WordNet
- subnormal body temperature
- a writer whose work is published in a newspaper or magazine or as part of a book
- of or relating to or affected by hypothermia
PrepTutorEJDIC
- 低体温;(医療における)体温低下[法]
- (…への)寄付者《+『to』+『名』(do『ing』)》 / (…への)貢献者,寄与者;一助,一因《+『to』+『名』(do『ing』)》 / (雑誌・新聞などへの)寄稿家《+『to』+『名』》
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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/11/03 16:41:23」(JST)
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This article is about accidental hypothermia. For deliberately induced cooling, see Therapeutic hypothermia. For the 2010 horror film, see Hypothermia (film).
| Hypothermia | |
|---|---|
| Classification and external resources | |
|
During Napoleon Bonaparte's retreat from Russia in the winter of 1812, many troops suffered from hypothermia.
|
|
| ICD-10 | T68 |
| ICD-9 | 991.6 |
| DiseasesDB | 6542 |
| MedlinePlus | 000038 |
| eMedicine | med/1144 |
| Patient UK | Hypothermia |
| MeSH | D007035 |
Hypothermia (from Greek ὑποθερμία) is a condition in which the body's core temperature drops below that required for normal metabolism and body functions. This is generally considered to be less than 35.0 °C (95.0 °F).[1] Characteristic symptoms depend on the temperature. In mild hypothermia there is shivering and mental confusion. In severe hypothermia there may be paradoxical undressing, where a person removes their clothing, as well as an increased risk of the heart stopping.[1]
Body temperature is usually maintained near a constant level of 36.5–37.5 °C (97.7–99.5 °F) through biologic homeostasis or thermoregulation. If a person is exposed to cold, and their internal mechanisms cannot replenish the heat that is being lost, the body's core temperature falls. This can occur due to excessive cold or health problems that decrease a person's ability to generate heat.[1]
The treatment of mild hypothermia involves: warm drinks, warm clothing and staying active.[1] In those with moderate hypothermia minimizing movement is recommended along with heating blankets and warmed intravenous fluids.[1] In severe hypothermia extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass may be useful.[1] In those without vitals signs cardiopulmonary resuscitation (CPR) is indicated along with the above measures.[1] In those whose heart has stopped, rewarming is typically continued until a person's temperature is greater than 32 °C (90 °F) before rewarming is deemed ineffective.[1]
It is the cause of at least 1500 deaths a year in the United States.[1] One of the lowest documented body temperatures from which anyone has recovered was 13.0 °C (55.4 °F) in a near-drowning incident involving a 7-year-old girl in Sweden in December 2010.[2] Hypothermia is the opposite of hyperthermia, which is present in heat exhaustion and heat stroke.
Contents
- 1 Classification
- 2 Signs and symptoms
- 2.1 Mild
- 2.2 Moderate
- 2.3 Severe
- 2.4 Paradoxical undressing
- 2.5 Terminal burrowing
- 3 Causes
- 3.1 Alcohol
- 3.2 Poverty
- 3.3 Water immersion
- 4 Pathophysiology
- 5 Diagnosis
- 6 Prevention
- 7 Management
- 7.1 Rewarming
- 7.2 Fluids
- 7.3 Dysrhythmias
- 8 Prognosis
- 9 Epidemiology
- 10 History
- 11 Other animals
- 12 See also
- 13 References
- 14 External links
Classification
| Hypothermia classification | |||
|---|---|---|---|
| Swiss system[1] | Symptoms | By degree[3] | Temperature |
| Stage 1 | Awake and shivering | Mild | 32–35 °C (90–95 °F) |
| Stage 2 | Drowsy and not shivering | Moderate | 28–32 °C (82–90 °F) |
| Stage 3 | Unconscious, not shivering | Severe | 20–28 °C (68–82 °F) |
| Stage 4 | No vital signs | Profound | <20 °C (68 °F) |
Hypothermia is often defined as any body temperature below 35.0 °C (95.0 °F).[3] With this method it is divided into degrees of severity based on the core temperature.[3]
Another classification system, the Swiss staging system, divides hypothermia based on the presenting symptoms which is preferred when it is not possible to determine an accurate core temperature.[1]
Other cold-related injuries that can be present either alone or in combination with hypothermia include:
- Chilblains, superficial ulcers of the skin that occur when a predisposed individual is repeatedly exposed to cold.[4]
- Frostbite, the freezing and destruction of tissue.[4]
- Frostnip, a superficial cooling of tissues without cellular destruction.[5]
- Trench foot or immersion foot, caused by to repetitive exposure to water at non-freezing temperatures.[4]
The normal human body temperature is often stated as 36.5–37.5 °C (97.7–99.5 °F).[6] Hyperthermia and fever, are defined as a temperature of greater than 37.5–38.3 °C (99.5–100.9 °F).[7]
Signs and symptoms
Signs and symptoms vary depending on the degree of hypothermia, and may be divided by the three stages of severity. Infants with hypothermia may feel cold when touched, with bright red skin and unusual lack of energy.[8]
Mild
Symptoms of mild hypothermia may be vague,[9] with sympathetic nervous system excitation (shivering, hypertension, tachycardia, tachypnea, and vasoconstriction). These are all physiological responses to preserve heat.[10] Cold diuresis, mental confusion, and hepatic dysfunction may also be present.[11] Hyperglycemia may be present, as glucose consumption by cells and insulin secretion both decrease, and tissue sensitivity to insulin may be blunted.[12] Sympathetic activation also releases glucose from the liver. In many cases, however, especially in alcoholic patients, hypoglycemia appears to be a more common presentation.[12] Hypoglycemia is also found in many hypothermic patients, because hypothermia may be a result of hypoglycemia.[13]
Moderate
Low body temperature results in shivering becoming more violent. Muscle mis-coordination becomes apparent.[14][15][16] Movements are slow and labored, accompanied by a stumbling pace and mild confusion, although the person may appear alert. Surface blood vessels contract further as the body focuses its remaining resources on keeping the vital organs warm. The subject becomes pale. Lips, ears, fingers, and toes may become blue.
