Hypothermia Of The Body: First Aid And Consequences

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Hypothermia: what to do?

A decrease in body temperature to a level that is dangerous to life and health is called hypothermia. It mainly develops as a result of exposure to negative temperatures after being in the cold without the protection provided by warm clothing. Hypothermia can occur in any person when a number of negative factors coincide.

Before hypothermia of its own nucleus (heart and blood vessels), the human body attempts to rectify the situation: trembling occurs, signals are sent to the brain. After the body temperature drops to a critical level, the metabolic rate drops sharply, the life support of organs stops, without which a person can temporarily exist. If the danger of hypothermia persists for more than two hours in a row (in severe frost, this period is significantly reduced), as well as for those who suffer from a serious illness or from blood loss, the chances of a successful outcome are small. A frozen person feels very tired, and if he falls, he will no longer be able to rise.

Lack of help is not a prerequisite for death from hypothermia - while the body is in a state of suspended animation, there is a chance of salvation. If we use the wrong tactics of warming, then, oddly enough, it can much more quickly lead a frozen person to death.

Content:

• 13 facts about hypothermia
• Causes of hypothermia
• Symptoms and degrees of hypothermia
• First aid for hypothermia
• Treatment of hypothermia in the hospital
• Possible complications
• Hypothermia in children
• Preventive measures

13 facts about hypothermia

Important facts about hypothermia:

1. It is not necessary to be exposed to frost at -30 ° to get hypothermia. Even a positive temperature below + 10 ° can become fatal if you stay outdoors in wet clothes for a long time, undergo chemotherapy or radiation before that, and also lose more than 0.7 liters of blood.
2. In a state of intoxication, people are most often exposed to hypothermia.
3. The body temperature is regulated by the hypothalamus - the main gland of the human endocrine system.
4. In addition to the hypothalamus, the spinal cord is responsible for thermoregulation, as well as the medulla oblongata and midbrain located in the final part of the brain. If their functions are impaired as a result of any pathology, hypothermia can occur much faster even at positive air temperatures.
5. Staying motionless in frost at -35 ° is accompanied by a decrease in body temperature by 1 ° every half hour.
6. If apathy occurs, unwillingness to go in search of help, it means that the body temperature has dropped to 32.9 °.
7. If there is stiffness in the joints, the movements of the limbs are limited, therefore, the body temperature dropped below 32.2 °.

8. Upon reaching the level of 31.1 °, trembling disappears, with the help of which the body increases the amount of heat produced by 2 times. However, at this stage, even such a waste of energy is unjustified.
9. If a freezing person falls, having lost his last strength, he usually does not remember anything from that moment, because the body cuts off the parts of the cerebral cortex responsible for memory from saving.
10. Hypothermia is extremely dangerous for children from 1 month to 6 years old, because their thermoregulatory system is not yet perfect.
11. Hypothermia is not as dangerous for newborns as it is for adults, although they do not experience tremors. As a defense, the body uses brown adipose tissue, which is available in excess of the infant for up to 28 days. It is located in the projection of the shoulders, back, neck, and surrounds the kidneys.
12. A small amount of brown adipose tissue is present in an adult, it produces heat in emergency cases. This tissue forms during intense physical exertion.
13. If the freezing person experiences a sensation of heat, he is close to agony and death.

If the body temperature reaches 24 °, irreversible changes have occurred in the body. However, during open heart surgery, the patient's temperature is artificially reduced to 20 ° for a short time in order to be able to perform surgical manipulations within 17 minutes with the heart-lung machine turned off.

Measures taken by the body to adapt to hypothermia:

• Tremors due to muscle contraction - increases the amount of heat in the human body several times, raises the temperature of the contracting muscle by 2 °. Exercise increases heat generation 2-2.5 times more intense than tremors.
• Increase in the amount of energy required for the operation of the main thermoregulatory body. The main burden associated with life support processes falls on the thyroid gland, therefore, in people with a history of hypothyroidism, hypothermia occurs much faster;
• Energy expenditure of lipid tissue (overweight people are less likely to suffer from hypothermia);
• Acceleration of metabolism in the liver, leading to an increase in the amount of energy for the life support of the body;
• Increased heart rate, resulting in increased heat
• Inclusion in the processes of life support of areas of the renal and brain tissue;
• Decrease in the area of contact of the body surface with the environment (rolling into a "ball");
• Deterioration of blood supply to the skin, muscles of the extremities, subcutaneous tissue, sweat glands, which increase the evaporation of heat;
• Reducing the frequency of breathing movements that waste heat;

• Atavism in the form of "goose bumps", "goose bumps", a kind of "rearing the fur", the purpose of which is to create a layer of warm air around the body.

