Monday Medical: Hypothermia

Never as funny IRL as this looks.

Hypothermia is technically anytime your body's core temperature is below 95° F.

Last week, Southern Califrutopia had its first "cool" day of the season. Cool is a relative term.

Hereabouts, it means shorts and a T-shirt aren't cutting it. We only visit snow in the mountains, we don't live in it, and our snow blower is called "the Sun". For some of you in other hardier places, our cool temp would be what you call "summer". YMMV. The greater lessons still apply.

Nonetheless, it wasn't that cold, even here. But my patient was over 60. Strike One. (Big risk factor. Older people, just like kids, don't cope well with thermoregulation, both having less muscle mass to generate heat, and a wonky temp control system. One because it's new, the other because it's worn out and old.)

And it was a perfect day for hypothermia. Low 50s. Overcast, hazy sunshine. Breezy, occasional drizzle. Strike Two.

Because on really cold-@$$ days, (and as I said, that is whatever it is to you, in your area) you bundle up. But 50s is just right for thinking, "Hey, it's just brisk, and I'll be working, not sitting, so I don't need to layer up."

My guy spent the day doing yard work. Six hours non-stop. In a sweatshirt.

Strike Three.

Kids, write this on your hand with a laundry pen: 

Cotton KILLS.

And I mean literally. It holds wet, and keeps it right next to the skin, on days when it's too cold to evaporate and dry off. Great in the desert in summer, but catastrophic for a wet day in fall or winter.

At 32° F., all that moisture next to your skin will freeze, wrapping you in a sheet of ice.

And. Then. You. Will. Die.

Deader-than-canned-tuna dead.

Frostbitten solid frozen toes and fingers and hands and feet and nose and ears dead. 

 Don't believe me. Wrap yourself in a bath sheet or beach towel, and soak it with cold water. Now go stand outside on a windy fall/winter day. 

(Please, come back in before you die, but after the point is driven well home.)

Silk, wool, and high-tech synthetics - like good old fleece - are all a hundred times better (or more) than a soaked cotton t-shirt and faux flannel shirt, plus soaking wet cotton jeans (that feel like frozen iron sheets), all made of 100% cotton.

No points for guessing of what 100% of my guy's sweatshirt was made.

Then, after he was worked out, sweaty, and already more chilled, he came in.

It felt hot inside (because he was part popsicled already). And because it was 20° warmer inside than out. But his internal thermostat was already out of whack. Strike Four.

So, in a genius move, he peeled off his sweatshirt (which had, indeed, become sweaty), and sat in front of a fan to cool off! Strike Five.

Which worked.

He rapidly cooled an already chilly body, after burning most of his calories, and was now sitting inside a cool room which took him to the near border of early hypothermia. Strike Six.

Oh, BTW, that 95° F. body core temp number?

Like scuba diving tables, that was determined by Uncle Sugar's best medical experts, based on the physiological responses of young, fit healthy studs in the Navy SEALs, Army Rangers, etc., with 5% body fat, and resting pulse rates in the 40s and 50s, not by testing the effects on out-of-shape 50+ sedentary adults. So for most people, you can throw that 95° number right out the window, unless you're in BUD/S now, waiting to start Hell Week.

This I where the family's common sense accidentally-on-purpose saved a life. Suddenly Paps was feeling weak, thinking fuzzy, not acting right, couldn't stand, and just didn't seem to be himself.

So they called 9-1-1. They knew something was wrong, just not what, exactly.

To arriving medics, given his age and chief complaints, he could have been a cardiac problem, like a heart attack, or a stroke. That's what they thought they had. Great guesses. But not really the problem.

When he got to me, he was shivering uncontrollably, on and off.

So badly that we couldn't get a temperature under the tongue.

Forehead and ear temps are really more like skin temps, not core temps, most of the time, and this was too big to risk on unreliable methods

Time for the tailpipe temperature: one red thermometer, inserted into the exit.

That's a core temp.

He had severe cardiac arrhythmia (really funky heartbeats), low blood pressure, lack of coordination, confusion, weakness, and moderate near-continuous shivering.

