Hypothermia is defined as a body
core temperature
Normal human body-temperature (normothermia, euthermia) is the typical temperature range found in humans. The normal human body temperature range is typically stated as .
Human body temperature varies. It depends on sex, age, time of day, exert ...
below in humans.
Symptoms depend on the temperature. In mild hypothermia, there is
shivering
Shivering (also called shuddering) is a bodily function in response to cold and extreme fear in warm-blooded animals. When the core body temperature drops, the shivering reflex is triggered to maintain homeostasis. Skeletal muscles begin to s ...
and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe hypothermia, there may be hallucinations and
paradoxical undressing
Hypothermia is defined as a body core temperature below in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe h ...
, in which a person removes their clothing, as well as an increased risk of the
heart stopping.
Hypothermia has two main types of causes. It classically occurs from exposure to cold weather and cold water immersion. It may also occur from any condition that decreases heat production or increases heat loss.
Commonly, this includes
alcohol intoxication
Alcohol intoxication, also known as alcohol poisoning, commonly described as drunkenness or inebriation, is the negative behavior and physical effects caused by a recent consumption of alcohol. In addition to the toxicity of ethanol, the main p ...
but may also include
low blood sugar
Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose belo ...
,
anorexia
Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. ''Anorexia'' is a term of Gre ...
and advanced age.
Body temperature
Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when the surrounding temperature is very different. A thermoconforming organism, by contrast, simply adopts the surrounding temperature ...
is usually maintained near a constant level of through
thermoregulation
Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when the surrounding temperature is very different. A thermoconforming organism, by contrast, simply adopts the surrounding temperature ...
.
Efforts to increase body temperature involve shivering, increased voluntary activity, and putting on warmer clothing.
Hypothermia may be diagnosed based on either a person's symptoms in the presence of risk factors or by measuring a person's core temperature.
The treatment of mild hypothermia involves warm drinks, warm clothing, and voluntary physical activity.
In those with moderate hypothermia, heating blankets and warmed
intravenous fluid
Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
s are recommended.
People with moderate or severe hypothermia should be moved gently.
In severe hypothermia,
extracorporeal membrane oxygenation
Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequat ...
(ECMO) or
cardiopulmonary bypass
Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a he ...
may be useful.
In those without a
pulse
In medicine, a pulse represents the tactile arterial palpation of the cardiac cycle (heartbeat) by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed near the surface of the body, such as at the nec ...
,
cardiopulmonary resuscitation
Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spont ...
(CPR) is indicated along with the above measures.
Rewarming is typically continued until a person's temperature is greater than .
If there is no improvement at this point or the blood potassium level is greater than 12 mmol/liter at any time, resuscitation may be discontinued.
Hypothermia is the cause of at least 1,500 deaths a year in the United States.
It is more common in older people and males.
One of the lowest documented body temperatures from which someone with accidental hypothermia has survived is in a 2-year-old boy from Poland named Adam. Survival after more than six hours of CPR has been described.
In individuals for whom ECMO or bypass is used, survival is around 50%.
Deaths due to hypothermia have played an important role in many wars.
The term is from
Greek
Greek may refer to:
Greece
Anything of, from, or related to Greece, a country in Southern Europe:
*Greeks, an ethnic group.
*Greek language, a branch of the Indo-European language family.
**Proto-Greek language, the assumed last common ancestor ...
ῠ̔πο (ypo), meaning "under", and θέρμη (''thérmē''), meaning "heat". The opposite of hypothermia is
hyperthermia
Hyperthermia, also known simply as overheating, is a condition in which an individual's body temperature is elevated beyond normal due to failed thermoregulation. The person's body produces or absorbs more heat than it dissipates. When extreme ...
, an increased body temperature due to failed thermoregulation.
[
]
Classification
Hypothermia is often defined as any body temperature below . With this method it is divided into degrees of severity based on the core temperature
Normal human body-temperature (normothermia, euthermia) is the typical temperature range found in humans. The normal human body temperature range is typically stated as .
Human body temperature varies. It depends on sex, age, time of day, exert ...
.
Another classification system, the Swiss staging system, divides hypothermia based on the presenting symptoms which is preferred when it is not possible to determine an accurate core temperature.
Other cold-related injuries that can be present either alone or in combination with hypothermia include:
*Chilblains
Chilblains, also known as pernio, is a medical condition in which damage occurs to capillary beds in the skin, most often in the hands or feet, when blood perfuses into the nearby tissue resulting in redness, itching, inflammation, and possibly b ...
: condition caused by repeated exposure of skin to temperatures just above freezing. The cold causes damage to small blood vessels in the skin. This damage is permanent and the redness and itching will return with additional exposure. The redness and itching typically occurs on cheeks, ears, fingers, and toes.
*Frostbite
Frostbite is a skin injury that occurs when exposed to extreme low temperatures, causing the freezing of the skin or other tissues, commonly affecting the fingers, toes, nose, ears, cheeks and chin areas. Most often, frostbite occurs in the han ...
