UKC

I thought with all the snow around a topic on hypothermia would be good.

Can people recommend a good source/read on the topic particularly for climbing or mountain marathoning?

Cheers,

Matt

In reply to Herdwickmatt:

Medicine for mountaineers & other wilderness activities (The mountaineers books) is quite useful!!

Performing in extreme environments by Lawrence E. Armstrong is also very good.

Hope this helps

In reply to climber_medic: bump

In reply to Herdwickmatt: From the nhs website:

The symptoms of hypothermia depend on how cold the environment is and how long you are exposed for.
Severe hypothermia needs urgent medical treatment in hospital. Shivering is a good guide to how severe the condition is. If the person can stop shivering on their own, the hypothermia is mild, but if they cannot stop shivering, it is moderate to severe.

In mild cases, symptoms include:
shivering,
feeling cold,
low energy,
discomfort at higher temperatures than normal, or
cold, pale skin.

The symptoms of moderate hypothermia include:
violent, uncontrollable shivering,
being unable to think or pay attention,
confusion (some people don't realise they are affected),
loss of judgement and reasoning,
difficulty moving around or stumbling (weakness),
feeling afraid,
memory loss,
fumbling hands and loss of coordination,
drowsiness,
slurred speech,
listlessness and indifference, or
slow, shallow breathing and a weak pulse.

The symptoms of severe hypothermia include:
loss of control of hands, feet, and limbs,
uncontrollable shivering that suddenly stops,
unconsciousness,
shallow or no breathing,
weak, irregular or no pulse,
stiff muscles, and
dilated pupils.
Babies with hypothermia may look healthy but their skin will feel cold. They may also be limp, unusually quiet and refuse to feed.
Although hypothermia is defined as occuring when the body temperature drops below 35°C (95°F), mild hypothermia can start at higher body temperatures.

In reply to Herdwickmatt: One thing I'd mention is that it can come on incredibly quickly

eg windchill - a friend got hypothermic in less than 10 minutes because he didn't put a shell on as we crested a ridge into the wind in winter. A rain squall hit and before he could get the jacket on he was drenched to the skin. Within 10 mins he just wanted to '...lie down in the heather...I'll be fine...' We marched him off the mountain and it was hours until he was right.

In reply to Herdwickmatt:

This is the guide i use for winter kitesurfing

Signs and symptoms

Normal body temperature in humans is 36.5–37.5 °C (98–100 °F). A number of skin conditions may be associated with hypothermia or may occur with normal body temperature. These include: cryopedis and frostbite. Symptoms of hypothermia may be divided into the three stages of severity.

Stage 1
Body temperature drops by 1–2 °C (1.8–3.6 °F) below normal temperature (down to 35–37 °C or 95–98.6 °F). Mild to strong shivering occurs.[3][4] The victim is unable to perform complex tasks with the hands; the hands become numb. 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 (which is of limited use in humans due to lack of sufficient hair, but useful in other species). Victim may feel sick to their stomach, and very tired. 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 muscles not working. They might start to have trouble seeing.

Stage 2
Body temperature drops by 2–4 °C (3.8–7.6 °F) below normal temperature (33–35 °C or 91–94.8 °F). Shivering becomes more violent. Muscle mis-coordination becomes apparent.[3][4][5] Movements are slow and labored, accompanied by a stumbling pace and mild confusion, although the victim may appear alert. Surface blood vessels contract further as the body focuses its remaining resources on keeping the vital organs warm. The victim becomes pale. Lips, ears, fingers and toes may become blue.

Stage 3
Body temperature drops below approximately 32 °C (89.6 °F). Shivering usually stops.[3][4] Difficulty speaking, sluggish thinking, and amnesia start to appear; inability to use hands and stumbling is also usually present. Cellular metabolic processes shut down. Below 30 °C (86.0 °F), the exposed skin becomes blue and puffy, muscle coordination becomes very poor, walking becomes almost impossible, and the victim exhibits incoherent/irrational behavior including terminal burrowing or even a stupor. Pulse and respiration rates decrease significantly, but fast heart rates (ventricular tachycardia, atrial fibrillation) can occur. Major organs fail. Clinical death occurs. Because of decreased cellular activity in stage 3 hypothermia, the body will actually take longer to undergo brain death.

In reply to Herdwickmatt:

www.hypothermia.org

http://scotclimb.org.uk/safety/hypothermia.shtml

In reply to Herdwickmatt:

You seem to have received some good quality hypothermia advice but not much on spotting. Not being much of a boulderer I will leave that to those with more experience.

Iain.

In reply to Herdwickmatt:

One of the symptoms that hasn't been mentioned which I have seen in all of the cases of stage 2 hypothermia I have witnessed is irritability. People have become irritated and verbally aggressive in a way that is out of character for them. The onset of this has always been very sudden and has no apparent trigger.

This is probably linked to the confusion that people have mentioned and would probably be described as "altered mental state" or something similar by clinicians. Definitely worth keeping an eye out for!

