Patients presenting in cardiac arrest from accidental hypothermia may be rewarmed effectively using TL. Among survivors, normal neurological recovery is seen. [ncbi.nlm.nih.gov]

• Hypothermia

  Mild hypothermia was diagnosed in 75.5% of the patients, moderate (32-28°C) in 16.5%, while severe hypothermia (less than 28°C) in 8% of the cases. Cardiopulmonary resuscitation was carried out in 7.5% of the patients. [ncbi.nlm.nih.gov]

• Shivering

  Over half of them identified the initial symptom of AH as obvious shivering (69.4%) and apathy (45.0%). As for the aggravate symptoms, 60.9% chose the wrong answer of more obvious shivering instead of the right one-absence of shivering (5.4%). [ncbi.nlm.nih.gov]

  […] symptoms HT I 35–32° (95–89.6°) Conscious, shivering HT II 32–28° (89.6–82.4°) Impaired consciousness, no shivering HT III 28–24° (82.4–75.2°) Unconscious, no shivering, vital signs present HT IV 24–13.7° ( Unconscious, no vital signs, apparent death [omcr.oxfordjournals.org]

  Also will stop shivering as soon as placed in bath. Warming far safer if done core to surface. [crashingpatient.com]

• Malnutrition

  The diagnosis of hypothermia is easy in patients with a history of prolonged exposure to a cold environment but accidental hypothermia may also occur as a consequence of prolonged immobilization and malnutrition. [ncbi.nlm.nih.gov]

  Best Review Article accidentalhypothermia Back to top Predisposing factors hypoglycemia, malnutrition, ETOH, Addison’s, infection, and Myxedema (especially if failure to rewarm) Do not need to worry until temp hits 30-32° C, People die from poor judgment [crashingpatient.com]

  […] drowning, alpine environment, poverty (lack of heating or shelter) drugs/ tox – alcohol, sedatives, vasodilators Sepsis CNS disorders e.g. hypothalamic lesions, hypopituitarism Endocrine/ metabolic – hypothyroidism, adrenal insufficiency, hypothermia, malnutrition [lifeinthefastlane.com]

  Other causes include severe malnutrition or hypoglycemia and neuromuscular inefficiencies seen in the extremes of age. [emedicine.medscape.com]

• Myxedema

  Concomitant problems of alcoholism, stroke, myxedema, tuberculosis and paraplegia were also treated. Rapid external rewarming by immersion can result in a low mortality in patients with severe hypothermia. [ncbi.nlm.nih.gov]

  Myxedema coma, infections and neurological diseases were discarded. The cause of severe hypothermia was unclear, and the probable source was suspected to be accidental. [scielo.conicyt.cl]

  If patients aren’t rewarming 1°C/hr and they’re above 32°C, consider: sepsis, cortisol deficiency, myxedema, ethanol. The J wave or “Osborn” wave is found in many cases of hypothermia, often quoted at ~80%. [foamcast.org]

  Best Review Article accidentalhypothermia Back to top Predisposing factors hypoglycemia, malnutrition, ETOH, Addison’s, infection, and Myxedema (especially if failure to rewarm) Do not need to worry until temp hits 30-32° C, People die from poor judgment [crashingpatient.com]

• Chills

  The rapid and complete recovery experienced in the case presented is not surprising since the patient's premorbid condition was good, chilling had been rapid, metabolic exhaustion was mild, and internal rewarming was accomplished without delay, using [ncbi.nlm.nih.gov]

  Tourniquets are applied to the limb to inhibit circulation and avoid general chilling of the patient. The limb is chilled for 3 to 5 hours before amputation. General Hypothermia. [medical-dictionary.thefreedictionary.com]

  When mild or moderate, hypothermic patients present with symptoms that can be fairly misleading, these include, but are not limited to dizziness, confusion, dyspnea and chills. [news-medical.net]

  In 2001 the wind chill was changed to a new system based on the cooling effect on a human face. Wind chill is the term used for the cooling effect of wind in a cold environment. Convective cooling in water is greater than in air. [ahcmedia.com]