: the freezing and destruction of tissue, which happens below the freezing point of water
*Frostnip
Frostbite is a skin injury that occurs when exposed to extreme low temperatures, causing the freezing of the skin or other tissues, commonly affecting the fingers, toes, nose, ears, cheeks and chin areas. Most often, frostbite occurs in the hand ...
: a superficial cooling of tissues without cellular destruction
*Trench foot
Trench foot is a type of foot damage due to moisture. Initial symptoms often include tingling or itching which can progress to numbness. The feet may become red or bluish in color. As the condition worsens the feet can start to swell and smel ...
or immersion foot: a condition caused by repetitive exposure to water at non-freezing temperatures
The normal human body temperature
Normal human body-temperature (normothermia, euthermia) is the typical temperature range found in humans. The normal human body temperature range is typically stated as .
Human body temperature varies. It depends on sex, age, time of day, exert ...
is often stated as . Hyperthermia and fever
Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...
, are defined as a temperature of greater than .[
]
Signs and symptoms
Signs and symptoms vary depending on the degree of hypothermia, and may be divided by the three stages of severity. People with hypothermia may appear pale and feel cold to touch.
Infants with hypothermia may feel cold when touched, with bright red skin and an unusual lack of energy.
Cold stress refers to a near-normal body temperature with low skin temperature, signs include shivering. Cold stress is caused by cold exposure and it can lead to hypothermia and frostbite if not treated.
Individuals with hypothermia often have impaired judgement, impaired sense of time and place, unusual aggression and numbness. A person with hypothermia can be euphoric and hallucinating.
Mild
Symptoms of mild hypothermia may be vague, with sympathetic nervous system excitation (shivering, high blood pressure
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
, fast heart rate
Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal (su ...
, fast respiratory rate, and contraction of blood vessels). These are all physiological responses to preserve heat. Increased urine production due to cold, mental confusion, and liver dysfunction
Liver disease, or hepatic disease, is any of many diseases of the liver. If long-lasting it is termed chronic liver disease. Although the diseases differ in detail, liver diseases often have features in common.
Signs and symptoms
Some of the sig ...
may also be present.[Marx 2010 p.1869] Hyperglycemia
Hyperglycemia is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/L (200 mg/dL), but symptoms may not start to become noticeable until even ...
may be present, as glucose
Glucose is a simple sugar with the molecular formula . Glucose is overall the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, using ...
consumption by cells and insulin
Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the ''INS'' gene. It is considered to be the main anabolic hormone of the body. It regulates the metabolism o ...
secretion both decrease, and tissue sensitivity to insulin may be blunted. Sympathetic activation also releases glucose from the liver. In many cases, however, especially in people with alcoholic
Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Because there is disagreement on the definition of the word ''alcoholism'', it is not a recognized diagnostic entity. Predomin ...
intoxication, hypoglycemia appears to be a more common cause. Hypoglycemia is also found in many people with hypothermia, as hypothermia may be a result of hypoglycemia.
Moderate
As hypothermia progresses, symptoms include: mental status changes such as amnesia, confusion, slurred speech, decreased reflexes, and loss of fine motor skills.
Severe
As the temperature decreases, further physiological systems falter and heart rate
Heart rate (or pulse rate) is the frequency of the heartbeat measured by the number of contractions (beats) of the heart per minute (bpm). The heart rate can vary according to the body's physical needs, including the need to absorb oxygen and excr ...
, respiratory rate
The respiratory rate is the rate at which breathing occurs; it is set and controlled by the respiratory center of the brain. A person's respiratory rate is usually measured in breaths per minute.
Measurement
The respiratory rate in humans is mea ...
, and blood pressure
Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
all decrease. This results in an expected heart rate in the 30s at a temperature of .
There is often cold, inflamed skin, hallucinations, lack of reflexes, fixed dilated pupils, low blood pressure, pulmonary edema, and shivering is often absent. Pulse and respiration
Respiration may refer to:
Biology
* Cellular respiration, the process in which nutrients are converted into useful energy in a cell
** Anaerobic respiration, cellular respiration without oxygen
** Maintenance respiration, the amount of cellula ...
rates decrease significantly, but fast heart rates (ventricular tachycardia, atrial fibrillation) can also occur. Atrial fibrillation is not typically a concern in and of itself.
Paradoxical undressing
Twenty to fifty percent of hypothermia deaths are associated with paradoxical undressing. This typically occurs during moderate and severe hypothermia, as the person becomes disoriented, confused, and combative. They may begin discarding their clothing, which, in turn, increases the rate of heat loss.
Rescuers who are trained in mountain survival techniques are taught to expect this; however, people who die from hypothermia in urban environments who are found in an undressed state are sometimes incorrectly assumed to have been subjected to sexual assault
Sexual assault is an act in which one intentionally sexually touches another person without that person's consent, or coerces or physically forces a person to engage in a sexual act against their will. It is a form of sexual violence, which ...
.
One explanation for the effect is a cold-induced malfunction of the hypothalamus
The hypothalamus () is a part of the brain that contains a number of small nuclei with a variety of functions. One of the most important functions is to link the nervous system to the endocrine system via the pituitary gland. The hypothalamu ...
