Emergency Medicine Book


Hypothermia Management in the Wilderness

Aka: Hypothermia Management in the Wilderness, Prevention of Cold Weather Injury
  1. See Also
    1. Hypothermia
    2. Hypothermia Causes
    3. Rewarming in Hypothermia
    4. Hypothermia Management
    5. Frostbite
    6. Immersion Foot (Trench Foot)
    7. Pernio (Chilblains)
    8. Emergency Car Kit
  2. Management: Methods of rewarming in wilderness
    1. General
      1. Move the patient to warm, dry environment
      2. Remove wet clothing
      3. Avoid excessive movement (risk of Arrhythmia)
    2. Passive external rewarming
      1. Warm dry blanket
      2. Hot water bottle
      3. Wrapped hot rocks
      4. Warm next to another body
    3. Active External Rewarming
      1. Radiant heat source
      2. Heat pads
      3. Immersion
    4. Active core rewarming
      1. Heated airway inhalation
      2. Heated IV fluids
      3. Gastrointestinal irrigation
      4. Peritoneal Dialysis
      5. Extracorporeal rewarming
      6. Diathermy
  3. Management: Wilderness
    1. Mild Hypothermia
      1. Prevent further heat loss
      2. Remove wet clothing
      3. Move to warm environment
      4. Oral rehydration
    2. Severe Hypothermia
      1. Evacuation
      2. Gentle handling
      3. ABC Management and Cardiac monitor
  4. Prevention: Wilderness
    1. See Emergency Car Kit
    2. Plan the activity
    3. Appropriate clothing (with back up items)
      1. Dress in layers
        1. Avoid cotton
        2. Base layer of polypropylene or polyester (long underwear)
        3. Middle layer of wool or fleece
        4. Outer layer of shell that repels water but is breathable (e.g. gortex)
      2. Loose clothing and boots promote greater circulation
      3. Wear a hat
      4. Wear mittens (preferred over gloves)
      5. Wear extra socks (e.g. liner and wool sock) with a boot sized to accomodate the additional bulk
        1. Change socks daily or when wet
    4. Appropriate Food and Fluids
      1. Drink fluids to maintain hydration
      2. Avoid Alcohol and Tobacco
      3. Adequate diet to maintain nutrition
    5. Other measures
      1. Use Supplemental Oxygen at very high altitude (7500 meters or above 24,000 feet)
  5. References
    1. Rathjen (2019) Am Fam Physician 100(11): 680-6 [PubMed]

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