Hypothermia treatment

[codprawn]

I have been looking for good article on Hypothermia for a while. It is a topic I am always concerned about - especially after having done some mountain climbing in the past. I have been attacked on some comments I have made on this before - it is VITAL people know the facts.

Most articles just say get medical help or use such and such equipment - not much good in the field - or at sea.

In British waters at this time of year it's information EVERYONE should be more familiar with - even some ambulance staff I spoke to weren't really sure!!!

This comes from The Search and Rescue Society of British Columbia - a pretty chilly place........

http://www.islandnet.com/sarbc/hypo1.html


Tha main points - please read!!!

TREATMENT FOR THE DIFFERENT LEVELS OF HYPOTHERMIA

Impending Hypothermia:

Seek or build a shelter to get the person out of the cold, windy, wet environment.

Start a fire or get a cookstove going to provide warmth. Provide the person with a hot drink (no alcohol, coffee or tea).

Halt further heat loss by insulating the person with extra clothes, etc. This person should recover from the present condition quite quickly.

Mild Hypothermia:

Remove or insulate the patient from the cold environment, keeping the head and neck covered. This prevents further heat loss and allows the body to rewarm itself.

Provide the patient with a warm, sweetened drink (no alcohol, coffee or tea) and some high energy food. Limited exercise may help to generate some internal heat, but it depletes energy reserves.

Moderate Hypothermia:

Remove or insulate the patient from the cold environment, keeping the head and neck covered. Apply mild heat (comfortable to your elbow) to the head, neck, chest, armpits and groin of the patient.

Use hot water bottles, wrapped Thermo-Pads, or warm moist towels.

It is possible that you may have to continue this treatment for some time. Offer sips of warm, sweetened liquids (no alcohol, coffee or tea) if the patient is fully conscious, beginning to rewarm and is able to swallow. Patient should be seen by a physician.

Severe Hypothermia:

Place patient in a prewarmed sleeping bag with one or two other people. Skin to skin contact in the areas of the chest (ribs) and neck is effective. Exhale warm air near the patient's nose and mouth, or introduce steam into the area.

Try to keep the patient awake, ignore pleas of "leave me alone, I'm ok". The patient is in serious trouble, keep a close, continuous watch over the patient.

Apply mild heat, with the aim of stopping temperature drop, not rewarming.

If patient has lost conciousness be very gentle, as by now the heart is extremely sensitive. Always assume the patient is revivable, do not give up.

Check for pulse at the carotid artery. If, after two minutes you find no pulse check on the other side of the neck for two minutes.

If there is any breathing or pulse, no matter how faint, do not give CPR but keep very close watch for changes in vital signs.

If no pulse is found begin CPR immediately, stopping only when the heart begins to beat or the person applying CPR can not carry on any longer without endangering himself.

Medical help is imperative, hospitalization is needed.

[v666]

Most of the information available is based on land, I have not found much for boating hypothermia.

For instance, whilst out walking spotting someone who is stumbling often, getting a little sharp with their comments, and possibly slowing up is not to difficult to spot - if you are looking for it.

But out on a small boat on an hour or 2 passage, spotting the early signs would be quite difficult.

I think looking for (expecting people to get hypothermia (self included) helps) the signs is very important, better to prevent than to treat.

Here is a basic list of the symptoms.


Signs that can be observed by others:
Slowing of pace, drowsiness, fatigue
Stumbling
Thickness of speech
Amnesia
Irrationality, poor judgment
Hallucinations
Loss of perceptual contact with environment
Blueness of skin (cyanosis)
Dilation (enlargement) of pupils
Decreased heart and respiration rate
Stupor


Signs that can be felt or noticed by victim:
Fatigue, drowsiness, exhaustion, unwillingness to go on
Feeling of deep cold or numbness
Poor coordination
Stumbling
Victim needs IMMEDIATE help if the following are present:
Poor articulation of words
Disorientation
Decrease in shivering followed by rigidity of muscles
Cyanosis (blueness of skin)
Slowness of pulse, irregular or weak pulse

[v666]

Never thought of looking for stuff from British Columbia, just found this

Cold Water Immersion

and This

[codprawn]

Whilst the descriptions are land based most of the treatments are the same.

