Hypothermia and Frostbites
It is very probable that everyone has encountered a mild case of hypothermia at some point in their life. Nevertheless, severe hypothermia is a life threatening condition that can lead to cardiac arrest, metabolic decompensation and multiorgan failure. Therefore, it is necessary to treat it adequately. This algorithm will guide you through the process of treating a hypothermic person, which begins by the first aid in the field, continues by the care of EMS members and doctors in the emergency department and is later completed by the treatment of frostbites.
Review
Hypothermia can be a very serious diagnosis that can lead to death of the patient if managed incorrectly. The situation can easily be underestimated, especially in alcohol-intoxicated patients. The authors present in a very illustrative way how to proceed in the treatment of a patient with hypothermia, from first aid to connection to the ECMO in the target medical facility. The algorithm succeeded in emphasizing the basic principles of the treatment of severely hypothermic patients:
- careful manipulation with the patient and prevention of further heat loss,
- airway management and maximizing oxygenation,
- resuscitation in hypothermic patient,
- the efficiency of defibrillation and drug administration in patients with a core temperature below 30 °C,
- specific therapy in hypothermic cardiac arrest - extracorporeal life support.
At the end of the algorithm, the authors also mentioned the risk of frostbite, including the basic rules for treatment.
S. Kosiński published a study in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine in 2015, which showed up to four times higher incidence of hypothermia in Poland than reported by official statistics as well as great lack of knowledge of medical staff regarding the management of patients with hypothermia. I believe that this algorithm will contribute to raising awareness of the issue of hypothermia and frostbite.
Sources
ŠEVČÍK, Pavel and Martin MATĚJOVIČ, ed. Intenzivní medicína. 3., přeprac. a rozš. ed. Praha: Galén, c2014. ISBN 978-80-7492-066-0.
TRUHÁŘ, Anatolij et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation [online]. 2015, 43(95), 148-201 [cit. 2020-03-24]. DOI: https://doi.org/10.1016/j.resuscitation.2015.07.017. Available at: https://www.resuscitationjournal.com/article/S0300-9572(15)00329-9/fulltext
KUBALOVÁ, Jana. Hypotermie v přednemocniční péči: Dokážeme rozpoznat kritický pokles teploty s ohrožením základních životních funkcí? Je nutné mít speciální teploměr ve výbavě záchranného vozidla? Urgentní medicína [online]. 2007, 10(1/2007), 13-20 [cit. 2020-03-24]. ISSN 1212 - 1924. Available at: https://urgentnimedicina.cz/casopisy/UM_2007_01.pdf
LI, James. Hypothermia. Medscape [online]. 2019 [cit. 2020-04-02]. Available at: https://emedicine.medscape.com/article/770542-overview
PETERS, Blair a Edward W BUCHEL, NARAYAN, Deepak, ed. Cold Injuries [online]. In: . Medscape, Oct 08 2019 [cit. 2020-03-26]. Available at: https://emedicine.medscape.com/article/1278523-overview
