# Hot and cold packs



## JJR512 (Jul 30, 2011)

What are the instant hot and cold packs good for?

I was originally going to also ask specifically which to use for a suspected strain, but figured I should just check my protocols first. But I don't recall the Maryland protocols saying much specifically about sprains. I did search them, and found in the WEMT optional protocols section that it essentially says "RICE (rest, ice, compression, elevation) for the first 24-48 hours, with heat after 36-48 hours" (paraphrased). But that's an optional supplemental protocol for wilderness EMS and I don't know if I'm authorized to follow it. Maybe it won't make any difference in my suburban area with transport times under 20 minutes.

Our hypothermia protocol calls for passive rewarming only. I don't recall ever being taught to use heat packs during EMT-B class at all. But we have them on our ambulances. Maybe they're for ALS, I don't know.

Our heat-related emergency protocol says to "cool patient as appropriate", and further says in the event of heat stroke to "aggressively cool patient". It does not explicitly say to use instant cold packs but it also doesn't say to _not_ use them, and the language suggests that they _should_ be used (as an "aggressive" means).

So basically the question is when, at the BLS level, are instant hot or cold packs typically used? In what situations might I want to consider using one or the other if my protocols don't say to not use them?


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## emt-mike (Jul 30, 2011)

In terms of heat emergencies you should place cool packs in armpits, knee pits and in the groin to facilitate cooling.


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## WuLabsWuTecH (Jul 30, 2011)

In EMT-B classes, we were taught to use cold packs on the femoral, brachial arteries for heat emergencies.  Passive rewarming for hypothermia.

We have used cold packs on backs of necks before to constrict blood vessels in someone who is epistaxisic and really bleeding in addition to direct pressure on the nose.

Induced hypothermia is another use in our ALS protocol (one bad thing about working on the ALS Medic all the time and never doing shifts on the squad is you start to forget what's basic and what's not, but i'm pretty sure induced hypothermia is medic only).

I'm trying to remember what the hot packs are there for...  I know it's for more than just keeping the fries warm when we take a run during lunch...


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## EMS49393 (Jul 30, 2011)

I've actually only ever used heat packs to try to bring out veins for IV's in super chilly patients that need fluids.  Other then that, I haven't used them.  We use warm blankets and warmed fluids (which I also wrap) for rewarming.

As far as cold packs, I do use them often.  Our cold packs are actually great, they only last around 15 minutes and really do not get very cold.  They are fantastic for reducing swelling in soft tissue injuries.  

You can use them to try to cool a patient and ours would likely work well, but some cold packs get and stay cold entirely too long.  When you cool a patient you have to be cautious not to let them start to shiver.  Shivering only creates more energy which equals more heat.  Wet sheets, not cold sheets, just wet sheets, are actually my preferred method of cooling a patient.  They can be removed quickly and replaced with dry sheets or even a light blanket if the patient is in danger of being cooled to the point of shivering.

Maryland protocols are not written to spoon feed every single treatment and explain the use of every single item on the ambulance (hard to believe when they're over 400 pages long).  You need to use some of your education when making decisions.  Of course, if in doubt, call EMRC and hash it out with a base station.  I drop tons of crap in the lap of base stations.  It takes the stress right off of me and puts it where it belongs, on the ER physician.  After all, they make way more money then I do.


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## sirengirl (Jul 30, 2011)

WuLabsWuTecH said:


> We have used cold packs on backs of necks before to constrict blood vessels in someone who is epistaxisic and really bleeding in addition to direct pressure on the nose.



Oh wow I hadn't ever heard of that. Imma remember that!!




EMS49393 said:


> I've actually only ever used heat packs to try to bring out veins for IV's in super chilly patients that need fluids.



Didn't realize you could use warm packs for IVs....

I learned two new things today and I've only been awake for half an hour! ^_^


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## Sasha (Jul 30, 2011)

I mainly have used cold packs for pain and swelling.


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## samiam (Jul 30, 2011)

Hot packs on patients who have cold extremities and the pulse ox wont read. It works really well.


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## fast65 (Jul 30, 2011)

sirengirl said:


> Oh wow I hadn't ever heard of that. Imma remember that!!
> 
> 
> 
> ...



Yup, it tends to bring the veins up closer to the surface because they're trying to cool off. Think about when you take a hot shower, your veins normally pop up, right?

We don't actually carry hot packs, but in medic school they always said that if you want to warm IV fluids then you can wrap a hot pack around the line and that should warm it up. So that's another application.


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## Tigger (Jul 30, 2011)

JJR512 said:


> What are the instant hot and cold packs good for?
> 
> I was originally going to also ask specifically which to use for a suspected strain, but figured I should just check my protocols first. But I don't recall the Maryland protocols saying much specifically about sprains. I did search them, and found in the WEMT optional protocols section that it essentially says "RICE (rest, ice, compression, elevation) for the first 24-48 hours, with heat after 36-48 hours" (paraphrased). But that's an optional supplemental protocol for wilderness EMS and I don't know if I'm authorized to follow it. Maybe it won't make any difference in my suburban area with transport times under 20 minutes.



