# Warm O2/Hypothermia PT



## Hockey (Jan 13, 2009)

Was bored today and reading around and got to the topic about Hypothermia.  Got my first poss frostbite/hypothermic patient.  Arrived, patient was homeless, and just shivering.  Shivering is better then no shivering.  

Well in one of the treatments I was reading, was to give the patient warm O2.  Only thing I could think of was to place a hot pack on the cannula.  But even then, its not going to really warm it up. 

I really don't think we have anything else on the rig that would "warm" the O2 up.  

With the recent and future record cold weather  have been having, I would like to possibly learn something new   My main thing is to get the wet clothes off and wrap the patient in the blanket.


----------



## traumateam1 (Jan 13, 2009)

Were they talking about putting warm water in a humidifier? Thus making the humidified O2 warm?


----------



## medicdan (Jan 13, 2009)

The easiest way is to keep the O2 bottle warm (in the truck).


----------



## Hastings (Jan 13, 2009)

If your O2 isn't already warmed (humidified, left in the rig with the heat on), you aren't going to actively heat it while you're giving it to the patient.

Humidified is the way to go.

And related, even better, warm IV fluids. That one is a lot more realistic on the spot.


----------



## rhan101277 (Jan 13, 2009)

Yeah we don't have humidified on the trucks here.


----------



## Hastings (Jan 13, 2009)

rhan101277 said:


> Yeah we don't have humidified on the trucks here.



We don't either.

Which is why we keep an O2 tank and bag of 1000mL next to the heater at all times.


----------



## MSDeltaFlt (Jan 13, 2009)

You're not going to be able to do that in the back of the ambulance.  The heated O2 will be done in the hospital.  It will need active warming and humidifying of the O2 on a high-flow system.  I'm not talking about a NRM.  I mean a real high-flow system.

So I wouldn't worry too much about the ''heated O2'' thing.  Just get them warm and dry as best as possible and an PUHA to the hospital.


----------



## Hockey (Jan 13, 2009)

traumateam1 said:


> Were they talking about putting warm water in a humidifier? Thus making the humidified O2 warm?



Negative



emt-student said:


> The easiest way is to keep the O2 bottle warm (in the truck).



With a torch right?


----------



## medicdan (Jan 13, 2009)

There was actually an interesting discussion of this a while ago, where the pros/cons of humidification in O2 were discussed. Searching is not a bad thing these days.

EDIT: Found the link immediately.
http://www.emtlife.com/showthread.php?t=4740
It turns out, I started the discussion, then feel on my own sword.


----------



## Hockey (Jan 13, 2009)

MSDeltaFlt said:


> You're not going to be able to do that in the back of the ambulance.  The heated O2 will be done in the hospital.  It will need active warming and humidifying of the O2 on a high-flow system.  I'm not talking about a NRM.  I mean a real high-flow system.
> 
> So I wouldn't worry too much about the ''heated O2'' thing.  Just get them warm and dry as best as possible and an PUHA to the hospital.



Alrighty thanks.

The patient I had only let me get a few layers (out of the 15!) off him before he started getting combative.  He refused to sit on the cot and only the bench.  Forgot we're the taxi in town 

I would have taken his temp but my department doesn't believe in giving them to us basics...:blink:


----------



## mycrofft (Jan 14, 2009)

*Humidifiers and cold don't mix.*

Condensation in the lines can freeze. Humifidier reservoirs can freeze, especially if straight water. Plastic reservoirs can become fragile if cold. 
I don't know but I suspect strongly that warm versus straight out of bottle O2 (which has not become cryogenic) is not going to make much difference for an adult, but even if it did, length of time to transport and difficulties in providing it almost certainly negate any (probably homeopathic) advantage.


----------



## BossyCow (Jan 14, 2009)

Big thing in a hypothermia pt is to remember you aren't going to warm them up as long as they are wet. You have to get them into something dry. Also warm the core, hot packs to the femorals and brachials by placing on the hips and in the armpits.

With a pt who is still shivering, conscious and alert something warm to drink is also helpful if available.