• Hypotension

  Rewarming using renal replacement therapy circuit was unsuccessful because of severe hypotension. We inserted the esophageal heat transfer device and rewarmed him successfully to target temperature 35-36°C. [ncbi.nlm.nih.gov]

  We report a 77-year-old female patient who was admitted to the Emergency Department with impairment of consciousness, hypotension, bradycardia and hypothermia. She required endotracheal intubation and transfer to Intensive Care Unit (ICU). [scielo.conicyt.cl]

  Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994; 331:1105-1109. 4. Gross D, Landau EH, Assalia A, Krausz MM. [books.google.it]

• Cyanosis

  In mild hypothermia, patients present with shivering, ataxia, cyanosis, dysarthria, tachycardia, and tachypnea. [crashingpatient.com]

  Patients may have a wide variety of dermatologic manifestations of hypothermia, including erythema, pallor, cyanosis, edema, pernio, frostnip, frostbite, panniculitis, cold urticaria, gangrene, and necrosis. CNS. [ahcmedia.com]

• Confusion

  In recent years, alterations in resuscitation care that sometimes confused or discouraged resuscitation teams have largely been supplanted by an emphasis on safe, rapid, effective rewarming. [ncbi.nlm.nih.gov]

  Victims of accidental hypothermia present year-round and in all climates with a potentially confusing array of signs and symptoms, but increasing severity of hypothermia produces a predictable pattern of systemic organ dysfunction and associated clinical [rc.rcjournal.com]

  This is especially seen in older hypothermic patients, who are indoors and present with symptoms such as confusion, speech difficulties and a lack of coordination. [news-medical.net]

• Altered Mental Status

  He may exhibit poor judgment, slurred speech, or altered mental status. In severe cases of hypothermia, the patient may present with altered mental status including coma, as well as depression of cardiac, respiratory and renal function. [crashingpatient.com]

  Age Very young and elderly persons are at increased risk and may present to the emergency department with symptoms that are not clinically obvious or specific for hypothermia, such as altered mental status. [emedicine.medscape.com]

  Less obvious is the elderly cardiac patient without adequate heating in the home who presents to the emergency department with a complaint of altered mental status. [ahcmedia.com]

• Irritability

  Tip: Avoid jostling the hypothermic patient too much because of myocardial irritability. Don’t send your patient into an arrhythmia. Go to the ALiEM Cards site for more resources. [aliem.com]

  Moreover, these patients may be irritable and have mood changes, lassitude and poor judgment. These symptoms are misleading, because they may be mistaken for other medical conditions, such as alcohol intoxication and stroke. [news-medical.net]

  Irritation to the cardiac membrane can precipitate ventricular fibrillation and cardiac arrest. Patient movement should be held to a minimum and invasive monitoring utilized only if absolutely necessary [ 4 ]. [omcr.oxfordjournals.org]

  The heart becomes quite irritable at temperatures below 30°C. [ahcmedia.com]

• Dysarthria

  Subjects with core body temperatures dropping from 95°F to 90°F develop amnesia, dysarthria, confusion, and disruptive behavior. 1 Further cooling as the body temperature falls to 82.4°F yields stupor, paradoxical undressing, and hallucinations. [mdedge.com]

  In mild hypothermia, patients present with shivering, ataxia, cyanosis, dysarthria, tachycardia, and tachypnea. [crashingpatient.com]

  Fine motor skills decline, manifested as difficulty with zippers, buttons, etc., followed by dysarthria and decline in gross motor skills. [ahcmedia.com]

• Stupor

  Subjects with core body temperatures dropping from 95°F to 90°F develop amnesia, dysarthria, confusion, and disruptive behavior. 1 Further cooling as the body temperature falls to 82.4°F yields stupor, paradoxical undressing, and hallucinations. [mdedge.com]