Causes of hypothermia

Hypothermia causes:

• Negative air temperature;
• High humidity;
• High wind speed (at 5 m / s, heat evaporates from the skin 2 times faster, at 10 m / s - 4 times);
• Out of season clothes, refusal to wear hats, gloves;
• Shoes are out of size, or made of rubber, or too thin soles;
• Wearing synthetic clothing in the cold season;
• Prolonged immobility in the open air;
• Intoxication, in which the blood vessels are dilated, due to which the warm blood coming from the heart quickly cools at the periphery, and then cools the heart and internal organs, moreover, the reactions of the central nervous system are slowed down, and a drunk person can fall asleep in the open air and not wake up …

Factors that increase the risk of hypothermia:

• Following a strict and unbalanced diet;
• Deficiency of vitamins in the diet;
• Chronic overwork;
• Long-term stress;
• Constantly reduced pressure;
• Long-term current somatic or infectious disease leading to exhaustion, lack of adipose and muscle tissue;
• History of heart failure, as blood thickens in the cold and it is difficult for the heart to pump it;
• The presence of cancer;
• Insufficiency of the adrenal glands (Addison's disease), one of the symptoms of which is low blood pressure, which reduces the rate of blood circulation;
• HIV infection;
• Hypothyroidism, due to which the activity of the thyroid gland, which is responsible for maintaining normal body temperature, is reduced;
• Liver cirrhosis, in which the functional tissue of the organ is replaced by fibrous fibers;
• Acute and sudden loss of blood, to which the body does not have time to develop a compensatory response;
• Traumatic brain injury with loss of consciousness.

Symptoms and degrees of hypothermia

The clinical picture of hypothermia depends on body temperature. At 36.0-36.1 °, the muscles are tense, ready for tremors, contributing to the replenishment of heat reserves. A plan of salvation is formed in a clear consciousness, and a person prepares to implement it, he has a fear of freezing. This stage is not yet hypothermia, but early rewarming is already necessary.

When cooled to 35 °, panic seizes a person, tremors appear throughout the body. Muscles lose flexibility and obedience, knees barely bend, arms stiffen. After rewarming, this muscle tension causes pain. This stage is not yet hypothermic.

At stage 2, the muscles stiffen, harden, pain occurs due to overstimulation of the nerve endings. While this stage has not yet arisen, a person possessed by panic fear tries to escape and get to warmth. As long as he has not yet fallen, and the clothes are not soaked with sweat and remain tight, the freezing person has a chance to survive.

There are four degrees of hypothermia:

• 1 degree. At the dynamic stage, the body temperature is reduced to 34-32 °. A person becomes covered with "goose bumps", vasospasm makes it pale. Movement slows down, limbs bend poorly. Respiration and heart rate decreases, blood pressure drops. Clarity of consciousness is lost, a person commits illogical actions. Panic is replaced by indifference and fatigue.
• 2nd degree. At the stage of stupor, the body temperature drops to 29 °. The trembling stops, drowsiness sets in. The heart rate drops to 50 beats per minute, arrhythmia appears, and it is difficult for the heart to pump thickened blood. Movements are impossible, consciousness is clouded, hallucinations appear. The kidneys work, but with tremendous stress, because all the blood is in the central vessels, the peripheral vessels are empty. Possibly uncontrolled urination, which aggravates the severity of the situation. At a temperature of 29.4 °, a sensation of heat appears, when it seems to a person that he is being warmed, and he begins to undress. This is the so-called "paradoxical stripping".
• 3 degree. The body temperature drops to 25 °, there is a sudden clarification of consciousness, and then it fades away. With a superficial coma, there is almost no reaction to pain stimuli, the eyes are closed. The heart rate is about 40 beats per minute, the breathing is shallow, the skin is cyanotic, edematous. Vomiting is fixed, convulsions may occur.
• 4 degree. The convulsive stage is considered irreversible, although there are examples when people survived even after the body temperature dropped to 16 °. Symptoms of the fourth stage are a drop in temperature below 24 °, depletion of the body's defense mechanisms. The skin is waxy, blue-yellow, the body and limbs are difficult to straighten, periodically there is a strong convulsion. A deep coma is expressed in the absence of a reaction to an appeal to a freezing person, slapping him on the cheeks. The pupils are dilated, breathing is rare and irregular. The heart rate is 20-25 beats per minute.