The descriptions on cold shock are good - very important to get the person out horizontally if possible.

This bit is scary - the water temp is the same as ours!!!

On a November night, a crab fishing boat was off B.C.'s north coast. The crewmembers were re-baiting a crab pot on deck when the vessel took a port turn. They had been pulling traps on the starboard side, leaving the buoy line in the water. The line became caught in the propeller and started to pull the trap off the table. One of the crew reached for the trap as it slid over the side of the boat and was pulled into the water with it. As he entered the water, he let go of the trap and remained at the surface. Lines and floating objects were thrown well within his reach but he made no attempt to hold onto them.

The crewmember was finally pulled on board after about 11 minutes in the water. He was unconscious and could not be revived. Neither he nor the other crewmembers were wearing a personal flotation device (PFD), life jacket, or immersion suit. The water temperature was 9°C (48°F)

[RichardB]

Originally Posted by codprawn

The descriptions on cold shock are good - very important to get the person out horizontally if possible.

Couple of points I learned recently (on canoe safety course that I thought I better do as kids have been getting into this too). On recovery from cold water, we were given warnings on even retrieving casualties vertically out of the water as this can result in quite sudden death as blood flows to the legs and leaves vital organs (post rescue collapse). Apparently this has been the cause of death of casualites who were (fast) hypothermic but consious when rescued. I asked about helicopter recovery where all the pictures seem to show people coming out vertically but didn't get a good answer (perhaps they get them level quick in the helicopter).

Second was that hypothermia was now being categorised into fast and slow. Fast hypothermia, from immersion in very cold water and rapid onset - warm up quickly. Slow, from longer onset (probably not immersion but wet weather, windchill) - slower warming. Seemed to make a lot of sense but I'd never heard the distinction before.

Cold shock seems to me to be something you can be prepared for. I've jumped / paddled / capsized in white water on the verge of freezing. Feels like a 6" nail being banged through the temples plus the respitory shock reaction is, let's say, 'interesting' (would be very easy to involuntary inhale) but it's still possible to function for a (pretty) short while if you know this happens. Imperative to get out very fast and warm quick (with help). God knows how you teach this though, I cant see many courses encouraging students to jump into near freezing water to get the idea - I've seen the Marines do it on TV for their arctic survival courses but... (Did you see the Top Gear crew having a go for their North Pole trip. - I bet the BBC risk assessment was interesting.)

I'd stress I'm not an expert here in any sense but have been in situations where I've had to deal with people on the verge of hypothermia - fortunately we caught it in time and never needed extenal help. The comments on recognising the symptoms are very apt but not always easy to spot at night on a long watch in a gale and rain - most of us feel something like that at 4am. I'd add that you sometimes really need to force the potential casualty to take action to get warm. It's too easy to ask "you ok" and get a mumbled "yeah" through the layers of waterproof and hood - if there isn't any real sense that they are with you (ie actually looking bloody miserable, having a decent whinge or retaining a sense of humour) they may be on the verge of trouble. If they sound 'zoned out' it is not good, check it out further or get them to do something.

[jyasaki]

Heard of a sort of interesting field trial a few years ago.

Some Silicon Valley medical company working with a college (Stanford, I think) was testing a new (experimental) rewarming system. Basically, it was a cuff similar to a blood pressure cuff. Somehow, the thing put a slight vacuum on the skins surface. The cuff also contained a heating unit.

Experiments were conducted on divers exiting Breakwater in Monterey. Core temps were taken before and after treatment, and were (when possible) conducted with and without the use of the rewarmer thing over a specified timeframe.

Theory was that by placing a vacuum on the skin, the capillaries could be opened up, allowing greater bloodflow. The heating supplied by the cuff then warmed that blood, and was transferred to other body parts through circulation.

