Page 105 - PJ MED OPS Handbook 8th Ed

PJ PEARL: Clear blisters indicate superficial injuries and hemorrhagic blisters indicate deep
injury. NOTE: In prolong field care or village operations, frostbite with dead digits should be
left alone to fall off on their own. Do not amputate.

3. Hypothermia
a. Move to warm environment, remove any wet clothing and begin rewarming (Blizzard Blanket,
Ranger Rescue Wrap, etc.)
b. Shield from wind
c. If able to tolerate PO, provide food and hydrate patient
d. Mild (90°–95°F/32°–35°C): exercise in place
e. Moderate (82°–90°F/28°–32°C)/Severe (Below 82°F/28°C):
i) Begin active external rewarming (Blizzard Blanket, Ranger Rescue Wrap, etc.)
ii) Do not exercise patient. Maintain a flat supine position on insulation.
iii) Do not give patients food or oral fluids.
iv) If IV fluids are indicated, administer glucose containing IV fluids warmed to 40°C (101.6°F)
or 1 amp of D50 with crystalloid.
v) If unconscious:
1) Avoid sudden movements and rough handling due to increased ventricular fibrilla-
tion risk with core temps <28°C.
2) Assess airway and breathing; if obtunded (GCS <8) or apneic, establish definitive air-
way and maintain adequate ventilation/oxygenation.
3) Check pulse over 60 sec due the potential for profound bradycardia; if pulseless,
initiate chest compressions.
4) Obtain core temperature and place patient on monitor as soon as available – initiate
standard ACLS if core temperature ≥28°C. Defibrillation can be attempted at lower
temps but should be held after 3 failed attempts until core temperature reaches
28°C. Below 28°C, the benefit of ACLS is unclear and vasopressors should be held due
to the risk of cumulative dosing.
5) High quality CPR should be continued along with aggressive rewarming for any hypo-
thermic patient in cardiac arrest regardless of core temperature. If continuous CPR is
not possible due to the need to move the patient, an intermittent CPR cycle can be
performed based on core temp.
– <20°C: 5min CPR/≤10min patient movement
– <28°C: 5min CPR/≤5min patient movement
– ≥28°C: 1min CPR/≤1min patient movement

NOTE: Do not place chemical or mechanical warmers on the patient’s skin. Monitor to
avoid burns.

DISPOSITION:
1. Urgent evacuation for moderate/severe hypothermia cases to a facility capable of active
rewarming and resuscitation.
2. Priority evacuation for cases of freezing cold injuries (frostbite).
3. Routine evacuation for cases of non-freezing cold injury which are non-ambulatory.
4. Evacuation not necessary for cases of non-freezing ambulatory cold injuries.

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 103