First aid for hypothermia

In case of slight hypothermia of the child after a winter walk, when his limbs are cold, but he does not worry and retains his appetite, rewarming occurs in the following sequence:

• Warm water is collected in the bath (37-38 °);
• Cold clothes are removed from the child, covered with a blanket.
• Rub the body and limbs under the blanket with warm hands.
• Suggest a warm drink or formula.
• They put the baby in warm water for 20 minutes.
• They wipe dry, put on warm clothes not for the child.

Likewise, you can keep older children and adults warm.

First aid rules in severe cases:

• Warming should be carried out gradually, because with rapid warming, blood from the brain rushes into the suddenly expanded capillaries, and it ceases to be supplied with blood due to a sharp decrease in pressure.
• Help for a frozen person begins to be provided, even if there are no signs of life, because the slowdown of chemical reactions from cold can show the death of a person, although he is still alive.

First aid algorithm:

• Take off wet clothes, remove snow and ice from the body.
• Call for emergency assistance, specifying the reason for the call.
• Wrap the person who is freezing in a warm blanket, put on a hat and mittens.
• When moving a person into the room, do not unbend his body, bent into the embryo position.
• If you experience convulsions, insert a small cloth roller into your mouth that does not block breathing.
• In the absence of a pulse, perform an indirect heart massage and artificial respiration - alternating 30 pressing on the chest with 2 breaths into the mouth or nose of the resuscitated person.
• If possible, measure body temperature by rectal method.
• Do not feed or water the victim to avoid intestinal ischemia.
• With slight hypothermia, give warm tea, broth, water to drink.
• The victim, who is conscious, is placed on the area of large vessels with bottles of warm water.
• Do not place a frozen person in a very hot bath to avoid shock due to a sharp expansion of the capillaries.

Prohibited procedures for acute hypothermia:

• Straightening bent joints with sharp movements;
• Rubbing with snow, only massage with warm hands is allowed;
• Pouring hot liquid into the mouth of an unconscious person, as well as trying to give the victim alcohol;
• Pouring hot water or placing in a hot bath.

Treatment of hypothermia in the hospital

Of course, a person with signs of hypothermia, found unconscious and with minimal signs of life, should be sent to the hospital.

There are other compelling reasons for hospitalization for hypothermia:

• Hypothermia of a child or elderly person;
• Determination of arrhythmic pulse;
• The presence of signs of frostbite of any, even minimal degree, especially if there is a history of diabetes mellitus, obliterating endarteritis, trophic ulcers, atherosclerosis of the lower extremities;
• Marked 2-4 stage of hypothermia;

Algorithm for providing medical care:

• A person suffering from hypothermia is placed on a mattress filled with warm water.
• Solutions warmed to 37 ° C or slightly higher are injected intravenously.
• To ensure full breathing, patients are given a mask with humidified oxygen, if they are unconscious, they are injected into a therapeutic sleep with an injection of Sibazon and sodium oxybutyrate, then they are transferred to artificial respiration using a forced ventilation apparatus.
• Defibrillation is performed according to indications.
• A mandatory measure in restoring the patient's vital activity in the 3 stages of hypothermia is to connect him to a heart-lung machine, which increases the body temperature by 1 ° every 3 minutes. In difficult cases, an operation is performed to rinse the internal organs with warm saline.
• The introduction of drugs that stimulate cardiac activity.
• Installation of an artificial pacemaker that provides ventricular defibrillation.
• Prevention of vascular spasm by the administration of antispasmodics after the restoration of the heart rhythm.
• The introduction of painkillers when pain occurs after frostbite and vasospasm.
• Stimulation of heart nutrition with vitamins and antihistamines.

