Hypothermia Question

A couple of years ago, IIRC, there was something on TV that showed a family that was out in the wilderness, and they pulled a man out of the water after a canoe accident. He was suffering from hypothermia, so they undressed him & put him in their tent, and the woman and the girl curled up with him to provide body heat.

But someone (the woman or the narrator) was under the impression that even after a victim's body temp is brought back up to normal, they are at risk... I THINK they mentioned he could have a heart attack, or some internal physical danger.

Is this true? Or is this just one of the bits of misinformation provided by Hollywood?

Sue

There is a risk, Susan.
If I were to wake up after a bout of hypothermia, with a young female curled up against me, I'd have a heart attack. Now mind you... that's not a complaint, but just a promise.

Seriously though, I think that once the initial risk has passed and there is adequate core temperature you don't have to continue applying the human-hot-water-bottles Unless you think the person won't maintain adequate core temp.

There is significant cardiac risk to hypothermic victims. There is a cardiac condition called ventricular fibrillation (v-fib). This is where the heart does not produce a coordinated contraction of the heart muscle (top to bottom); instead the heart muscle contracts almost like a bowl of Jell-O. The heart no longer functions as a pump, depriving itself, organs and tissues of oxygen. If not reversed, the heart will eventually stop altogether. Hypothermic victims who are rapidly re-warmed and/or roughly handled can go into v-fib easily. Treat hypothermic patients with “kid gloves”, using heat packs on hypothermic patients will not re-warm the body’s core; they mainly serve to prevent further heat loss. Check out the web site below for additional information.

Hypothermia


Pete

At last a topic I can reply to with some useful information.

I took a course on ice safety this winter, dealing with how to prevent falling through river and lake ice, and what to do if you (or a member of your party) falls through. The instructor indicated that warming shock is a problem for people with severe hypothermia, but not for mild hypothermia.

Mild hypothermia is indicated by shivering, slurred (but coherent) speak, and the ability to pass a simple dexterity test like bringing a cup to the lips and drinking.

The line between these can be recognized by three important signs:
Hypothermia is severe when
- shivering stops
- the patient is no longer verbally coherent
- muscle control is so poor that the patient fails the cup test

For mild hypothermia, the patient should be made dry and warm, and given food, fluids and exercise.

Severe hypotheria patients should be given the hypo-wrap treatment.

Many years ago, I read somewhere that sleeping with your partner with your feet in their armpits and theirs in yours would help to reduce the likelyhood of frostbite to the feet, which I understand is the most susceptible area for that problem. I have never been able to fathom the practicallity of such a position. Has anyone on this forum ever heard of this method actually being used?

For the weight of a Jon-e hand warmer fuel and the warmers themselves, I would much rather carry a bag that would accomodate both feet and put either a small or large Jon-e in it for heat.

Will just heating the armpits and crouch suffice to increase the core temperature of hypothermia victims?

Bountyhunter

The human body doesn't take kindly to radical physiological changes. Victims of earthquakes or other events that cause compression also require special care. The layman's reaction is to always 'do something' oblivious to the medical maxim ' do no harm.' It's not unlike horseowners who trowel salves into a cut for the DVM to remove while the Bute wears off. Unless we are Trustbox or Paramedicpete, a field reference, ie WHERE THERE IS NO DOCTOR and a means of getting the victim to one take a prominent place in my FAK.

Additionally there is what is called after drop. This is what generally triggers the V-fib. The body slows to almost the point of shutdown of blood flow to the extremites to try to conserve core temp. This is what usually leads to frost bite of fingers and toes. When the body is warmed the core temp goes up first. Then the body recommences flow to the arms and legs to restore their function. But the blood there is usually much colder than the core. Like pouring ice water into a pot of boiling water. This causes the core temp to rapidly drop. This shock of the sudden after drop causes a drastic shock to an already weakened system. This is the shock thatoften triggers cardiac arrest.

But can you bring core temp back to normal with just body heat? For instance, if you have to deal with the problem while someone else hikes out for help.

Pete, that Res-Q-Air looks really useful for people out in the sticks, as long as there's a power source around. Any idea on the price?

Sue

I stand corrected.. thanks to Pete and others:
"I think that once the initial risk has passed and there is adequate core temperature you don't have to continue applying the human-hot-water-bottles Unless you think the person won't maintain adequate core temp." WRONG Wrong!
It would appear that one can't determine in the field that the risk has passed, and should therefore continue to treat the re-warmed victim as at-risk. Sorry!

No, sorry I do not. I would guess around $1,200.

