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Hypothermia

Hypothermia is a medical condition in which the victim's core body temperature has dropped to significantly below normal and normal metabolism begins to be impaired. This begins to occur when the core temperature drops below 35 degrees Celsius (95 degrees Fahrenheit). If body temperature falls below 32 °C (90 °F), the condition can become critical and eventually fatal. Body temperatures below 27 °C (80 °F) are almost uniformly fatal, though body temperatures as low as 14 °C (57.5 °F) have been known to survive. The opposite condition, where temperature is too high, is hyperthermia. more...

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For unknown reasons, people who fall critically unconscious (and arguably die, though there are some who argue that any reversible condition is not, by definition, death) in very cold water can, in rare cases, be resuscitated, even though they would be expected to have died of drowning and/or hypothermia. See Mammalian diving reflex.

Types

There are three types of hypothermia, acute, subacute, and chronic.

  • Acute hypothermia is the most dangerous; the body temperature drops very swiftly, often in a matter of seconds or minutes, such as when a victim falls through an ice-covered lake.
  • Subacute hypothermia occurs on a scale of hours, most commonly by remaining in a cold environment for an extended period of time.
  • Chronic hypothermia is typically caused by an underlying disease.

Symptoms

  • Amnesia
  • Ataxia
  • Cold skin, even in torso
  • Confusion, progressing to delirium
  • Diuresis
  • Dysarthria
  • Gray complexion (pallor)
  • Hypokinesia
  • Increased muscle tone
  • Low blood pressure (hypotension)
  • Peripheral cyanosis
  • Rapid breathing (tachypnea) and heart rate (tachycardia), slowing and weakening as temperature decreases
  • Shivering
  • Tremor
  • Uncontrollable bleeding due to reduced coagulation enzyme activity
  • Weakness

Treatment

Treatment for hypothermia involves raising the core body temperature of the victim.

The first aid response to someone experiencing hypothermia, however, must be made with caution.

  • Do not rub or massage the casualty
  • Do not give alcohol
  • Do not treat any frostbite
  • Do not allow the body to become vertical

Any of these actions will divert blood from the critical internal organs and will worsen the situation.

What you should do:

  • Call the emergency services
  • Get the patient to shelter
  • If possible, put the patient in a bath with medium-temperature water, with the clothes on
  • Place hot water bottles (wrapped in a cotton sock) in the patient's armpits and between their legs
  • Give food and warm drinks
  • Monitor the patient and be prepared to give Cardio-pulmonary resuscitation.
  • Remove wet clothing if and only if a dry change is available

If the hypothermia has become severe, notably if the patient is incoherent or unconscious, re-warming must be done under strictly controlled circumstances in a hospital. Bystanders should only remove the patient from the cold environment, give warm drinks (not too warm because it can lead to temperature shock) and get the patient to advanced medical care as quickly as possible.

Read more at Wikipedia.org


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Resuscitative hypothermia after cardiac arrest: performance in a community hospital
From CHEST, 10/1/05 by Cindy Grimes

PURPOSE: Induced hypothermia improves outcome after cardiac arrest due to ventricular fibrillation. We studied induced hypothermia in a community hospital setting after cardiac arrest due to any cause.

METHODS: A case-control study was conducted in a publicly owned, non-academic, acute care hospital. Thirty-eight patients who underwent induced hypothermia were compared to 103 patients who did not undergo hypothermia. After resuscitation from cardiac arrest, patients underwent hypothermia using an established protocol at the discretion of the treating clinicians. Hypothermia was achieved with either external devices or an intravascular cooling catheter system. Outcome measures included mortality, neurologic recovery, and length of stay (LOS).

RESULTS: The groups were similar in age, sex, APACHE III score, and Glasgow Coma Score (GCS). Hospital mortality in the hypothermia group was 53% versus 71% in the control group (p=0.07). Hospital mortality in 10 patients treated with intravascular cooling was 40%. Compared to Apache III predicted mortality, the hypothermia group mortality ratio was 0.76, versus 1.4 for the control group. Among survivors, the change in GCS from admission to ICU discharge was 7.2 +/- 4.0 (baseline 4.4, discharge 11.7) in the hypothermia group and 6.6 +/- 4.3 (baseline 4.0, discharge 10.6) in the control group (p=0.32). Also among survivors, the ICU LOS was 2.6 +/- 3.5 days less than Apache III predicted in the hypothermia group versus 0.5 +/- 6.8 days less in the control group (p=0.08).

CONCLUSION: Induced hypothermia following cardiac arrest performs well in a community hospital setting. The intravascular cooling catheter was a safe, effective means of inducing hypothermia with a trend towards improved outcomes. Induced hypothermia may be applicable to all cardiac arrest patients regardless of cause.

CLINICAL IMPLICATIONS: Induced hypothermia is safe, simple, and inexpensive. Hospital protocols may help to ensure timely application of this important intervention. Intravascular cooling techniques show promise in terms of ease of use, effectiveness of cooling, and maintaining accessibility to the patient. Further study is needed to determine the optimal patients and techniques for therapeutic hypothermia.

DISCLOSURE: Kenneth Hurwitz, None.

Cindy Grimes RN Rhonda Anderson MSN Todd Horiuchi MD Mauricio Concha MD Bruce Fleegler MD Kenneth Hurwitz MD * Sarasota Memorial Hospital, Sarasota, FL

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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