Severe
As the temperature decreases, further physiological systems falter and heart rate, respiratory rate, and blood pressure all decrease. This results in an expected heart rate in the 30s at a temperature of 28 °C (82 °F).[11]
Difficulty speaking, sluggish thinking, and amnesia start to appear; inability to use hands and stumbling are also usually present. Cellular metabolic processes shut down. Below 30 °C (86 °F), the exposed skin becomes blue and puffy, muscle coordination very poor, and walking almost impossible, and the person exhibits incoherent/irrational behavior, including terminal burrowing (see below) or even stupor. Pulse and respiration rates decrease significantly, but fast heart rates (ventricular tachycardia, atrial fibrillation) can also occur. Atrial fibrillation is not typically a concern in and of itself.[1] Major organs fail. Clinical death occurs.
Paradoxical undressing
Twenty to fifty percent of hypothermia deaths are associated with paradoxical undressing. This typically occurs during moderate to severe hypothermia, as the person becomes disoriented, confused, and combative. They may begin discarding their clothing, which, in turn, increases the rate of heat loss.[17][18]
Rescuers who are trained in mountain survival techniques are taught to expect this; however, some may assume incorrectly that urban victims of hypothermia have been subjected to a sexual assault.[19]
One explanation for the effect is a cold-induced malfunction of the hypothalamus, the part of the brain that regulates body temperature. Another explanation is that the muscles contracting peripheral blood vessels become exhausted (known as a loss of vasomotor tone) and relax, leading to a sudden surge of blood (and heat) to the extremities, fooling the person into feeling overheated.[19][20]
Terminal burrowing
An apparent self-protective behaviour known as terminal burrowing, or hide-and-die syndrome,[21] occurs in the final stages of hypothermia. The afflicted will enter small, enclosed spaces, such as underneath beds or behind wardrobes. It is often associated with paradoxical undressing.[22] Researchers in Germany claim this is "obviously an autonomous process of the brain stem, which is triggered in the final state of hypothermia and produces a primitive and burrowing-like behavior of protection, as seen in hibernating animals."[23] This happens mostly in cases where temperature drops slowly.[20]
Causes
The rate of hypothermia is strongly related to age in the United States.
Hypothermia usually occurs from exposure to low temperatures, and is frequently complicated by alcohol consumption.[24] Any condition that decreases heat production, increases heat loss, or impairs thermoregulation, however, may contribute.[25] Thus, hypothermia risk factors include: substance abuse (including alcohol abuse), homelessness, any condition that affects judgment (such as hypoglycemia), the extremes of age, poor clothing, chronic medical conditions (such as hypothyroidism and sepsis), and living in a cold environment.[26][27] Hypothermia occurs frequently in major trauma, and is also observed in severe cases of anorexia nervosa.
Alcohol
Alcohol consumption increases the risk of hypothermia by its action as a vasodilator. It increases blood flow to the skin and extremities, making a person feel warm, while increasing heat loss.[28] Between 33% and 73% of hypothermia cases are complicated by alcohol.[24]
Poverty
In the UK, 28,354 cases of hypothermia were treated in 2012/13 – an increase of 25% from the previous year.[29] Some cases of hypothermia death, as well as other preventable deaths, happen because poor people cannot easily afford to keep warm. Rising fuel bills have increased the numbers who have difficulty paying for adequate heating in the UK. Some pensioners and disabled people are at risk because they do not work and cannot easily get out of their homes. Better heat insulation can help.[30][31][32]
Water immersion
Hypothermia continues to be a major limitation to swimming or diving in cold water.[14] The reduction in finger dexterity due to pain or numbness decreases general safety and work capacity, which consequently increases the risk of other injuries.[14][16]
Other factors predisposing to immersion hypothermia include dehydration, inadequate rewarming between repetitive dives, starting a dive while wearing cold, wet dry suit undergarments, sweating with work, inadequate thermal insulation (for example, thin dry suit undergarment), and poor physical conditioning.[14]
Heat is lost much more quickly in water[14] than in air. Thus, water temperatures that would be quite reasonable as outdoor air temperatures can lead to hypothermia in survivors, although this is not usually the direct clinical cause of death for those who are not rescued. A water temperature of 10 °C (50 °F) can lead to death in as little as one hour, and water temperatures near freezing can cause death in as little as 15 minutes.[33] A notable example of this occurred during the sinking of the Titanic, when most people who entered the −2 °C (28 °F) water died within 15–30 minutes.[34]
The actual cause of death in cold water is usually the bodily reactions to heat loss and to freezing water, rather than hypothermia (loss of core temperature) itself. For example, plunged into freezing seas, around 20% of victims die within 2 minutes from cold shock, (uncontrolled rapid breathing, and gasping, causing water inhalation, massive increase in blood pressure and cardiac strain leading to cardiac arrest, and panic); another 50% die within 15–30 minutes from cold incapacitation (inability to use or control limbs and hands for swimming or gripping, as the body "protectively" shuts down the peripheral muscles of the limbs to protect its core),[35] and exhaustion and unconsciousness cause drowning, claiming the rest within a similar time.[33]
Pathophysiology
| Temperature classification | |
|---|---|
|
|
|
| Hypothermia | <35.0 °C (95.0 °F)[36] |
| Normal | 36.5–37.5 °C (97.7–99.5 °F)[37] |
| Fever | >37.5 or 38.3 °C (99.5 or 100.9 °F)[38][7] |
| Hyperthermia | >38.3 or 40.0 °C (100.9 or 104.0 °F)[38][7] |
| Hyperpyrexia | >40.0 or 41.5 °C (104.0 or 106.7 °F)[39][40] |
| Note: The difference between fever and hyperthermia is the underlying mechanism. Different sources have different cuts offs for fever, hyperthermia and hyperpyrexia. |
|
|
|
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%).[9] Heat production may be increased 2 to 4 fold through muscle contractions (i.e. exercise and shivering).[9] The rate of heat loss is determined, as with any object, by convection, conduction, and radiation.[9] The rates of these can be affected by body mass index, body surface area to volume ratios, clothing and other environmental conditions.[41]
Many changes to physiology occur as body temperature decreases. These occur in the cardiovascular system leading to the Osborn J wave and other dysrhythmias, decreased CNS electrical activity, cold diuresis, and non-cardiogenic pulmonary edema.[42]
Research has shown that glomerular filtration rate (GFR) decreases as a result of hypothermia.[43] In essence, Hypothermia increases preglomerular vasoconstriction, thus decreasing both renal blood flow (RBF) and GFR.[44]
Diagnosis
Atrial fibrillation and Osborn J waves in a person with hypothermia. Note what could be mistaken for ST elevation.