----------



## Hockey (Jan 14, 2009)

BossyCow said:


> Big thing in a hypothermia pt is to remember you aren't going to warm them up as long as they are wet. You have to get them into something dry. Also warm the core, hot packs to the femorals and brachials by placing on the hips and in the armpits.
> 
> With a pt who is still shivering, conscious and alert *something warm to drink is also helpful if available*.



If I ever did that, the RN's at the hospital would FLIP


----------



## BossyCow (Jan 14, 2009)

Hockey9019 said:


> If I ever did that, the RN's at the hospital would FLIP




LOL in SAR if I don't do it, the pt dies.


----------



## Hockey (Jan 14, 2009)

BossyCow said:


> LOL in SAR if I don't do it, the pt dies.



True that, true that!


----------



## Gbro (Jan 17, 2009)

Hockey9019 said:


> Was bored today and reading around and got to the topic about Hypothermia.  Got my first poss frostbite/hypothermic patient.  Arrived, patient was homeless, and just shivering.  Shivering is better then no shivering.
> With the recent and future record cold weather  have been having, I would like to possibly learn something new  *My main thing is to get the wet clothes off and wrap the patient in the blanket*.



I have mixed thoughts about the blanket. Getting wet clothing off is a must, however covering over with a blanket might not be the best inside a warm ambulance. 
I have heated blankets by holding them close to the heater and swapped out every few min. A blanket is nothing more than insulation. 
Also used hot pacs like Bossy posted ,





> Also warm the core, hot packs to the femorals and brachials by placing on the hips and in the armpits.


 They need to be used with care as some can get quite hot. 

http://www.answers.com/topic/hypothermia-treatment


> Moderate hypothermia is often treated first with active external rewarming and then with passive rewarming. Active external rewarming involves applying heat to the skin, for instance by placing the patient in a warm bath or wrapping the patient in electric heating blankets.


----------



## csly27 (Jan 18, 2009)

BossyCow said:


> Big thing in a hypothermia pt is to remember you aren't going to warm them up as long as they are wet. You have to get them into something dry. Also warm the core, hot packs to the femorals and brachials by placing on the hips and in the armpits.
> 
> With a pt who is still shivering, conscious and alert something warm to drink is also helpful if available.



just a quick question. about the hot packs. I was under the impression that hot packs could re warm the pt too fast and cause circulation problems. Or is that just in sever hypothermic pts? just a little confused about that.


----------



## Outbac1 (Jan 18, 2009)

I've had two hypothermic pts in the last three days. The first had a core temp (rectal), of 31.6C and took about 5 hrs to warm up to 37C. The second had a core temp (rectal), of 28.5C and took about the same time to warm up. Both got warm O2, gastric lavage and a warm air blanket (bear hugger), warm blankets and warm IV saline. Both are expected to recover but one may lose their feet. 

  Like many places it's been a mite chilly lately, (-25 to -35C).


----------



## WiFi_Cowgirl (Jan 20, 2009)

Oxygen coming out of the tank, makes cold air, going in makes hot. So, how much can you really warm it up with hot packs? I'd focus the warming effort to the victim, not the oxygen. Wrapping the oxygen hoses with heat packs is about the stupidist idea I ever heard. I've never even used the humidifier.


----------



## BossyCow (Jan 22, 2009)

csly27 said:


> just a quick question. about the hot packs. I was under the impression that hot packs could re warm the pt too fast and cause circulation problems. Or is that just in sever hypothermic pts? just a little confused about that.



Depends on the pack and depends on the way its placed. I have an intense dislike of the standard issue EMS/FA heat packs. They heat up too high, burn out too fast out date quickly and are prone to puncture and accidental activation. I much prefer the slower heating foot and hand warmers sold in retail. They hold their heat longer and are a much more gentle heat. In SAR I carry ziplock bags of ordinary deicer. Added to water from your water bottle or any available water source (not necessarily drinkable water) they create a nice little heat pack placed in a plastic water bottle, nalgene bottle or other water carrying device. They are light and durable and don't get activated until you add the water.

