Materiały źródłowe

• #1 Hypothermia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545239/

  Hypothermia occurs when the body dissipates more heat than it absorbs or creates, resulting in failure to maintain homeostasis and proper bodily function. […] Hypothermia is defined as a drop in body temperature below 35 C. The condition is common in cold geographic areas and during cooler months, though it can also develop in locations with milder climates. […] The hypothalamus regulates body temperature through autonomic mechanisms. This region of the brain receives input from central and peripheral thermal receptors. Muscle tone and basal metabolic rate (BMR) increase initially in response to cold stress. Heat production can double through these mechanisms. Shivering also enhances heat production, increasing metabolism 2 to 5 times the baseline BMR. […] Thyroid, catecholamine, and adrenal hormones also increase in response to cold stress. Cold-induced, sympathetically mediated peripheral vasoconstriction reduces heat loss. Behavioral changes like adding more clothing, seeking shelter, starting a fire, and exercising help retain or produce body heat.

• #1 Hypothermia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545239/

  The body’s core temperature arises from the balance between heat produced by the body and heat lost to the surroundings. The normal value ranges from 36.5 to 37.5 C. Four mechanisms are responsible for heat loss: radiation, conduction, convection, and evaporation. […] While normal body heat loss is most often due to radiation, hypothermia is more likely to arise from cold air exposure (convection), cold water contact (conduction), and excessive sweating (evaporation). […] The body initially increases metabolism, ventilation, and cardiac output to maintain function when the ambient temperature drops. Heat loss can overwhelm the body and disrupt the shivering mechanism without external warming. Multiple organ systems, including neurologic, metabolic, and cardiac, will cease to function, ultimately leading to death.

• #2 Hypothermia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/770542-overview

  Hypothermia describes a state in which the body’s mechanism for temperature regulation is overwhelmed in the face of a cold stressor. […] The body’s core temperature is tightly regulated in the „thermoneutral zone” between 36.5C and 37.5C, outside of which thermoregulatory responses are usually activated. The body maintains a stable core temperature through balancing heat production and heat loss. […] The hypothalamus controls thermoregulation via increased heat conservation (peripheral vasoconstriction and behavior responses) and heat production (shivering and increasing levels of thyroxine and epinephrine). Alterations of the CNS may impair these mechanisms. […] Hypothermia affects virtually all organ systems. Perhaps the most significant effects are seen in the cardiovascular system and the CNS. Hypothermia results in decreased depolarization of cardiac pacemaker cells, causing bradycardia.

• #2 Hypothermia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/770542-overview

  The mechanisms for heat preservation may be overwhelmed in the face of cold stress and core temperature can drop secondary to fatigue or glycogen depletion. […] Atrial and ventricular arrhythmias can result from hypothermia; asystole and ventricular fibrillation have been noted to begin spontaneously at core temperatures below 25-28C. […] Hypothermia progressively depresses the CNS, decreasing CNS metabolism in a linear fashion as the core temperature drops. […] The term „core temperature after drop” refers to a further decrease in core temperature and associated clinical deterioration of a patient after rewarming has been initiated. […] Several etiologies related to endocrine derangements may cause decreased heat production. […] This may occur with CNS trauma, strokes, toxicologic and metabolic derangements, intracranial bleeding, Parkinson disease, CNS tumors, Wernicke disease, and multiple sclerosis. […] Hypothermia may be related to drug administration; such medications include beta-blockers, clonidine, meperidine, neuroleptics, and general anesthetic agents.

• #3 Hypothermia and frostbite – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hypothermia-and-frostbite/

  Hypothermia is defined as a drop in core body temperature below 35C (95F). […] Impaired thermoregulation, decreased heat production, and increased heat loss can contribute to accidental hypothermia. […] Hypothermia affects all organ systems. […] The body loses heat through radiation; (most significant means of heat loss), conduction, convection, and direct contact with cold surfaces. […] The hypothalamus attempts to maintain a temperature of approximately 36.5C (97.7F) to 37.5C (99.5F) by conserving heat (peripheral vasoconstriction direct and sympathetic) and cold-induced thermogenesis (increasing heat production). […] Shivering thermogenesis is the primary means of maintaining core body temperature in cold environments. […] General tissue oxygen demand decreases by 6% per degree Celsius below 35C.

• #3 Hypothermia and frostbite – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hypothermia-and-frostbite/

  Weakened cellular immune response is a consequence of hypothermia. […] Cardiovascular effects include depolarization of cardiac cells, cardiac output, and mean arterial pressure. […] Hypothermia can occur in nonfreezing conditions if combined stressors like wind chill, wet skin, and exhaustion are present.

• #4 Hypothermia: Signs, Symptoms, Causes, and Treatment

  https://www.webmd.com/a-to-z-guides/what-is-hypothermia

  Normally, the activity of the heart and liver make most of your body heat. But as core body temperature cools, these organs produce less heat, in essence causing a protective „shut down” to preserve heat and protect the brain. Low body temperature can slow brain activity, breathing, and heart rate. […] Possible low body temperature causes include: Cold exposure. When the balance between the body’s heat production and heat loss tips toward heat loss for a long time, hypothermia can happen. It’s usually because you’ve been in the cold without enough warm, dry clothing for protection. […] But much milder environments can also lead to hypothermia, depending on your age, body mass, body fat, overall health, and length of time in the cold. A frail, older adult in a 60-degree house after a power outage can develop mild hypothermia overnight.

• #5 What Is Hypothermia? Symptoms, Signs, Treatment Protocol & Causes

  https://www.emedicinehealth.com/hypothermia/article_em.htm

  Primary hypothermia is due to exposure to a cold or frigid environment, with no underlying medical condition, causing disruption in temperature regulation. […] In primary hypothermia, the body is unable to generate heat fast enough to compensate for ongoing heat losses. This primarily is a disease of exposure. […] Sometimes the body’s temperature control can be altered by disease. In this case, core body temperature can decrease in almost any environment. This condition is called secondary hypothermia. In secondary hypothermia, something goes wrong with the body’s heat-balancing mechanisms. People with such diseases as stroke, spinal cord injury, low blood sugar, and a variety of skin disorders can become hypothermic in only mildly cool air.

