110 220 Definition Core, internal body temperature 95º F (35ºC) severe hypothermic core temperature is 90ºF (32.2ºC). Hypothermia occurs most commonly from prolonged exposure to cold air or cold water temperatures, often without adequate clothing however, other etiologies include metabolic imbalance and receiving cold infusions. Frostbite develops when ice crystals form in body tissue and is manifested most commonly in the ears, cheeks, nose, fingers, and toes. The young and the old are especially vulnerable. Also those with diabetes or who have un- derlying vascular or systemic disease are at increased risk of hypothermia. Because hy- pothermia occurs gradually, people may not be aware of the exposure. Characteristics Possible manifestations include shivering, slurred speech, confusion, altered level of con- sciousness, sleepiness, fatigue, lethargy, impaired vision, cool and pale skin, bronchospasms, and signs of frostbite. (For frostbite characteristics, see Guideline 107, Frostbite, page 208.) Symptoms of shock also can be present. Policy Hypothermia is a medical emergency that requires medical intervention or immediate trans- port to a hospital. Evaluate in the occupational health unit any employee with symptoms of hypothermia and immediately refer for medical evaluation, and transfer to the hospital. Objectives Clinical Assessments and Interventions Referral for Medical Action Hypothermia ● Immediate medical treatment re- quired (i.e., transfer to hospital). Follow-up Actions ● Collaborate with personal health care provider regarding treatment plan and rehabilitation. ● Provide support and counseling during any necessary rehabilita- tion. ● Analyze job and develop proce- dures to prevent hypothermia if indicated. ● Educate employee regarding pre- cautions to prevent hypothermia. ● Assist in returning employee to the workplace in an appropriate job. ● Refer employee to EAP for coun- seling and support as needed, es- Assess extent of in- jury and prevent fur- ther damage. Maintain employee comfort and monitor for changes in vital functions. ● Move employee to a warm environment. ● If possible, obtain exposure account and medical history. ● Monitor vital signs at least every 5 minutes. ● Assess for signs of frostbite (see Guideline 107, Frostbite, page 208). ● Do not massage or rub frostbitten area. ● For mild hypothermia: – Remove any wet clothing. – Wrap in blankets (insulating blankets, if available). – Apply loose, dry, sterile dressing to frost- bitten areas as gently as possible. – Maintain employee at rest. – Monitor and provide care for shock. – Administer oxygen per standing order, if needed. – Administer small amounts of warm fluids (but no caffeine) if fully conscious and alert. – Maintain patent airway. Guideline continues on next page