低体温

子供は風の子。否。あなどってはいけない低体温。低温状況をコントロールしてこそ本当の風の子。

体温調整&低温生理学
低体温は、低温状況において、傷病者が通常の体温を維持できなくなった時に起こる。低温状況は、温度の低下、湿度の向上、風速の向上で悪化する。人は、低温状況に震えることによる熱生成と、血管収縮による熱保存により、体温を維持しようとする。熱生成には、効率的な代謝とカロリー供給が必要である。震えや運動による熱生成は、カロリーを消費する。体力、水分補給、健康、傷害は、すべて人の熱を生成する能力に影響を与える。

低体温のはじまりは、低温状況の厳しさ、長時間の暴露、傷病者の健康状態により様々である。急性の低体温は、冷たい水に浸かると、傷病者の健康状態に関わらず、数分から数時間で起こる。準急性の低体温は、野外での中度の低温状況でも、体力を消耗すると、数時間から数日で起こる。長期の野外遠征では、慢性的なカロリー摂取やグリコーゲン、脂質の不足や、健康状態、水分補給、体力消耗などの要因により、慢性定期な寒さ反応を起こしている。そのような状況で低温状況になると、容易に低体温に陥る。

備考
・メンバーの体温を36度以下にしない。
・32度以下は、心臓が電気的に不安定になり、心停止しやすい状態になる。
・30度以下は、60秒間脈拍を確認する。もしなければ3分間人工呼吸をして、再び確認する。
・体温計がない場合は、VPUは中度低体温か重度低体温として扱う。

寒さ反応の処置
シェルター・隔離・加温
・濡れた服を着替える
・中間着を着せる
・シェルターを考える
・避難するときは、1人用低体温パッケージを行う。
・キャンプするときは、3人用低体温パッケージを行う。
・湯たんぽを体幹を温める。
食べ物・飲み物
・消費したカロリーを与える。単糖から始め、炭水化物、タンパク質、脂質を徐々に与える。
・温かい水と電解質を与え、利尿による損失を補う。
安全vs運動
・カロリーが蓄えが低い場合、安静にさせる。
・もし低温状況で運動しておらず(ビレー、ラフティング)、カロリーを摂れる場合は、運動をさせる。
避難
・低温状況を解決できれば、避難の必要はない。
・装備、ルート、食料、経験を再評価し、低温状況を解決できない疑いがあればレベル3の避難を開始する。

軽度低体温の処置
一般
・寒さ反応と同様の処置を行う。
避難
・傷病者の再加温が成功し、正常な判断ができるようになれば、避難の必要はない。
・装備、ルート、食料、経験を再評価し、低温状況を解決できない疑いがあればレベル3の避難を開始する。
・再加温が不可能な場合、レベル1の避難を開始する。

中度低体温の処置
一般
・32度以下で心臓は電気的に不安定になり、心停止しやすい状態になる。
・傷病者を丁寧に扱い、心室細動を起こすのを避ける。
・食べ物、飲み物を口から与えない。
・心室細動を避けるために運動をさせない。運動により、酸性の冷えた血液が急激に深部に戻り、心筋の電気的統制を乱す。
・急激な加温(お湯につける、サウナなど)を避ける。加温は、体表の血管拡張を起こし、深部の血圧を下げ、心室細動のトリガーとなる。
・避難するときは1人用低体温パッケージ、キャンプするときは、3人用低体温パッケージを行う。
避難
・もし、再加温に成功し、傷病者の意識が戻り、正常の判断ができるようになったら、レベル3の避難を行う。
・それ以外の傷病者は1人用低体温パッケージでレベル1の避難を行う。

重度低体温
一般
・中度低体温と同様な処置を行う。野外での再加温は不可能である。
・VPUの傷病者には人工呼吸を行う。
・脈拍が取れなくても胸骨圧迫を行わない。
・二次救命処置における薬剤投与や心室除細動は、30度以下では効果がない。もし体温がわからないか、30度以上であれば、AEDのプロトコルに従う。もし30度以下で、AEDがショックの指示をしたら、ショックを一度与える。もし成功しなかったら、AEDは中止する。
避難
・1人用低体温パッケージで丁寧にレベル1の避難を行う。

正しい低体温の理解にはデジタルハンドブックを参照し、正しい処置を身につけるためにはWFA/WFRコースに参加し、SOAPノートに基づいた評価と処置が必要である。

Author: Paul Nicolazzo/ Translator: Taito Okamura

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