• #6 Hypothermia: Reversible Causes of Cardiac Arrest | Ausmed

  https://www.ausmed.com/learn/articles/hypothermia

  Hypothermia occurs when the core body temperature drops to below 35C (95F) (Mayo Clinic 2020). […] The term primary hypothermia is used when the ability of an otherwise healthy person to maintain their core body temperature is overwhelmed by excessive cold temperatures, particularly when energy stores within the body have been depleted (Davis 2018). […] Secondary hypothermia is when hypothermia is associated with acute events or illness, such as cerebrovascular accident (CVA), diabetic ketoacidosis (DKA) or burns. Secondary hypothermia can occur even where the environment is warm (Duong Patel 2020; Davis 2018). […] When the body is exposed to the cold, the initial response is to increase active movement and start shivering. […] If the core temperature falls to less than 32C (90F), atrial fibrillation is common, but this is not a significant cause for concern unless there are other indicators of cardiac instability (Brown et al. 2012).

• #6 Hypothermia: Reversible Causes of Cardiac Arrest | Ausmed

  https://www.ausmed.com/learn/articles/hypothermia

  The risk of cardiac arrest increases as the core temperature drops below 32C, and increases substantially if the temperature reaches less than 28C (Brown et al. 2012). […] At this level, a severe depression of critical body functions occurs, which may make the victim seem clinically dead during the initial assessment. […] Patients with hypothermia are often bradycardic (Soar et al. 2015) and may present in asystole (Vanden Hoek et al. 2010). […] Look also at electrolytes for example, a low serum potassium (hypokalaemia) may be a possible indicator of hypothermia as the primary cause of the arrest (Vanden Hoek et al. 2010). […] Hypothermia is an unusual aetiology for cardiac arrest, particularly in acute inpatient settings, but must not be excluded from consideration as a potentially-reversible cause.

• #7 Hypothermia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hypothermia_pathophysiology

  Normal body temperature in humans is 37C (98.6F). Hypothermia can be divided into three stages of severity. […] In stage 1, body temperature drops by 1-2C below normal temperature (1.8-3.6F). Mild to strong shivering occurs. Blood vessels in the outer extremities constrict, lessening heat loss to the outside air. Breathing becomes quick and shallow. Goose bumps form, raising body hair on end in an attempt to create an insulating layer of air around the body (this is of limited use in humans due to lack of sufficient hair, but it can be useful in other species). Often, a person will experience a warm sensation, as if they have recovered, but they are in fact heading into Stage 2. Another test to see if the person is entering stage 2 is if they are unable to touch their thumb with their little finger; this is the first stage of poor muscle coordination.

• #8 Hypothermia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/environmental-injuries-and-toxicology/Chapter-406/hypothermia

  Exposure to extreme cold results in a series of predictable changes in human physiology, which can be broadly described as „everything stops working”. […] Hypothermia results in a series of predictable physiological derangements in the human organism. The nature and severity of these derangements depends on the depth of hypothermia. […] A definition of the stages of hypothermia offered in the college model answer is as follows: Mild hypothermia: 32-35 degrees, Moderate hypothermia: 28-32 degrees, Severe hypothermia: under 28 degrees. […] The first three HT grades correlate roughly with the mild-moderate-severe temperature range; HT 4 spans the interval of 24-28 degrees and is defined as „apparent” death because historically people retrieved from frozen lakes with this sort of temperature have been asystolic, and yet went on to make reasonable neurological recoveries.

• #8 Hypothermia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/environmental-injuries-and-toxicology/Chapter-406/hypothermia

  The „real” death in HT 5 is associated with a temperature below 13.7 degrees, which is the lowest temperature ever survived by anybody. […] The physiological consequences of hypothermia include decreased metabolism and oxygen consumption, decreased carbohydrate metabolism and hyperglycaemia, decreased drug metabolism and clearance, increased hematocrit and blood viscosity, confusion and decreased level of consciousness, and decreased granulocyte and monocyte activity.

• #9 Hypothermia – Wikipedia

  https://en.wikipedia.org/wiki/Hypothermia

  Hypothermia has two main types of causes. It classically occurs from exposure to cold weather and cold water immersion. It may also occur from any condition that decreases heat production or increases heat loss. […] Heat is primarily generated in muscle tissue, including the heart, and in the liver, while it is lost through the skin (90%) and lungs (10%). Heat production may be increased (to over 1200 W in trained endurance athletes) through muscle contractions (i.e. exercise and shivering). The rate of heat loss is determined, as with any object, by convection, conduction, and radiation. The rates of these can be affected by body mass index, body surface area to volume ratios, clothing and other environmental conditions. […] Many changes to physiology occur as body temperatures decrease. These occur in the cardiovascular system leading to the Osborn J wave and other dysrhythmias, decreased central nervous system electrical activity, cold diuresis, and non-cardiogenic pulmonary edema. […] Research has shown that glomerular filtration rates (GFR) decrease as a result of hypothermia. In essence, hypothermia increases preglomerular vasoconstriction, thus decreasing both renal blood flow (RBF) and GFR.

• #10 Accidental hypothermia in adults: Clinical manifestations and evaluation – UpToDate

  https://www.uptodate.com/contents/accidental-hypothermia-in-adults

  Body temperature reflects the balance between heat production and heat loss. Heat is generated by cellular metabolism (most prominently in the heart and liver) and lost by the skin and lungs via the following processes: […] Of these, convective heat loss to cold air and conductive heat loss to water are the most common mechanisms of accidental hypothermia. […] The hypothalamus receives input from central and peripheral thermal receptors. In response to a cold stress, the hypothalamus attempts to stimulate heat production through shivering and increased thyroid, catecholamine, and adrenal activity. Sympathetically mediated vasoconstriction minimizes heat loss by reducing blood flow to peripheral tissues, where cooling is greatest. […] Cooling decreases tissue metabolism and inhibits neural activity. During the initial phase of cooling, shivering in response to skin cooling produces heat and increases metabolism, ventilation, and cardiac output. Neurologic function begins declining even above a core temperature of 35°C (95°F). Once the core temperature reaches 32°C (90°F), metabolism, ventilation, and cardiac output begin to decline, and shivering becomes less effective until it finally ceases as core temperature continues to drop.

