Thirty-two patients had a cardiac arrest (CA): 15 patients presented unwitnessed cardiac arrest (UCA) and 17 patients presented rescue collapse (RC). [ncbi.nlm.nih.gov]

• Hypothermia

  SETTING: Patients consulted and treated by the Severe Hypothermia Treatment Centre. PARTICIPANTS: Patients who underwent accidental hypothermia. [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]

  […] hypothermia, no vital signs, asystole Stage Core temperature C ( F) Clinical 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 [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]

  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]

  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]

  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]

  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]

  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]

• 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]

  Patients with severe hypothermia demonstrate signs of physiologic derangement including coma, absence of reflexes, profound metabolic disturbances, apnea, hypotension, and dysrhythmias. [crashingpatient.com]

  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]

• 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]

  It can make you sleepy, confused and clumsy. Because it happens gradually and affects your thinking, you may not realize you need help. That makes it especially dangerous. A body temperature below 95![DEGREE SIGN]! [fpnotebook.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]

  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]

  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]

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

• 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]

  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]

  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]

• 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]

  Patients may have ataxia, dysarthria, amnesia, hyporeflexia, areflexia, hypoesthesia, poor suck reflex (in infants), and central pontine myelinolysis. Psychiatric. [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]

  Changes 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

  • CBC: Hematocrit increases as the plasma volume decreases. [ahcmedia.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]

• Prolonged QT Interval

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

• 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]

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]

[…] decline in the core (body) temperature below 35ºC ,' a temperature at which thermoregulatory systems begin to fail, as compensatory responses intended to reduce heat loss through conduction, convection, evaporation, radiation, and respiration are limited Etiology [medical-dictionary.thefreedictionary.com]

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]

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 to a significant [emdocs.net]

The pathophysiologic response to hypothermia is outlined in Table 3 (1-6). [crashingpatient.com]

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]