No One Chapter 27: Field and Home MedicineSection 27.12
27.12 Hypothermia and Frostbite
Difficulty: Moderate · Time: about 1–3 hours · Cost: $0–$30
Hypothermia
| Stage | Signs |
|---|---|
| Mild (core about 90 to 95 degrees Fahrenheit, or 32 to 35 degrees Celsius) | Shivering, clumsiness, mild confusion, slurred speech (“the umbles”: stumbles, mumbles, fumbles, grumbles) |
| Moderate | Shivering slows or stops, worsening confusion, drowsiness |
| Severe | Unconscious, very slow breathing and pulse; may appear dead |
What you need
- Dry insulation: sleeping bags, blankets, foam pads
- A plastic sheet, tarp, or emergency blanket (vapor barrier)
- Hot-water bottles or chemical heat packs, wrapped in cloth
- Warm, sweet drinks (for alert patients only)
Steps
- Handle gently. Rough movement can trigger a dangerous heart rhythm in severe hypothermia.
- Get them out of wind and wet and into the warmest shelter available.
- Remove wet clothing (cut it off if needed to avoid excess movement) and replace it with dry layers.
- Insulate from the ground first, then wrap: a “hypothermia burrito” of pad underneath, sleeping bag or blankets around them, and a plastic or foil layer outside to stop heat and moisture loss. Cover the head, leaving the face clear.
- Add heat to the chest, armpits, and back with wrapped hot-water bottles or heat packs. Do not apply heat directly to skin.
- If alert and able to swallow, give warm, sweet drinks and high-calorie food. No alcohol.
- Moderate or severe: Keep the person lying flat. Do not let them walk. Get medical help urgently.
- Severe with no detectable breathing or pulse: Check for a full 60 seconds (pulses can be very faint). If none, begin CPR. Hypothermic patients have survived long periods of CPR; “nobody is dead until they are warm and dead” is a rule emergency medicine follows.
Frostbite
Signs: frostnip is white, numb skin that recovers with warming. Frostbite is skin that is white or gray-yellow, hard or waxy, and numb.
- Get out of the cold and treat any hypothermia first.
- Do not rub frostbitten skin or rub it with snow.
- Rewarm only if there is no chance of refreezing. Freezing, thawing, and refreezing causes much worse damage. If you must walk out on a frozen foot, it is better to keep it frozen until you reach safety.
- Rewarm in water at 99 to 102 degrees Fahrenheit (37 to 39 degrees Celsius), warm but not hot to a healthy hand, for 15 to 30 minutes until skin is soft and color returns. It will be very painful; give ibuprofen if available.
- Do not use dry heat (stoves, fires, heating pads); numb skin burns easily.
- Leave blisters intact, pad between fingers and toes with dry gauze, cover loosely, and seek medical care.
Safety
- Handle severely hypothermic people very gently; rough movement can trigger a dangerous heart rhythm. Never rub frostbitten skin.
