Accidental Hypothermia

Abstract

A ccidental hypothermia (i.e., an involuntary drop in core body temperature to <35°C [95°F]) is a condition associated with significant morbidity and mortality. 1-4 Each year, approximately 1500 patients in the United States have hypothermia noted on their death certificate; however, the incidence of primary and secondary hypothermia and the associated morbidity and mortality remain unknown. 5 In a single tertiary care center, 14 different rewarming methods were used to treat 84 cases of accidental hypothermia, 3 which reflects the uncertainties about treatment and the potential for complications. 3 Certain treatment approaches are available only in specialized centers, and clarification is needed regarding the choice between transporting a patient to a specialized center and providing treatment locally. Existing recommendations do not include recent developments in rewarming methods nor do they assist with decisions regarding transportation. 6-8 PR E SEN TAT IONWith cold exposure, the initial response of the body is to maintain a normal core temperature (approximately 37°C [99°F]) by means of active movement and involuntary shivering. Primary hypothermia occurs when heat production in an otherwise healthy person is overcome by the stress of excessive cold, especially when the energy stores of the body are depleted. Secondary hypothermia can occur in ill persons with a wide variety of medical conditions (Table 1), even in a warm environment. Death in patients with secondary hypothermia is often caused by the underlying condition rather than by hypothermia. In all types of hypothermia, consciousness, breathing, and circulation are initially intact but are impaired as the body cools. 10

Severe Accidental Hypothermia in A Trauma Patient in A Tropical City

“…Alcohol consumption and environmental factors are well-known causes of hypothermia in trauma patients (4). Hypovolemic shock further impaired the thermoregulatory function of the hypothalamus.…”

Management of hypothermia — Severe Accidental Hypothermia Centre in Krakow

“…Zaawansowane stadia wychłodzenia wymagają użycia specjalnych technik. W przypadku ofiar hipotermii w stadium III i IV wg klasyfikacji szwajcarskiej z klinicznie jawną niestabilnością krążeniową oraz temperaturą ciała poniżej 28 o C standardy przewidują leczenie za pomocą ciągłego pozaustrojowego natleniania (ECMO) lub krążenia pozaustrojowego (CPB) [13].…”

Wilderness medicine

“…In contrast to classic heatstroke, exertional heatstroke can occur even in moderate temperatures, especially among endurance wilderness athletes. [56] Removal from the heat stress and rapid whole body cooling are essential to mitigate encephalopathy, coagulopathy, and multi-organ failure. [57][58][59] The optimal cooling technique is total body immersion in ice or cold water, but this intervention is usually not practical in wilderness settings.…”