Pete

They used to teach in First Aid that you should do the "curl up in a sleeping bag" technique for hypothermia, but it is no longer sanctioned by agencies like the Red Cross or Saint John Ambulance (at least in Canada).

Applying warm packs to the neck, armpits, and genital areas is okay, but you must be very careful that you don't burn the casualty in doing so. Casualties in hypothermia are more susceptible to tissue damage, I understand, so anything that's warmer than normal body temperature will be too hot. (Even those chemical handwarmers will be too hot for direct skin contact.) I'm not sure if that applies to severe hypothermia or not; will have to get my books out and review.

Rubbing the skin to improve circulation is another huge no-no in hypothermia. All you're doing is forcing the body to circulate extremely cold blood into the partially warmed body core, which contributes to the "shock-cooling" effect that Paramedicpete described.

Well I think it's safe to say after reading through this thread that the most surefire way to survive hypothermia is to not get to that point to begin with. Fire, exercise, chemical heat packs and the like, although not all effective "cures" for hypothermia are all great ways to "prevent" hypothermia in the first place and should probably be used at the very first signs of any possible hypothermia symptoms. I.E. you get cold, stop and build a fire rather than think, "oh its just a couple more miles to camp, I'll rest here a while then hike the rest of the way before I get much colder". Living where I do, I'll be the first to admit that I am not expert on this subject. I do spend my Christmas' every year in the Sierra Navada Mountains though (and it "can" get pretty cold here for a couple days a year too <img src="/images/graemlins/wink.gif" alt="" />) so I still like to know what to do.

I was reading somewhere (Cody Lundin's book?) that most cases of hypothermia occur when the air temp is between freezing and 50°F. I guess if the weather was any colder, a person would be dressed more suitably.

One thing I wonder about is if hypothermia occurs to someone in a group survival situation: the light plane is down, one person falls into a creek and gets wet, the temp is just above freezing, and the wind is blowing. The wet person becomes moderately (trouble speaking, not always coherent) hypothermic, the small group finds shelter, builds a fire, and cuddles up with the hypothermic person. If they keep that person warm for 24 hrs in dry clothes, can they bring that person back to a normal core temp without outside help?

Sue

Likely yes, if the person is not in severe hypothermia. I would guess that many of us have experienced mild hypothermia at one time or another, possible even moderate hypothermia and have recovered without any outside assistance.

Where many run into trouble are days where the air temps. may hover around 45-55 degrees and the weather is damp or wet and a mild to strong wind is blowing. People will often dress for severely cold weather, but will often under estimate the weather in the spring and fall (and in some areas even summer time conditions especially at night) and travel/hike with cotton jeans, shirt, hat and light jackets. They get wet either by the weather or sweat getting their clothes damp. They stop to rest/snack and that mild breeze that felt good while hiking starts to steal body heat by convection and evaporation. If you have enough fuel on board (I am strong supporter of the importance of high energy food in a survival situation), the body will shiver producing body heat or if you resume hiking, the body will generally produce heat, maintaining body core temp. Ingesting warm liquids will assist in warding off mild to moderate hypothermia.

Children, especially young ones have a higher head to body surface area ration. Children need to have a warm, close fitting hat. The old adage if your feet or hands are cold put on a hat is not just an “old wives” tail; it is an essential survival technique.

Wool or synthetic (polypro, fleece) clothes in layers topped with a wind/rain barrier and a close fitting warm wool/fleece hat, coupled with high-energy foods and the ability to intake warm liquids will go along way in preventing/treating mild to moderate hypothermia.

Pete

That makes a lot of sense. I'm guilty of underdressing in those situations. When the temp is 75 in the afternoon and can drop to 40 at night I admit that I will go on a day hike dressed for the 75 degree weather but not the 40 and certainly not the 'just fell in lake, spranged my angle and now I'm spending the night wet in 40 degree weather with wet clothing designed for 75 degrees'. Yes Yes, I am certainly guilty of that. Not because I don't know better but rather because I insist on travelling as light as possible 99% of the time. Before you guys start yelling at me... I do carry redundant, waterproof firemaking devices which I am quite skilled at using and I have equal skill in building shelter. I know I know... when I'm freezing and my hands are shaking it's not so easy (and yes I am usually alone out there) but I suppose thats a chance I take.

Sure it is a good idea to treat hypothermia at the first signs. But, and I always seem to come up with buts, in most cases you can't really recognise the symptoms by your self. Most people don't notice it at first. They just feel cold. As we all would. Then as it advances the mind is affected. Then things go downhill fast. Sure if anyone gets dunked in the river at 20 below they are going to realize that they need to get warm now. The reason most people that die from it in those mid temperatures is that it creeps up on you slowly then affects your judgement about what is happening. The person that will spot the suigns is your partner not you.

