Hypothermia- Cold that Kills

Winter weather can be hard, especially in very cold climates.  In geographical locations where the temperatures tend to dip below freezing in the winter, the elderly are at high risk for getting hypothermia if they don’t take the proper precautions.  Hypothermia is a serious medical condition that can be fatal if not treated quickly and properly.

Hypothermia Causes:

Adults can develop hypothermia if they are exposed to cold temperatures for too long.  A person is considered to have hypothermia when their core body temperature falls below 95 degrees.  This can happen outdoors or even indoors if the home is not properly heated.  Children and people with diabetes, thyroid conditions, or who are on certain medication can be at an even higher risk for hypothermia.

Hypothermia Symptoms:

Hypothermia can cause confusion, drowsiness, slurred speech, a weak pulse, slow, shallow breathing, and even unconsciousness.  If these symptoms appear in a patient or an elderly adult, it is important that they be taken to the emergency room immediately as hypothermia can be fatal if left untreated.

Signs and symptoms of hypothermia include:
Symptoms Shivering is likely the first thing you’ll notice as the temperature starts to drop because it’s your body’s automatic defense against cold temperature — an attempt to warm itself.

  •  Shivering
  • Slurred speech or mumbling
  • Slow, shallow breathing
  • Weak pulse
  • Clumsiness or lack of coordination
  • Drowsiness or very low energy
  • Confusion or memory loss
  • Loss of consciousness
  • Bright red, cold skin (in infants)

Someone with hypothermia usually isn’t aware of his or her condition because the symptoms often begin gradually. Also, the confused thinking associated with hypothermia prevents self-awareness. The confused thinking can also lead to risk-taking behavior.

Hypothermia Treatment:

A person suspected of having hypothermia should be moved to a warm environment as soon as possible.  If a person suspected of having hypothermia is unconscious, it should be treated as an emergency.  Caregivers should call 911 and begin CPR.  When an elderly adult is brought to the hospital with hypothermia, the hospital staff may give the patient warmed IV fluids and oxygen.

Call 911 or your local emergency number if you suspect someone has hypothermia.

While you wait for emergency help to arrive, gently move the person inside if possible. Jarring movements can trigger dangerous irregular heartbeats. Carefully remove his or her wet clothing, replacing it with warm, dry coats or blankets.

Hypothermia Prevention:

No one should have to suffer from hypothermia.  Children and the elderly are particularly at risk. Caregivers should be vigilant about keeping the elderly adults under their care warm and protected during the winter months.  When temperatures are below freezing and there is a very low wind chill, elderly adults should stay indoors.  If they must go out, they should dress in layers, wear hats and gloves, and limit their time outside.  It is possible for elderly adults to get hypothermia even while they’re indoors if the home is not properly heated.  Caregivers should make sure the heat is regulated in the home and stays at a warm and comfortable temperature.  There are government programs available that can provide some assistance for home heating.

 

Hypothermia Prevention

Before you or your children step out into cold air, remember the advice that follows with the simple acronym COLD — cover, overexertion, layers, dry:

  • Cover. Wear a hat or other protective covering to prevent body heat from escaping from your head, face and neck. Cover your hands with mittens instead of gloves.
  • Overexertion. Avoid activities that would cause you to sweat a lot. The combination of wet clothing and cold weather can cause you to lose body heat more quickly.
  • Layers. Wear loose fitting, layered, lightweight clothing. Outer clothing made of tightly woven, water-repellent material is best for wind protection. Wool, silk or polypropylene inner layers hold body heat better than cotton does.
  • Dry. Stay as dry as possible. Get out of wet clothing as soon as possible. Be especially careful to keep your hands and feet dry, as it’s easy for snow to get into mittens and boots.

Keeping children safe from the cold

To help prevent hypothermia when children are outside in the winter:

  • Dress infants and young children in one more layer than an adult would wear in the same conditions.
  • Bring children indoors if they start shivering — that’s the first sign that hypothermia is starting.
  • Have children come inside frequently to warm themselves when they’re playing outside.
  • Don’t let babies sleep in a cold room.

