BS clear. • Differential diagnoses?

  18. Patient #3 • What questions are you going to ask to determine the problem? • Drunk? • Hypoglycemia? • Stroke? • Head injury? • Carbon Monoxide Poisoning? • Pt. states he was just fishing with his buddy, had a couple of beers and doesn’t remember anything else

  19. Patient #3 • With bystanders help, you figure out where he was fishing and find his friend in the hut • His friend is passed out inside • Pulse 120, RR 12, BP 116/70, SpO2 92% • What are your priorities? • Additional resources needed? • Secure airway • Oxygen

  20. Carbon Monoxide • Carbon Monoxide is colorless, odorless, tasteless gas • CO exposure accounts for an estimated 15,000 emergency department visits and 500 unintentional deaths in the United States each year

  21. Carbon Monoxide

  22. Carbon Monoxide • CO has a half-life of 4-5 hours • Oxygen can reduce that • Hyperbaric Oxygen can reduce it even more • Hyperbaric chambers in the Northwest • WA: Spokane (Deac), Seattle (Virginia Mason), Clarkston (Tri-State), Richland (Kadlec) • Alaska: Anchorage, Juneau, Wasilla • Montana: Billings Clinic • Idaho: Boise, Idaho Falls, Pocatello • Oregon: Portland, Hillsboro, Eugene, McMinnville

  23. Carbon Monoxide • Detecting CO in blood • Standard oximetry not helpful • Co-oximetry

  24. Carbon Monoxide

  25. Patient #4

  26. Patient #4 • 65 year old woman rescued from house fire • Scene safety concerns • Patient condition • Unresponsive • No evidence of trauma or burns • HR 140, RR 12, BP 130/78, • SpO2 on Oxygen is 98%

  27. Patient #4 • Differential diagnoses? • Head trauma, CO poisoning, Medical Event • CO level is 12% • Patient still unresponsive • Consider Cyanide Poisoning • Management • Secure Airway • O2 • Assist respirations • Cyanokit

  28. Cyanide Poisoning • Cyanide may be a factor in ~4,000 fire-related deaths in the U.S. each year • Study of smoke inhalation deaths • 87% of the fatalities had toxic levels of cyanide • Cyanide is commonly found in the smoke of closed-space fires • Synthetic construction materials, furniture • Natural materials like wool and cotton produce cyanide when burned

  29. Cyanide Poisoning • Treatment • Hydroxocobalamin (Cyanokit) • 5 grams (diluted in 200ml) over 15 minutes • Can safely be used for suspected cyanide poisoning as it bonds with cyanide in the body to form Vitamin B-12

  30. Patient #5 You are called to the home of a 28 year old pregnant woman with respiratory distress

  31. Patient #5 • 34 weeks pregnant • 2 day history of cough, muscle aches • Now with fever and increasing respiratory distress • VS: HR 120, RR 24, SpO2 82% Protect yourself N-95 mask, gloves

  32. Patient #5 • After Oxygen: • SpO2 87% • Still in respiratory distress • Breath sounds: • Insp. Crackles & exp. wheezes • Impression? • Influenza, Respiratory distress

  33. Novel H1N1 in the US, By Age Group

  34. Novel H1N1 U.S. Deaths, By Age Group

  35. Flu Hospitalizations, Spokane Area

  36. Patient #6 • 24 year-old male crashes on snowmobile http://www.youtube.com/watch?v=UoA7jK26SOE

  37. Patient #6 • Scene safety concerns • Transport decision • Helicopter safety concerns • Skids sinking into snow • White-out conditions upon landing

  38. Patient #6 • Upon your arrival: • Pt is conscious, sitting on tailgate of truck • c/o back and neck pain • HR 80, RR20, BP hard to hear through clothes, SpO2 97% • Skin feels cool • Your assessment • Are you going to cut off his snowsuit?

  39. Patient #6 • Management: • C-spine immobilization • ABCs • How are you going to place him in C-spine precautions? http://www.emsonline.net/head2009/skills.asp

  40. Contact: Renee Anderson509-232-81551-866-630-4033andersr@inhs.org Fax: 509-232-8168

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