Accurate determination of core temperature often requires a special low temperature thermometer, as most clinical thermometers do not measure accurately below 34.4 °C (93.9 °F).[10] A low temperature thermometer can be placed in the rectum, esophagus or the bladder. Esophageal measurements are the most accurate and are recommended once a person is intubated.[1] Other methods of measurement such as in the mouth, under the arm, or using an infrared ear thermometer are often not accurate.[1]
As a hypothermic person's heart rate may be very slow, prolonged feeling for a pulse could be required before detecting. In 2005, the American Heart Association recommended at least 30–45 seconds to verify the absence of a pulse before initiating CPR.[45] Others recommend a 60 second check.[1]
The classical ECG finding of hypothermia is the Osborn J wave. Also, ventricular fibrillation frequently occurs below 28 °C (82 °F) and asystole below 20 °C (68 °F).[9] The Osborn J may look very similar to those of an acute ST elevation myocardial infarction.[11] Thrombolysis as a reaction to the presence of Osborn J waves is not indicated, as it would only worsen the underlying coagulopathy caused by hypothermia.
Prevention
Appropriate clothing helps to prevent hypothermia. Synthetic and wool fabrics are superior to cotton as they provide better insulation when wet and dry. Some synthetic fabrics, such as polypropylene and polyester, are used in clothing designed to wick perspiration away from the body, such as liner socks and moisture-wicking undergarments. Clothing should be loose fitting, as tight clothing reduces the circulation of warm blood.[46] In planning outdoor activity, prepare appropriately for possible cold weather. Those who drink alcohol before or during outdoor activity should ensure at least one sober person is present responsible for safety.
Covering the head is effective, but no more effective than covering any other part of the body. While common folklore says that people lose most of their heat through their heads, heat loss from the head is no more significant than that from other uncovered parts of the body.[47][48] However, heat loss from the head is significant in infants, whose head is larger relative to the rest of the body than in adults. Several studies have shown that for uncovered infants, lined hats significantly reduce heat loss and thermal stress.[49][50][51] Children have a larger surface area per unit mass, and other things being equal should have one more layer of clothing than adults in similar conditions, and the time they spend in cold environments should be limited. However children are often more active than adults, and may generate more heat. In both adults and children, overexertion causes sweating and thus increases heat loss.[52]
Building a shelter can aid survival where there is danger of death from exposure. Shelters can be of many different types, metal can conduct heat away from the occupants and is sometimes best avoided. The shelter should not be too big so body warmth stays near the occupants. Good ventilation is essential especially if a fire will be lit in the shelter. Fires should be put out before the occupants sleep to prevent carbon monoxide poisoning. People caught in very cold, snowy conditions can build an igloo or snow cave to shelter.[53][54]
The United States Coast Guard promotes using life vests to protect against hypothermia through the 50/50/50 rule: If someone is in 50 °F (10 °C) water for 50 minutes, he/she has a 50 percent better chance of survival if wearing a life jacket.[citation needed][55] A heat escape lessening position can be used to increase survival in cold water.
Babies should sleep at 16-20 °C (61-68 °F) and housebound people should be checked regularly to make sure the temperature of the home is sufficient.[23][52][56] [57]
Management
| Degree[1][45] | Rewarming technique |
|---|---|
| Mild (stage 1) | Passive rewarming |
| Moderate (stage 2) | Active external rewarming |
| Severe (stage 3 and 4) | Active internal rewarming |
Aggressiveness of treatment is matched to the degree of hypothermia.[1] Treatment ranges from noninvasive, passive external warming to active external rewarming, to active core rewarming.[10] In severe cases resuscitation begins with simultaneous removal from the cold environment and management of the airway, breathing, and circulation. Rapid rewarming is then commenced. Moving the person as little and as gently as possible is recommended as aggressive handling may increase risks of a dysrhythmia.[45]
Hypoglycemia is a frequent complication and needs to be tested for and treated. Intravenous thiamine and glucose is often recommended, as many causes of hypothermia are complicated by Wernicke's encephalopathy.[58] The UK NHS advises the lay public against putting a person in a hot bath, massaging their arms and legs or using a heating pad.[56]
Rewarming
Rewarming can be done with a number of different methods including passive external rewarming, active external rewarming, and active internal rewarming.[59] Passive external rewarming involves the use of a person's own ability to generate heat by providing properly insulated dry clothing and moving to a warm environment.[60] It is recommended for those with mild hypothermia.[60]
Active external rewarming involves applying warming devices externally, such as a heating blanket.[1] These may function by warmed forced air (a Bair Hugger is a commonly used device), chemical reactions, or electricity.[1][60] In wilderness environments, hypothermia may be helped by placing a hot water bottle in both armpits and groin.[61] These methods are recommended for moderate hypothermia.[60] Active core rewarming involves the use of intravenous warmed fluids, irrigation of body cavities with warmed fluids (the chest or abdomen), use of warm humidified inhaled air, or use of extracorporeal rewarming such as via a heart lung machine or extracorporeal membrane oxygenation.[59] Extracorporeal rewarming is the fastest method for those with severe hypothermia.[60] Survival rates with normal mental functioning have been reported at around 50%.[1] Chest irrigation is recommended if bypass or ECMO is not possible.[1]
Rewarming collapse (or rewarming shock) is a sudden drop in blood pressure in combination with a low cardiac output which may occur during active treatment of a severely hypothermic person.[62][63] There was a theoretical concern that external rewarming rather than internal rewarming may increase the risk. These concerns were partly believed to be due to "after-drop", a situation detected during laboratory experiments where there is a continued decrease in core temperature after rewarming has been started.[1] Recent studies have not supported these concerns, and problems are not found with active external rewarming.[1][45]
