Cold Temperature-related Emergencies for Certified Emergency Nursing (CEN)
Included In This Lesson
Outline
Cold Temperature-related Emergencies
Definition/Etiology:
Cold Emergencies:
- Hypothermia
- Mild: 93-95
- Moderate: 86-93
- Severe: <86F
Frostbite:
Traumatic condition results from the formation of ice crystals in the extracellular spaces. Once the cells are frozen, the damage is irreversible.
Pathophysiology:
Hypothermia: Heat loss through convection, conduction, radiation or evaporation. Heat loss can overwhelm the body’s ability to compensate. Most of the body’s processes are temp related and changes evolve with decreasing temps.
Frostbite: Frostbite tends to occur when the body is exposed to intense cold, resulting in vasoconstriction. The resulting decrease in blood flow fails to deliver heat to the tissues and eventually leads to ice crystal formation. Body parts most prone to frostbite include the feet, hand, ears, lips, and nose.
Clinical Presentation:
Hypothermia:
Different systems will show different symptoms as the temp drops:
CNS: Progressive decline in LOC
- Sluggish pupils
- Unconsciousness may result between 89.6 and 86F
Cardiovascular:
- Initially – tachycardia, HTN, & cardiac output.
- Later – Bradycardia
- A-fib
- Prolonged QT
- Asystole almost universal at 64.4F
Respiratory:
- Depressed cough reflex
- Increased secretions can lead to aspiration
Renal:
- “Cold Diuresis” – peripheral vasoconstriction leads to central hypovolemia
Hematologic:
- Coagulopathies and DIC
Digestive:
- Slowed peristalsis
- Slowed hepatic function
- Insulin ineffective at 86F
Frostbite:
Superficial-
- Local burning, numbness, tingling
- Whitish, waxy skin
- Stinging during rewarming
- Large blisters
Deep Frostbite-
- Slight burning followed by numbness as the area freezes
- Whitish or yellow-white discoloration
- Swelling and intense burning during rewarming
- Blisters
- Edema that may persist for months
- Severe discoloration and gangrene are late findings
Collaborative Management:
Hypothermia:
- Not dead till warm and dead!
- Rewarm!
- Heating blankets
- Bair hugger
- Apply external heat
- Warm IV solution
- Peritoneal lavage
- Severe may require extracorporeal circulation via cardiac bypass, or hemodialysis. Yes, these patients may be so cold that the only way to warm them is to remove their blood, warm it, and put it back.
- Give meds judiciously – basically be careful and remember what you give! Hypothermic patients metabolize drugs poorly and may receive a large bolus once warmed.
Frostbite:
- Protect injured part from further damage
- Do not use friction for rewarming – makes things worse
- Immerse part in temp controlled water t 98.6-104F
- Encourage gentle motion in water, but no rubbing
- Once thawed, protect and immobilize the extremities. Use bulky sterile dressings and avoid pressure
- NSAIDS and more if needed
- Rehydrate and address any other concerns
Evaluation | Patient Monitoring | Education:
Number 1 eval….core temp!
For hypothermia, are they getting warmer? Temp sensing foley is probably a good initial intervention for evaluation.
Frostbite –
Evaluate injured areas. Treat for pain during rewarming. Assess perfusion during rewarming.
Education: Well, what happened, why did the frostbite occur? Were they shoveling snow or are they homeless and don’t have warm clothing?
Remind not to smoke or drink in extreme cold. Keep skin and clothing dry.
Linchpins: (Key Points)
- NDTWD – Not dead till warm and dead
- Fast or slow – rewarming in hypothermia – fast. In frostbite – not so much
- Pain control – this is going to hurt
- Blinders – what are the underlying causes or concurrent conditions
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2022). Emergency Nursing Orientation 3.0. Cambridge, MA: Elsevier, Inc.
- Sheehy, S. B., Hammond, B. B., & Zimmerman, P. G. (2013). Sheehy’s manual of emergency care (Vol. 7th Edition). St. Louis, MO: Elsevier/Mosby.
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System