• #11 Hypothermia: Signs, Symptoms, Causes, and Treatment

  https://www.webmd.com/a-to-z-guides/what-is-hypothermia

  Your body loses heat in one of four ways: Radiation. This is the most common method of heat loss. Heat leaves your body by infrared electromagnetic waves and goes into the air. This happens naturally when bare skin is exposed to air. […] Conduction. Heat is transferred directly from one object to another. For instance, if you splash cold water on your face, you feel cooler because heat from your body is transferred to the water. […] Convection. You lose heat because of moving air. Although the thin air layer near your skin is warm, the heat is carried away by the wind. You may experience this as the „wind chill factor.” […] Evaporation. When you sweat, water vaporizes from your skin and transfers heat to the air around you.

• #12 Hypothermia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypothermia/symptoms-causes/syc-20352682

  Hypothermia occurs when the body loses heat faster than it produces it. […] The mechanisms of heat loss from the body include: […] Most heat loss is due to heat radiated from unprotected surfaces of the body. […] Direct contact with something very cold takes heat away from the body. […] Wind removes body heat by carrying away the thin layer of warm air at the surface of the skin.

• #13 Accidental Hypothermia

  https://mobile.fpnotebook.com/ER/Environ/AcdntlHypthrm.htm

  Optimal Body Temperature is within 2-3 degrees F of 98.6 F (or 1-2 degrees C of 37 C) […] Skin is responsible for 90% of total heat loss […] Vasodilation (e.g. Alcohol) further increases significant heat loss […] Radiative heat loss (50% of heat loss) […] Majority of radiative heat loss via head (60%) […] Conductive heat loss (2-3% of heat loss) […] Wet clothing: Heat loss increases x5 […] Cold water immersion: Heat loss increases x25 […] Frostbite may occur within seconds of contact with cold bare metal […] Convective heat loss (10%) […] Important in windy conditions […] Convective loss increases with shivering […] Evaporative heat loss (Up to 27%) […] Respiratory heat loss (Up to 9%).

• #14 Pathophysiology – RCEMLearning

  https://www.rcemlearning.co.uk/modules/hypothermia-and-frostbite/lessons/pathophysiology-32/

  The body maintains the core temperature of 36.5-37.5oC by balancing heat production and heat loss. […] The hypothalamus controls thermoregulation via increased heat conservation (peripheral vasoconstriction and behaviour responses) and heat production (shivering and increasing levels of thyroxine and adrenaline). […] Once heat is lost, the body sacrifices the extremity with an intense peripheral vasoconstriction and counter-current exchange of heat (from the warm arteries to the cool veins) to preserve the core temperature and the life of the patient.

• #15 Hypothermia in Neonates – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/perinatal-problems/hypothermia-in-neonates

  Thermal equilibrium is affected by relative humidity, air flow, direct contact with cool surfaces, proximity to cool objects, and ambient air temperature. Neonates are prone to rapid heat loss and consequent hypothermia because of a high surface area to volume ratio, which is even higher in low-birth-weight neonates. There are several mechanisms for heat loss: […] Prolonged, unrecognized cold stress may divert calories to produce heat, impairing growth. Neonates have a metabolic response to cooling that involves chemical (nonshivering) thermogenesis by sympathetic nerve discharge of norepinephrine in the brown fat. This specialized tissue of the neonate, located in the nape of the neck, between the scapulae, and around the kidneys and adrenals, responds by lipolysis followed by oxidation or re-esterification of the fatty acids that are released. These reactions produce heat locally, and a rich blood supply to the brown fat helps transfer this heat to the rest of the neonates body. This reaction increases the metabolic rate and oxygen consumption 2- to 3-fold. Thus, in neonates with respiratory insufficiency (eg, a preterm infant with respiratory distress syndrome), cold stress may also result in tissue hypoxia and neurologic damage. Activation of glycogen stores can cause transient hyperglycemia. Persistent hypothermia can result in hypoglycemia and metabolic acidosis and increases the risk of late-onset sepsis and mortality.

• #15 Hypothermia in Neonates – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/perinatal-problems/hypothermia-in-neonates

  Despite their compensatory mechanisms, neonates, particularly low-birth-weight neonates, have limited capacity to thermoregulate and are prone to decreased core temperature. Even before temperature decreases, cold stress occurs when heat loss requires an increase in metabolic heat production. […] The neutral thermal environment (thermoneutrality) is the optimal temperature zone for neonates; it is defined as the environmental temperature at which metabolic demands (and thus caloric expenditure) to maintain body temperature in the normal range (36.5 to 37.5 C rectal) are lowest. The specific environmental temperature required to maintain thermoneutrality depends on whether neonates are wet (eg, after delivery or a bath) or clothed and on their weight, gestational age, and age in hours and days.

• #16 Hypothermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/hypothermia

  Hypothermia slows all physiologic functions, including cardiovascular and respiratory systems, nerve conduction, mental acuity, neuromuscular reaction time, and metabolic rate. […] Thermoregulation ceases below about 30 C; the body must then depend on an external heat source for rewarming. […] Renal cell dysfunction and decreased levels of vasopressin (ADH) lead to production of a large volume of dilute urine (cold diuresis). […] Vasoconstriction, which occurs with hypothermia, may mask hypovolemia, which then manifests as sudden shock or cardiac arrest during rewarming (rewarming collapse) when peripheral vasculature dilates. […] Immersion in cold water can trigger the diving reflex, which involves apnea, bradycardia, and increased peripheral vascular resistance; blood is shunted to essential organs (eg, heart, brain).

• #16 Hypothermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/hypothermia

  The reflex is most pronounced in small children and may help protect them. […] Also, hypothermia due to total immersion in near-freezing water may protect the brain from hypoxia by decreasing metabolic demands. […] The decreased demand probably accounts for the occasional survival after prolonged cardiac arrest due to extreme hypothermia.

• #17 Accidental Hypothermia: 2021 Update

  https://www.mdpi.com/1660-4601/19/1/501

  Hypothermia causes a decrease in vital signs and can lead to cardiac arrest. A windy and wet environment will speed cooling. The wind chill index describes the combined effect of ambient air temperature and wind speed on the skin surface temperature. In avalanches, the cooling rate of buried victims may reach 9 °C/h. The cooling rate of hyperthermic patients during immersion in water at 1–2 °C can reach 5 °C/10 min. The cooling rate of normothermic or hypothermic patients in cold water depends heavily on conditions. It is much slower, but still significant. […] In young, healthy adults, hypothermia-induced cardiac arrest may occur below 30 °C. In elderly patients and those with comorbidities, the myocardium may become more irritable and hypothermia-induced cardiac arrest may be triggered below 32 °C.

