MEDICAL EMERGENCY - HYPOTHERMIA

When the body loses heat faster than it can produce it causing a dangerously low body temperature, it is called hypothermia a life threatening condition. We are nearing winter conditions and hypothermia is a constant threat during this season. Exposure to cold weather or immersion in cold water is most often the cause of hypothermia. Hypothermia is defined as any body temperature below 35.0 C/95 F.

Mild - 32-35C Moderate - 28-32C
Severe - 20-28C Profound - less than 20C

Symptoms of hypothermia are the body’s response to chilling effects of the extreme coldness on vital bodily function. Shivering is the body’s defense in an attempt to warm itself. Constant shivering is a sign of hypothermia. Other symptoms are:

* Poor coordination
* Stumbling
* Drowsiness or low energy level
* Slurred speech
* Inability to concentrate/ Confusion
* Lethargy
* Progressive loss of consciousness
* Weak pulse
* Shallow breathing

A person with hypothermia is rarely aware of his condition. Hypothermia prevents self awareness and often causes self injury when preventable. If untreated hypothermia can lead to complete heart failure, respiratory arrest, and death. Cold related injuries include but are not limited to:

* Frostbite - freezing of body tissue.
* Gangrene - death of tissue resulting in interruption of blood flow.
* Chilblains - damage to nerves and small vessels usually in hands and feet after prolonged exposure.
* Trench foot - damage to nerves and small blood vessels



Treatment upon arrival to emergency room includes:

* Blood warming - blood warming may be accomplished by running blood through a warming device and back into body.
* Warm IV fluids - using an IV fluid heater.
* Airway re-warming - use device to deliver humidified oxygen after heating.
* Cavity lavage - a warm solution may be instilled into the stomach, urinary bladder, or rectal cavity.

Treatment involves removal from the cold environment and reheating along with maintenance of airway, breathing, and circulation. Intravenous Thiamine and glucose is often recommended. Monitoring and maintenance of blood pressure and electrolyte levels are of utmost importance as the body is brought back to normal temperature range. Gentle care of the body is a must to prevent further tissue damage to the patient. Hypothermic protocols specific to each emergency room should be in place as well as a cart designed and prepared for hypothermic treatment according to predetermined protocols.