It’s important to understand which sectors of the population are most susceptible to hypothermia, especially during the winter:
- Infants — due to the fact that they have less muscle mass and less ability to effectively shiver in order to satisfactorily produce body heat, they are more vulnerable and need heat and suitably warm clothing.
- Invalids and the elderly — due to their decreased muscle mass and ability to effectively shiver and produce energy, and due to decline in nutrition which causes anemia.
- Anemic patients — suffer from iron deficiency, decrease in amount of blood; they commonly feel cold since blood is an important component in the production and preservation of body heat.
- Those who have extensive exposure to cold environment — homeless people, transients, field laborers, soldiers, etc. who are regularly exposed to low temperatures reach a stage in which it is significantly difficult to produce and preserve a standard body temperature.
- Alcohol and drug users — drugs and alcohol are a common cause of suppression of the central nervous system. In the case of overdose, loss of consciousness is possible, as well as suppression of basic physical activity and orientation. Therefore, even if the patient feels the low temperature, he will not have the ability to protect himself and to move to a warmer place.
- Hypovolemia — bleeding, dehydration, etc. are a major cause of hypothermia due to the significant loss of blood.
- Brain injury in the hypothalamus — this is where the body’s temperature control center is located. Therefore, a brain injury is liable to cause significant damage to the body temperature balance to the point of hypothermia.
- Patients suffering from cirrhosis or viral hepatitis — since the liver is the main organ which produces and maintains body heat, if it is damaged due to hepatitis or cirrhosis, this will cause a major decrease in body temperature.
The main concern with regards to hypothermia is the suppression and slowing down of all the basic and vital bodily functions, such as the heartbeat, breathing, and oxygen consumption, and as well as the suppression of metabolic processes in the liver, pancreas, kidneys and more. Above it all hovers the issue of resistance to treatment; a severely hypothermic patient will almost never react to medical treatment or to the administration of electric shocks. So even if an EMT arrives to provide first aid, the patient still won’t respond to treatment. Another issue here is, due to the decrease in metabolic processes, perfusion, blood flow, tissue oxygenation and disposal of waste products, acidosis develops. This causes significant damage to the central nervous system—primarily to the brain. The damage is manifested by confusion, disorientation in time and place, ataxia (duck walk), loss of coordination, listlessness and apathy to the point of loss of consciousness and death.
The main danger is death, but wait! Not so fast. We know that brain cells die and irreversible brain damage occurs when the brain doesn’t receive the oxygen it constantly needs. However, due to the decrease in metabolism during hypothermia, the necessity for oxygen also decreases. This causes death by hypothermia to be long and agonizing. Even if the patient has been in cold conditions for an extended period of time and has severe hypothermia, and even if the patient shows no signs of life, that does not mean he is dead. This is mainly because, when treating a hypothermic patient, paramedics have a hard time even evaluating and manually taking measures due to the fact that the external areas of the patient are cold and sealed (therefore heartbeat, saturation, sugar, etc. may give us a false representation). Due to this difficulty, we understand that it is impossible to determine death or “not to start CPR” because signs of life may be hiding under the cold.
A patient is not dead until warm and dead!
Therefore, severely hypothermic patients who are not showing any signs of life (consciousness, breathing, heartbeat) require resuscitation. Complete CPR must be performed and at the same time the patient should be heated in order to aid in treatment (defibrillation and resuscitation drugs). A frozen patient’s medical condition will remain unknown until her body temperature returns to normal.
Now that we understand the dangers and causes of hypothermia, we will review the various injuries and bodily damage that are caused by the cold.
To begin with, it’s important to note that the best way to deal with hypothermia is by prevention. Therefore, it is highly recommended to focus on population sectors such as children, the elderly, and the ill who have difficulty in actively keeping themselves warm. One should make sure to eat nutritious and warm food, drink a satisfactory amount of hot drinks, wear dry and warm clothes, and be physically active on a regular basis.
Wishing you a safe and warm remainder of the winter!
In the event of an Emergency, dial 1221