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Low Temperature (Hypothermia)

 

<!--<h1>Low Temperature (Hypothermia)</h1>--> Besides exposure to cold, including submersion, other causes or risk factors for hypothermia are sepsis, particularly in the elderly, endocrine insufficiencies such as hypothyroidism, hypoadrenalisms, hypopituitarism, hypoglycemia, as well as ethanol, sedative-hypnotics, opioids and drugs of abuse, blunting the awareness of temperature. <br><br> Hypothermia is a core temperature of 95F (35C) or less (some use 96F/35.6C or less). As the body temperature declines, efforts to increase the temperature are activated: shivering, increased activity and vasoconstriction occur. As the temperature falls, these compensatory measures fail. At 90F (32.2C) metabolism slows and the mental status/level of consciousness is affected. Shivering ceases at 86F (30C). Below this, cardiac arrhythmias may occur. At 80F (26.7C) respiratory and heart rates slow, blood pressure falls and consciousness is lost. Successful rewarming may occur even with a core temperature of 75F (24C). <br><br> The thermometer must read low. Most glass thermometers read to 94F (34.6C). Electronic thermometers, on the other hand, read to 84F (28.9C). A rectal or tympanic temperature is necessary for a core reading. A lowreading rectal probe is part of many rewarming mattress devices (i.e., K-thermia). The machine records the rectal temperature, and the rewarmer is set to the required temperature. <br><br> Treatment depends on the degree of hypothermia. Mild cases (90-95F/32-35C) respond to rewarming with rewarming blankets. More severe cases (less than 86F/30C) may require combinations of the ABCs of resuscitation (Fig. 8.15), warm IV fluids heated to 104F (40C), heated humidified oxygen, and peritoneal, gastric and bladder lavage (also heated to 104F (40C). <br><br> Pulseless nonbreathing hypothermic patients should be resuscitated while rewarmed. Even though a person appears lifeless, rewarming may result in complete recovery. Recovery has been documented in cases of hypothermic cardiac arrest for 3 hours and in cold water submersion for 40 minutes. <br><br> Resuscitative measures should be undertaken until the core temperature is 90F. Death in hypothermia is failure to revive after rewarming. <br> Certain aspects of cold injury (local hypothermia) may accompany hypothermia. <br><br> Chilblain is exposure of a body part (nose, fingers, toes) to above-freezing cold, causing itchy lesions. Treatment is warming at room temperature. <br><br> Frostbite, on the other hand, is tissue damage from freezing cold. With a severe wind-chill, even exposure for a few minutes may produce white insensitive areas of skin. The degree of frostbite is comparable to the degree of a burn (first degree, second degree, etc.). Treatment is rewarming of the body part in hot water (about 104F/40C) for about 20 minutes.

 


 
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