Page 46 - 2026 SMOG

HOT/COLD WEATHER INJURY
HOT Weather Signs & Symptoms COLD Weather Signs & Symptoms
• Altered Mental Status (AMS) • Cold, Clammy skin
• LOC • Shivering or lack of shivering
• Pale or clammy skin • Mental status change
• Hypotension or shock • Extremity pain or numbness
• Seizure • Bradycardia or Arrhythmia
• Nausea or Vomiting • Hypotension or Shock
HOT Weather Treatment
• Remove from heat source/loosen or remove clothing.
• If AMS, move to ALTERED MENTAL STATUS PROTOCOL
˚ Assess glucose. If outside normal limits, move to HYPERGLYCEMIA/HYPOGLYCEMIA
PROTOCOL.
• Consider intubation if needed.
• 1L IV bolus or PO fluids
• Monitor 12-lead EKG for arrhythmias.
• If the patient develops a seizure, move to SEIZURE PROTOCOL
• AMS and core temp >40°C/104°F
˚ Start aggressive cooling (Tepid water to skin and fanning/ice packs in groin, axilla, and neck.
Discontinue once temp <40°C/104°F)
˚ Consider benzodiazepines to block/stop shivering and rebound hypothermia.
Midazolam 0.1mg/kg
■
• AMS and core temp <40°C/104°F
˚ Tepid water or room temperature water to the skin
• Continuous monitoring
COLD Weather Treatment
• Remove wet clothing
• Assess: mental status, rectal temperature, glucose
• Core Temp <96°F (Non Core Temp <97°F)
˚ HPMK kit/Hypothermia blankets
˚ Dry clothing
˚ Hot Packs to groin, axilla, abdomen (avoid burning pt)
˚ Warmed IV fluids
Up to 150mL/min to allow for proper warming through the device
■
■ Must be used in conjunction with HPMK/hypothermia blankets
• Monitor 12-lead EKG
Notes, Warnings, Cautions
HOT Weather
• The best method to cool the patient is sublimation, sprinkling w/ water + fanning to evaporate on
the skin.
• Elevated risk groups: elderly, very young, highly active
• Sweating does not exclude heat stroke/heat illness
COLD Weather
• “No patient is dead until they are warm and dead”
• Hypothermia is defined as core temp <96°F (Non Core Temp <97°F)
• Pulse may be very slow in a hypothermic patient—wait at least one minute to feel pulse
Reference: CPG ID #23 (Hypothermia: Prevention and Management)

38 • MEDICAL