Fluids
Warm sweetened liquids can be given provided the person is alert and can swallow. Many recommend that alcohol[23][56] and drinks with lots of caffeine be avoided.[64] As most people are moderately dehydrated due to cold-induced diuresis, warmed intravenous fluids to a temperature of 38–45 °C (100–113 °F) is often recommended.[10][1]
Dysrhythmias
In those without signs of life cardiopulmonary resuscitation (CPR) should be continued during active rewarming.[1] For ventricular fibrillation or ventricular tachycardia, a single defibrillation should be attempted.[65] People with severe hypothermia however may not respond to pacing or defibrillation.[65] It is not known if further defibrillation should be withheld until the core temperature reaches 30 °C (86 °F).[65] In Europe epinephrine is not recommended until the temperature reaches 30 °C (86 °F) while the American Heart Association recommended up to three doses of epinephrine before 30 °C (86 °F) is reached.[1] Once a temperature of 30 °C (86 °F) is reached, normal ACLS protocols should be followed.[45]
Prognosis
It is usually recommended not to declare a person dead until their body is warmed to a near normal body temperature of greater than 32 °C (90 °F),[1] since extreme hypothermia can suppress heart and brain function.[66] Exceptions include if there is an obvious fatal injuries or the chest is frozen so that it cannot be compressed.[45] If a person was buried in an avalanche for more than 35 minutes and is found with a mouth packed full of snow without a pulse stopping early may also be reasonable.[1] This is also the case if a person's blood potassium is greater than 12 mmol/l.[1]
Those who are stiff with pupils that do not move may survive if treated aggressively.[1] Survival with good function also occasionally occurs even after the need for hours of CPR.[1] Children who have a near-drowning accidents in water near 0 °C (32 °F) can occasionally be revived even over an hour after losing consciousness.[67] The cold water lowers metabolism, allowing the brain to withstand a much longer period of hypoxia. While survival is possible, mortality from severe or profound hypothermia remains high despite optimal treatment. Studies estimate mortality at between 38%[68][69] and 75%.[9]
In those who have hypothermia due to another underlying health problem, when death occurs it is frequently from that underlying health problem.[1]
Epidemiology
In the past, hypothermia occurred most frequently in homeless people, but recreational exposure to cold environments is now the main cause of hypothermia. Between 1995 and 2004 in the United States, an average of 1560 cold-related emergency department visits occurred per year and in the years 1999 to 2004, an average of 647 people died per year due to hypothermia.[26][70]
History
The armies of Napoleon retreat from Russia in 1812.
Snow-storm: Hannibal and His Army Crossing the Alps, J. M. W. Turner
Hypothermia has played a major role in the success or failure of many military campaigns from Hannibal's loss of nearly half his men in the Second Punic War (218 B.C.) to the near destruction of Napoleon's armies in Russia in 1812. Men wandered around confused through hypothermia, some lost consciousness and died, others shivered, later developed torpor and tended to sleep. Others too weak to walk fell on their knees, some stayed that way some time resisting death. The pulse was of some was weak and hard to detect, others groaned, yet others had eyes open and wild with quiet delirium.[71] Loss of life to hypothermia in Russian regions continued through the first and second world wars, especially in the Battle of Stalingrad.[72]
Civilian examples of deaths caused by hypothermia are found during the sinkings of the RMS Titanic and RMS Lusitania, and more recently of the MS Estonia.[73][74][75]
Antarctic explorers developed hypothermia, Ernest Shackleton and his team measured body temperatures "below 94.2° which spells death at home" though this probably referred to oral temperatures rather than core temperature and corresponded to mild hypothermia. One of Scott's team, Atkinson became confused through hypothermia.[71]
Nazi human experimentation during World War II amounting to medical torture included hypothermia experiments and many victims died. There were 360 to 400 experiments and 280 to 300 subjects indicating some had more than one experiment performed on them. Different methods of rewarming were attempted, "One assistant later testified that some victims were thrown into boiling water for rewarming".[76]
Other animals
Many animals other than humans often induce hypothermia during hibernation or torpor.
Water bears (Tardigrade), microscopic multicellular organisms, can survive freezing at low temperatures by replacing most of their internal water with the sugar trehalose, preventing the crystallization that otherwise damages cell membranes.
See also
- "To Build a Fire"—A short story by Jack London portraying the effects of cold and hypothermia
References
- ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af Brown, DJ; Brugger, H; Boyd, J; Paal, P (Nov 15, 2012). "Accidental hypothermia.". The New England Journal of Medicine 367 (20): 1930–8. doi:10.1056/NEJMra1114208. PMID 23150960.
- ^ Remarkable recovery of 7-year-old girl, Radio Sweden, 17 January 2011
- ^ a b c Marx, John (2006). Rosen's emergency medicine: concepts and clinical practice. Mosby/Elsevier. p. 2239. ISBN 978-0-323-02845-5.
- ^ a b c "Cold Stress". Center for Disease Control and Prevention.
- ^ Marx 2010 p.1862
- ^ Karakitsos D, Karabinis A (September 2008). "Hypothermia therapy after traumatic brain injury in children". N. Engl. J. Med. 359 (11): 1179–80. doi:10.1056/NEJMc081418. PMID 18788094.
- ^ a b c Laupland KB (July 2009). "Fever in the critically ill medical patient". Crit. Care Med. 37 (7 Suppl): S273–8. doi:10.1097/CCM.0b013e3181aa6117. PMID 19535958.
- ^ What Is Hypothermia?
- ^ a b c d e f Hanania NA, Zimmerman JL (1999). "Accidental hypothermia". Crit Care Clin 15 (2): 235–49. doi:10.1016/s0749-0704(05)70052-x. PMID 10331126.
- ^ a b c d McCullough L, Arora S (December 2004). "Diagnosis and treatment of hypothermia". Am Fam Physician 70 (12): 2325–32. PMID 15617296.