I don't remember specifics, but the results were what they called "promising"; to me they were pretty impressive. Core temps were raised substantially faster than through normal warming (i.e. jackets and warm drinks.)

Had I actually witnessed the tests, though, I think I'd have suggested a neck cuff. I'd have volunteered a couple of my friends to test it out, too.

Haven't had time to look at all the info people have posted, but I'll get to it soon. Appreciate the research people have done.

jky

[Tideway]

Hi Jvasaki,

Interesting idea, where were the cuffs? Were they worn for the dive or put on once the diver was cold? Be interested in a link if you can find one?I'd always been told/thought that you should avoid direct warming on the skin surface or extremities, as the opening of the capillaries etc would cause a drop in blood pressure and possible cardic failure/collapse, similar to that mentioned in an earlier post.

Covering the head with a balaclava/hat and removing wet clothes, covering with blankets etc all are good responses to potential hypothermia, and having seen a few people with this, it is amazing how quickly they go down hill. Any lack of response to direct questions or the symptoms mentioned earlier should be heeded. It is quite frightening when you see it happen to someone.

t

[codprawn]

The best treatment of all is currently warm IVs and a system called resqcu air or similar which is basically warm moist oxygen - sadly not always available to us!!!

[DJL]

Originally Posted by RichardB

I asked about helicopter recovery where all the pictures seem to show people coming out vertically but didn't get a good answer (perhaps they get them level quick in the helicopter).

I believe they winch with double slings/strops, one around the shoulders and one under the knees - keeps the patient pretty much horizontal.

If they were winching from a boat/land etc then they will probably go with the stretcher.

[Simon Hawkins]

Before Christmas I did an exercise with the lifeboat and Whisky Bravo doing this very thing. They wanted me to put one of my crew in the water and then for them to lower their winchman into the water ( yes they do wear flippers). They placed a double strop onto him, one under the arms and the other under the the knees, so to place the casualty into a sitting position. The wichman will then be lifted into the helicopter with the casualty.

If the casualty is on a boat then they will try and lower a stretcher, by hi - line transfer. We did this the same day.

[RichardB]

Originally Posted by Simon Hawkins

Before Christmas I did an exercise with the lifeboat and Whisky Bravo doing this very thing. They wanted me to put one of my crew in the water and then for them to lower their winchman into the water ( yes they do wear flippers). They placed a double strop onto him, one under the arms and the other under the the knees, so to place the casualty into a sitting position. The wichman will then be lifted into the helicopter with the casualty.

If the casualty is on a boat then they will try and lower a stretcher, by hi - line transfer. We did this the same day.

Ah, that's really interesting. I had wondered if things had changed as I could only recall seeing a strop under the arms being used but I may not have been watching closely.

[codprawn]

I suppose it's for this reason the Yanks use a rescue cage BUT from what I have seen the lack of control is terrible. The cage seems to spin totally out of control and it always looks so clumsy - I don't know why they never seem to use a winchman on the cable at the same time as the casualty.

[jyasaki]

Originally Posted by Tideway

Hi Jvasaki,

Interesting idea, where were the cuffs? Were they worn for the dive or put on once the diver was cold?

Cuff was put (I believe) on the bicep. That was done only during treatment. I have no idea how the thing pulled the vacuum on the skin, but I remember e-mailing one of the testers who replied that very little suction was required; not even enough to be uncomfortable.

The "do not immerse in warm water" thing is because the all the capillaries exposed to the warm bath open well before the core temp starts to increase, which leads to all sorts of weird problems. With the new device, the warming is much more gradual, and tends towards the core first (well, the arm, then the core), so less shock to the system.

Be interested in a link if you can find one?

As I said, the device was experimental, plus it was a few years ago. But I'll see what I can find.

jky

[prairie tuber]

Here is an excellent, practical resource. I know one of the co-authors personally and he is a world reknown researcher on cold water immersion physiology.

http://www.mountaineersbooks.org/pro...ils.cfm?PC=698