1. Hypothermia

2. Outline  What is Hypothermia  What are the symptoms  What can be done to prevent it  How do you treat someone with Hypothermia  Summary

3. What is Hypothermia?  Lowering of core body temperature. Normal temperature 37.5˚C Normal temperature 37.5˚C Lowering of core body temperature to below 35˚C (95˚F) Lowering of core body temperature to below 35˚C (95˚F)  Mild Hypothermia 35˚C – 34˚C  Moderate hypothermia 30˚C – 33.9˚C  Severe Hypothermia below 30˚C

4. What is Hypothermia  Body losses heat  Radiation can occur when ambient temperature is below 98.6˚F  Conduction water conducts heat away 25 times faster than air  Convection ie wind chill, swimming.  Evaporation ie sweating Diagram from Princeton University

5. Symptoms temp ˚CBody Symptoms 37.5Normal 36Feel Cold 35Shivering 34Clumsy, Irrational, Confused 33Muscle Stiffness 32Shivering stops, Collapse 31Semi Conscious 30Unconscious 29Slow pulse and Breathing 28Cardiac Arrest Hospital 999

6. Regulating Core temperature  What your body does Hot Hot Sweat – cools by evaporationSweat – cools by evaporation Vasodilation – blood vessel open on surfaceVasodilation – blood vessel open on surface Take layers offTake layers off Cold Cold Shiver – muscle activityShiver – muscle activity Vasoconstriction – reduce blood flow to surfaceVasoconstriction – reduce blood flow to surface Put layers onPut layers on

7. Prevention Wear the correct clothing Take layers off or put layers on Take layers off or put layers on  Stay Dry  Prevent Windchill  Provide Energy  Don’t get dehydrated  Avoid alcohol

8. Wetsuits and Drysuits  Wetsuits work by trapping a layer of water near the skin thereby (when immersed) Reducing conduction by insulation Reducing conduction by insulation Reducing convection Reducing convection  Drysuits work by keeping occupant dry Prevent convection Prevent convection Require additional insulation to prevent conduction Require additional insulation to prevent conduction

9. Other Clothing  Thermals under drysuit  Man-made materials next to skin reduce moisture  Hat – 30% heat loss through head  Personal bouyancy – don’t need to work to stay afloat (reduces convection)

10. Prevention - if you fall in!  Get out of the water if possible Climb onto upturned boat Climb onto upturned boat  Minimise movement BA/ LJ helps you stay afloat without swimming BA/ LJ helps you stay afloat without swimming Help position Help position Stay with boat Stay with boat  Share warmth

11. Pictures from www.hypothermia.org

12. Picture from www.hypothermia.org

13. Survival time in water Graph from www.hypothermia.org

14. Treatment  Mild Hypothermia Reduce heat loss Reduce heat loss Additional clothingAdditional clothing Dry clothingDry clothing ShelterShelter Add Fuels and Fluids Add Fuels and Fluids Carbohydrates – warm liquids better than solidsCarbohydrates – warm liquids better than solids Avoid Alcohol, Caffeine and NicotineAvoid Alcohol, Caffeine and Nicotine Slowly Warm Core Slowly Warm Core Consider Professional Assistance Consider Professional Assistance

15. Moderate or Severe Hypothermia  Check ABC  Shelter, Insulate – keep horizontal if possible  Get assistance – 999  Patient should be kept horizontal, insulated and breathing/signs of life monitored until ambulance crew arrive. Minimise any movement.  Treat the patient for ABC and shock only ON NO ACCOUNT IS EXTERNAL HEAT TO BE APPLIED IF THE PATIENT IS INCOHERENT OR UNCONCIOUS.

16. Moderate or Severe Hypothermia  Rescue Keep patient horizontal Keep patient horizontal Minimal physical activity Minimal physical activity  Examine ABC (airway, breathing, circulation) ABC (airway, breathing, circulation) Respiration and pulse may be very slow Respiration and pulse may be very slow Check for other injuries Check for other injuries Mental status (ability to think and walk) Mental status (ability to think and walk)

17. Moderate or Severe Hypothermia  Stabilise CPR CPR Control bleeding Control bleeding Deal with shock Deal with shock Nil by mouth Nil by mouth

18. Moderate or Severe Hypothermia  Insulate Prevent further heat loss Prevent further heat loss Provide humidified, heated air via mask if available (this is carried by SAR teams in Canada) Provide humidified, heated air via mask if available (this is carried by SAR teams in Canada) Gentle heat to neck, armpitts and groin? Gentle heat to neck, armpitts and groin? External heat from rescuer? External heat from rescuer?  Transport Get patient to hospital ASAP Get patient to hospital ASAP

19. Dangers of Rewarming  Blood chemistry at extremities changes and may cause cardiac failure (VF) if it returns to the heart.  Cold blood at extremities may cause VF if it returns to the heart.  Chart shows effect of rewarming.  Body capable of rewarming itself at 2˚C per hour.

20. Rewarming Mild hypothermic Victim

21. Key points  Advice from the RNLI At first sign of Hypothermia head for shore At first sign of Hypothermia head for shore Get out of the wind, warm them up with dry clothing Get out of the wind, warm them up with dry clothing If deteriorates or doesn’t improve If deteriorates or doesn’t improve GET MEDICAL HELP NOW

22. Summary  Hypothermia - cooling of core body temperature to below 35˚C  Prevent further heat loss  Minimise movement  Treat for shock – ABC  Get Help  Don’t artificially rewarm incoherent or unconscious casualties

23. References/Resources  Safety on the Sea series from RNLI  The RYA sailing manual Bob Bond  www.hypothermia.org www.hypothermia.org  Princeton university outdoor education guide from www.princeton.edu/~oa/safety/hypocold.s html www.princeton.edu/~oa/safety/hypocold.s html www.princeton.edu/~oa/safety/hypocold.s html  Search & Rescue society of British Columbia www.sarbc.org/hypo1.html www.sarbc.org/hypo1.html