Monday, December 5, 2011

Getting Cold Out There

I woke up cold today, so I'm inspired to write about hypothermia.

I've been thinking about it since The EMT Spot wrote a post about the possibility of accidentally inducing hypothermia in patients by not warming saline for IVs.

There are a lot of reasons a patient might be hypothermic.

Some are obvious, like the ambient temperature being low. Or a patient not dressed for the conditions.

But some might be overlooked, if you get tunnel vision.

One of the most common of those occurs regularly in my house. My kitchen floor is tile. Real ceramic tile, not some sort of plastic stuff. And while the tile is easy to clean, looks great, and it feels good on my feet in the summer, it is undeniably COLD much of the time. It stays cool in the summer (great!) and is downright frigid in the winter (not so great!).

If, for example, someone were to fall on such a kitchen floor, and not be able to call for help, and not be found until the next morning... I'm sure they would be freezing cold. Whether or not their body temperature drops to clinical hypothermia, they're going to feel cold, and be miserable.

Likewise, consider garage floors to be heat sinks that suck the warmth right out of a person, any time of the year. Basement floors, too.

One of the other reasons a person on the floor for any length of time is going to be cold is that they probably aren't moving, either. Moving creates body heat. If you don't think so, go run a mile. NOT moving will make a person colder than they'd be if they were moving.

Yet another thing to consider is that not everyone out there can afford to keep their house very warm all year. Around here, there are a variety of heating methods, and some of them do not heat the entire house evenly- so consider distance from the heat source. You may not be able to tell if the house is cold, since you likely will have just come in from the cold, and anything inside will feel warmer, by comparison. Unless you are there long enough to notice, or unless you take off your coat and any other long sleeved layers, you can't go by how it feels to you. Look for objective measurements- like a thermostat or thermometer, or even water frozen in a glass if there is no heat at all. Or look at how family members are dressed- do they have on multiple layers to stay warm?

Another thing that will drop someone's temperature in a hurry is if they are WET. Water is excellent at removing heat from something. Like a fire, for example, which is why water can put out a fire.

If you have a patient on the floor who has been incontinent, that greatly increases the likelihood of hypothermia. As does being diaphoretic. Or being outside in the rain... or overnight or in the early morning, when there is dew.

Likewise, windy conditions, whether it's outdoors, or a window fan.

Another thing people often don't consider has to do with medical conditions. There are a fair number of medications that influence someone's ability to thermoregulate. There are also a number of medical conditions that affect thermoregulation- thyroid issues immediately come to mind. Alcohol use can increase heat loss.  Menopause plays hell with the ability to thermoregulate- in both directions. Do some research. Make a list of conditions and medications to keep an eye out for, but you probably won't list everything. It comes down to keeping an open mind. As is often the case, an older person with multiple medical issues, and multiple medications, is at higher risk.

Stay observant and aware of the conditions both of the surroundings, and your patient, and be alert to things that can lead to hypothermia that might be obvious, or not-so-obvious. Be quick to take action to keep your patient warm- maybe even consider assigning someone the task of keeping that in mind, so no one thinks someone else will take care of it. Especially when it's cold outside, bring those blankets out early.

Now I'll go wrap up in a blanket myself and get on with my day, hopefully a little warmer.

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