Treatment for hypothermia is enumerated as follows:
1. Carefully observe respiratory effort and heart beat; CPR may be required while the warming process is underway.
2. Rewarm the victim as soon as possible. It may be necessary to treat other injuries before the victim can be moved to a warmer place. Severe bleeding must be controlled and fractures splinted over clothing before the victim is moved.
3. Replace wet or frozen clothing and remove anything that constricts the victims arms, legs, or fingers, interfering with circulation.
4. If the victim is inside a warm place and is conscious, the most effective method of warming is immersion in a tub of warm (100° to 105°F or 38° to 41°C) water. The water should be warm to the elbownever hot. Observe closely for signs of respiratory failure and cardiac arrest (rewarming shock). Rewarming shock can be minimized by warming the body trunk before the limbs to prevent vasodilation in the extremities with subsequent shock due to blood volume shifts.
5. If a tub is not available, apply external heat to both sides of the victim. Natural body heat (skin to skin) from two rescuers is the best method. This is called buddy warming. If this is not practical, use hot water bottles or an electric rewarming blanket, but do not place them next to bare skin, and be careful to monitor the temperature of the artificial heat source, since the victim is very susceptible to burn injury. Because the victim is unable to generate adequate body heat, placement under a blanket or in a sleeping bag is not sufficient treatment.
6. If the victim is conscious, give warm liquids to drink. Never give alcoholic beverages or allow the victim to smoke.
7. Dry the victim thoroughly if water is used for rewarming.
8. As soon as possible, transfer the victim to a definitive care facility. Be alert for the signs of respiratory and cardiac arrest during transfer, and keep the victim warm.
Local cooling injuries, affecting parts of the body, fall into two categories: freezing and nonfreezing injuries. In the order of increasing seriousness, they include chilblain, immersion foot, superficial frostbite, and deep frostbite. The areas most commonly affected are the face and extremities.
CHILBLAIN. Chilblain is a mild cold injury caused by prolonged and repeated exposure for several hours to air temperatures from above freezing (32°F/0°C) to as high as 60°F (16°C). Chilblain is characterized by redness, swelling, tingling, and pain to the affected skin area. Injuries of this nature require no specific treatment except warming of the affected part (if possible use a water bath of 90° to 105°F), keeping it dry, and preventing further exposure.
IMMERSION FOOT. Immersion foot, which also may occur in the hands, results from prolonged exposure to wet cold at temperatures ranging from just above freezing to 50°F (10°C) and usually in connection with limited motion of the extremities and water-soaked protective clothing.
Signs and symptoms of immersion foot are tingling and numbness of the affected areas; swelling of the legs, feet, or hands; bluish discoloration of the skin; and painful blisters. Gangrene may occur. General treatment for immersion foot is as follows:
1. Get the victim off his or her feet as soon as possible.
2. Remove wet shoes, socks, and gloves to improve circulation.
3. Expose the affected area to warm dry air.
4. Keep the victim warm.
5. Do not rupture blisters or apply salves and ointments.
6. If the skin is not broken or loose, the injured part may be left exposed; however, if it is necessary to transport the victim, cover the injured area with loosely wrapped fluff bandages of sterile gauze.
7. If the skin is broken, place a sterile sheet under the extremity and gently wrap it to protect the sensitive tissue from pressure and additional injury.
8. Transport the victim as soon as possible to a medical treatment facility as a litter patient.
FROSTBITE. Frostbite occurs when ice crystals form in the skin or deeper tissues after exposure to a temperature of 32°F (0°C) or lower. 4-83