During your night shift your ambulance is dispatched to a reported of a “Man Wondering” the roadway. It’s a cold, windy, and rainy night in March. As you respond to the call the dispatcher informs you that a by standard has stopped and has the man in his car. On your arrival you’re meet by police whom stats that the man isn’t answering many questions. But he thinks that the patient is from the local seniors home, which is just down the road. The officer has sent someone down to talk to staff in the hopes of identifying the man and getting more information.

You find the man sitting in the back of a car. He is wearing a tee shirt, pajama bottoms, and a pair of old shoes. His clothing is soaked and his shivering.

On your assessment you find that the patient is only able to give you his first name, which is Randy. The man is unable to tell you where he lives and carries no identification except for a medical alert bracelet that indicated he has Alzheimer’s. Randy seems content and smiles with every question as he shivers in the back of the car.

You move the patient to the ambulance and begin your treatment.

 Assessment

The patient is alert, but only able to tell you his name.

HEET: Pupils equal and reactive to light, patent airway, no signs of trauma

CHEST: bilateral breath sounds are heard, clear heart tones, no signs of trauma, no shortness of breath, no described chest pain.

ABD: Soft, non-tender

PELVIS: stable, no crepitus

EXT: minor abrasions on both knees and palms, equal grips, weak distal pulses.

VITAL SIGNS:  BP 120/60, Pulse 58 Resp. 24, Sp02 92%

SKIN: pale, cold to touch

Patient assessment suggests possible underlying illness, primarily the decrease mental status. You have no way of knowing whether this is a chronic or an acute condition.

Questions:

1) An officer returns to the scene with staff from the nursing home. They would like the man stay with them and not go hospital. "With a little hot coco Randy will be nice and warm in his bed." Do you transport to the ER or let Randy head home to the nursing home?

2)If there is no Osborn J-waves showing up on the cardiac monitor, is the patient not hypothermic?

Considerations

In the field body temperature determination is not an exact procedure. It is the patient's core body temperature that needs to be measured. Temperature taken orally, under the arm, or even tympanic can be misleading. For this reason this patient requires transport to the local ER for further evaluations and treatment. During transport to the hospital EMS personnel must make sure IV fluids given to the patient are not too warm or too cold since the effects can have major negative out comes for a hypothermic patient.

Treatment considerations

• Move patient to a warm ambulance, remove patient’s wet clothing and cover with blankets. Intravenous solutions should be given within their specified temperature range. Many times solutions left in an ambulance may either be cold or warm depending on ambient temperatures of the ambulance.
• Oxygen is indicated in this patient, and may improve his mental status.
• Cardiac monitoring is indicated. (watching for Osborn  J waves)
• Watch for changes in patient’s condition en route to the hospital.

 
Conclusion

In most cases hypothermia is a result of another illness or accident. In this case the crew must pay detective to determine the overall picture. Since hypothermia at this early stage can be treated the EMS crew must make sure that their treatments help to improve the patient condition and don’t cause the body core temperature to continue to drop.