• #17 Accidental Hypothermia: 2021 Update

  https://www.mdpi.com/1660-4601/19/1/501

  Hypothermic cardiac arrest is fundamentally different than normothermic cardiac arrest. Treatment and outcomes differ substantially. […] Cardiocirculatory collapse during extrication or transfer of hypothermic patients is referred to as rescue collapse. This can manifest as a witnessed cardiac arrest. The underlying mechanism is not well understood and may be multifactorial. In hypothermic patients, rescue collapse may be coincidental during rescue, but is more likely to be caused by hypovolemia, cardiac dysrhythmias triggered by interventions, such as central venous catheterisation, biochemical changes, or, most frequently, by mechanical stimuli such as sudden movement. […] In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed, and asystolic cardiac arrest.

• #18 Diagnosis and Treatment of Hypothermia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2325.html

  Although the pathophysiology and clinical findings of hypothermia occur along a continuum, the generally accepted definition divides the spectrum into three zones: mild, moderate, and severe. […] Renal failure secondary to rhabdomyolysis or acute tubular necrosis may occur. […] A major complication of active external rewarming is core temperature afterdrop, which results when cold peripheral blood rapidly returns to the heart. […] Active core rewarming techniques exist on a spectrum of invasiveness and potential complications. […] The most effective method of active core rewarming is extracorporeal blood warming, accomplished by cardiopulmonary bypass, arteriovenous rewarming, venovenous rewarming, or hemodialysis.

• #18 Diagnosis and Treatment of Hypothermia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2325.html

  Although hypothermia is most common in patients who are exposed to a cold environment, it can develop secondary to toxin exposure, metabolic derangements, infections, and dysfunction of the central nervous and endocrine systems. […] Body heat is lost to the environment via five mechanisms: radiation, conduction, convection, evaporation, and respiration. […] To maintain temperature homeostasis, the hypothalamus orchestrates a counterattack against heat loss via heat conservation and heat production. […] The causes of hypothermia are numerous, but a few deserve special mention because failure to recognize atypical presentations and initiate early treatment of specific causes increases the rates of morbidity and mortality. […] Other causes of hypothermia include metabolic disorders that are linked to a decreased basal metabolic rate and can be related to dysfunction of the thyroid, adrenal, or pituitary glands.

• #19 Impact of hyper- and hypothermia on cellular and whole-body physiology | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-024-00774-8

  Hypothermia has suppressive effects on inflammation to maintain homeostasis. […] In contrast to beneficial effects on inflammation, hypothermia impairs the hemostasis that can increase bleeding in various clinical settings by inhibiting enzymatic reactions of coagulation, and clinically prolong PT and aPTT and clot formation.

• #19 Impact of hyper- and hypothermia on cellular and whole-body physiology | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-024-00774-8

  Hypothermia presents another health risk associated with low temperatures, with cardiac arrest being the primary cause of mortality in hypothermic patients. […] However, hypothermia has notable cellular protective effects via mitochondrial protection, especially during conditions of cellular stress such as ischemia or oxidative damage. Studies on hypothermic treatment in cardiac cells show that it reduces mitochondrial permeability transition pore (mPTP) opening, preventing cytochrome c release and thereby reducing apoptosis. […] Furthermore, hypothermia decreases ROS production in mitochondria during stress conditions. […] The protective effects of hypothermia on mitochondria suppress apoptosis, particularly after traumatic brain injury or ischemic events, by decreasing the activation of apoptotic proteins like caspase-3.

• #20 Hypothermia in Trauma

  https://www.mdpi.com/1660-4601/18/16/8719

  The three factors are highly interrelated and create a vicious circle if not addressed in a very early stage of trauma management. […] Hypothermia is the next factor that affects blood clotting in different ways. All chemical reactions are temperature-dependent. This is also the case with blood clotting. Therefore, it seems evident that the function of the humoral coagulation cascade deteriorates with decreasing temperatures. […] However, several studies have also shown that platelet function is influenced by temperature. […] The value of exposure during physical exam should be weighed against the risk of hypothermia and should be performed sequentially by body region, preserving insulating clothing in the non-examined area. […] Normothermia provides the optimum conditions for hemostasis.

• #20 Hypothermia in Trauma

  https://www.mdpi.com/1660-4601/18/16/8719

  Hypothermia in trauma patients is a common condition. It is aggravated by traumatic hemorrhage, which leads to hypovolemic shock. This hypovolemic shock results in a lethal triad of hypothermia, coagulopathy, and acidosis, leading to ongoing bleeding. […] Hypothermia is currently estimated to occur less frequently with modern hemostatic, goal-directed resuscitation with warm fluids. Risk factors for hypothermia in trauma include the severity of injury, (prehospital) anesthesia or intubation, low environmental temperature or wet clothing, and administration of cold fluids. […] Hypothermia in trauma patients leads to higher in-hospital mortality, higher transfusion requirements, and longer length of stay. Mortality increases with the degree of hypothermia in severely injured patients. […] The combination of hypothermia, acidosis, and coagulopathy has become well-known as the trauma triad of death, diminishing the chances of survival in severely injured patients.

• #20 Hypothermia in Trauma

  https://www.mdpi.com/1660-4601/18/16/8719

  Several reviews have assessed the effect of hypothermia on the outcome of major trauma patients and concluded it to be an independent predictor for mortality. […] Hypothermia is a marker for a poor prognosis after hemorrhage, probably representing metabolic dysfunction. […] However, it has been hypothesized that hypothermia could be part of the detrimental physiological effects of severe injury and hemorrhage (and thus acidosis and coagulopathy) instead of a true independent predictor for mortality. […] Early, aggressive, goal-directed temperature management of trauma patients is of utmost importance for their survival, especially in hypothermic patients with hemorrhagic shock.

• #21 Hypothermia – EMCrit Project

  https://emcrit.org/ibcc/hypothermia/

  Hypothermia may cause rhabdomyolysis. […] Hypothermia commonly occurs due to sepsis (particularly if no other cause is evident). […] Hypothermia should be treated with respect (it’s generally more ominous than fever). […] The key therapy for bradycardia is re-warming. […] Hypothermia tends to cause hypokalemia. With re-warming, the potassium will tend to rise. […] Hypothermia causes a clinical tendency to bleed despite normal levels of clotting factors. […] The only way to reverse this coagulopathy is re-warming. For active hemorrhage in the hypothermic patient, desmopressin might improve platelet function. […] Hypothermia may mask EKG changes due to hyperkalemia.