The case wheer after drop was first recognized was a group of fishermen haulled out of the ocean. They were treated for hypothermia. After the initial warming they all appeared to be recovering then suddenly died of heart failure. This is what started researcher to question what happened and the answers were what has formed the current recommandations for treatment.

Just seems basic to me. The first signs are that you feel cold. That happens long before judgement is impaired. So feeling cold = need to warm up immediatly. Seems simple to me but I know it is not that simple in reality for most folks.

Brian;

No offense, buddy, but you live in Texas. While I realize that Texas is not Tahiti (I believe it has even snowed in some parts of Texas), I believe your advice would be totally impractical in many parts of the world.

Up here in Canada, and probably in the northern border states and Alaska as well, "feeling cold" is not a sign of hypothermia, it's the body's natural condition between November and March. If I had to stop and warm up every time I felt cold, there would have to a 24-hour doughnut shop on every street corner, and it would take me a full day to walk downtown. <img src="/images/graemlins/smirk.gif" alt="" />

The rule of thumb I have heard from most experts is to try touching your thumb and little finger together. The minute you have difficulty doing that, stop and build a fire. (I know I've heard that from Mors Kochanski, but I don't know if he was the one who discovered it or not.)

Also, the simplistic advice "warm up immediately" can lead you astray, if your idea of warming up is to get back to the ski lodge. In some circumstances, this is the best option; in others, it will kill you.

I'm not going to stop and build a lean-to and a campfire in the parking lot of the Chateau Lake Louise, but what if I'm a mile away? What if I'm a half-mile away? What if I'm only 5 minutes away? Wait a min - those last two are pretty much the same thing.

A co-worker of mine lost his teenage son winter before last when the boy decided to walk home from a party. He hadn't been drinking to excess (a major cause of hypothermia and death in some parts of Canada) and it was "only" a 10-minute walk. He never made it home; a search party found his body the next day, 100 yards from the nearest house.

Touch my thumb to my little finger? I can't do that on my best days anymore. Guess I have to build a fire in my office (fingers won't BEND that far anymore)

Hahaha yes my comments is based on the areas I frequent. Canadians, Alaskans, Siberians, etc should NOT follow any advice (and why would they anyway) given by me and in anyway related to weather! <img src="/images/graemlins/grin.gif" alt="" /> I have heard the same thing about touching your thumb to your pinky finger. That's what everyone says when we're hiking and skiing at Christmas in the Sierra Navada Mountains. For what its worth I dress so that I don't feel cold when I'm there as well.

kc2ixe:

You too, huh!?

Bountyhunter

I recently completed a Marine STCW Class and Two instructors, one EMT-PM and a USCG Ret. Capt of S& R commented slow reheat is best. Warm bodies work best, no hot liquids, be gentle as body at that point is fragile. Dry clothes, cover head, cover top and bottom with blankets. Too fast of reheat "fools" body and allows cold blood to reenter heart causing failures. Too warm can cause burns. Most Hypothermic patients do not realize it can only take a few seconds in 50 degree or less water.

If this is the case then wouldnt every person who ever swam the english channel now be dead? <img src="/images/graemlins/wink.gif" alt="" /> What factors determine who is safe in water below 50 degrees and who isnt?

Brian:

From what little I have read about English Channel swimmers, most of them used grease, wet suits, or dry suits to handle temperature problems.

I believe most of them had escorts in boats in case of emergencies.

Bountyhunter

Again from my ice safety course, The instructor told us that it can take hours to get hypothermic from immersion in ice-cold water. What gets people is the shock to the system that leads to shallow breathing, panic and loss of consciousness. In fact, one recommendation given when self-extraction from the ice is impossible is to extend your wet sleeves onto the ice surface so that they freeze in place to hold you out of the water after you've lost consciousness.

Most people that die in this situation drown before hypothermia sets in. The recommendation from the course was to take the first two minutes of immersion to allow the shock to pass before calmly initiating self-extrication. You then have 10 or so minutes before passing out. He even did a real-life demonstration (wearing a dry suit full of holes).

Part of the course was a viewing of some videos of "Professor Popsicle", a guy who studies hypothermia, often using himself as a guinea pig. The videos are available online at:

http://outside.away.com/outside/features/200212/200212_popsicle_splash.html#

Those old men in the speedos that they show on the tube when they cover these stories must be using greese then. That certainly does make sense.

Brian:

Any old man that even dares to try swimming the English Channel is a better man than I am!

Bountyhunter <img src="/images/graemlins/tongue.gif" alt="" />