- ^ a b c Marx 2010 p.1869
- ^ a b Altus P, Hickman JW (May 1981). "Accidental hypothermia: hypoglycemia or hyperglycemia". West. J. Med. 134 (5): 455–6. PMC 1272797. PMID 7257359.
- ^ eMedicine Specialties > Emergency Medicine > Environmental >Hypothermia Author: Jamie Alison Edelstein, MD. Coauthors: James Li, MD; Mark A Silverberg, MD; Wyatt Decker, MD. Updated: Oct 29, 2009
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- ^ Francis, TJR (1998). "Immersion hypothermia". South Pacific Underwater Medicine Society Journal 28 (3). ISSN 0813-1988. OCLC 16986801. Retrieved 2008-06-11.
- ^ a b Cheung SS, Montie DL, White MD, Behm D (September 2003). "Changes in manual dexterity following short-term hand and forearm immersion in 10 degrees C water". Aviat Space Environ Med 74 (9): 990–3. PMID 14503680. Retrieved 2008-06-11.
- ^ New Scientist (2007). "The word: Paradoxical undressing – being-human". New Scientist. Retrieved 2008-06-18.
- ^ Wedin B, Vanggaard L, Hirvonen J (July 1979). ""Paradoxical undressing" in fatal hypothermia". J. Forensic Sci. 24 (3): 543–53. PMID 541627.
- ^ a b Ramsay, David; Michael J. Shkrum (2006). Forensic Pathology of Trauma (Forensic Science and Medicine). Totowa, NJ: Humana Press. p. 417. ISBN 1-58829-458-7.
- ^ a b Terminal burrowing behaviour"--a phenomenon of lethal hypothermia
- ^ Carter N, Green MA, Milroy CM, Clark JC (1995). "Letter to the editor: Terminal burrowing behaviour — a phenomenon of lethal hypothermia". International Journal of Legal Medicine (Berlin / Heidelberg: Springer) 108 (2): 116. doi:10.1007/BF01369918. PMID 8547158. Retrieved September 12, 2010.
- ^ Rothschild MA, Schneider V (1995). ""Terminal burrowing behaviour"--a phenomenon of lethal hypothermia". Int J Legal Med 107 (5): 250–6. doi:10.1007/BF01245483. PMID 7632602.
- ^ a b c Get Naked and Dig: The Bizarre Effects of Hypothermia
- ^ a b Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice 7th edition. Philadelphia, PA: Mosby/Elsevier. p. Chapter 183. ISBN 978-0-323-05472-0.
- ^ Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice 7th edition. Philadelphia, PA: Mosby/Elsevier. p. 1870. ISBN 978-0-323-05472-0.
- ^ a b Baumgartner, Hypothermia and Other Cold-Related Morbidity Emergency Department Visits: United States, 1995–2004 Wilderness and Environmental Medicine, 19, 233 237 (2008)
- ^ "Hypothermia-related deaths—United States, 1999–2002 and 2005". MMWR Morb. Mortal. Wkly. Rep. 55 (10): 282–4. March 2006. PMID 16543884.
- ^ Hicks, R (January 2007). "Hypothermia". BBC Health. Retrieved 2008-02-19.
- ^ Labour decry 'shocking' rise in hypothermia cases
- ^ Excess winter deaths
- ^ The scandal of fuel poverty
- ^ Fuel poverty
- ^ a b "Hypothermia safety". United States Power Squadrons. January 23, 2007. Retrieved 2008-02-19.
- ^ Sinking of the RMS Titanic#CITEREFButler1998
- ^ http://www.gcaptain.com/cold_water/?11198 "The Truth About Cold Water" - drowning expert Mario Vittone, pub. gCaptain 2013-04-12 and own website 2010-10-21: [S]omething that almost no one in the maritime industry understands ... That includes mariners [and] even many (most) rescue professionals: It is impossible to get hypothermic in cold water unless you are wearing flotation, because without flotation you won't live long enough to become hypothermic. [Emphasis in original, and details of causes in article]
- ^ Marx, John (2006). Rosen's emergency medicine: concepts and clinical practice. Mosby/Elsevier. p. 2239. ISBN 9780323028455.
- ^ Karakitsos D, Karabinis A (September 2008). "Hypothermia therapy after traumatic brain injury in children". N. Engl. J. Med. 359 (11): 1179–80. doi:10.1056/NEJMc081418. PMID 18788094.
- ^ a b Axelrod YK, Diringer MN (May 2008). "Temperature management in acute neurologic disorders". Neurol. Clin. 26 (2): 585–603, xi. doi:10.1016/j.ncl.2008.02.005. PMID 18514828.
- ^ Manson's Tropical Diseases: Expert Consult. Saunders. 2008. p. 1229. ISBN 9781416044703.
- ^ Trautner BW, Caviness AC, Gerlacher GR, Demmler G, Macias CG (July 2006). "Prospective evaluation of the risk of serious bacterial infection in children who present to the emergency department with hyperpyrexia (temperature of 106 degrees F or higher)". Pediatrics 118 (1): 34–40. doi:10.1542/peds.2005-2823. PMC 2077849. PMID 16818546.
- ^ Nuckton TJ, Claman DM, Goldreich D, Wendt FC, Nuckton JG (2000 Oct;18(6):703-7.). "Hypothermia and afterdrop following open water swimming: the Alcatraz/San Francisco Swim Study". Am J Emerg Med (NCBI) 18 (6): 703–7. doi:10.1053/ajem.2000.16313. PMID 11043627. Check date values in:
|date=(help) - ^ Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice 7th edition. Philadelphia, PA: Mosby/Elsevier. pp. 1869–1870. ISBN 978-0-323-05472-0.
- ^ Broman M, Källskog O (1995). "The effects of hypothermia on renal function and haemodynamics in the rat". Acta physiologica Scandinavica 153 (2): 179–184. doi:10.1111/j.1748-1716.1995.tb09849.x. PMID 7778458.
