How to Treat Hypothermia

1
When Cold is Too Cold

man jumping into icy water
Cold and wet is worse than cold and dry. Ty Milford / Getty Images

Humans are amazingly resilient and have the ability to handle a wide range of environments. That being said, there are limits to how hot or how cold we can stay—or for how long we can endure. For a while, we can tolerate temperatures that are out of our comfort range, but eventually—even when it doesn't seem to be that cold—our ability to compensate fails and our core temperature begins to fall.

Once you learn how to recognize hypothermia, we'll talk about the two steps to treat it. The process is simple:

  1. Take away the cold (how to do that here)
  2. Add heat (how to do that here)

Officially, hypothermia is defined as a core body temperature of less than 95 degrees Fahrenheit, but that doesn't tell the whole story. There is a sliding scale of severity that a patient goes through as hypothermia progresses from mild to severe and, eventually, to death.

There is one very big complication if the patient is severely cold and has suffered cardiac arrest. In that case, treatment—CPR—has to be started first and continued. It doesn't change the other two steps. The patient will still need to be removed from the cold and warmed while CPR continues.

The next slide shows you how to recognize hypothermia, both in the most minor patients as well as in severe, life-threatening cases.

2
Signs and Symptoms

cold man standing outside
Shivering is the first sign of hypothermia. Hero Images / Getty Images

Hypothermia happens when the core body temperature—the temperature of the organs and blood in the center of the body, not the skin—dips below 95 degrees Fahrenheit.

Almost everyone has experienced the mildest form of hypothermia. It starts with shivering, "chills" and loss of fine motor skills (meaning that you have fumbling fingers: a hard time doing things like signing your name or opening packages). Shivering comes from burning fuel (blood sugar) to create heat. Usually, we burn fuel for energy to make our muscles move and heat is the byproduct. When we're cold, we burn fuel to get the heat and energy is the byproduct. We move our muscles involuntarily (shiver) to get rid of the energy.

Most of the time, we don't stay exposed to the cold long enough to progress to more severe hypothermia; either we put on our coats or go inside. If we didn't, here's what to expect in generally this order:

  • fatigue
  • shivering stops to conserve energy
  • slurred speech
  • confusion
  • loss of consciousness

Some cold exposures are worse than others. Wet patients lose body heat much faster than dry patients. Wind carries heat away faster than still air does.

Treatment for hypothermia is always the same two steps: remove the cold and add heat. How we apply those steps depends on how severe the hypothermia has become. On the next two slides, you'll see how to handle each step depending on how the patient looks.

3
Step 1: Remove the Cold

Boy wrapped in a space blanket
Space blankets are one option to keep the cold out. Science Photo Library / Getty Images

Stay Safe! If it is cold enough to cause hypothermia for the patient, it's cold enough to cause hypothermia in the rescuers.

Before you can do anything to begin warming the patient, you have to stop the loss of heat. Hypothermia happens because the body has lost its ability to compensate for the cold environment. You won't get very far trying to warm the patient until you block the cold.

IMPORTANT: If the patient is unconscious and not responding, make sure he or she is breathing. If not, begin CPR. Continue to perform CPR through the rest of the treatment, even while warming the patient (next slide).

Remove the cold by stopping the exposure. Remove wet clothing. Leave dry clothing on the patient. If you can, move the patient to warm, dry shelter.

Call 911 for patients that show signs of severe hypothermia:

  • slurred speech
  • confusion
  • unconsciousness

Wrap the patient with blankets. Space blankets (they look like tin foil) work well to reflect body heat back into the patient. However, nothing beats a nice down comforter or an electric blanket to keep you warm and toasty.

Blankets bridge the gap between stopping the cold and adding heat. The next slide takes you through the process of warming a hypothermic patient and the complications that come with severe hypothermia cases.

4
Step 2: Add Heat

hot cocoa
Hot cocoa is a good option for mild hypothermia. Annabelle Breakey / Getty Images

Warming a hypothermic patient depends on the severity of the hypothermia. Mild hypothermia patients who are able to follow directions and sit upright may drink warm, non-alcoholic beverages while snuggled up to the fireplace and wrapped in blankets. Coffee, tea or hot cocoa are all fine. Alcohol is forbidden because it actually cools you down (see this article on how that happens).

Severe cases of hypothermia need medical attention. Severely hypothermic patients (typically those who are unconscious) may get worse as warming is initiated. As the cold blood in the extremities begins to flow back toward the heart, the patient's core body temperature may go lower for a few minutes. Be alert for a change in the patient's condition, including the possibility of cardiac arrest.

If you are in a situation that forces you to try to warm a severe hypothermia patient, as quickly as possible begin to warm them with blankets and warmth (electric or chemical heat packs) to the neck, groin and armpits. Make sure, as you learned in the last slide, that all wet clothing is removed. dry clothing can be left on the patient.

In very cold environments, look for frostbite.

Just because they are severely hypothermic doesn't mean the patient doesn't have other medical problems. Consider other causes of unconsciousness.

Source:

Giesbrecht and Wilkerson. "Hypothermia Frostbite and Other Cold Injuries". The Mountaineers Books. 2006

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