Understanding, identifying & treating
By Daniel Du Pont, BA, EMT & Edward T. Dickinson, MD, NRP, FACEP
Medic 15 is dispatched on a cold winter morning to the parking lot behind a local gas station for
a third-party report of a subject down. You
arrive to find a middle-age male lying supine
on the ground with a stellate laceration on his
forehead. He’s unresponsive, appears to be
breathing slowly, is very pale and is notice-ably cold to the touch. As you run through
the ABCs (i.e., airway, breathing and circulation), you start to think about prioritizing the
patient’s problems and how the cold might
affect the patient.
Hypothermia is commonly defined as a core
temperature that’s less than 95 degrees F
( 35 degrees C). 1 In emergency medicine,
there are two general types of hypothermia:
therapeutic hypothermia (i.e., the intentional
use of hypothermia in post-cardiac arrest
patients to optimize neurological recovery)
and accidental hypothermia.
Accidental hypothermia, the focus of this
article, is a common condition that carries the
risk of substantial morbidity and mortality.
It can either be a primary cause of death or
contribute to making almost any other medical
or traumatic condition worse. Consequently,
it’s difficult to know how many deaths should
be attributed to hypothermia each year in the
United States, with estimates varying from 600
to more than 1,500. 2-4 Always be aware of the
possibility of hypothermia; it’s seen in all 50
states and during every month of the year. 5
The human body produces heat through
metabolism and exercise. In order to maintain a constant temperature, that heat production must balance out the multiple ways
As core temperature falls, the body’s central nervous
system becomes depressed, and patients can experience slurred speech, confusion, impaired judgement
and amnesia. AP Photo/Brennan Linsley
Conduction: Transfer of heat to a solid object or a liquid by direct contact.
Convection: Mechanism by which body heat is picked up and carried away by moving fluid currents.
Core body temperature: The temperature in the part of the body comprising the heart, lungs,
brain and abdominal viscera.
Evaporation: The conversion of a liquid to a gas.
Hypothermia: Condition in which the core body temperature falls significantly below normal.
Radiation: Emission of heat in the form of electromagnetic energy.
LEARNING OBJEC TIVES
>>Explain the four different ways a body
can lose heat.
>>Define the four stages of hypothermia and understand the assesment
>>Understand the treatment strategies
for accidental hypothermia.