  Grade °C °F Physiologic Changes Mild 35 95.0 Maximum shivering, impaired judgment, confusion 34 93.2 Tachycardia, tachypnea, increased SVR, cold diuresis 33 91.4 Bradycardia, respiratory depression, hyperglycemia, dysarthria, ataxia Moderate 32 89.6 Stupor [crashingpatient.com]

Results of an extensive diagnostic workup revealed only adrenal insufficiency, and the electrocardiographic abnormalities resolved after warming. [ncbi.nlm.nih.gov]

• Potassium Increased

  As hypothermia progresses, the sodium levels tend to decrease while potassium increases, presumably due to a reduction in enzymatic activity of the cell membrane sodium–potassium pump. [medintensiva.org]

• Hematocrit Increased

  For each 1°C drop in core temperature, the hematocrit increases approximately 2%. • Serum electrolytes: Hypokalemia or hyperkalemia may occur and should be monitored closely during the rewarming process. [ahcmedia.com]

• Prolonged QT Interval

  An increased PR interval, a widened QRS complex, and a prolonged QT interval signal progressing hypothermia. [nursingcenter.com]

• Prolonged PR Interval

  Multiple other findings eventually develop including a shortened QT interval, ST depression, bundle branch blocks, widened QRS, prolonged PR interval, flattened T wave and ultimately a sine wave. Hyperparathyroidism (D) may lead to hypercalcemia. [foamcast.org]

• Electrocardiogram Change

  CONCLUSIONS: Electrocardiogram changes in accidental hypothermia are frequent and characteristic for this entity improving diagnosis in usually unconscious patients, and in many cases, it may be the diagnostic clue in patients with conscience deficit [ncbi.nlm.nih.gov]

Abstract We sought to organize a functional system of recognition and advanced treatment of hypothermic patients with extracorporeal rewarming as a treatment option. [ncbi.nlm.nih.gov]

The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing. [journals.viamedica.pl]

Abstract BACKGROUND: Accidental hypothermic cardiac arrest is associated with unfortunate prognosis and large studies are rare. [ncbi.nlm.nih.gov]

The etiology of hypothermia was exposure to cold air (64%) and cold water immersion (36%). Two (18%) were treated with extracorporeal membrane oxygenation and the rest with cardiopulmonary bypass. [ncbi.nlm.nih.gov]

Applicable To Accidental hypothermia Hypothermia NOS Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]

Etiology Decreased heat production Several etiologies related to endocrine derangements may cause decreased heat production. These include hypopituitarism, hypoadrenalism, and hypothyroidism. [emedicine.medscape.com]

LEVEL OF EVIDENCE: Prognostic and epidemiological study, level III. [ncbi.nlm.nih.gov]

The loss of body heat, either from the decreased heat production, increased heat loss, or alterations in thermoregulation are important in the epidemiology of this injury. [dtic.mil]

This review will detail the pathophysiological consequences of hypothermia, as well as the most recent principle recommendations in dealing with it. Copyright © 2016. Published by Elsevier Masson SAS. [ncbi.nlm.nih.gov]

This article reviews the epidemiology, pathophysiology, clinical presentation, and treatment of accidental hypothermia. [rc.rcjournal.com]

Pathophysiology Breath holding underwater > involuntary gasp > aspiration/laryngospasm > LOC > active aspiration > death 90% “wet drowning” and 10% “dry drowning” Aspiration leads to loss of surfactant, atelectasis, V/Q mismatch, and ARDS Hypoxemia leads [emdocs.net]

Hypothermia: pathophysiology, clinical settings, and management. Ann Intern Med. 1978 ; 89 : 519 –527. ↵ Steinman AM. Cardiopulmonary resuscitation and hypothermia. Circulation. 1986 ; 74 (pt 2): IV29 –IV32. ↵ Southwick FS, Dalglish PH Jr. [circ.ahajournals.org]

This issue focuses on methods of effective rewarming and prevention of further morbidity and mortality. [ncbi.nlm.nih.gov]

Regular consumption of high-energy food rich in carbohydrates aids the body in heat production, while 13-17 c (3-4L) of water a day prevents rapid dehydration from evaporation. [science.jrank.org]