, 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 vasomotor tone
Vascular resistance is the resistance that must be overcome to push blood through the circulatory system and create fluid dynamics, flow. The resistance offered by the systemic circulation is known as the systemic vascular resistance (SVR) or may ...
) and relax, leading to a sudden surge of blood (and heat) to the extremities, causing the person to feel overheated.
Terminal burrowing
An apparent self-protective behaviour, known as "terminal burrowing", or "hide-and-die syndrome", occurs in the final stages of hypothermia. Those affected will enter small, enclosed spaces, such as underneath beds or behind wardrobes. It is often associated with paradoxical undressing. Researchers in Germany claim this is "obviously an autonomous process of the brain stem, which is triggered in the final state of hypothermia and produces a primitive and burrowing-like behavior of protection, as seen in hibernating mammals". This happens mostly in cases where temperature drops slowly.
Causes
Hypothermia usually occurs from exposure to low temperatures, and is frequently complicated by alcohol
Alcohol most commonly refers to:
* Alcohol (chemistry), an organic compound in which a hydroxyl group is bound to a carbon atom
* Alcohol (drug), an intoxicant found in alcoholic drinks
Alcohol may also refer to:
Chemicals
* Ethanol, one of sev ...
consumption. Any condition that decreases heat production, increases heat loss, or impairs thermoregulation, however, may contribute. Thus, hypothermia risk factors include: substance use disorder
Substance use disorder (SUD) is the persistent use of drugs (including alcohol) despite substantial harm and adverse consequences as a result of their use. Substance use disorders are characterized by an array of mental/emotional, physical, and ...
s (including alcohol use disorder
Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Because there is disagreement on the definition of the word ''alcoholism'', it is not a recognized diagnostic entity. Predomin ...
), homelessness
Homelessness or houselessness – also known as a state of being unhoused or unsheltered – is the condition of lacking stable, safe, and adequate housing. People can be categorized as homeless if they are:
* living on the streets, also kn ...
, any condition that affects judgment (such as hypoglycemia), the extremes of age, poor clothing, chronic medical conditions (such as hypothyroidism and sepsis
Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
), and living in a cold environment. Hypothermia occurs frequently in major trauma
Trauma most often refers to:
*Major trauma, in physical medicine, severe physical injury caused by an external source
*Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event
*Traumatic inju ...
, and is also observed in severe cases of anorexia nervosa
Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. ''Anorexia'' is a term of Gr ...
. Hypothermia is also associated with worse outcomes in people with sepsis. While most people with sepsis develop fevers (elevated body temperature), some develop hypothermia.
In urban areas, hypothermia frequently occurs with chronic cold exposure, such as in cases of homelessness, as well as with immersion accidents involving drugs, alcohol or mental illness. While studies have shown that people experiencing homelessness are at risk of premature death from hypothermia, the true incidence of hypothermia-related deaths in this population is difficult to determine. In more rural environments, the incidence of hypothermia is higher among people with significant comorbidities and less able to move independently. With rising interest in wilderness exploration, and outdoor and water sports, the incidence of hypothermia secondary to accidental exposure may become more frequent in the general population.
Alcohol
Alcohol consumption increases the risk of hypothermia in two ways: vasodilation
Vasodilation is the widening of blood vessels. It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles. The process is the opposite of vasoconstriction, ...
and temperature controlling systems in the brain. Vasodilation increases blood flow to the skin, resulting in heat being lost to the environment. This produces the effect of feeling warm, when one is actually losing heat. Alcohol also affects the temperature-regulating system in the brain, decreasing the body's ability to shiver and use energy that would normally aid the body in generating heat. The overall effects of alcohol lead to a decrease in body temperature and a decreased ability to generate body heat in response to cold environments. Alcohol is a common risk factor for death due to hypothermia. Between 33% and 73% of hypothermia cases are complicated by alcohol.
Water immersion
Hypothermia continues to be a major limitation to swimming or diving
Diving most often refers to:
* Diving (sport), the sport of jumping into deep water
* Underwater diving, human activity underwater for recreational or occupational purposes
Diving or Dive may also refer to:
Sports
* Dive (American football), a ...
in cold water. The reduction in finger dexterity due to pain or numbness decreases general safety and work capacity, which consequently increases the risk of other injuries.
Other factors predisposing to immersion hypothermia include dehydration
In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mil ...
, inadequate rewarming between repetitive dives, starting a dive while wearing cold, wet dry suit
A dry suit or drysuit provides the wearer with environmental protection by way of thermal insulation and exclusion of water, and is worn by divers, boaters, water sports enthusiasts, and others who work or play in or near cold or contaminated ...
undergarments, sweating
Perspiration, also known as sweating, is the production of fluids secreted by the sweat glands in the skin of mammals.
Two types of sweat glands can be found in humans: eccrine glands and apocrine glands. The eccrine sweat glands are distr ...
with work, inadequate thermal insulation
Thermal insulation is the reduction of heat transfer (i.e., the transfer of thermal energy between objects of differing temperature) between objects in thermal contact or in range of radiative influence. Thermal insulation can be achieved with s ...