• #22 Intraoperative Hypothermia – OpenAnesthesia

  https://www.openanesthesia.org/keywords/intraoperative-hypothermia/

  Hypothermia causes coagulopathy primarily by impairing platelet aggregation via reduced release of thromboxane A3, thereby affecting platelet plug formation. It also reduces the activity of enzymes in the coagulation cascade. A combination of these factors increases perioperative blood loss and the need for transfusion. […] Perioperative hypothermia increases the risk of surgical site infections. The primary mechanisms are reduced tissue perfusion, decreased motility of macrophages and other key immune cells, and reduced scar formation. […] Even mild hypothermia prolongs the action of neuromuscular blocking agents. […] Hypothermia also decreases the minimum alveolar concentration (MAC) of volatile anesthetics. MAC decreases by 5% for every one-degree decrease in core temperature. […] Postoperative shivering is common in hypothermic patients. Shivering increases metabolic activity and causes sympathetic stimulation, increasing myocardial oxygen consumption and the risk of myocardial ischemia and arrhythmias, especially in patients with coronary artery disease.

• #22 Intraoperative Hypothermia – OpenAnesthesia

  https://www.openanesthesia.org/keywords/intraoperative-hypothermia/

  Unwarmed anesthetized patients become hypothermic, typically by 1-2C, from a combination of anesthesia-induced thermoregulatory impairment, cool operating room (OR) ambient temperature, and evaporative losses from surgical incisions. […] Both general and neuraxial anesthesia significantly impair thermoregulation and synchronously reduce the thresholds for vasoconstriction and shivering. […] Intraoperative hypothermia typically has a characteristic three-phase pattern and results initially from an internal redistribution of heat from the core to the periphery, followed by heat loss exceeding metabolic heat production and a plateau phase when thermoregulatory thresholds are activated, or heat loss matches heat production. […] The core temperature of surgical patients should be maintained above 35.5C since lower temperatures are associated with several complications, including coagulopathy, surgical-site infection, delayed drug metabolism, prolonged recovery, and shivering.

• #23 Therapeutic hypothermia after cardiac arrest

  https://www.myamericannurse.com/therapeutic-hypothermia-after-cardiac-arrest-what-why-who-and-how/

  Therapeutic hypothermia may lead to fluid and electrolyte imbalances, arrhythmias, insulin resistance, shivering, coagulation problems, and other adverse effects. […] Fluid and electrolyte shifts (especially of potassium, magnesium, and calcium) are common with therapeutic hypothermia. During the induction and maintenance phases, electrolytes shift intracellularly. Careful electrolyte monitoring and replacement are crucial to maintain normal electrolyte levels and prevent potential arrhythmias. […] Therapeutic hypothermia causes insulin resistance, commonly leading to hyperglycemia, which increases the infection risk. Standardized glucose monitoring and insulin administration can help control hyperglycemia. […] The body’s natural defense mechanism against cold, shivering increases metabolic activity and enhances oxygen consumption and rewarming. […] Mild platelet dysfunction may arise during hypothermia, increasing the bleeding risk.

• #23 Therapeutic hypothermia after cardiac arrest

  https://www.myamericannurse.com/therapeutic-hypothermia-after-cardiac-arrest-what-why-who-and-how/

  Hypothermia counteracts neuroexcitation in brain cells by stabilizing calcium and glutamate release, reducing the degree of cell death. It also stabilizes the blood-brain barrier and suppresses the inflammatory process, reducing cerebral edema. Cerebral metabolism decreases 6% to 10% for every degree Celsius that body temperature drops. As cerebral metabolism declines, the brain needs less oxygen. […] In essence, hypothermia counteracts many of the destructive mechanisms of cardiac arrest. Its effects resemble those of cardiac defibrillation, which makes the heart stop and then reset itself to a normal rhythm. Similarly, hypothermia halts destructive brain mechanisms and lets the brain reset itself to normal functioning. […] Therapeutic hypothermia occurs in three phases: induction, maintenance, and rewarming. Clinicians must control hypothermia and rewarming to prevent potential adverse effects, such as arrhythmias and skin breakdown during the cold phases (induction and maintenance) and rapid electrolyte shifts during the rewarming phase.

• #24

  https://apicareonline.com/index.php/APIC/article/view/100

  Hypothermia may increase the susceptibility of patients to infection in the surgical wound by peripheral vasoconstriction and impaired immunity. […] The presence of hypothermia results from the reduction of oxygen available at the tissue level secondary to hypoperfusion as well as the exhaustion of the systems to maintain the temperature. Hypothermia is a cause of platelet dysfunction through a depression of thromboxane B2-dependent temperature production and altered enzyme kinetics. […] In the polytrauma patient, from the moment of the accident and during the different phases of resuscitation, there are different risk factors that favor the development of hypothermia. […] This classification was redesigned in 2008, in the eighth edition of the Advanced Trauma Life Support (ATLS). It set temperature at 36 C for patients with hemorrhagic shock due to increased heat loss secondary to tissue hypoperfusion and decreased oxygen exchange and the progressive loss of heat production secondary to hypovolemic shock.

• #24

  https://apicareonline.com/index.php/APIC/article/view/100

  The use of hypothermia for therapeutic purposes was initially carried out on the basis of the first observational studies that attributed its beneficial effects solely to decrease of metabolism. Several studies have shown that in addition to decreasing metabolism and O2 needs, it modulates inflammation, prevents mitochondrial dysfunction, regulates cellular apoptosis and decreases free radical production, oxidative stress and vascular permeability.

• #25 Risk factors, host response and outcome of hypothermic sepsis | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1510-3

  Hypothermia is associated with adverse outcome in patients with sepsis. […] The objective of this study was to characterize the host immune response in patients with hypothermic sepsis in order to determine if an excessive anti-inflammatory response could explain immunosuppression and adverse outcome. […] Hypothermia was identified in 186 patients and was independently associated with mortality. […] Hypothermia during sepsis is independently associated with mortality, which cannot be attributed to alterations in the host immune responses that were measured in this study. […] Given that risk factors for hypothermic sepsis are mainly cardiovascular and that the endothelial activation marker fractalkine increased in hypothermia, these findings may suggest that vascular dysfunction plays a role in hypothermic sepsis.

