P E D I A T R I C P R O T O C O L

HYPOTHERMIA / FROSTBITE 3‐5 kg 6‐7 kg 8‐9 kg 10‐11 kg 12‐14 kg 15‐18 kg 19‐23 kg 24‐29 kg 30‐36 kg 6‐11 lbs 13‐15 lbs 18‐20 lbs 22‐24 lbs 26‐31 lbs 33‐37 lbs 42‐51 lbs 53‐64 lbs 66‐81 lbs 18‐24 in 24‐26 in 26‐29 in 29‐33 in 33‐38 in 38‐43 in 43‐48 in 48‐52 in 52‐57 in Breathing

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UNIVERSAL PATIENT CARE PROTOCOL Airway Remove wet clothing

Evidence or decreased core temperature? Shock / Handle patient gently

Apply hot packs indirectly to skin and / or

blankets and turn up vehicle heat

Circulation CARDIAC MONITOR

CAPNOGRAPHY PROCEDURE

IV / IO PROCEDURE

Cardiac

Appropriate Protocol Based on patient Signs and Symptoms TRANSPORT to appropriate facility CONTACT receiving facility

CONSULT Medical Direction where indicated APPROPRIATE transfer of care

Medical

Trauma

EMT Intervention AEMT Intervention PARAMEDIC Intervention Online Medical Control

Northeast Ohio Regional EMS Protocol ‐ 12 | 10

P E D I A T R I C P R O T O C O L Airway HYPOTHERMIA / FROSTBITE

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HISTORY SIGNS AND SYMPTOMS DIFFERENTIAL DIAGNOSIS Breathing  Past medical history  Cold, clammy  Sepsis  Medications  Shivering  Environmental exposure  Exposure to environment even  Mental status changes  Hypoglycemia in normal temperatures  Extremity pain or sensory  CNS dysfunction

 Exposure to extreme cold abnormality  Stroke  Extremes of age  Bradycardia  Head injury Circulation  Drug use: Alcohol, barbiturates  Hypotension or shock  Spinal cord injury  Infections / sepsis  Length of exposure / wetness KEY POINTS

 Exam: Mental Status, Heart, Lungs, Abdomen, Extremities, Neuro /

 Hypothermic / drowning / near drowning patients that appear cold and dead are NOT dead until they are warm Shock and dead, or have other signs of obvious death (putrification, traumatic injury unsustainable to life).  Defined as core temperature < 95° F (35° C).  Extremes of age are more susceptible (i.e. young and old).  Patients with low core temperatures will not respond to ALS drug interventions. Maintain warming procedure and supportive care. Warming procedures includes removing wet clothing, limiting exposure, and covering the patient with warm blankets if available.  Do not allow patients with frozen extremities to ambulate. Cardiac  Superficial frostbite can be treated by using the patient’s own body heat.  Do not attempt to rewarm deep frostbite unless there is an extreme delay in transport, and there is a no risk that the affected body part will be refrozen. Contact Medical Command prior to rewarming a deep frostbite injury.  With temperature less than 88° F (31° C) ventricular fibrillation is common cause of death. Handling patients gently may prevent this. (rarely responds to defibrillation).  If the temperature is unable to be measured, treat the patient based on the suspected temperature.  Hypothermia may produce severe bradycardia.  Shivering stops below 90° F (32° C).  Hot packs can be activated and placed in the armpit and groin area if available.

 Care should be taken not to place the packs directly against the patient's skin. Medical  Consider withholding CPR if patient has organized rhythm. Discuss with Online Medical Control.  All hypothermic patients should have resuscitation performed until care is transferred, or if there are other signs of obvious death (putrification, traumatic injury unsustainable to life).  The most common mechanism of death in hypothermia is ventricular fibrillation. If the hypothermia victim is in ventricular fibrillation, CPR should be initiated. If V fib is not present, then all treatment and transport decisions should be tempered by the fact that V fib can be caused by rough handling, noxious stimuli or even minor mechanical disturbances, this means that respiratory support with 100% oxygen should be done gently, including intubation, avoiding hyperventilation.  The heart is most likely to fibrillate between 85 ‐ 88° F (29 ‐ 31° C) Defibrillate VF / VT at 2 – 4 j / kg with effective CPR intervals.  Do not allow patients with frozen extremities to ambulate. Trauma  Superficial frostbite can be treated by using the patient’s own body heat.  Do not attempt to rewarm deep frostbite unless there is an extreme delay in transport, and there is a no risk

that the affected body part will be refrozen. Contact Online Medical Control prior to rewarming a deep frostbite injury.

Northeast Ohio Regional EMS Protocol ‐ 13 | 10