hypothermia
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)




