Hypothermia is a condition in which an organism's temperature drops below
that required for normal metabolism and bodily functions. In warm-blooded
animals, core body temperature is maintained near a constant level through
biologic homeostasis. But when the body is exposed to cold its internal
mechanisms may be unable to replenish the heat that is being lost to the
organism's surroundings.
Hypothermia is the opposite of hyperthermia, the
condition which causes heat exhaustion and heat
stroke.
Symptoms
Normal body temperature in humans is 37°C (98.6°F).
Hypothermia can be divided in three stages of severity.
In stage 1, body
temperature drops by 1-2°C below normal temperature (1.8-3.6°F). Mild to strong
shivering occurs. The victim is unable to perform complex tasks with the hands;
the hands become numb. Blood vessels in the outer extremities constrict,
lessening heat loss to the outside air. Breathing becomes quick and shallow.
Goose bumps form, raising body hair on end in an attempt to create an insulating
layer of air around the body (limited use in humans due to lack of sufficient
hair, but useful in other species). Often, a person will experience a warm
sensation, as if they have recovered, but they are in fact heading into Stage 2.
Another test to see if the person is entering stage 2 is if they are unable to
touch their thumb with their little finger; this is the first stage of muscles
not working.
In stage 2, body temperature drops by 2-4°C (3.6-7.2°F).
Shivering becomes more violent. Muscle mis-coordination becomes apparent.
Movements are slow and labored, accompanied by a stumbling pace and mild
confusion, although the victim may appear alert. Surface blood vessels contract
further as the body focuses its remaining resources on keeping the vital organs
warm. The victim becomes pale. Lips, ears, fingers and toes may become
blue.
In stage 3, body temperature drops below approximately 32°C (90°F).
Shivering usually stops. Difficulty speaking, sluggish thinking, and amnesia
start to appear; inability to use hands and stumbling are also usually present.
Cellular metabolic processes shut down. Below 30°C (86°F) the exposed skin
becomes blue and puffy, muscle coordination becomes very poor, walking becomes
almost impossible, and the victim exhibits incoherent/irrational behavior
including terminal burrowing or even a stupor. Pulse and respiration rates
decrease significantly but fast heart rates (ventricular tachycardia, atrial
fibrillation) can occur. Major organs fail. Clinical death occurs. Because of
decreased cellular activity in stage 3 hypothermia, the body will actually take
longer to undergo brain death.
Treatment
Treatment for hypothermia
consists of drying, sheltering, and gradually warming.(Do not rub the patients
body, warm with blankets and, if possible, your own body heat). While blankets
help a person retain body heat, they are not sufficient to treat hypothermia. It
is vital that you warm the core of the body first or the cold blood will be
forced towards the heart and may cause death. In the field, a mildly hypothermic
person can be effectively rewarmed through close body contact from a companion
and by drinking warm, sweet liquids.
Moderate and severe cases of hypothermia
require immediate evacuation and treatment in a hospital. In hospital, warming
is accomplished by external techniques such as heated blankets for mild
hypothermia and by more invasive techniques such as warm fluids injected in the
veins or even lavage (washing) of the bladder, stomach, chest and abdominal
cavities with warmed fluids for severely hypothermic patients. These patients
are at high risk for arrhythmias (irregular heartbeats), and care must be taken
to minimize jostling and other disturbances until they have been sufficiently
warmed, as these arrhythmias are very difficult to treat while the victim is
still cold.
An important tenet of treatment is that a person is not dead
until they are warm and dead. Remarkable accounts of recovery after prolonged
cardiac arrest have been reported in patients with hypothermia. This is
presumably because the low temperature prevents some of the cellular damage that
occurs when blood flow and oxygen are lost for an extended period of
time.
Prevention
Appropriate clothing helps to prevent hypothermia.
Wearing cotton in cool weather is a particular hypothermia risk as it retains
water, and water rapidly conducts heat away from the body. Even in dry weather,
cotton clothing can become damp from perspiration, and chilly after the wearer
stops exercising. Synthetic and wool fabrics provide far better insulation when
wet and are quicker to dry. Some synthetic fabrics are designed to wick
perspiration away from the body. In air, most heat (up to 40 percent) is lost
through the head, hypothermia can thus be most effectively prevented by covering
the head.
Heat loss on land is very difficult to predict due to multiple
variables such as clothing type and quantity, amount of insulating fat on the
victim, environmental humidity or personal dampness such as after exertion, the
circumstances surrounding the hypothermic episode and etc. Heat is lost much
faster in water, hence the need for wetsuits or drysuits in cold-weather
activities such as kayaking. Water temperatures that would be quite reasonable
as outdoor air temperatures can lead to hypothermia very quickly. For example, a
water temperature of 10 degrees Celsius (50 F) can be expected to lead to death
in approximately 1 hour, and water temperatures hovering at freezing can lead to
death in as little as 15 minutes.
Alcohol consumption prior to cold exposure
may increase one's risk of becoming hypothermic. Alcohol acts as a vasodilator,
increasing blood flow to the body's extremities, thereby increasing heat
loss.Ironically, this may cause the victim to feel warm while he or she is
rapidly losing heat to the surrounding environment.
Benefits
There is
considerable evidence that children who suffer near-drowning accidents in water
near 0°C (32°F, 273 K) can be revived up to two hours after losing
consciousness. The cold water considerably lowers metabolism, allowing the brain
to withstand a much longer period of hypoxia.
Paradoxical
undressing
20% to 50% of hypothermal deaths are associated with a phenomenon
known as paradoxical undressing. This typically occurs during moderate to severe
hypothermia as the victim becomes disoriented, confused, and combative. The
hypothermic victim may begin discarding the clothing he or she has been wearing,
which in turn increases the rate of temperature loss. There have been several
published case studies of victims throwing off their clothes before help reached
them.
Rescuers who are trained in mountain survival techniques have been
taught to expect this effect. However, the phenomenon still regularly leads
police to assume incorrectly that urban victims of hypothermia have been
subjected to a sexual assault.
One explanation for the effect is a
cold-induced malfunction of the hypothalamus, the part of the brain that
regulates body temperature. Another explanation is that the muscles contracting
peripheral blood vessels become exhausted (known as a loss of vasomoter tone)
and relax, leading to a sudden surge of blood (and heat) to the extremities,
fooling the victim into feeling warm. (These are cited from the magazine "New
Scientist" and are not Journal
articles)