(for example, thin dry suit undergarment), and poor physical conditioning.
Heat is lost much more quickly in water than in air. Thus, water temperatures that would be quite reasonable as outdoor air temperatures can lead to hypothermia in survivors, although this is not usually the direct clinical cause of death for those who are not rescued. A water temperature of can lead to death in as little as one hour, and water temperatures near freezing can cause death in as little as 15 minutes. During the sinking of the ''Titanic'', most people who entered the water died in 15–30 minutes.
The actual cause of death in cold water is usually the bodily reactions to heat loss and to freezing water, rather than hypothermia (loss of core temperature) itself. For example, plunged into freezing seas, around 20% of victims die within two minutes from cold shock
Cold shock response is a series of neurogenic cardio-respiratory responses caused by sudden immersion in cold water.
In cold water immersions, such as by falling through thin ice, cold shock response is perhaps the most common cause of death. Als ...
(uncontrolled rapid breathing
Tachypnea, also spelt tachypnoea, is a respiratory rate greater than normal, resulting in abnormally rapid and shallow breathing.
In adult humans at rest, any respiratory rate of 1220 per minute is considered clinically normal, with tachypnea b ...
, and gasping, causing water inhalation, massive increase in blood pressure and cardiac strain leading to cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possib ...
, and panic
Panic is a sudden sensation of fear, which is so strong as to dominate or prevent reason and logical thinking, replacing it with overwhelming feelings of anxiety and frantic agitation consistent with an animalistic fight-or-flight reactio ...
); another 50% die within 15–30 minutes from cold incapacitation: inability to use or control limbs and hands for swimming or gripping, as the body "protectively" shuts down the peripheral muscles of the limbs to protect its core. Exhaustion and unconsciousness cause drowning, claiming the rest within a similar time.
Pathophysiology
Heat is primarily generated in muscle tissue, including the heart, and in the liver, while it is lost through the skin (90%) and lungs (10%). Heat production may be increased two- to four-fold through muscle contractions (i.e. exercise and shivering). The rate of heat loss is determined, as with any object, by convection
Convection is single or multiphase fluid flow that occurs spontaneously due to the combined effects of material property heterogeneity and body forces on a fluid, most commonly density and gravity (see buoyancy). When the cause of the convec ...
, conduction
Conductor or conduction may refer to:
Music
* Conductor (music), a person who leads a musical ensemble, such as an orchestra.
* Conductor (album), ''Conductor'' (album), an album by indie rock band The Comas
* Conduction, a type of structured f ...
, and radiation
In physics, radiation is the emission or transmission of energy in the form of waves or particles through space or through a material medium. This includes:
* ''electromagnetic radiation'', such as radio waves, microwaves, infrared, visi ...
. The rates of these can be affected by body mass index
Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms and he ...
, body surface area
The surface area of a solid object is a measure of the total area that the surface of the object occupies. The mathematical definition of surface area in the presence of curved surfaces is considerably more involved than the definition of arc ...
to volume
Volume is a measure of occupied three-dimensional space. It is often quantified numerically using SI derived units (such as the cubic metre and litre) or by various imperial or US customary units (such as the gallon, quart, cubic inch). The de ...
ratios, clothing and other environmental conditions.
Many changes to physiology occur as body temperatures decrease. These occur in the cardiovascular system leading to the Osborn J wave and other dysrhythmias, decreased central nervous system
The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain and spinal cord. The CNS is so named because the brain integrates the received information and coordinates and influences the activity of all par ...
electrical activity, cold diuresis, and non-cardiogenic pulmonary edema.
Research has shown that glomerular filtration rates (GFR) decrease as a result of hypothermia. In essence, hypothermia increases preglomerular vasoconstriction, thus decreasing both renal blood flow (RBF) and GFR.
Diagnosis
Accurate determination of core temperature often requires a special low temperature thermometer, as most clinical thermometers do not measure accurately below . A low temperature thermometer can be placed in the rectum, esophagus or bladder. Esophageal measurements are the most accurate and are recommended once a person is intubated
Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Patients are generally anesthetized beforehand. Examples include tracheal intubation, and the balloon tamponade with a Sengstaken-Blakemo ...
. Other methods of measurement such as in the mouth, under the arm, or using an infrared
Infrared (IR), sometimes called infrared light, is electromagnetic radiation (EMR) with wavelengths longer than those of visible light. It is therefore invisible to the human eye. IR is generally understood to encompass wavelengths from around ...
ear thermometer are often not accurate.
As a hypothermic person's heart rate may be very slow, prolonged feeling for a pulse could be required before detecting. In 2005, the American Heart Association
The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and death ...
recommended at least 30–45 seconds to verify the absence of a pulse before initiating CPR. Others recommend a 60-second check.