• #25 Risk factors, host response and outcome of hypothermic sepsis | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1510-3

  Other mechanisms have yet to be explored in hypothermic patients with sepsis. Endothelial dysfunction could also play a role in the development of hypothermia, as generalized peripheral vasodilation and loss of endothelial integrity during sepsis may result in heat loss by hampering the body’s ability to regulate its core temperature. […] An excessive anti-inflammatory response has been proposed as a mechanism for hypothermia. […] Interestingly, systemic fractalkine levels were significantly higher in hypothermic patients compared to nonhypothermic patients, and this difference was maintained after correcting for disease severity. […] Taken together with the presence of mainly cardiovascular risk factors in patients with hypothermia, our data suggest that the endothelium may somehow be implicated in hypothermia through an as yet unknown mechanism. […] In conclusion, hypothermia during sepsis is independently associated with 90-day mortality. However, neither the etiology of hypothermia or increased mortality due to hypothermia are explained by a dysfunctional host immune response.

• #26 Perioperative hypothermia: Causes, consequences and treatment

  https://www.wjgnet.com/2218-6182/full/v4/i3/58.htm

  Perioperative hypothermia, core temperature below 36.0C, transpires due to disruption of thermoregulation by anesthesia coupled with cold exposure to procedural surroundings and cleansing agents. […] Although most publications have focused on thermoregulation disruption with general anesthesia, neuraxial anesthesia may also cause significant hypothermia. […] The clinical consequences of perioperative hypothermia are multiple and include patient discomfort, shivering, platelet dysfunction, coagulopathy, and increased vasoconstriction associated with a higher risk of wound infection. […] Furthermore, postoperative cardiac events occur at a higher rate; although it is unclear whether this is due to increased oxygen consumption or norepinephrine levels. […] Hypothermia may also affect pharmacokinetics and prolong postoperative recovery times and hospital length of stay.

• #27 [Hypothermia–mechanism of action and pathophysiological changes in the human body] – PubMed

  https://pubmed.ncbi.nlm.nih.gov/25614675/

  This review focuses on the physiological responses and pathophysiological changes induced by hypothermia. Normal body function depends on its ability to maintain thermal homeostasis. […] Lowering of body temperature disrupts the physiological processes at the molecular, cellular and system level, but hypothermia induced prior to cardiosurgical or neurosurgical procedures, by the decrease in tissue oxygen demand, can reduce the risk of cerebral or cardiac ischemic damage. […] Therapeutic hypothermia has been recommended as a clinical procedure in situations characterized by ischemia, such as cardiac arrest, stroke and brain injuries.

• #28 Hypothermia for acute brain injury—mechanisms and practical aspects | Nature Reviews Neurology

  https://www.nature.com/articles/nrneurol.2012.21

  Hypothermia is widely accepted as the gold-standard method by which the body can protect the brain. […] This Review provides an overview of the potential neuroprotective mechanisms of hypothermia, practical considerations for the application of TTM, and disease-specific evidence for the use of this therapy in patients with acute brain injuries. […] Targeted temperature management (TTM) is the most powerful mechanism of neuroprotection currently available. […] Hypothermia is proven to have clinically beneficial effects in preventing secondary brain injury in patients who have experienced cardiac arrest, and in neonates with hypoxic-ischemic injuries. […] Cooling is an effective mechanism to reduce intracranial pressure in patients who do not respond to standard medications. […] Polderman, K. H. Mechanisms of action, physiological effects, and complications of hypothermia.

• #29 The Protective Role and Mechanism of Mild Therapeutic Hypothermia Prot | NDT

  https://www.dovepress.com/the-protective-role-and-mechanism-of-mild-therapeutic-hypothermia-prot-peer-reviewed-fulltext-article-NDT

  Moderate therapeutic hypothermia is protective against several cellular stressors. However, the mechanisms behind this protection are not entirely known. […] The neuroprotective mechanisms of hypothermia are complex and multifaceted, including reduction in brain metabolic rate, alterations in cerebral blood flow, a lowering of the critical oxygen transport threshold, attenuation of oxidative stress-induced processes, calcium antagonistic effects, and others. […] Hypothermia treatment has been shown to modulate calcium levels in several animal models. […] Therefore, it is reasonable to speculate that therapeutic hypothermia may protect against brain cell injury by regulating Ca2+ levels in cells exposed to peroxide. […] Our study confirmed that hypothermia treatment played protective effects on peroxide-induced brain injury, and this treatment should be carried out timely to prevent potential irreversible brain injuries. […] In conclusion, hypothermia therapy can protect brain cells from hydrogen peroxide-induced damages. Combination with antioxidant is recommended in clinical practices to improve brain injury recovery.

• #30 Targeted Temperature Management (Therapeutic Hypothermia): Practice Essentials, Overview, Pathophysiology

  https://emedicine.medscape.com/article/812407-overview

  Cardiac arrest and return of spontaneous circulation (ROSC) is a case of whole-body ischemia and subsequent reperfusion injury. This injury mechanism along with pre-arrest comorbidities cause enormous biochemical, structural, and functional insults, which in a complex interrelated process leads to progressive cell destruction, multiorgan dysfunction, neuronal apoptosis, and death. Many of these processes are temperature sensitive. Hypothermia has been shown to attenuate or ameliorate many deleterious temperature-sensitive mechanisms, thereby contributing to protection of the brain and heart. […] The pathophysiologic mechanisms involved in hypothermia are incompletely understood but have been studied in cellular, animal, and human models. […] The following actions are associated with hypothermia: Reducing cerebral metabolism (approximately 6-8% per 1C) and demand, Reducing excitatory amino acids (glutamate release), Attenuation and/or reversibility of ischemic depolarization of the central nervous system (CNS), leading to membrane stabilization, electrolyte redistribution, and normalization of intracellular water concentration and intracellular pH (stabilization of the blood-brain barrier), Attenuation of oxygen free radical production and lipid peroxidation, Restoration of normal intracellular signaling mechanisms (including calcium modulation) and inhibition of deleterious signaling mechanisms, such as apoptotic signaling, Restoration of protein synthesis and gene expression, Inhibition of deleterious inflammatory products (ie, cytokines, interleukins, arachidonic acid cascade end products), Attenuation of cerebrospinal fluid (CSF) platelet-activating factor (PAF), Inhibition of cytoskeletal breakdown. […] In the heart, hypothermia may decrease the area of injury, promote epicardial reflow, decrease myocardial metabolic demand, and preserve intracellular high-energy phosphate stores.