- ^ Broman M, Källskog O, Kopp UC, Wolgast M (1998). "Influence of the sympathetic nervous system on renal function during hypothermia". Acta physiologica Scandinavica 163 (3): 241–249. doi:10.1046/j.1365-201x.1998.00356.x. PMID 9715736.
- ^ a b c d e f ECC Committee, Subcommittees and Task Forces of the American Heart Association (December 2005). "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation 112 (24 Suppl): IV–136. doi:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375.
- ^ "Workplace Safety & Health Topics: Cold Stress". National Institute for Occupational Safety and Health. Retrieved 21 March 2014.
- ^ Sessler DI, Moayeri A, Støen R, Glosten B, Hynson J, McGuire J (1990). "Thermoregulatory vasoconstriction decreases cutaneous heat loss". Anesthesiology 73 (4): 656–60. doi:10.1097/00000542-199010000-00011. PMID 2221434. Archived from the original on 2013-01-28.
- ^ Sample, Ian (December 18, 2008). "Scientists debunk myth that most heat is lost through head | Science". The Guardian (London). Archived from the original on 2012-05-27. Retrieved June 23, 2010.
- ^ Stothers JK (1981). "Head insulation and heat loss in the newborn". British Medical Journal, Archives of Disease in Childhood (Royal Coll Paediatrics) 56 (7): 530–534. doi:10.1136/adc.56.7.530. PMC 1627361. PMID 7271287. Archived from the original on 2012-07-08. (full text)
- ^ Chaput de Saintonge DM, Cross KW, Shathorn MK, Lewis SR, Stothers JK (September 2, 1979). "Hats for the newborn infant". British Medical Journal 2 (6190): 570–1. doi:10.1136/bmj.2.6190.570. PMC 1596505. PMID 387172.
- ^ Lang N, Bromiker R, Arad I (November 2004). "The effect of wool vs. cotton head covering and length of stay with the mother following delivery on infant temperature". International Journal of Nursing Studies 41 (8): 843–846. doi:10.1016/j.ijnurstu.2004.03.010. PMID 15476757. Archived from the original on 2012-09-06.
- ^ a b hypothermia Prevention
- ^ How to build an Igloo, survive a blizzard, finish your mission on time This web page gives basic instructions for westerners.
- ^ Cold Weather Survival, Shelkters This has instructions about building different types of shelter
- ^ United States Coast Guard. "Recreational Boating Safety Information". United States Coast Guard. Retrieved 2008-06-18. [dead link]
- ^ a b c Preventing hypothermia
- ^ Can hypothermia be prevented?
- ^ Tintinalli, Judith (2004). Emergency Medicine: A Comprehensive Study Guide, Sixth edition. McGraw-Hill Professional. p. 1181. ISBN 0-07-138875-3.
- ^ a b McCullough L, Arora S (Dec 2004). "Diagnosis and treatment of hypothermia". Am Fam Physician 70 (12): 2325–32. PMID 15617296.
- ^ a b c d e Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, Jeejeebhoy FM, Gabrielli A (2010-11-02). "Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation 122 (18 Suppl 3): S829–61. doi:10.1161/CIRCULATIONAHA.110.971069. PMID 20956228.
- ^ Auerbach, [edited by] Paul S. (2007). Wilderness medicine. (5th ed.). St. Louis, Mo.: Elsevier Mosby. pp. Chapter 5. ISBN 978-0-323-03228-5.
- ^ Tveita T (October 2000). "Rewarming from hypothermia. Newer aspects on the pathophysiology of rewarming shock". Int J Circumpolar Health 59 (3–4): 260–6. PMID 11209678.
- ^ Kondratiev TV, Myhre ES, Simonsen O, Nymark TB, Tveita T (February 2006). "Cardiovascular effects of epinephrine during rewarming from hypothermia in an intact animal model". J. Appl. Physiol. 100 (2): 457–64. doi:10.1152/japplphysiol.00356.2005. PMID 16210439.
- ^ Auerbach, [edited by] Paul S. (2011). "Accidental Hypothermia". Wilderness medicine (6th ed. ed.). Philadelphia, PA: Elsevier/Mosby. pp. Chapter 5. ISBN 1437716784.
- ^ a b c Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, Jeejeebhoy FM, Gabrielli A (2010). "Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation 122 (18 Suppl 3): S829–61. doi:10.1161/CIRCULATIONAHA.110.971069. PMID 20956228.
- ^ Iyer A, Rajkumar V, Sadasivan D, Bruce J, Gilfillan I (2007). "No one is dead until warm and dead". The Journal of thoracic and cardiovascular surgery 134 (4): 1042–3. doi:10.1016/j.jtcvs.2007.05.028. PMID 17903527.
- ^ Bolte RG, Black PG, Bowers RS, Thorne JK, Corneli HM (1988). "The use of extracorporeal rewarming in a child submerged for 66 minutes". Journal of the American Medical Association 260 (3): 377–379. doi:10.1001/jama.260.3.377. PMID 3379747.
- ^ Morita S, Seiji M, Inokuchi S, Sadaki I, Inoue S, Shigeaki I, Akieda K, Kazuki A, Umezawa K, Kazuo U, Nakagawa Y, Yoshihide N, Yamamoto I, Isotoshi Y (December 2008). "The efficacy of rewarming with a portable and percutaneous cardiopulmonary bypass system in accidental deep hypothermia patients with hemodynamic instability". J Trauma 65 (6): 1391–5. doi:10.1097/TA.0b013e3181485490. PMID 19077632.
- ^ Vassal T, Benoit-Gonin B, Carrat F, Guidet B, Maury E, Offenstadt G (December 2001). "Severe accidental hypothermia treated in an ICU: prognosis and outcome". Chest 120 (6): 1998–2003. doi:10.1378/chest.120.6.1998. PMID 11742934.
- ^ "Hypothermia-Related Mortality – Montana, 1999–2004".
- ^ a b Guly, H (Jan 2011). "History of accidental hypothermia.". Resuscitation 82 (1): 122–5. doi:10.1016/j.resuscitation.2010.09.465. PMC 3060344. PMID 21036455.