The classical ECG finding of hypothermia is the Osborn J wave. Also, ventricular fibrillation
Ventricular fibrillation (V-fib or VF) is an abnormal heart rhythm in which the ventricles of the heart quiver. It is due to disorganized electrical activity. Ventricular fibrillation results in cardiac arrest with loss of consciousness and no p ...
frequently occurs below and asystole
Asystole (New Latin, from Greek privative a "not, without" + ''systolē'' "contraction") is the absence of ventricular contractions in the context of a lethal heart arrhythmia (in contrast to an induced asystole on a cooled patient on a heart-lun ...
below . The Osborn J may look very similar to those of an acute ST elevation myocardial infarction. Thrombolysis as a reaction to the presence of Osborn J waves is not indicated, as it would only worsen the underlying coagulopathy
Coagulopathy (also called a bleeding disorder) is a condition in which the blood's ability to coagulate (form clots) is impaired. This condition can cause a tendency toward prolonged or excessive bleeding (bleeding diathesis), which may occur spo ...
caused by hypothermia.
Prevention
Proper clothing helps to prevent hypothermia. Synthetic Synthetic things are composed of multiple parts, often with the implication that they are artificial. In particular, 'synthetic' may refer to:
Science
* Synthetic chemical or compound, produced by the process of chemical synthesis
* Synthetic o ...
and wool
Wool is the textile fibre obtained from sheep and other mammals, especially goats, rabbits, and camelids. The term may also refer to inorganic materials, such as mineral wool and glass wool, that have properties similar to animal wool.
As ...
fabrics are superior to cotton as they provide better insulation when wet and dry. Some synthetic fabrics, such as polypropylene and polyester, are used in clothing designed to wick perspiration away from the body, such as liner socks and moisture-wicking undergarments. Clothing should be loose fitting, as tight clothing reduces the circulation of warm blood. In planning outdoor activity, prepare appropriately for possible cold weather. Those who drink alcohol before or during outdoor activity should ensure at least one sober person is present responsible for safety.
Covering the head is effective, but no more effective than covering any other part of the body. While common folklore says that people lose most of their heat through their heads, heat loss from the head is no more significant than that from other uncovered parts of the body. However, heat loss from the head is significant in infants, whose head is larger relative to the rest of the body than in adults. Several studies have shown that for uncovered infants, lined hats significantly reduce heat loss and thermal stress. Children have a larger surface area per unit mass, and other things being equal should have one more layer of clothing than adults in similar conditions, and the time they spend in cold environments should be limited. However children are often more active than adults, and may generate more heat. In both adults and children, overexertion causes sweating and thus increases heat loss.
Building a shelter can aid survival where there is danger of death from exposure. Shelters can be of many different types, metal can conduct heat away from the occupants and is sometimes best avoided. The shelter should not be too big so body warmth stays near the occupants. Good ventilation is essential especially if a fire will be lit in the shelter. Fires should be put out before the occupants sleep to prevent carbon monoxide
Carbon monoxide (chemical formula CO) is a colorless, poisonous, odorless, tasteless, flammable gas that is slightly less dense than air. Carbon monoxide consists of one carbon atom and one oxygen atom connected by a triple bond. It is the simple ...
poisoning. People caught in very cold, snowy conditions can build an igloo
An igloo (Inuit languages: , Inuktitut syllabics (plural: )), also known as a snow house or snow hut, is a type of shelter built of suitable snow.
Although igloos are often associated with all Inuit, they were traditionally used only b ...
or snow cave
A snow cave is a shelter constructed from snow by certain animals in the wild, human mountain climbers, winter recreational enthusiasts, and winter survivalists. It has thermal properties similar to an igloo and is particularly effective at prov ...
to shelter.
The United States Coast Guard
The United States Coast Guard (USCG) is the maritime security, search and rescue, and law enforcement service branch of the United States Armed Forces and one of the country's eight uniformed services. The service is a maritime, military, mult ...
promotes using life vests to protect against hypothermia through the 50/50/50 rule: If someone is in water for 50 minutes, he/she has a 50 percent better chance of survival if wearing a life jacket. A heat escape lessening position
The heat escape lessening position (HELP) is a human position to reduce heat loss while immersed in cold water.
Position
HELP is taught as part of the curriculum in Australia, North America, and Ireland for lifeguard and boating safety training. ...
can be used to increase survival in cold water.
Babies should sleep at 16–20 °C (61–68 °F) and housebound people should be checked regularly to make sure the temperature of the home is at least 18 °C (64 °F).
Management
Aggressiveness of treatment is matched to the degree of hypothermia. Treatment ranges from noninvasive, passive external warming to active external rewarming, to active core rewarming. In severe cases resuscitation begins with simultaneous removal from the cold environment and management of the airway, breathing, and circulation. Rapid rewarming is then commenced. Moving the person as little and as gently as possible is recommended as aggressive handling may increase risks of a dysrhythmia.
Hypoglycemia
Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose belo ...
is a frequent complication and needs to be tested for and treated. Intravenous thiamine
Thiamine, also known as thiamin and vitamin B1, is a vitamin, an essential micronutrient, that cannot be made in the body. It is found in food and commercially synthesized to be a dietary supplement or medication. Phosphorylated forms of thi ...
and glucose
Glucose is a simple sugar with the molecular formula . Glucose is overall the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, using ...
is often recommended, as many causes of hypothermia are complicated by Wernicke's encephalopathy.
