Treating Severe Hypothermia

Reading the tragic events in Oregon reminded me of a book written about a blizzard in the Midwest in the 1880's. It was known as the children's blizzard due to the high number of children who were caught at school during the blizzard and died trying to make it home. It was a real fast-moving monster.

The author described, on many occasions, people who were almost frozen to death, warmed up by a fireplace, given warm drinks, then, after a time, felt pretty good. They would stand up, walk around for a minute or two, then literally drop dead right in front of their rescuers. It had something to do with their circulatory system not yet being over the shock or something like that. The take home message that I learned was not to let them stand up, let the doctors at the hospital do that.

Anyone with medical training care to elaborate? What are the proper procedures for re-warming a severely hypothermic person?

Hypothermia = Thicker blood, Slower moving, but increased heart rate... thaw = thinner blood but heart rate stays up = heart attack?
(This is 100% a guess!!!)

I know if you thaw frostbite to fast the skin/cells can die.

Cardiac arrythmias are common with hypothermia. The stress of standing up can cause orthostatic hypotension, which in English is a drop in blood pressure caused by standing up (this doesn't require hypothermia). A sudden drop in blood pressure combined with an electrically compromised heart doesn't sound like a good thing. I'm not knowledgable enough to take us from long Q-T intervals plus sudden hypotension to V-Fib, but the latter would kill you pretty well.

Take a look at this web site:

Hypothermia Treatment

Pete

Sodak, I believe what you're describing is explained towards the very end of the webpage that Pete linked to--the sudden introduction of still-cold/cool blood from the extremities into the core circulation. The heart is still not really recovered and the sudden shock of more cold blood causes cardiac arrest or other cardiac abnormality. Very insidious.

It's similar to the danger faced by people pinned under heavy objects, like in an earthquake, through "crush syndrome". They victim will seem fine when they are initially rescued, can walk around and hug people, then shortly thereafter, just drop dead. It's a different mechanism, but it's equally terrible because the victim seems fine at first.

Wow, that goes a little beyond the old "get naked in a sleeping bag with the victim" EMT training I got in the late 70's...

Thanks for the link and the explanations! I'm tucking this one away in the bookmark file.

Hmm, this makes me think that an effective field expedient augmentation would be to have a warm person respirate into a hypothermic individual just like artificial respiration techniques, only with a conscious victim. It may not be ideally warm, but exhaled breath is quite a bit warmer than ambient, full of moisture, and not overly lean on oxygen. Makes sense to me. What do you think Pete?

http://wildernessmedicinenewsletter.wordpress.com/tag/hypothermia/

Do not recall where I picked this up, but I recall someone once stating that you warm the indiviidual in the same way they became hypothermic, i.e. hypothermia due to extended exposure, warm cautiously, and incrementally. Hypothermic due to rapid heat loss, a dunking for example, allows for rapid re-heating. Any of our experts know if this is correct?

You may be on to something there, benjammin. At the very bottom of the page in the linked to by jshannon, it says:



Interesting...

If you look at the “Field Chart” Field Chart at around 29C with “slow pulse and breathing” the recommendation is to assist with rescue breathing.

I do not think a person who is not semi-conscious or unconscious is going to tolerate mouth-to-mouth breathing very well. It is also very tiring to the “rescuer” to perform this for any significant length of time.

If the patient/victim is breathing adequately on their own, I would suggest using some type of permeable cloth/bandana/etc. over the mouth/nose (make sure to monitor closely) that would allow the patient’/victim’s own breath to moisturize the material. Then having them in a warm environment should allow for warmed humid air to gradually warm the lungs or at least prevent/reduce further heat loss through respiration. One, could place a heat pack near the patient’s/victim’s mouth/nose to warm the air. If one has access to O2, wrapping the supply line around a heat pack and placing a saline moistened gauze pad in the mask should also help. I.V. solutions and I.V. lines can also be warmed with heat packs.

Pete

You may be right. I think for a conscious person, it would depend a great deal on who's providing the warm air. Such notions cojure memories of the Jim Carey/Lauren Holly fantasy kissing scene from "Dumb and Dumber" (yecccchhhh!!!!)

I know it would be a real challenge to offer assisted respiration to some of my old hunting buddies, especially if they were hypothermic yet still cohesive. I reckon I'd have to knock them cold with the frying pan first so's they wouldn't struggle so much.

Pete, do you know how much a unit like the Res-Q-Air costs? I couldn't find a single online price for it, just a phone number or email address. (Kind of makes you wonder why they want to be so coy about the price, doesn't it?)

Sue

Having been a lifeguard and performing rescure breathing a few times, it can be a really discusting process. Imagine having someone puke into your mouth! It's gross. Given, that was with drowning victims vomiting up ingested water, it might be different with hypothermic victims.

I would be curious to know what peoples view on the Good Samaritan Law is here? Do you think that one should be trained in CPR/Rescure Breathing to try it?

Yes, I am a retarded,,uh, I mean, RETIRED Coastie icebreaker sailor. We learned to reheat the core by warm drink, hot bath (body in the water, legs and arms outside of the water) or strip them & yourself and get under the covers or in the sleeping bag with them to re-warm them.
From the time you rescue them, do not make or allow them to walk,,,,carry them to a warm place & start warming them up without causing them to exert/expend any more energy.
First get them into the warm environment, add some hot drink (cocoa or broth preferred), while preparing the means to rewarm them via bath, microwave warmed towel wraps, warm bath (appendages out of the water), body to body heat transfer.
After they have been sufficiently re-warmed, spoon feed them some more broth, hot cocoa, etc to replenish their energy levels, & they will start making their own body heat again.
Don't forget about the mammilian diving reflex, it makes it possible to save someone but it also means that the majority of their bodily functions have shutdown. After re-warming the person, you must spoon feed easily convertible energy into their body until their body's sub-systems come back online.

Hi Sue,

Sorry, I do not know the cost for the Res-Q-Air. Based upon other EMS equipment, my guess would be between $1,500 and $2,500 at least.

Many suppliers of EMS equipment (not supplies) do not publish prices, as pricing may depend upon the number of units ordered or government agency vs. non-government agency purchase. Also with big-ticket items, costs for components may change quickly on a world market, making published prices outdated.

This medical device is very specialized, and I am sure most general EMS providing agencies would not be able to justify such a purchase. Fewer units sold, will generally cause the price to increase.

Pete