Ice is an excellent form of "pain relief" for a BLS provider when it comes to orthopedic injuries. If grandma has a big bump on her wrist from when she fell down, put one of those cold packs on it. If that's too cold grab a facecloth and put it on the injury site first. If you are going to splint said injury, consider applying the splint in such a way to keep the ice on the site. 

Protocols can't cover every possible scenario, you may have to occasionally use common sense when treating a patient. Clearly a hot pack would be a more choice for any sort of acute orthopedic injury, think about the physiology associated with applying heat or ice.


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## Shishkabob (Jul 30, 2011)

Hot packs for cold people, cold packs for hot people.


Both for isolated extremity pain that don't require narcotics for pain management.


Cold packs for patients that get ROSC.


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## medichopeful (Jul 30, 2011)

In Mass, if we have a patient who's hypothermic and responding appropriately, we're allowed to do active rewarming (for this we'd use hot packs).  If they're not responding appropriately, it's all passive.

Cold packs have a much broader range of things they can be used for.  They can be used for hyperthermia, pain relief, lowering someone's temperature (from an illness), reducing swelling, and helping constrict blood vessels to stop bleeding.


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## Tigger (Jul 30, 2011)

Linuss said:


> Hot packs for cold people, cold packs for hot people.
> 
> 
> Both for isolated extremity pain that don't require narcotics for pain management.
> ...



Just curious, but what's the rationale behind using hot packs on isolated muscoskeletal injuries? In my experience that makes the problem worse.



Sent from my out of area communications device.


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## Sasha (Jul 30, 2011)

Tigger said:


> Just curious, but what's the rationale behind using hot packs on isolated muscoskeletal injuries? In my experience that makes the problem worse. Heats going to dilate those injured vessels.
> 
> 
> 
> Sent from my out of area communications device.



Plus one. My undertanding heat isnt recommended til well after the injury

Sent from LuLu using Tapatalk


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## mycrofft (Jul 30, 2011)

*Chem hot packs are for cold ambo operators*

And to warm (not heat) up MRE's etc.


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## Shishkabob (Jul 30, 2011)

Tigger said:


> Just curious, but what's the rationale behind using hot packs on isolated muscoskeletal injuries? In my experience that makes the problem worse.



Did I say muscoskeletal injuries, or did I say pain?



Some people prefer hot packs for things such as muscle cramps / pain, and I'm asked for both from patients from time to time.


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## WuLabsWuTecH (Jul 30, 2011)

Linuss said:


> Hot packs for cold people, cold packs for hot people.



The ladies think I'm oh so hot while the bro's think i'm real chill... What do we use on me?


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## Shishkabob (Jul 30, 2011)

Haldol.

Clearly there's some psychosis going on.


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## Tigger (Jul 31, 2011)

Linuss said:


> Did I say muscoskeletal injuries, or did I say pain?
> 
> 
> 
> Some people prefer hot packs for things such as muscle cramps / pain, and I'm asked for both from patients from time to time.



I still don't see much use for heat in treating pain. Even if the pain stems purely from nervous system damage, that heat is only going to increase stimulation, and likely increase pain levels. 

Whatever the patient wants I guess...


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## Aidey (Jul 31, 2011)

In my experience you are wrong. If I am super sore from the gym heat is the only thing that helps.


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## reaper (Jul 31, 2011)

Muscle strains are better treated with heat. Swelling likes cold!


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## Aidey (Jul 31, 2011)

My understanding is that a lot of arthritis suffers find heat helps them too. 

The other thing I like using heat packs for is keeping babies warm without turning the box into a sauna. If the baby is legitimately sick I like to strip them down to their diaper, especially if it is a respiratory thing. I always cover them back up with a blanket, but I've found that sticking a heat pack in the middle of the blanket folds or on top of the blanket keeps them the right temp.


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## Underoath87 (Jul 31, 2011)

Aidey said:


> In my experience you are wrong. If I am super sore from the gym heat is the only thing that helps.



That's because DOMS from lifting is not an actual injury.  You're just warming up the muscles to get rid of soreness from micro-tears.  If you're REALLY sore, it is almost impossible to move until you have warmed up and strecthed out your muscles.

But cold is going to anesthetize an actual injury by reducing inflammation, though it certainly won't improve performace.


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## usalsfyre (Jul 31, 2011)

Ice for muscoskeletal injuries, heat exhaustion and ROSC hypothermia. Hot packs for rewarning of hypothermia and keeping trauma patients warm.

It always amazed me the restrictions on active rewarming. You have to get those folks warmed back up, and there's much less chance of overshooting than say, actively cooling heat stroke.

Small rant, we've turned providers into such protocol monkeys they're afraid of providing a commonly accepted and appropriate layperson treatment because it's not specifically mentioned in a set of protocols?!? We're failing miserably folks...


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## Tigger (Jul 31, 2011)

usalsfyre said:


> Small rant, we've turned providers into such protocol monkeys they're afraid of providing a commonly accepted and appropriate layperson treatment because it's not specifically mentioned in a set of protocols?!? We're failing miserably folks...



+ A very large number for that one. No set of protocols can ever cover every scenario. Common sense however, can.


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