The UK National Health Service
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
advises against putting a person in a hot bath, massaging their arms and legs, using a heating pad, or giving them alcohol. These measures can cause a rapid fall in blood pressure and potential cardiac arrest.
Rewarming
Rewarming can be done with a number of methods including passive external rewarming, active external rewarming, and active internal rewarming. Passive external rewarming involves the use of a person's own ability to generate heat by providing properly insulated dry clothing and moving to a warm environment. Passive external rewarming is recommended for those with mild hypothermia.
Active external rewarming involves applying warming devices externally, such as a heating blanket. These may function by warmed forced air (Bair Hugger
The Bair Hugger system is a convective temperature management system used in a hospital or surgery center to maintain a patient's core body temperature. The Bair Hugger system consists of a reusable warming unit and single-use disposable warming ...
is a commonly used device), chemical reactions, or electricity. In wilderness environments, hypothermia may be helped by placing hot water bottle
A hot-water bottle is a bottle filled with hot water and sealed with a stopper, used to provide warmth, typically while in bed, but also for the application of heat to a specific part of the body.
Early history
Containers for warmth in bed we ...
s in both armpits and in the groin. Active external rewarming is recommended for moderate hypothermia. Active core rewarming involves the use of intravenous warmed fluids, irrigation of body cavities with warmed fluids (the chest
The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the crea ...
or abdomen
The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. ...
), use of warm humidified inhaled air, or use of extracorporeal
An extracorporeal is a medical procedure which is performed outside the body. Extracorporeal devices are the artificial organs that remain outside the body while treating a patient. Extracorporeal devices are useful in hemodialysis and cardiac surg ...
rewarming such as via a heart lung machine
Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a he ...
or extracorporeal membrane oxygenation
Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequat ...
(ECMO). Extracorporeal rewarming is the fastest method for those with severe hypothermia. When severe hypothermia has led to cardiac arrest, effective extracorporeal warming results in survival with normal mental function about 50% of the time. Chest irrigation is recommended if bypass or ECMO is not possible.
Rewarming shock (or rewarming collapse) is a sudden drop in blood pressure
Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
in combination with a low cardiac output
In cardiac physiology, cardiac output (CO), also known as heart output and often denoted by the symbols Q, \dot Q, or \dot Q_ , edited by Catherine E. Williamson, Phillip Bennett is the volumetric flow rate of the heart's pumping output: t ...
which may occur during active treatment of a severely hypothermic person. There was a theoretical concern that external rewarming rather than internal rewarming may increase the risk. These concerns were partly believed to be due to afterdrop Afterdrop is a continued cooling of a patient's core temperature during the initial stages of rewarming from hypothermia.
Afterdrop is attributed to the return of cold blood to extremities from the core due to peripheral vasodilatation, thus causin ...
, a situation detected during laboratory experiments where there is a continued decrease in core temperature after rewarming has been started. Recent studies have not supported these concerns, and problems are not found with active external rewarming.
Fluids
For people who are alert and able to swallow, drinking warm sweetened liquids can help raise the temperature. Many recommend alcohol
Alcohol most commonly refers to:
* Alcohol (chemistry), an organic compound in which a hydroxyl group is bound to a carbon atom
* Alcohol (drug), an intoxicant found in alcoholic drinks
Alcohol may also refer to:
Chemicals
* Ethanol, one of sev ...
and caffeinated drink
A caffeinated drink, or caffeinated beverage, is a drink that contains caffeine, a stimulant that is legal practically all over the world.
The most common naturally caffeinated beverages are coffee and tea, which in one form or another (usually ...
s be avoided. As most people are moderately dehydrated due to cold-induced diuresis, warmed intravenous fluid
Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
s to a temperature of are often recommended.
Cardiac arrest
In those without signs of life, cardiopulmonary resuscitation
Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spont ...
(CPR) should be continued during active rewarming. For ventricular fibrillation
Ventricular fibrillation (V-fib or VF) is an abnormal heart rhythm in which the ventricles of the heart quiver. It is due to disorganized electrical activity. Ventricular fibrillation results in cardiac arrest with loss of consciousness and no p ...
or ventricular tachycardia
Ventricular tachycardia (V-tach or VT) is a fast heart rate arising from the lower chambers of the heart. Although a few seconds of VT may not result in permanent problems, longer periods are dangerous; and multiple episodes over a short period ...
, a single defibrillation
Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current (often called a ''cou ...
should be attempted. However, people with severe hypothermia may not respond to pacing or defibrillation. It is not known if further defibrillation should be withheld until the core temperature reaches . In Europe, epinephrine
Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...
is not recommended until the person's core temperature reaches , while the American Heart Association
The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and death ...
recommends up to three doses of epinephrine before a core temperature of is reached. Once a temperature of has been reached, normal ACLS protocols should be followed.