- ^ Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice 7th edition. Philadelphia, PA: Mosby/Elsevier. p. 1868. ISBN 978-0-323-05472-0.
- ^ Findings: Titanic victims in 'cold shock' Times Higher Education 2010-03-23
- ^ Remember the Lusitania Two new books reëxamine the disaster New Yorker Retrieved 2010-03-23
- ^ Soomer H, Ranta H, Penttilä A (2001). "Identification of victims from the M/S Estonia". International Journal of Legal Medicine 114 (4–5): 259–262. doi:10.1007/s004140000180. PMID 11355406.
- ^ Berger, RL (May 17, 1990). "Nazi science--the Dachau hypothermia experiments.". The New England Journal of Medicine 322 (20): 1435–40. doi:10.1056/NEJM199005173222006. PMID 2184357.
- Bibliography
- Marx, John (2010). Rosen's Emergency Medicine: Concepts and Clinical Practice (7th ed.). Philadelphia: Mosby/Elsevier. p. 1862. ISBN 978-0-323-05472-0.
External links
| Find more about hypothermia at Wikipedia's sister projects | |
| Definitions from Wiktionary | |
| Media from Commons | |
| Quotations from Wikiquote | |
| Source texts from Wikisource | |
| Textbooks from Wikibooks | |
| Travel guide from Wikivoyage | |
| Learning resources from Wikiversity | |
- Princeton Outdoor Guide to Hypothermia
- Wilderness Management of Hypothermia
- CDC - NIOSH Workplace Safety & Health Topic: Cold Stress
- The cold hard facts of freezing to death
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UpToDate Contents
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- 1. 成人における偶発性低体温 accidental hypothermia in adults
- 2. 小児における低体温：臨床症状および診断 hypothermia in children clinical manifestations and diagnosis
- 3. 麻酔後回復室（PACU）における心血管の障害 cardiovascular problems in the post anesthesia care unit pacu
- 4. 小児における低体温：マネージメント hypothermia in children management
- 5. 成人における心停止後のマネージメント post cardiac arrest management in adults
English Journal
- Cardiovascular effects of mild hypothermia in post-cardiac arrest patients by beat-to-beat monitoring. A single centre pilot study.
- Lazzeri C1, Sori A, Bernardo P, Chiostri M, Tommasi E, Zucchini M, Romano SM, Gensini GF, Valente S.
- Acute cardiac care.Acute Card Care.2014 Jun;16(2):67-73. doi: 10.3109/17482941.2014.889310. Epub 2014 Mar 21.
- Abstract Background: Data on the hemodynamic and cardiovascular effects of hypothermia in patients with cardiac arrest are scarce. The aim of this study was to evaluate the hemodynamic changes induced by hypothermia by means of Most Care(®) (pressure recording analytical method, PRAM methodology),
- PMID 24654656
- Alcohol-attributable mortality among american indians and alaska natives in the United States, 1999-2009.
- Landen M1, Roeber J, Naimi T, Nielsen L, Sewell M.
- American journal of public health.Am J Public Health.2014 Jun;104 Suppl 3:S343-9. doi: 10.2105/AJPH.2013.301648. Epub 2014 Apr 22.
- Objectives. We describe the relative burden of alcohol-attributable death among American Indians/Alaska Natives (AI/ANs) in the United States. Methods. National Death Index records were linked with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN.
- PMID 24754661
- Peri-operative warming devices: performance and clinical application.
- John M1, Ford J, Harper M.
- Anaesthesia.Anaesthesia.2014 Jun;69(6):623-38. doi: 10.1111/anae.12626. Epub 2014 Apr 10.
- Since the adverse consequences of accidental peri-operative hypothermia have been recognised, there has been a rapid expansion in the development of new warming equipment designed to prevent it. This is a review of peri-operative warming devices and a critique of the evidence assessing their perform
- PMID 24720346
Japanese Journal
- 心臓カテーテル検査室の温熱条件の長期観察 : 心臓カテーテルを受ける冠疾患患者の体温管理のために
- 菅屋 潤壹,鬼塚 知里,澄川 美智 [他]
- 椙山女学園大学看護学研究 6, 9-21, 2014-03
- NAID 40020046092
- Critical roles of nardilysin in the maintenance of body temperature homoeostasis.
- Hiraoka Yoshinori,Matsuoka Tatsuhiko,Ohno Mikiko,Nakamura Kazuhiro,Saijo Sayaka,Matsumura Shigenobu,Nishi Kiyoto,Sakamoto Jiro,Chen Po-Min,Inoue Kazuo,Fushiki Tohru,Kita Toru,Kimura Takeshi,Nishi Eiichiro
- Nature communications 5, 2014-02-04
- … Despite these findings, Nrd1(-/-) mice show hypothermia and cold intolerance that are attributed to the lowered set point of body temperature, poor insulation and impaired cold-induced thermogenesis. …
- NAID 120005367798
- 粘液水腫性昏睡 (特集 内分泌緊急症)
- 大野 洋介,白石 美絵乃,山本 頼綱 [他]
- 内分泌・糖尿病・代謝内科 38(2), 117-123, 2014-02
- NAID 40020003139
Related Links
- Aggressiveness of treatment is matched to the degree of hypothermia. [2] Treatment ranges from noninvasive, passive external warming to active external rewarming, to active core rewarming. [14] In severe cases resuscitation begins ...
- Hypothermia Prevention, Recognition and Treatment. Articles, protocols and research on the life-saving skills of keeping hypothermia victims alive by core rewarming techniques. ... "No previously healthy person should die of ...