• #31 Biomarker patterns and mechanistic insights into hypothermia from a postmortem metabolomics investigation | Scientific Reports

  https://www.nature.com/articles/s41598-024-68973-9

  Postmortem metabolomics holds promise for identifying crucial biological markers relevant to death investigations and clinical scenarios. […] Our retrospective analysis involved 1095 postmortem femoral blood samples, including 150 hypothermia cases, 278 matched controls, and 667 randomly selected test cases, analyzed using UHPLC-QTOF mass spectrometry. […] Discriminative metabolite patterns, including acylcarnitines, stress hormones, and NAD metabolites, along with identified pathways, suggest that metabolomics analysis can be helpful to diagnose fatal hypothermia. […] Exposure to cold seems to trigger a stress response in the body, increasing cortisol production to maintain core temperature, possibly explaining the observed upregulation of cortisol levels and alterations in metabolic markers related to renal function.

• #31 Biomarker patterns and mechanistic insights into hypothermia from a postmortem metabolomics investigation | Scientific Reports

  https://www.nature.com/articles/s41598-024-68973-9

  In addition, thermogenesis seems to increase metabolism in brown adipose tissue, contributing to changes in nicotinamide metabolism and elevated levels of ketone bodies and acylcarnitines, these findings highlight the effectiveness of UHPLC-QTOF mass spectrometry, multivariate analysis, and pathway identification of postmortem samples in identifying metabolite markers with forensic and clinical significance. […] The primary objective of our research is to discern distinct biomarker patterns associated with hypothermia, enhancing the accuracy of its identification during postmortem examinations. […] Additionally, our study seeks to elucidate the mechanistic underpinnings of these biomarker patterns within physiological pathways, aiming to enhance our comprehension of the biological mechanisms underlying hypothermia.

• #31 Biomarker patterns and mechanistic insights into hypothermia from a postmortem metabolomics investigation | Scientific Reports

  https://www.nature.com/articles/s41598-024-68973-9

  Its complex pathophysiology has intrigued researchers for years, leading to investigations into the metabolic dysfunctions it induces in search of potential biomarkers. […] Recognizing the challenges in finding a single marker that might be too unspecific, our approach aims to identify a pattern capable of classifying hypothermia cases with high sensitivity and specificity and explore the potential for incorporating these biomarkers into forensic screening methods. […] The rise in cortisol levels might reflect the biological stress response to cold, and cortisol has been suggested as a marker for cold exposure. […] Another significant mechanism during hypothermia induced stress is vasoconstriction, where peripheral blood vessels constrict to minimize heat loss. […] This change in blood flow can lead to reduced renal perfusion and glomerular filtration rates, possibly explaining the observed alterations in metabolic markers related to renal function.

• #31 Biomarker patterns and mechanistic insights into hypothermia from a postmortem metabolomics investigation | Scientific Reports

  https://www.nature.com/articles/s41598-024-68973-9

  As the body fights the cold, its metabolic rate significantly increases. […] This increased metabolism is an energy-intensive process aimed at generating heat and preserving core body temperature. […] Thermogenesis consumes NADH, which may explain the observed patterns in nicotinamide metabolism. […] Furthermore, the thermogenesis in brown adipose tissue could account for the accumulation of end products from the Krebs cycle and -oxidation, such as hippuric acid, phenylacetylglutamine, and hydroxybutyric acid. […] Additionally, there’s a consensus in the literature regarding increased levels of blood ketone bodies, including -hydroxybutyrate, acetone, isopropyl alcohol, and increased cortisol levels. […] The increase in -oxidation in brown adipose tissue may also contribute to the elevated levels of circulating acylcarnitines, and might be why the carnitine shuttle seems affected.

• #32 Severe Hypothermia – RCEMLearning

  https://www.rcemlearning.co.uk/reference/severe-hypothermia/

  Hypothermia is the pathological state in which the core body temperature falls below 35oC. […] The body maintains the core temperature between 36.5 and 37.5 by balancing heat production and heat loss. Heat is generated by cellular metabolism at a rate of 40-60 kcal of heat /square metre of body surface area. […] The hypothalamus controls thermoregulation via increased heat conservation (peripheral vasoconstriction and behaviour responses) and heat production (shivering and increasing levels of thyroxine and adrenaline). […] The mechanisms for heat preservation may be overwhelmed in the face of cold stress and core temperature can drop secondary to fatigue or glycogen depletion. […] This is the fall in the patients core temperature after the initiation of rewarming. Although the exact mechanism for the afterdrop is somewhat controversial, the most likely explanation is the rewarming of peripheral sites and the abated vasoconstriction results in the return of cool blood to the central circulation from the peripheral circulation.

• #32 Severe Hypothermia – RCEMLearning

  https://www.rcemlearning.co.uk/reference/severe-hypothermia/

  The management of hypothermia requires initial evaluation and support of the airway, breathing, and circulation; prevention of further heat loss; initiation of re-warming appropriate to the degree of hypothermia; and treatment of complications. […] The appropriate intervention depends on the severity of the hypothermia, the available resource and the clinical state of the patient. […] The general treatment of any coagulopathies is by re-warming and not the administration of clotting factors. […] The treatment of VF in the hypothermic patient is controversial. […] The patient should be defibrillated, if VF persists, two further shocks should be given. […] The treatment strategy will depend on the severity of the hypothermia. Mild hypothermia patients can be treated with passive rewarming, whereas moderate to severe hypothermia patients need for active and invasive methods to achieve rewarming. […] Active core rewarming should be reserved for those patients with severe and profound hypothermia who have not responded to less aggressive measures.

• #33

  https://www.vin.com/apputil/content/defaultadv1.aspx?id=8249939&pid=19840&

  General anesthesia and surgery result in both primary and secondary hypothermia. […] Minimizing the duration of anesthetic and surgical procedures may reduce the incidence of secondary hypothermia. […] Therapeutic efforts are aimed at rapidly rewarming patients during fluid resuscitation as well as reducing additional heat loss. […] A patient’s core body temperature may continue to drop for a period of time after the onset of rewarming. This condition, referred to as the „afterdrop”, is caused by the return of cold peripheral blood to the body core and movement of blood from the warmer core to the periphery. A second important complication to anticipate is the development of rewarming shock. Rapid rewarming will cause a great metabolic burden on patients as well as significant vasodilation that may overwhelm an already compromised circulatory system.