Prognosis
It is usually recommended not to declare a person dead until their body is warmed to a near normal body temperature of greater than , since extreme hypothermia can suppress heart and brain function. This is summarized in the common saying "You're not dead until you're warm and dead." Exceptions include if there are obvious fatal injuries or the chest is frozen so that it cannot be compressed. If a person was buried in an avalanche
An avalanche is a rapid flow of snow down a slope, such as a hill or mountain.
Avalanches can be set off spontaneously, by such factors as increased precipitation or snowpack weakening, or by external means such as humans, animals, and earth ...
for more than 35 minutes and is found with a mouth packed full of snow without a pulse, stopping early may also be reasonable. This is also the case if a person's blood potassium is greater than 12 mmol/L.
Those who are stiff with pupils that do not move may survive if treated aggressively. Survival with good function also occasionally occurs even after the need for hours of CPR. Children who have near-drowning
Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer a ...
accidents in water near can occasionally be revived, even over an hour after losing consciousness. The cold water lowers the metabolism
Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...
, allowing the brain to withstand a much longer period of hypoxia
Hypoxia means a lower than normal level of oxygen, and may refer to:
Reduced or insufficient oxygen
* Hypoxia (environmental), abnormally low oxygen content of the specific environment
* Hypoxia (medical), abnormally low level of oxygen in the tis ...
. While survival is possible, mortality
Mortality is the state of being mortal, or susceptible to death; the opposite of immortality.
Mortality may also refer to:
* Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...
from severe or profound hypothermia remains high despite optimal treatment. Studies estimate mortality at between 38% and 75%.
In those who have hypothermia due to another underlying health problem, when death occurs it is frequently from that underlying health problem.
Epidemiology
Between 1995 and 2004 in the United States, an average of 1560 cold-related emergency department visits occurred per year and in the years 1999 to 2004, an average of 647 people died per year due to hypothermia.[Baumgartner, Hypothermia and Other Cold-Related Morbidity Emergency Department Visits: United States, 1995–2004 Wilderness and Environmental Medicine, 19, 233 237 (2008)] Of deaths reported between 1999 and 2002 in the US, 49% of those affected were 65 years or older and two-thirds were male. Most deaths were not work related (63%) and 23% of affected people were at home. Hypothermia was most common during the autumn and winter months of October through March. In the United Kingdom, an estimated 300 deaths per year are due to hypothermia, whereas the annual incidence of hypothermia-related deaths in Canada is 8000.
History
Hypothermia has played a major role in the success or failure of many military campaigns, from Hannibal
Hannibal (; xpu, 𐤇𐤍𐤁𐤏𐤋, ''Ḥannibaʿl''; 247 – between 183 and 181 BC) was a Carthaginian general and statesman who commanded the forces of Carthage in their battle against the Roman Republic during the Second Puni ...
's loss of nearly half his men in the Second Punic War
The Second Punic War (218 to 201 BC) was the second of three wars fought between Carthage and Rome, the two main powers of the western Mediterranean in the 3rd century BC. For 17 years the two states struggled for supremacy, primarily in Ital ...
(218 B.C.) to the near destruction of Napoleon
Napoleon Bonaparte ; it, Napoleone Bonaparte, ; co, Napulione Buonaparte. (born Napoleone Buonaparte; 15 August 1769 – 5 May 1821), later known by his regnal name Napoleon I, was a French military commander and political leader who ...
's armies in Russia in 1812. Men wandered around confused by hypothermia, some lost consciousness and died, others shivered, later developed torpor
Torpor is a state of decreased physiological activity in an animal, usually marked by a reduced body temperature and metabolic rate. Torpor enables animals to survive periods of reduced food availability. The term "torpor" can refer to the time ...
, and tended to sleep. Others too weak to walk fell on their knees; some stayed that way for some time resisting death. The pulse
In medicine, a pulse represents the tactile arterial palpation of the cardiac cycle (heartbeat) by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed near the surface of the body, such as at the nec ...
of some was weak and hard to detect; others groaned; yet others had eyes open and wild with quiet delirium. Deaths from hypothermia in Russian regions continued through the first
First or 1st is the ordinal form of the number one (#1).
First or 1st may also refer to:
*World record, specifically the first instance of a particular achievement
Arts and media Music
* 1$T, American rapper, singer-songwriter, DJ, and rec ...
and second
The second (symbol: s) is the unit of time in the International System of Units (SI), historically defined as of a day – this factor derived from the division of the day first into 24 hours, then to 60 minutes and finally to 60 seconds ...
world wars, especially in the Battle of Stalingrad
The Battle of Stalingrad (23 August 19422 February 1943) was a major battle on the Eastern Front of World War II where Nazi Germany and its allies unsuccessfully fought the Soviet Union for control of the city of Stalingrad (later re ...
.
Civilian examples of deaths caused by hypothermia occurred during the sinkings of the RMS ''Titanic'' and RMS ''Lusitania'', and more recently of the MS ''Estonia''.