Related Pictures
★リンクテーブル★
| リンク元 | 「低体温」「体温」「5H5T」「contributor」「人工冬眠療法」 |
| 拡張検索 | 「induced hypothermia」 |
「低体温」
概念
- 深部体温が35℃以下に低下した場合をいう。
分類
原因
- 1. 治療上、故意の低体温 → 神経的予後改善、脳神経手術など
- 2. 偶発性低体温
- 1-1. 一次性偶発性低体温：基礎疾患がない人が寒冷に暴露
- 1-2. 二次性偶発性低体温：重篤な基礎疾患に合併して起こる低体温 → 重篤
重症度
- SQ.497
- 軽度 ：32-35℃
- 中等度：28-32℃
- 重度 ：28℃未満
リスクファクター
- HIM.135
- 年齢：高齢、新生児
- 環境：職業、スポーツ、服装、immersion
- 中毒、薬剤：エタノール、フェノチアジン、バルビツール酸、麻酔薬、筋弛緩薬、抗うつ薬、癌腫症
- エネルギー枯渇：栄養失調症、マラスムス、クワシオルコル
- 内分泌：糖尿病、低血糖、甲状腺機能低下症、副腎機能低下症、下垂体機能低下症
- 神経関連：脳血管疾患、下垂体障害、パーキンソン病、脊椎損傷
- 多臓器：外傷、敗血症、ショック、肝不全、腎不全
- やけど、剥脱性皮膚疾患
- 不動、衰弱
症状
(HIM.136)
| 中枢神経系 | 心臓血管系 | 呼吸器 | 腎臓＆内分泌 | 神経筋肉 | |
| 軽度 35-32.2℃ |
・中枢神経系の代謝の直線的な抑制(linear depression) ・健忘 ・感情鈍麻 ・判断の誤り ・不適応な行動 |
・頻脈の後に次第に徐脈 ・心周期の延長 ・血管収縮 ・心拍出量の増加 ・血圧の上昇 |
・頻呼吸、そして進行性の毎分換気量の減少 ・酸素消費量の減少 ・気管支漏 ・気管支攣縮 |
・利尿 ・カテコラミン、副腎ステロイド、T3(トリヨードサイロニン)・T4(サイロキシン)の増加 (血中濃度のことと思う) ・戦慄による代謝の増加 |
・基礎代謝(basal metabolism)の80%減少 ・increased preshivering muscle tone, then fatiguing |
| 中等度 32.2-28.0℃ |
・EEGの異常 ・意識レベルの進行的な低下(progressive depression) ・瞳孔散大 ・逆説的脱衣(paradoxical undressing) ・幻視 |
・脈拍数と心拍出量の進行性の減少 ・心房や心室の不整脈の増加 ・低体温を示唆するECG(J波) |
・低換気 ・体温8℃低下するごとに二酸化炭素消費量が50%減少する ・防護的気道反射(protective airway reflexes)の消失 |
・腎血流量50%増加 ・腎自己調整能は保たれる ・インスリン作用の低下 |
・反射低下 ・戦慄による熱産生の減少 ・固縮 |
| 重度 <28℃ |
・脳血管の自己調節能の喪失 ・脳血流量の減少 ・昏睡 ・眼反射(ocular reflex)の喪失 ・EEGの進行的な低下(decrease) |
・血圧、心拍数、および心拍出量の進行性の減少 ・リエントリー性のリズム異常(dysthythmia) ・心室細動の最大リスク ・心停止 |
・肺鬱血と肺水腫 ・酸素消費量75%減少 ・無呼吸 |
・心拍出量低下に伴う腎血流量の減少 ・極度の乏尿 ・(体温の？)変温性 |
・不動 ・神経伝導速度の低下 ・末梢の反射消失 ・角膜反射、または眼球頭反射(頭位変換眼球反射)の消失 |
ICU.615
| 重症度 | 体温 | 臨床症状 |
| 軽度 | 32-35℃ | 錯乱、寒気、蒼白、ふるえ、頻脈 |
| 中等度 | 28-31.8℃ | 嗜眠、震えの減少または消失、徐脈、呼吸数減少 |
| 重度 | <28℃ | 睡気または昏睡、ふるえの欠如、浮腫状の皮膚、散大し固定した瞳孔、徐脈、低血圧、乏尿 |
| 重篤 | <25℃ | 呼吸停止、心停止 |
心電図
- ECGP.187
- 心室内伝導遅延の発生
- J点の上昇によるJ波を伴うST上昇(Osborn波、hypothermic hump)
- 洞性徐脈、房室接合部性調律、PR時間延長、QT時間延長。陰性T波、重症名不整脈もある。
- V3, V4で顕著
- 体温28℃以下で心室細動。
治療
- 復温
- 軽度低体温 ：表面加温法(適切な室内温度、衣服の除去、毛布)
- 中等度低体温：表面加温法(電気毛布、温水ブランケット、赤外線ヒーター、ウォームマット)
- 高度低体温 ：中心加温法による急速加温 → 以前は末梢血管が拡張、代謝の急激な変動により冷たい血液が心臓に流れ込み心室細動を誘発するリスクがあったため緩徐加温としていたが、それでも死亡率は高かった。このため急速加温する事になっている。
参考
- 1.
「体温」
- 英
- body temperature
- 関
- 発熱
- 口腔温：36.8±0.4 ℃
- 部位：直腸(口腔温度より0.4℃高い) > 口腔 > 腋窩
- 時間：夕方(18時)＞朝(6時) 差は0.5℃
臨床関連
- 体温の異常
- 高体温 hyperthermia====
- 熱射病 heat stroke
- 悪性高熱症 malignant hyperthermia：麻酔
- (神経遮断性)悪性症候群 neuroleptic malignant hyperthermia：抗精神病薬の中断
- 病態の診断基準
- SIRSの診断基準：37℃より±1℃より大きいまたは小さいこと。すなわち、＞38℃ or ＜36℃
「5H5T」
- 関
- 無脈性電気活動
| hypovolemia | 循環血液量減少 |
| hypoxia | 低酸素血症 |
| hypothermia | 低体温 |
| hyperkalemia/hypokalemia | 高K血症/低K血症 |
| hydrogen ion | アシドーシス |
| tamponade | 心タンポナーデ |
| tension pneumothorax | 緊張性気胸 |
| tablet | 薬物中毒 |
| thrombosis, pulmonary | 肺塞栓 |
| thrombosis, coronary | 急性心筋梗塞 |
「contributor」
- n.
- 寄贈者。寄稿家、投稿者。貢献者。誘因、一員(to)
- hypothyroidism should be considered as a possible contributor to hypothermia.(CASES.141)