Hypothermia Risk factors

  • Exhaustion. Your tolerance for cold diminishes when you are fatigued.
  • Older age. The body’s ability to regulate temperature and to sense cold may lessen with age. And some older adults may not be able to communicate when they are cold or to move to a warm location if they do feel cold.
  • Very young age. Children lose heat faster than adults do. Children may also ignore the cold because they’re having too much fun to think about it. And they may not have the judgment to dress properly in cold weather or to get out of the cold when they should.
  • Mental problems. People with a mental illness, dementia or other conditions that interfere with judgment may not dress appropriately for the weather or understand the risk of cold weather. People with dementia may wander from home or get lost easily, making them more likely to be stranded outside in cold or wet weather.
  • Alcohol and drug use. Alcohol may make your body feel warm inside, but it causes your blood vessels to expand, resulting in more rapid heat loss from the surface of your skin. The body’s natural shivering response is diminished in people who’ve been drinking alcohol. In addition, the use of alcohol or recreational drugs can affect your judgment about the need to get inside or wear warm clothes in cold weather conditions. If a person is intoxicated and passes out in cold weather, he or she is likely to develop hypothermia.
  • Certain medical conditions. Some health disorders affect your body’s ability to regulate body temperature. Examples include an underactive thyroid (hypothyroidism), poor nutrition or anorexia nervosa, diabetes, stroke, severe arthritis, Parkinson’s disease, trauma, and spinal cord injuries.
  • Medications. Some drugs can change the body’s ability to regulate its temperature. Examples include certain antidepressants, antipsychotics, narcotic pain medications and sedatives.

Hypothermia Treatments

What is the treatment for hypothermia?

For severe cases of hypothermia, treatment begins immediately in the field by careful handling of the patient to avoid developing ventricular fibrillation or any other cardiac dysrhythmia that hypothermic patients are prone to develop. Place the patient in an environment that is warm; remove all wet clothing and replace it with dry towels and blankets or sleeping bags. Simultaneously, be aware that the patient may have suffered other problems, like trauma and these problems may also need immediate attention (respiratory and/or cardiac failure).

External rewarming can begin prior to hospital arrival with warm packs (warm water bottles, warm chemical packs) placed on the person’s armpits, groin, and abdomen. Be sure the warm packs (about 105.8 F or 41 C) are not hot to avoid skin burns. Do not attempt to warm extremities by rubbing them.

Core temperatures should be measured by a rectal, bladder, or esophageal thermometer. Do not use tympanic or skin thermometers. Hypothermic induced dysrhythmias have been treated with bretylium, but this drug may not be available as it is no longer being manufactured.

After warming has begun with dry coverings, most guidelines recommend using warm humidified oxygen and heated intravenous saline (heated to about 113 F or 45 C) as additional treatments. In severe cases of hypothermia others also suggest instilling warm fluid into the patient’s bladder. Thoracic lavage (flushing the thoracic [chest] region with warm water) with isotonic saline (pre-warmed to about 105.8 F or 41 C) has also been done.

Patients with mild to moderate hypothermia (95 F to 89.9 F or 35 C to 32.16 C) and no other injuries or problems require less drastic methods to rewarm. Patients whose body temperature normalizes by gradually rewarming in a warm, dry room with towels and blankets, usually do not need admission to the hospital. However, those with more severe hypothermia may need to be observed in the hospital.

Ideally, treatment will allow the body to return to its normal temperature. At normal temperature, the symptoms of hypothermia should gradually disappear. Consequently, the saying in most emergency departments that treat hypothermic patients is that “the hypothermic patient is not dead until they are warm and dead.”

Be Prepared

Preventing hypothermia is possible.

  • Before participating in any cold-weather activities make sure that you are in good physical condition and have the right clothing and nutrition before engaging in such activities.
  • If you go camping or hiking in cold-weather, travel with a partner for safety and let people know where you are going.
  • Multiple layers of clothing that are loose fitting and tend to remain dry are the best for cold-weather activities. Note that rain and wind can markedly increase the rate of heat loss from the body, so if these conditions develop, you need to be prepared to stay warm and dry.
  • For individuals that have a higher risk for hypothermia (elderly and young children, for example), during wintry weather, keep homes heated to about 21.1 C (70 F), especially in the bedrooms at night.

Prognosis

What is the prognosis for hypothermia?

If the person with mild hypothermia is treated quickly, does not require hospitalization, and has little or no residual problems, the prognosis is usually very good. However, some patients may suffer from extremity damage due to frostbite while others may be more prone to develop hypothermia in the future. People that have concurrent problems (alcoholism, psychiatric problems, advanced age or are homeless) have a worse prognosis. They may have mortality rate as high as about 40%.