• #34 Hypothermia | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/healthyliving/hypothermia

  If core body temperature is lower than 28C, the condition is life-threatening without immediate medical attention. […] A person with severe hypothermia may only take one breath per minute, with a heart rate of less than 20 beats per minute. […] The first step in all cases of hypothermia is to prevent any further heat loss. […] Below approximately 30oC the heart is very vulnerable and there are case studies of simple movements like rolling the person over prompting a cardiac arrest. […] When applying heat close to the skin such as with hot water bottles or heat packs be careful not to make them too hot, as the person may have impaired sensation to their skin and is at risk of suffering burns. […] Hypothermia can occur in the home. The elderly and some people with medical conditions are more susceptible to hypothermia.

• #35 HYPOTHERMIA: CAUSES, SIGNS, HOW TO STAY PROTECTED | Mya Care

  https://myacare.com/blog/hypothermia-causes-signs-how-to-stay-protected

  The exact mechanism behind paradoxical undressing has yet to be fully understood. Researchers think it happens as a result of vasoconstriction and disorientation. […] In severe hypothermia, the blood vessels dilate, leading to a feeling of warmth that confuses the victim and causes them to undress to „cool down”. Extreme low core temperature also affects the brain, leading to confusion, hallucinations, and disorientation, which might be contributing factors. […] Secondary hypothermia is caused by underlying medical conditions or illnesses that affect the body’s ability to regulate temperature. These include Parkinson’s disease, brain tumors, multiple sclerosis and other neurological disorders, diabetes, hypothyroidism, and cardiovascular disease. […] Medications, such as certain anesthetics, can lower core body temperature and the body’s ability to regulate temperature by suppressing brain function. Other medicines that can interfere with temperature control include Clonidine and beta blockers.

• #36 Hypothermia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23300

  Hypothermia management focuses on quick rewarming and preventing further heat loss, ensuring that the airway, breathing, and circulation are adequately and promptly addressed. Wet clothing should be immediately removed and replaced with dry clothing or insulation.[14][15] […] Rewarming of hypothermic patients involves passive external rewarming, active external rewarming, active internal rewarming, or a combination of these techniques. The treatment of choice for mild hypothermia is passive external rewarming at a rate of 0.5 to 2 C per hour. […] Some patients may require more invasive methods besides active external rewarming. Methods range from airway rewarming with humidified air to full cardiopulmonary bypass. […] Cardiopulmonary bypass surgery and venoarterial ECMO are the most effective but highly invasive rewarming methods. These procedures are reserved for patients in cardiac arrest, hemodynamically unstable individuals, and people unresponsive to less invasive rewarming techniques. […] Hypothermia arises from inadequate heat retention or massive heat loss due to various causes. Symptoms range from mild to severe. Severe hypothermia may result in death if not treated promptly.

• #36 Hypothermia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23300

  Hypothermia occurs when the body releases more heat than it absorbs or generates. Vital factors that help retain heat in the body include central and peripheral nervous system regulation and behavioral adaptation.[6][7] […] The body’s core temperature arises from the balance between heat produced by the body and heat lost to the surroundings. The normal value ranges from 36.5 to 37.5 C. Four mechanisms are responsible for heat loss: radiation, conduction, convection, and evaporation. […] While normal body heat loss is most often due to radiation, hypothermia is more likely to arise from cold air exposure (convection), cold water contact (conduction), and excessive sweating (evaporation).[10] […] The body initially increases metabolism, ventilation, and cardiac output to maintain function when the ambient temperature drops. Heat loss can overwhelm the body and disrupt the shivering mechanism without external warming. Multiple organ systems, including neurologic, metabolic, and cardiac, will cease to function, ultimately leading to death.[11]

• #37 Management of severe accidental hypothermia | Medicina Intensiva

  https://www.medintensiva.org/en-management-severe-accidental-hypothermia-articulo-S2173572712000586

  Ventricular fibrillation (VF) and asystolia may occur below a CBT of 28C. […] Inadequate patient management, e.g., involving sudden postural changes, can trigger ventricular fibrillation. […] Oxygen consumption decreases by 6% for every 1C drop in CBT, and this reduction also affects the central nervous system (CNS) (brain and spinal cord). […] The management of severe accidental hypothermia is not exclusive of rescue or urgent pre-hospital medicine but can also be extended to Critical Care Medicine and even heart surgery and extracorporeal circulation programs. […] The basic principles for the classification, resuscitation and management of accidental hypothermia victims are the same in the maritime, mountaineering and urban settings. […] The general objectives of pre-hospital care are withdrawal and insulation from the cold environment, the prevention of a posterior drop in CBT (afterdrop), careful management of the victim and transfer to a hospital with the technological means required for treating this grade of hypothermia.

• #37 Management of severe accidental hypothermia | Medicina Intensiva

  https://www.medintensiva.org/en-management-severe-accidental-hypothermia-articulo-S2173572712000586

  Extracorporeal rewarming is the technique affording the fastest recovery of patient CBT (up to 10C/h). […] According to many authors, it is the best option for rewarming patients under cardiac arrest. […] The rewarming rate depends on the relationship between the temperature of the blood and the flow allowed by the extracorporeal pump.

• #38 Hypothermia | Causes, Symptoms & Prevention | Britannica

  https://www.britannica.com/science/hypothermia

  hypothermia, abnormally low body temperature in a warm-blooded creature, associated with a general slowing of physiologic activity. […] In human beings, hypothermia may be artificially induced to decrease the metabolic need for oxygen during certain surgical procedures and for the control of some kinds of cancer. […] Controlled induction of hypothermia has many important medical applications. […] Accidental hypothermia may be life-threatening and constitutes a medical emergency. […] Hypothermia is serious at body temperatures below 35 C (95 F); below 32.2 C (90 F), the point at which the normal shivering reaction ceases, the condition warrants emergency treatment. […] Accidental hypothermia is treated by a slow, gradual rewarming of the victim, using blankets and other passive means rather than direct application of heat.

• #39 Death Due to Hypothermia Morphological Findings, their Pathogenesis and Diagnostic Value | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-59745-110-9_1

  Morphological findings in fatalities due to hypothermia are variable and unspecific. […] The main pathogenetic mechanisms of morphological alterations due to hypothermia are disturbances of microcirculation, changes of rheology, cold stress, and hypoxidosis. […] Typical morphological findings can be found in two thirds of all cases.

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