Hypothermia - Medical Malpractice Lawyer

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Hypothermia - Medical Malpractice

Hypothermia begins to happen when a person's core temperature is less than 95 degrees Fahrenheit. It can occur indoors or outdoors and is most prevalent in the very young or the very old. It can occur due to exposure to cold air, cold wind or cold water (immersion hypothermia). The body temperature you have is a mixture of the heat energy of the body and the heat loss to the body. If heat loss exceeds the heat energy production, you can become hypothermic.

You can lose heat in several different ways. About 55 to 65 percent is lost due to radiation of heat from the body. Conduction accounts for only 2 to 3 percent of heat loss unless you are immersed in cold water, when the heat loss can be 50 percent. Convection accounts for ten percent and 2-9 percent is lost through the lungs and breathing in cold air. Evaporation from the skin and the lungs accounts for 20-27 percent of heat loss. Children are more affected because they have a relatively increased skin surface area when compared to body mass.

Normally, the body makes heat to counteract external cold but at a certain level of exposure, the body ceases to produce heat and the body temperature drops dramatically. The body can shiver above 89.6 degrees, which can generate heat for the body. Shivering sets it for a few hours but the body soon loses its heat stores and becomes exhausted. Blood vessels contract in the arms and legs, which causes the core temperature to be higher. Hormones are released that speed up the basal metabolic rate so that stored fuels are used to increase the body temperature.

Between 75.2 degrees and 89.6 degrees, shivering can no longer happen and the basal metabolic rate slows. Below 75.2 degrees, most all mechanisms for the conservation of heat become inactive and the core body temperature drops rapidly. It can take several hours for the body to reach this temperature unless a person is immersed in cold water. The elderly can become hypothermic over several days when exposed to air conditioning indoors. Those most prone to hypothermia include those who are homeless, mentally ill, and alcoholics, who cannot tell they are getting cold or cannot find a place to warm up.

Symptoms of hypothermia include shivering, increased respiratory rate, and increased blood pressure, especially in the early phases. The pulse, respiratory rate and blood pressure then begin to drop as the temperature drops even more. People are clumsy, have slurred speech, confusion and apathy. As the core temperature drops below 89.9 degrees, there is no more shivering. The consumption of oxygen begins to drop and the heart rate can become irregular. The person is often in a stupor.

Below 82.4 degrees, there is a lack of reflexes, decreased cardiac output and more cardiac arrhythmias. The person has decreased brain activity and can appear dead or in a coma.

The diagnosis of hypothermia depends on a thorough history and physical examination. Doctors will get a core temperature to determine how hypothermic the patient is and will look for signs like shivering to help determine where in the process the patient is. The best temperature device is a thermometer placed in the esophagus to get a core body temperature. ECGs will be performed to look for arrhythmias.

The treatment of hypothermia includes warming the body through several different methods. Sometimes CPR is required while the body is being warmed. Thiamine and sugar is given for increasing energy stores. If there is ventricular fibrillation, the person is treated by means of defibrillation. IVs provide warmed fluid to the body and a catheter in the bladder can flush the bladder with warmed fluid. Gastric lavage can occur using a tube placed into the stomach in which warm fluid is flushed in and out of the abdomen.

There is passive external rewarming, which is good for mild hypothermia. There is active external warming, in which heat is applied to the skin. It is somewhat controversial because it can dilate the superficial vessels and take blood away from the central core. Active core rewarming works to increase the core body temperature through the methods mentioned above. It is used when the temperature is less than 89.9 degrees. The airway can be warmed and peritoneal dialysis works well to increase the core temperature. Diathermy involves using ultrasound and low frequency microwave radiation in order to deliver heat to tissues deep within the tissues.

The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here