Media Share 9/MEDIASHARE_09.ISO/private/hypoth.zip/HYPOTH.TXT

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                                        August 5, 1987

HYPOTHERMIA -- THE SILENT KILLER

    It's August now.  The last of the summer warmth.  Days grow shorter.
Autumn is near.  And then winter...

    This segment is on hypothermia.  Hypothermia ia condition of general
body cooling (in contrast to frostbite which is localized).  It can kill
you.  But do not let the introduction mislead you.  Hypothermia generally
occurs during cold weather, but it can occur at any temperature (but
generally below 60 degrees).


CAUSES:

    Three factors are major causal factors in hypothermia: cold, water, and
wind.
    1) In a cold environment, the body must work harder to regulate heat;
contact with cold air, water, snow, ground or clothing will cause heat
losses due to conduction.
    2) If a person is submersed in water, heat will be lost due to
conduction and convection.  At a water temperature of 32 degrees death
occurs in 15 minutes; at 70 degrees survival for as long as 48 hours has
been observed.  Loss of heat by evaporation is a major contributor also. Wet
skin or clothing will cool of the body quickly, especially if it is windy
and/or cold.
    3) Wind will cause heat loss due to convection, and will accelerate
heat loss due to evaporation.
    4) Hypothermia occurs much more quickly in the elderly and chronically
ill.

    Hypothermia is insidious.  As the body's core temperature drops, more
and more body systems suffer from the effects of cold.  The presence and
severity of hypothermia can be assessed by the signs and symptoms below.  A
patient is hypothermic at any temperature below 98.6 degrees fahrenheit
(rectal).  98-94 degrees is mild hypothermia; 94-84 degrees is moderate
hypothermia, and below 84 degrees is severe hypothermia.

STAGES OF HYPOTHERMIA:

    98 - 95 degrees - Sensation of chilliness, skin numbness; minor
impairment in muscular performance, especially in use of hands; shivering
begins.

    95 - 93 degrees - More obvious muscle incoordination and weakness; slow
stumbling pace; mild confusion and apathy.  Skin pale and cold to touch.

    93 - 90 degrees - Gross muscular incoordination with frequent stumbling
and falling and inability to use hands; mental sluggishness with slow
thought and speech; retrograde amnesia.

    90 - 86 degrees - Cessation of shivering; severe muscular
incoordination with stiffness and inability to walk or stand; incoherence,
confusion, irrationality.

    86 - 82 degrees - Severe muscular rigidity; patient barely arousable;
dilatation of pupils; inapparent heartbeat and pulse.  Skin ice cold.

    82- 78 degrees and below - Unconsciousness; death due to cessation of
heart action.

TREATMENT OF HYPOTHERMIA:

    Two situations are possible.  One is where evacuation to a medical
facility is possible within several hours.  The other is where evacuation
will be delayed or impossible.  The other parameter is stage of hypothermia.

    Moderate hypothermia;

    Get the patient as sheltered as possible (tent, snow cave, etc.)
Remove wet clothing and replace with dry clothing.  Keep patient laying
down. Place patient in a sleeping bag with a second rescuer of normal body
temperature. Direct skin to skin contact is preferable.  Warm stones or
bottles can also be placed in the bag (be careful not to burn patient).
Make sure all extremities and exposed areas (e.g. face, nose, ears) are
protected.  if patient is conscious and able to swallow without danger to
his/her airway, give sugar and sweet, warm (not hot) fluids by mouth.  DO
NOT GIVE ALCOHOL. If evacuation is IMPOSSIBLE and facilities permit, immerse
patient in tub of water at 105 degrees Fahrenheit.  Monitor patient's
temperature rectally with thermometer if possible.  Continue rewarming
efforts until patient's core temperature is restored to normal.  Always
evacuate a hypothermic patient as quickly and gently as possible, including
rewarmed patients.

    Severe hypothermia:

    Patients in severe hypothermia are often erroneously thought to be
dead.  Neither pulse, nor heart sounds, nor respirations may be apparent.
Handle a severely hypothermic patient with great care - VERY GENTLE
HANDLING.  Cut away wet clothing and replace with dry clothing.  Maintain an
airway, but use no adjuncts (e.g. oral airway).  Once you start CPR, DON'T
GIVE UP.  Get help.  Do not attempt to rewarm patient unless evacuation is
IMPOSSIBLE.  Keep patient supine, in a 10 degree head-down tilt.

    Handle every hypothermic patient very gentle.  Rough handling can cause
cardiac arrest and death.  Get every patient into shelter, replace wet
clothes with dry ones.  Apply external heat if condition dictates.  And give
warm, sugary food and drink if patient's condition allows. Get help.
If possible, have rescuers bring a heated oxygen unit, and administer to
patient.  Perhaps equipment can be air-dropped.  Keep calm and do not become
a victim yourself.

THE HYPOTHERMIC PATIENT ISN'T DEAD UNTIL HE'S WARM AND DEAD.

    PREVENTION OF HYPOTHERMIA:

    Dress properly for current and possible conditions.  Be prepared for
sudden weather changes especially at elevations.  Have at least one wool
garment for the upper and lower parts of your body.  Wool is the only
material with any insulating value when wet.  Carry or wear a windproof,
waterproof garment.  Always have a wool hat and wool mittens.  Have extra
clothing available especially mittens and hats.  A large proportion of body
heat is lost through the head.  Wear suitable boots, insulated if necessary;
wear wool socks, and always carry extra wool socks.  Avoid getting
overheated and perspiring, this cools you down - fast.  Wear layers and
remove clothing as necessary.  Better having extra than too little.  Dress
sensibly and expect the worst.
    Sit out bad weather.  Better waiting than be overtaken by a blizzard or
thunderstorm.  Do not push on through the night.  Make camp early and rest
thoroughly.  You can continue tomorrow with a much greater safety margin.
    Do not get exhausted.  Exhaustion promotes heat loss, and thus
hypothermia.  Besides, if your exhausted, you are probably drenched.
    Do not get in over your head. If your experience is limited to day
hikes on moderate trails, do not try to go out and tackle Mt. Washington in
February.  Be smart.  Learn to use a map and compass.  Learn fire starting
techniques.  Learn first-aid.  Be calm.  Be prepared.
    Lastly, learn about hypothermia.  Know the causes, warning signs, and
treatment.  Learn how not to get cold.


NOTE: Special hypothermia thermometers are available which measure between
about 70 and 100 degrees Fahrenheit.  I recommend carrying one in your
first-aid kit on all cold weather excursions.  Contact me for information on
where you can purchase one.

    I hope you found this information useful and important and feel free to
contact me if you have any questions.  Have fun in the great outdoors, but
be careful.  Mother Nature is never malicious, just incredibly powerful.



                                        Gary Ross, EMT-D
                                           73317,3317

°