Advanced Trauma Life Support ATLS Student Course Manual 2018
Appendix B HYPOTHERMIA AND HEAT INJURIES OBJECTIVES 1. Identify the problems encountered with injuries due to exposure. 2. Explain the mechanism and risks posed by hypothermia and heat injury in injured patients. 4. Define the two levels of heat injury. 5. Describe treatment approaches for hypothermia and heat injury. 3. Define the three levels of hypothermia. The body strives to maintain a constant temperature between 36.4°C (97.5°F) and 37.5°C (99.5°F). Exposure to extreme temperatures can override normal thermoregulation, raising or lowering the core body temperature. Significant alterations in core body temperature result in life-threatening systemic effects. Environmental exposure may be the only injury, or the exposure can complicate other traumatic injuries. Cold Injury: Systemic Hypothermia Hypothermia is defined as a core body temperature below 35°C (95°F). In the absence of concomitant traumatic injury, hypothermia may be classified as mild (35°C to 32°C, or 95°F to 89.6°F), moderate (32°C to 30°C, or 89.6°F to 86°F), or severe (below 30°C, or 86°F). Hypothermia in the presence of traumatic injury can be particularly troubling. It occurs in 10% of injured patients and as many as one-third of severely injured patients (Injury Severity Score > or equal to 16).The synergy of hypothermia and injury can lead to increased organ failure and mortality. Therefore in the presence of injury, different thresholds for classification are recommended: mild hypothermia is 36° C (96.8° F), moderate hypothermia is
266 APPENDIX B n Hypothermia and Heat Injuries table b-1 staging and management of accidental hypothermia STAGE CLINICAL SYMPTOMS TYPICAL CORE TEMPERATURE a TREATMENT 1 Conscious shivering 35°C to 32°C (95-89.6 F) Warm environment and clothing, warm sweet drinks, and active movement (if possible) 2 Impaired consciousness, not shivering < 32°C to 28°C (< 89.6- 82.4 F) Cardiac monitoring, minimal and cautious movements to avoid arrhythmias, horizontal position and immobilization, full-body insulation, active external rewarming 3 Unconscious and not shivering; vital signs present < 28°C to 24°C (
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266<br />
APPENDIX B n Hypothermia and Heat Injuries<br />
table b-1 staging and management of accidental hypothermia<br />
STAGE<br />
CLINICAL<br />
SYMPTOMS<br />
TYPICAL CORE<br />
TEMPERATURE a<br />
TREATMENT<br />
1 Conscious shivering 35°C to 32°C<br />
(95-89.6 F)<br />
Warm environment and clothing, warm sweet drinks, and<br />
active movement (if possible)<br />
2 Impaired consciousness,<br />
not shivering<br />
< 32°C to 28°C<br />
(< 89.6- 82.4 F)<br />
Cardiac monitoring, minimal and cautious movements to<br />
avoid arrhythmias, horizontal position and immobilization,<br />
full-body insulation, active external rewarming<br />
3 Unconscious and not<br />
shivering; vital signs<br />
present<br />
< 28°C to 24°C<br />
(
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