hypothermia and O2 Admin

[HelenP]

Originally Posted by David Pye

Does anyone specifically use warm air/o2 to warm casualties up?

I would have thought it wouldn't have made THAT much difference as gas is a relatively poor conductor of heat.

Perhaps someone more up to speed with hypothermia treatment could confirm - I thought it involved warm water baths etc?

I am occasionally involved in warming very hypothermic patients, and frequently involved in warming mildly hypothermic patients. Although it wouldnt make a massive difference in actively warming someone, warmed air it is part of a load of things you can do. Its not so much that it actively warms but more that a lot of heat energy is used (by the body) in warming and humdifying the air that we breath in so doing this in advance does help. Others things include simple external heating eg blankets, warming the environment etc. Warmed intravenous fluids. More invasive measures which are less often used include putting warmed fluid into bladders/ stomach/ peritoneal cavity etc and in extreme cases you can take blood out, warm it and then out it back in. However I dont think someone being hypothermic is a reason not to give oxygen.

HTH
Helen

Edit: Obviously most of the things mentioned above are only things that could be done in a hospital setting the best thing that can be done in the community is dry the casualty, wrap them up well and get them to hospital.

[Twinset & Wing]

Originally Posted by David Pye

Does anyone specifically use warm air/o2 to warm casualties up?

I would have thought it wouldn't have made THAT much difference as gas is a relatively poor conductor of heat.

Perhaps someone more up to speed with hypothermia treatment could confirm - I thought it involved warm water baths etc?

Hi there, In both mountain rescue and cave rescue circles we use a device called a little dragon, it uses sodalime like in a rebreather to warm O2 before a patient inhales it, I have to say that it does make a difference from the few times I have seen it in use.

As far as warm baths e.t.c go there is passive and active re-warming. If somebody had become hypothermic quickly e.g, a sudden suit flood while having a deco obligation as in has "crashed and burnt" then active re-warming is the better option that would be putting them fully clothed into a warm(not hot) shower and getting there temprature up quicky again then stripping them off in the shower drying them off and dressing them in warm dry clothes.

If on the other had somebidy had gotten lost on a mountain and been under sub standard shelter for say 12-24 hours or more and were hypothermic then passive re-warming would be the order of the day, warm thick casualty bags, little dragons, none direct heat.

in summary, warm air is a bonus not a requirement and certainly dont withold treatment because you dont have the equipment to warm the O2. Als remember t re warm casualties in the way they went down, if they go down quickly rapid,active warming is required, if they go down slowly then warm them up passivley slow and steady wins the race....most of all if in doubt get them to deifinitive care ASAP.

Also please remember that in a worst case scenareo situation a casualty is not dead untill they are warm and dead, hypothermia can mask signs of life significantly do not give up.

Giles

p.s I have a good article somewhere on hypothermia stages and treatment, i will try and dig it out and post it.

[frosty the snowman]

Originally Posted by scubagit

Ok, I know everyone says that O2 should never be given to a hypothermic casualty without using an O2 heater/hydrator, but according to a senior well respected diver (and medic) I had a conversation with, this is a myth.
Can anyone shed any light on this theory? From what I believe, the O2 will do no good as it's job is to aid in flushing out nitrogen and raise PPO2 and also prevent the build up of scar tissue. The problem is that O2 admin to a hypothermic casualty can lead to after drop (further drop in core temp).
Opinions please.....

I've never heard of this and think your well respected diver and medic is correct. After drop occurs when cold peripheral blood is returned to the core too quickly, before it has been warmed (which is why hypothermic casualties should not have their limbs massaged to 'get the circulation going'). Divers are often cold after a dive and that's no reason to withold oxygen if they need it.

[scubagit]

Cheers guys for all of your input.
Until about six months ago, I would have given O2 for any diving related incident. It was only last year when a group of us were doing the CMAS D*** course and this year the M1 instructor course this subject started to raise it's head. During the D*** course there are simulated incidents which you as D.O.D have to manage. I remember being corrected by an examiner for saying as part of the Hypothermia treatment, give O2. On my M1 course it reared it's ugly head once again when we were giving lectures to course instructors. It was only on the day of the M1 exam that it came up in conversation with the above mentioned diver that not giving O2 to a hypothermic casualty was in fact Bull and would we mind researching the topic for an article, a "Dispeling the myth" kind of thing.
Anyway considering the feedback from you guys and much research, it appears that this subject is sorted.
I'll post the article when it is done.
Cheers,

SG