Special Operations Forces Medical Handbook

6-44

Assessment:
Differential Diagnosis - head trauma, hypoglycemia and alcoholic stupor. Differentiate by history of cold
exposure.

Plan:

Treatment (see Figure 6-2, Hypothermia: EMS Prehospital Care)
Primary:

1. Handle individuals carefully to prevent ventricular arrhythmias.


2. Ventilate by mouth or by mask, O 2 if available. Ventilation changes the fibrillatory threshold and allows
   safer transport.


3. If pulse and respiration are absent while in the field, do not initiate chest compression; merely ventilate. If
   in a vehicle and no cardiac activity is evident, initiate CPR and defibrillate.


4. If more than thirty minutes from definitive care, and warming will compromise the evacuation effort, do not
   initiate warming procedures. However, any warmth applied inside the wrapped insulation layers is useful.


5. Remove wet clothes and insulate, particularly the torso, head and neck. Apply a vapor barrier over the
   insulating layers.


6. Apply sweet fluids orally if awake. Otherwise, give 250-500 cc IV bolus of warmed normal saline followed
   by rapid drip.


7. Patients may appear cold, stiff, blue and may appear to be dead, but this diagnosis cannot be made until
   they have been rewarmed in a treatment facility.

Patient Education
General: Follow preventive measures, including proper use of cold weather clothing, staying dry, getting out
of the wind, and monitoring buddies.
Diet: Eat a high calorie, high fat diet to improve performance in the cold.
Medications: Avoid medications that compromise judgment and shivering, including tranquilizers, alcohol,
and some anti-depressants.
Prevention and Hygiene: Stay dry, well fed and rested.
Revaluation: Core temperature may continue to decrease (after drop) after the patient is removed from the
cold. This can be life threatening if a two or three degree drop occurs at a core temperature of 88°F or less.

Follow-up Actions
Evacuation/Consultant Criteria: Depending on the timeliness of evacuation, patients with severe
hypothermia should be transported. Lesser degrees of hypothermia can usually be treated locally.
NOTES: Many trauma victims become slowly hypothermic, which may be as life threatening as the trauma
itself. Do not overlook it. A short period of successful ventilation oxygenates the patient perceived to be
dead, and allows them to be handled, insulated, packaged and transported, while minimizing the likelihood of
ventricular fibrillation during this process.

Cold Illnesses and Injuries: Non-freezing Cold Injury

(Trenchfoot and Immersion Foot)

Murray Hamlet, DVM

Introduction: Having cold, wet feet for an extended period (2 days or more) will produce trenchfoot. Sitting
in a life raft with wet extremities produces immersion foot. Tissue death occurs as a result of long-term
vasospasm from cold, usually above freezing. The colder it is, the less time it takes to produce damage and
vice versa. This injury is common in POWs, escape and evasion victims, and life-raft survivors. It is also
common in combat soldiers exposed to water-filled trenches. Chilblains follow cold, wet exposure of the hands
or feet of less than 12 hours. They will be swollen, pink, mildly tender, and pruritic, but will recover in 24
hours. A longer exposure (12 hours or more) produces pernio, resulting in thin, partial thickness, necrotic
plaques on the dorsum of the hands or feet. These will slough without scarring in a few days, but the area
may remain very painful for months or years.