After the frozen person arrives at the hospital, doctors use an electronic sensor placed in the rectum to monitor body temperature. Its decrease in the first time after warming a person is considered the norm, because cold skin and subcutaneous tissue cool the entire body and internal organs. With the correct introduction of warm saline, the body temperature rises by 1 ° every 15 minutes.

At the same time, heart rate, blood pressure, and respiratory rate are monitored. For this, an EKG is performed or a cardiac monitor is installed to monitor the heart rate.

Possible complications

Hypothermia leads to very serious consequences:

• Frostbite of limbs and other parts of the body;
• Pneumonia;
• Influenza, ARVI;
• ENT diseases;
• Aggravation of existing somatic pathologies.

Death as a result of hypothermia can occur from excessively rapid warming, ventricular fibrillation, cardiac arrest, frostbite of the extremities in the last stage.

It may not be hypothermia of the whole body, but hypothermia of its individual parts or organs. With hypothermia of the head, vasospasm occurs, leading to headaches and dizziness. A course of therapeutic treatment is required.

Consequences of hypothermia of the head:

• Meningitis:
• ARVI;
• Inflammation of the sinuses;
• Aggravation of the course of hypertension;
• Hearing impairment due to inflammation of the inner ear;
• Inflammation of the trigeminal or facial nerve.

Complications due to hypothermia of the legs:

• Adnexitis;
• Cystitis;
• Pyelonephritis;
• Articular pathologies;
• Frostbite of the extremities;
• Colds.

With hypothermia of the lower back, radiculitis, inflammation of the kidney tissue, and prostatitis can develop. Hypothermia of the trigeminal nerve and its branches, innervating the teeth, leads to an inflammatory process, accompanied by a very strong twitching pain. In case of complications of this process, physiotherapeutic treatment and therapy with painkillers under the guidance of a neuropathologist are required.

Overcooling of the tooth leads to the appearance of granulomas - capsules with pus on the root. Its symptoms are gum swelling and redness. The disease requires the help of a dentist.

Hypothermia in children

Hypothermia does not always develop in children after being outdoors in insufficiently warm clothes.

Causes of hypothermia in childhood:

• Delay in changing wet diapers;
• Low air temperature in the room despite the fact that the child is not dressed warmly enough;
• Bathing your baby in cold water;
• Prolonged exposure to air in cold and humid weather.

In a private home, a child can be left unattended and go out into the street. The likelihood of hypothermia increases in children suffering from anemia and rickets, as well as in insufficiently and monotonously eating babies.

Symptoms of hypothermia in children:

• Weakness, drowsiness;
• Rapid breathing and tachycardia;
• Low skin temperature;
• Atypical behavior - silence, excessive calmness in a previously active child.

Up to 3 years of age, children do not have muscle tremors as a reaction to hypothermia. Important measures to save a hypothermic child are wrapping him up, calling emergency help, changing clothes, applying heating pads from small plastic bottles to large vessels.

Preventive measures

Basic rules for the prevention of hypothermia:

• Outerwear should be warm and dry, it is better if it is made of fur and natural fabrics.
• Dress according to the weather, wearing a hat and gloves.
• It is better not to drink alcohol in the cold season.
• The skin on the hands and face during frost should be protected with a fat cream.
• Shoes should not be tight, it is better if they are not rubber. If you have to wear rubber boots in rainy weather, you should put a fleece or wool lining in them.
• The sole of shoes for winter and autumn wear should not be thinner than 1 cm.
• It is undesirable to carry carry-on luggage for a considerable distance during the cold; when the first signs of hypothermia appear, you should go to a cafe or store in order to warm up.
• When traveling by car alone, it is advisable to inform family and friends of the route and approximate time of arrival.
• When driving off-road, it is better not to turn off the road, not to travel alone in winter.
• If you get into skids on the road, it is better not to leave the car until help arrives, if the settlement is far away.
• Before going out in winter, you should eat a good meal.
• It is advisable not to wear earrings and rings in cold weather; you cannot walk in cool weather with wet hair.
• To keep warm in the cold air, you can squat, run in place, and walk quickly.
• If you're cold, don't be shy about asking other people for help.

The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist

Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.