If you are using the regular EMS hot packs, you need to carry some sort of wrap so the heat isn't in direct contact with the patient's skin. We carry rolled stockinette cut to fit. We have also used towels or face cloths to use as a barrier. Aside from that issue, if you keep the heat packs close to the core instead of at the extremeties, you should be fine.


----------



## mikeylikesit (Jan 22, 2009)

Dry off the patient, and the warm liquad if available is the best sine the steam warms the lungs and the liquad waarms the core. they don't even have to drink it to get some good effect from the steam of the drink. not too hot though or you got some more problems.


----------



## csly27 (Jan 22, 2009)

BossyCow said:


> Depends on the pack and depends on the way its placed. I have an intense dislike of the standard issue EMS/FA heat packs. They heat up too high, burn out too fast out date quickly and are prone to puncture and accidental activation. I much prefer the slower heating foot and hand warmers sold in retail. They hold their heat longer and are a much more gentle heat. In SAR I carry ziplock bags of ordinary deicer. Added to water from your water bottle or any available water source (not necessarily drinkable water) they create a nice little heat pack placed in a plastic water bottle, nalgene bottle or other water carrying device. They are light and durable and don't get activated until you add the water.
> 
> If you are using the regular EMS hot packs, you need to carry some sort of wrap so the heat isn't in direct contact with the patient's skin. We carry rolled stockinette cut to fit. We have also used towels or face cloths to use as a barrier. Aside from that issue, if you keep the heat packs close to the core instead of at the extremeties, you should be fine.




Thanks that is good to know.


----------



## emtfarva (Feb 4, 2009)

*Another way to warm the O2*

My instructor in Emt School said that If you want warm or cool O2 take xtra O2 tubing and place the tubing in a coil by the ambulance heater from the O2 source to coil by the Heater to the Pt. We don't have heatpacks in our service. Also the Heatpacks could warm the Pt up to fast. I always try to leave our truck running if at all possible. that keeps the truck, stretcher, my partners drugs, O2, B/P cuffs, scopes and everything else warm or cool.


----------



## AlaskaEMT (Feb 5, 2009)

Warm saline IV if your ambulance has a warmer. (we have a fridge as well for cold NS).  Get them in the box, warm oxygen, warm packs on neck, groin, and armpits.  Consider wrapping their 02 tubing around your core if not in the ambulance.  You should not use BP cuffs as it can damage cold tissue.


----------



## Wyoming Medic (Feb 5, 2009)

Ummmmm  :glare:

oxygen is a compressed gas.  When it is in the tank it is at whatever temp the tank is at (in this case the temp of the ambulance).  Whenever gas is let out of a compressed state it cools RAPIDLY.  This is called Boyles (sp) law.  It also works in the opposite.  Whenever a gas is compressed rapidly it creates heat (Which is why SCBA cylinders and other gas cylinders are usually filled slowly).  It is a process called ADIBATIC (sp again) heating and cooling.

I can assure you that keeping the oxygen tank near any heat source will have negligible effect on the temp of the oxygen that the patient is breathing.  I would not worry about heating oxygen in the field and wait until you get to the hospital where they have actual oxygen heating systems.  Systems that can control the temp of the oxygen safely.  Even if you were to get any temp change (as in wrapping a coil of tubing in hot packs) there is no way to control it.

Another issue is that it actually changes the air density when a gas is heated.  This can be explained by the fact that helicopters cannot fly here on really hot summer days nor small plane take off from the airport.  The air density altitude is greatly diminished.  This may not mean too much but when we deal with hypothermic patients, they are typically at altitudes nearing 10-12K feet.  I want maximum oxygen efficiency.  This is really a small issue but it should be understood.  That is why water boils here around 190 Degrees F.  Way less air density.

We deal with hypothermic patients often here in the rockies.  I have many more things to worry about than attempting to jury rig a contraption together that may or may not heat the oxygen in a non controllable manner.

Until next time, same bat time, same bat channel  h34r:

Wy medic


----------



## Wyoming Medic (Feb 5, 2009)

Sorry, Just re-read my post above.  Air pressure is why water boils at such a low temp.  The rest of the items are density.


----------

