Hypothermia - the Warning Signs

From Wikipedia:
‘US patent 4634021 describes “A release mechanism is disclosed for releasing an object such as a ball from a body under the force of gravity. A bimetallic element obstructs or opens an opening in the body for retaining or releasing the object depending upon the temperature of the bimetallic element. The release mechanism may be incorporated into a novelty ‘brass monkey’ for ‘emasculating’ the monkey when the temperature decreases to a predetermined temperature at which the balls in the ‘brass monkey’ are permitted to drop to a base which is designed to produce an audible sound when struck by the balls.”’

Most of us have been so cold we thought we would never be warm again, but very few have had chance to experience the nightmare of hypothermia. If that sounds like hyperbole, read on.
Hypothermia is defined as a drop of core body temperature (the ‘actual’ temperature of your body as opposed to the perceived temperature, i.e. feeling your forehead) between 1.5 to 2°C. While this may sound like a negligible drop, this is enough to begin causing problems that will eventually stop your heart beating. Hypothermia as a condition is measured in three stages, and spotting the symptoms of these three stages is the best way to ensure that you, or others around you, do not become victims of, at its most basic, freezing to death.

Stage One
This is where hypothermia needs to be nipped in the bud, if at all possible. There are a few key signs to look out for when someone is in the first stage of hypothermia:
•    Constant shivering as the body attempts to generate heat through rapidly relaxing and constricting muscles;
•    An inability to perform complex tasks with the hands as a result of the body constricting blood vessels in the extremities in an attempt to stem heat loss;
•    Goose bumps will rise in an attempt to form an insulating layer of air around the body by raising the hair off the skin, useful in other animals but not such a great tool in the rapidly balding Homo Sapiens;
•    A feeling of being sick to the stomach, and chronic fatigue.

Stage one should be considered severe - the name ‘stage one’ is misleading. Attend to yourself or the person immediately. One of the most dangerous consequences of becoming hypothermic is a phenomenon known as ‘paradoxical undressing’. The victim will go into denial about their condition and will actually start to feel unbearably hot, becoming confused and combative as a result. They will attempt to remove their clothes in order to cool down, which will rapidly accelerate the severity of their condition.

Up to half of all victims of hypothermia will experience this phenomenon, some of whom will have such a severe attack as to rapidly accelerate their own death. The reasons for this are unclear, though current theories suggest is could be a breaking down of the hypothalmus, the part of the brain that regulates temperature, due to the intense cold. Another theory suggests it could be that the muscles constricting the blood vessels at the extremities become exhausted, leading to a sudden rush of blood to those areas, the victim then experiencing a rapid, painful burning sensation.
Paradoxical undressing is something that can happen as early as stage one. The consequences of hypothermia progressing to the next stage can be even more severe.

Stage Two
At this stage, core body temperature has dropped by another couple of degrees. Anything at or beyond this stage requires immediate hospitalization, so if you spot any of these symptoms in yourself or others, get to a doctor immediately:
•    Shivering becomes violent to the extent that it can be painful;
•    Movements become laboured and unsure, alongside confusion and stumbling even if the victim seems fully alert to their surroundings;
•    Blood vessels contract further and capillaries sink from the surface. Because of this withdrawal - the body’s attempt to keep the vital organs as warm as possible - the victim’s extremities, most notably their nose, ears and lips, may turn blue.

Hypothermia is something that hospital doctors are now fully capable of treating, if caught early enough. Treatments vary from something as simple as warm blankets and warm fluids for mild hypothermia to the introduction of warming fluids throughout the body to bring core temperature back to a safe level. During these procedures, it is vital the victim is kept still, as any movement can trigger heart murmurs, which are often fatal. However, if hypothermia reaches stage three, even these treatments can be ineffectual.

Stage Three
At this stage, body temperature will have dropped below 32°C. This is the point at which, despite its best efforts to keep the core temperature and vital organs at a sustainable temperature, the body will begin to fail:
•    Difficulty speaking and amnesia, irrational and incoherent behaviour including, disturbingly, attempting to burrow;
•    An inability to use hands and consistent, pronounced stumbling or even complete disability;
•    Exposed skin becomes blue and puffy.
These are just the outward signs that can be observed. Inside, the metabolic processes that keep the body alive are shutting down due to the severe change in internal conditions, major organs are failing and the heart can alternate between slowing to death or rapid beating as the body becomes its own worst enemy. Perhaps saddest of all, the slowing of metabolic rates means that the body takes longer to die.

Remarkably, this can also be a saving grace. Such low temperatures in the body mean that people can literally come back to life after prolonged periods of being clinically dead. There have been reports of children who have been revived after nearly an hour of unconsciousness. In fact, such is the regularity with which these events occur that a person cannot be considered dead until doctors have fully warmed the body. Needless to say, such miraculous revivals are not without their complications, and the best treatment for hypothermia is prevention, so keep an eye out for yourself and those around you, and ask them to do the same for you.