Antarctic
The Antarctic ( or , American English also or ; commonly ) is a polar region around Earth's South Pole, opposite the Arctic region around the North Pole. The Antarctic comprises the continent of Antarctica, the Kerguelen Plateau and other ...
explorers developed hypothermia; Ernest Shackleton
Sir Ernest Henry Shackleton (15 February 1874 – 5 January 1922) was an Anglo-Irish Antarctic explorer who led three British expeditions to the Antarctic. He was one of the principal figures of the period known as the Heroic Age of ...
and his team measured body temperatures "below 94.2°, which spells death at home", though this probably referred to oral temperatures rather than core temperature and corresponded to mild hypothermia. One of Scott's team, Atkinson, became confused through hypothermia.
Nazi human experimentation
Nazi human experimentation was a series of human experimentation, medical experiments on large numbers of prisoners, including children, by Nazi Germany in its Nazi concentration camps, concentration camps in the early to mid 1940s, during Wo ...
during World War II
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
amounting to medical torture
Medical torture describes the involvement of, or sometimes instigation by, medical personnel in acts of torture, either to judge what victims can endure, to apply treatments which will enhance torture, or as torturers in their own right. Medical to ...
included hypothermia experiments, which killed many victims. There were 360 to 400 experiments and 280 to 300 subjects, indicating some had more than one experiment performed on them. Various methods of rewarming were attempted: "One assistant later testified that some victims were thrown into boiling water for rewarming".
Medical use
Various degrees of hypothermia may be deliberately induced in medicine for purposes of treatment of brain injury, or lowering metabolism so that total brain ischemia
Brain ischemia is a condition in which there is insufficient bloodflow to the brain to meet metabolic demand. This leads to poor oxygen supply or cerebral hypoxia and thus leads to the death of brain tissue or cerebral infarction/ischemic stroke. ...
can be tolerated for a short time. Deep hypothermic circulatory arrest
Deep hypothermic circulatory arrest (DHCA) is a surgical technique that induces deep medical hypothermia. It involves cooling the body to temperatures between 20 °C (68 °F) to 25 °C (77 °F), and stopping blood circulation a ...
is a medical technique in which the brain is cooled as low as 10 °C, which allows the heart to be stopped and blood pressure to be lowered to zero, for the treatment of aneurysms and other circulatory problems that do not tolerate arterial pressure or blood flow. The time limit for this technique, as also for accidental arrest in ice water (which internal temperatures may drop to as low as 15 °C), is about one hour.
Other animals
Hypothermia can happen in most mammals in cold weather and can be fatal. Baby mammals, kittens
A kitten is a juvenile cat. After being born, kittens display primary altriciality and are totally dependent on their mothers for survival. They normally do not open their eyes for seven to ten days. After about two weeks, kittens develop qui ...
for example, are unable to regulate their body temperatures and have great risk of hypothermia if they are not kept warm by their mothers.
Many animals other than humans often induce hypothermia during hibernation
Hibernation is a state of minimal activity and metabolic depression undergone by some animal species. Hibernation is a seasonal heterothermy characterized by low body-temperature, slow breathing and heart-rate, and low metabolic rate. It most ...
or torpor
Torpor is a state of decreased physiological activity in an animal, usually marked by a reduced body temperature and metabolic rate. Torpor enables animals to survive periods of reduced food availability. The term "torpor" can refer to the time ...
.
Water bears (Tardigrade
Tardigrades (), known colloquially as water bears or moss piglets, are a phylum of eight-legged segmented micro-animals. They were first described by the German zoologist Johann August Ephraim Goeze in 1773, who called them Kleiner Wasserbär ...
), microscopic multicellular organisms, can survive freezing
Freezing is a phase transition where a liquid turns into a solid when its temperature is lowered below its freezing point. In accordance with the internationally established definition, freezing means the solidification phase change of a liquid o ...
at low temperatures by replacing most of their internal water with the sugar
Sugar is the generic name for sweet-tasting, soluble carbohydrates, many of which are used in food. Simple sugars, also called monosaccharides, include glucose, fructose, and galactose. Compound sugars, also called disaccharides or double ...
trehalose
Trehalose (from Turkish '' tıgala'' – a sugar derived from insect cocoons + -ose) is a sugar consisting of two molecules of glucose. It is also known as mycose or tremalose. Some bacteria, fungi, plants and invertebrate animals synthesize it ...
, preventing the crystallization that otherwise damages cell membranes
The cell membrane (also known as the plasma membrane (PM) or cytoplasmic membrane, and historically referred to as the plasmalemma) is a biological membrane that separates and protects the interior of all cells from the outside environment ( ...
.
See also
*
* , two versions of a short story by Jack London portraying the effects of cold and hypothermia
* , a short story by Hans Christian Andersen about a child dying of hypothermia
* Dyatlov Pass incident
The Dyatlov Pass incident (russian: , ) was an event in which nine Soviet hikers died in the northern Ural Mountains between February 1 and 2, 1959, in uncertain circumstances. The experienced trekking group from the Ural Polytechnical Insti ...
References
; Bibliography
*
External links
* CDC - NIOS
Workplace Safety & Health Topic: Cold Stress
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Diving medicine
Medical emergencies
Wilderness medical emergencies
Physiology
Causes of death
Cryobiology
Heat transfer
Effects of external causes
Cardiac arrhythmia
Thermoregulation
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