Otherwise, as above. However it is worth mentioning that when someone goes beyond stage 2 and into stage 3, warming them up without medical support can be very dangerous, as can moving them suddenly and jolting them around. If someone is that far gone, and especially if they are unconscious, get help as soon as you can, don't just assume they will be ok once they have warmed up. Incidentally, the military rescue teams that patrol the Lanin volcano in Argentina have a reputation for killing hypothermia victims by moving them too quickly or roughly when they are very cold. I suspect what with being in a military state but not actually having much to do they are bored stupid and get a little overexcited

In reply to Nigel Modern: In reply to Nigel Modern:


I think that this is really important to be aware of that someone with hypothermia is likely to be their own worst enemy as they can make very stupid irrational decisions making the situation much worse. So it can be really important to be able to be assertive enough to take charge if someone is behaving in this way, not always easy when as Katharyn says they also get irritable and combative.

Another point more related to water sports hypothermia is that its thought that moving someone from lying down to upright can be fatal (shock I think I can't remember) when pulling people out of cold water they should be put to warm lying down. Anyone back this up I can't remember where I heard it?

I find it really hard to differentiate between hypothermia, HACE and fatigue when climbing high, especially as they may all be working together.

In reply to Herdwickmatt: Joining a first aid course relevent for the outdoor environment would also be an exellent way of consolidating any reading.
http://www.remotefirstaid.com

Regards

Pete

In reply to kathrync: The irritability and irrational behaviour that you mention is to do with the hypothalamus.This integral part of the human brain also also regulates the bodies temperature hence the relationship between the two.

I've seen the signs and treated Hypothermia as a medic a couple of times and the general rule of thumb is that "A patient isn't dead until he/she is warm and dead"!!!

In reply to marsbar:

This might be similar to what I was saying about moving/jolting people with hypothermia in my post further up? Certainly sounds similar.

In reply to Herdwickmatt:

When on the hill in very bad conditions, the "umbles" - grumble, mumble, fumble, stumble - is (from my happily limited experience) a simple but effective shorthand for spotting the onset and progress of hypothermia in the field. Heard it first in Tasmania where wet/cold/windy conditions are virtually standard.

In reply to marsbar:

Your cardiac output becomes very low while severely hypothermic so your brain might not get enough blood if is higher than your heart. Pretty much the same function as when people faint, if they lie down they'll be fine (obviously depending on cause but as a general rule) but would die if kept sitting up

In reply to marsbar,

You are correct when you say that people rescued from water should be carried horizontally, the reason as I understand it is to do with their blood pressure.

The human body has a number of mechanisms to maintain homeostasis (keep parameters like blood pressure and temperature constant). When in water, the water exerts pressure on the body, sort of squashing it, and causes the blood pressure to rise. The body reacts to remove fluid from the blood and thus maintain normal blood pressure. When the casualty is removed from water, the blood pressure will drop rapidly. This sudden drop in blood pressure may well cause the casualty to lose consciousness. This is shock, the treatment for which is to lie the casualty down.

In reply to Herdwickmatt:

For me, someone may say nothing through Stage 1 (As described above (Very well I may add)) and the chances are it will progress into Stage 2 in which case cyanosis will occur and that will be the easiest one to spot just from a quick visual check, as said above it's a blueing of the extremities, end of the nose, lips, fingers etc.

I've never encountered Hypothermia myself but for me that would be the sure sign, if Stage 1 goes unnoticed.

In reply to Herdwickmatt:

I appologise if someone has said this already; i'm replying on my phone which has a tiny screen...

I remember signs of hypothermia as the "umbles".

Fumble
Mumble
Grumble
Stumble

A few years ago when I was in Scotland in January, I remember taking my gloves off to get something out of my bag (I don't know why I didn't keep them on), then being unable to put them on agin, my jacket was open, I can't remember why. I couldn't make my fingers work to close it (fumbling), this chilled me down, I was cold and I didn't realise.

I started walking along a ridge but kept stumbling.
"Katie, your crampon" my friend yelled above the howling wind that was whiping up spindrift into our faces.
I remember looking down at a single crampon behind me and thinking..."yup that is a crampon" then looking at my boot, without a crampon on but I didn't make a conection. My friend made it for me.
He re-attached the crampon and gave me a pair of huge warm mitts to replace my soden, freezing gloves.
The wind had really picked up, it was our 6th full day on the hill in as many days. Safe moving on the ridge required lots of bracing and crouching in the wind.
I stumbled again and sat down. Pulling my hood over my face and blocking out the world. "Get up, keep moving" we need to get down before dark my mate said sternly.
"You go, i'll follow..." I wanted to curl up into a ball and sleep. My mate says at this stage I started mumbling and grumbling about things, although he couldn't understand much about what I was saying, but that I started to get angry and aggitated when told what to do.
I don't remember much after that...my mate says I guzzled warm black currant juice and sparked back to life a bit. We walked off the hill together, warmed in the van and then back in the hotel.

It scares me when I think back, I wonder if I was on my own If I would just sit down and die, or if i'd get myself off the hill instead.
Firm encouragement, and a warm sugary drink definatly helped that day and the chance to rewarm.

In reply to Katie86:

had the same one day walking over wrynose and it started sleeting on top of us wading knee deep in snow. had to drag my companion to his feet and keep him moving to safety. Wonder what would have happened if both of us had got to that stage?

In reply to sutty:

It's a scary thort but a learning curve all the same... I've fallen asleep whilst roped up walking on snow, but that was sheer tirednes rather than hypothermic. Scary times.