His magic number, on arrival at the E.D.: 96.5° F.

Technically, not the magic less-than-95°-F. number that equals hypothermia.

Reality: given his age, physical condition, and symptoms, he was already well into moderate hypothermia.

We put him in a Bair Hugger. It's like a giant hot blow dryer that attaches to a big air mattress quilt, on top of which you pile a layer or two of warm blankets. Think of it as human air fryer, and you're on the right track. After we peeled him out of everything wet , and left him with just a flimsy (but clean and dry) cotton hospital gown. Within two hours, we'd brought him up to more than 98° measured orally, because he was no longer shivering uncontrollably.

Weakness: gone.

Shivering: gone.

Cardiac arrhythmia: gone.

Confusion: gone.

Blood pressure: normal.

Problem solved.

Wherever you live, environmental concerns are a problem, and unless you're Down Under in Oz now, it's approaching winter, so cold is the default environment.

Zero degrees with a -40 wind chill is bad, but you can get into trouble being just a little wet, a little old, a little out of shape, and a little under-protected.

{BTW, other risk factors are diabetes, thyroid problems, alcohol consumption, other substance/drug use, some Rx medications, and severe trauma. Strike 7, 8, 9, 10, 11,12, if you're keeping score at home.} 

 

Hypothermia creeps up on people, and they don't notice.

Shivering is an early sign.

Later, you stop shivering, because the internal thermostat in your head is fried, and you're freezing.

You're confused, sounding slurred (as if you were drunk), you're tired, drowsy, can't remember things, and uncoordinated.

You think you're warm or hot, so you start taking warm clothes off.

Your pulse slows, you may pass out, and you feel very cold.

Think Mumbling, Fumbling, Bumbling, Stumbling, and Tumbling.

And if someone doesn't intervene, you'll die, feeling warm and fuzzy on the inside, and being a frozen meat popsicle in reality. Like Jack, in that pic up top.

The treatment is simple: REWARM, rapidly. Get them out of the weather, out of wet clothes, and warm them, inside and out. Hot food, hot drinks, and anything else that you can use, will keep from turning a mild problem (frequently mistaken for other things) into a life-threatening one.

Cody Lundin (the hippy dippy barefoot dude co-starring in Dual Survival all these years, entitled his first survival book 98.6 Degrees - The Art Of Keeping Your @$$ Alive. He's a subject matter expert; it really is that simple. And that hard.

Layer clothes.

 

Dress warm enough to stay warm and feel warm, but not enough to sweat.

COTTON KILLS. Ditch it. Silk, wool or high-speed synthetics are the way to go.

Wear a hat! 90% of body heat is lost through the skin, and most of that right out your bare head.

Conduction sucks. If you sit on the ground put something between you and cold ground, rocks, snow, etc. (Duh.)

Stay well-hydrated. With WATER, not booze. Caffeine is a diuretic (makes you pee) too, and will dehydrate you. Go for hot, sugary drinks. Without caffeine.

EAT, bubbe. Food makes calories, which you need to generate body heat and muscle movement. Young  healthy military troops in cold weather burn twice the calories you do sitting in a cubicle, and even at 5000/day, they - and you - will still lose weight over time working hard in the cold.

Hot food, high in carbs, protein, and even fat, is healthy in cold weather. Fat has twice the calories of carbs or protein, and you need fat to stay alive at cold temps. Butter, mayo, guac, nuts, nut butter, etc., are all your cold-weather friends.

Like batteries, the heart gets wonky when you're cold. It's fragile, and prone to weird rhythms. Which can turn into cardiac arrest. Handle cold people gently. If the pulse stops, CPR starts.

Warm the core first, then the limbs.

I you see something, do something. The longer you wait, the worse it gets, and the harder it is to fix.

Anything from to bodies in a sleeping bag to building a bonfire, to dunking them in a tub of really warm water or a jacuzzi, can work. Use what you've got, and right away.

Stay frosty, but don't freeze your @$$ off.

That concludes your hypothermia briefing. In six months or so, we'll talk about heat emergencies.