Hypothermia - first aid

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose.Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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With hypothermia, the temperature inside the body drops below 35 ° C. At first, the person concerned trembles, he breathes quickly and has an accelerated heartbeat. If it cools down further, the body functions shut down and the person concerned loses consciousness. Severe hypothermia is life-threatening! Here you can read how you can best provide first aid and what you have to consider.

Brief overview

First aid: Dial an emergency call, rescue the victim, check breathing, if breathing has stopped, give chest compressions
Warm: protect with blankets, warm up slowly, start with the torso - do not rub
Moving little: In advanced hypothermia (clouding of consciousness or unconsciousness, muscle stiffening instead of trembling) move the patient as little as possible, there is a risk of heart failure

Attention:

Move the hypothermic as little as possible!
If breathing has stopped, continue to breathe, even if the hypothermic person appears lifeless!
Do not warm the patient up too quickly, for example by taking a hot bath or by placing the patient near a hot stove. Otherwise life-threatening cardiac arrhythmias can occur!
Warm up slowly starting from the trunk!
Never give alcohol to a hypothermic person! This causes the vessels to widen. Then the affected person loses even more warmth.

First aid measures in case of hypothermia

Hypothermia can be life threatening. Therefore, you should react quickly and provide first aid. What you should do in detail depends in part on the stage of hypothermia (see below: What are the signs of hypothermia?):

First aid for mild hypothermia (stage I)

Dial the emergency number 112!
Rescue the person from the danger area, provided you do not endanger yourself.
Bring the victim to a dry place that is room temperature or at least protected from the wind.
Remove wet, cold clothing and wrap the hypothermic person in blankets.
Warm up the victim slowly, always from the core. For example, place warm, damp towels on the hypothermic person's stomach and torso and then wrap them in blankets.
Soothe and comfort the hypothermic. Monitor his condition until the ambulance arrives.

First aid for moderate to severe hypothermia (from stage II)

First of all, call the emergency doctor (Tel. 112)!

Move the patient as little as possible and do not transport him! When moving, cold blood from arms and legs is conducted to the core of the body so that it continues to cool down (afterdrop). There is a risk of rescue death from cardiovascular arrest! Therefore, you should not move the hypothermic person's arms and legs as much as possible (also do not lift legs!). You should also absolutely refrain from massaging or rubbing the extremities (e.g. hands, feet)!

Check the patient's awareness, for example by gently shaking and speaking. The further procedure depends on the level of consciousness of the person concerned:

The patient is conscious:

Store it flat, if possible on a blanket underneath.
Remove wet and cold clothing - ideally by cutting it open so as to move the body as little as possible.
Wrap it in a blanket or thermal foil.
Infuse the hypothermic with warm sugary drinks such as tea.
Until the doctor arrives, you should calm down, comfort and carefully observe the person concerned (state of consciousness, breathing, etc.).

The patient is unconscious:

Check his breathing: is his chest rising and falling? Do you feel the air you breathe when you bring your cheek close to the mouth and nose of the unconscious person?
The person concerned is breathing? Carefully place it on its side and cover it. Monitor your breathing and heartbeat until the ambulance arrives.
The person concerned is not breathing? Look in his mouth to see if something is obstructing the airway (e.g. snow). If possible, you should remove such foreign objects with your fingers. If the patient is still not breathing, start the resuscitation. Continue this until the ambulance arrives or the patient is breathing alone again.

What are the signs of hypothermia?

Doctors differentiate between four stages of hypothermia:

Stage I: Slight hypothermia (stage of excitement)

The following symptoms can be observed with a slight hypothermia:

Shivering
bluish pale skin
cold limbs
accelerated breathing
accelerated heartbeat
The person concerned is conscious, appears excited, later increasingly calmer.

Stage II: Moderate hypothermia (stage of exhaustion)

If the core body temperature drops to 28 to 32 ° C, the symptoms change significantly:

indifference
Impaired consciousness
bluish-greyish skin
rigid muscles
no more trembling
slow heartbeat
slowed breathing
decreasing pain sensation

Stage III: Severe hypothermia (paralysis)

If the core body temperature drops to 24 to 28 ° C, the hypothermic stage of paralysis sets in. You can observe the following symptoms:

very slow breathing
wide open pupils
increasing tiredness, eventually loss of consciousness and a coma

Stage IV: apparent death (below 24 degrees)

If the core body temperature is less than 24 degrees, the stage of apparent death occurs.

unconsciousness
rigid pupils
no pulse palpable
no breathing recognizable
hardly measurable blood pressure

At this stage there is a risk of overlooking signs of life. Therefore, the rule "Nobody is dead until he is warm and dead" applies. In fact, hypothermia can protect the brain from the effects of oxygen deficiency for a certain period of time hypothermic patients have a little more time for resuscitation: They can still be resuscitated successfully and without permanent brain damage even after prolonged respiratory failure than patients with normal body temperature.

What happens with hypothermia?

If the temperature falls inside (core body temperature), the body tries to compensate for the hypothermia. The blood vessels on the surface of the body and in the limbs contract. This means that the blood inside the body cools less quickly. The body produces additional heat through the muscle activity when trembling. It also releases more adrenaline, which activates the body's functions.

With increasing cooling, the symptoms change:

The trembling stops.
The body functions shut down.
The cold numbs the nerves too. The skin feels numb and pain is less noticeable.
Breathing, blood pressure and heartbeat decrease increasingly. After all, the pulse can hardly be determined.
The brain is also working more and more slowly. The hypothermic moves in an uncoordinated manner, speaks indistinctly and appears confused.
He becomes increasingly apathetic and eventually loses consciousness.

Hypothermia - consequences

Hypothermia is a life-threatening condition from stage II. Even if the patient is conscious, there is a risk of dangerous cardiac arrhythmias. The so-called rescue death threatens if cold blood flows from the extremities and the body shell into the interior of the body through movement.

Therapeutic hypothermia

Sometimes emergency and intensive care physicians deliberately create mild hypothermia in the patient. This can be the case, for example, after resuscitation that was performed outside the clinic and in which the patient initially remains unconscious, even after his heart is beating again. The doctors then lower his body temperature to 32 to 34 degrees Celsius for 12 to 24 hours. It does this by letting the blood pass through an aperture that cools it down slightly.

The purpose of the measure: With a slight hypothermia, metabolic processes in the body run more slowly and the tissue (especially the sensitive brain) can cope better with an insufficient supply of oxygen.

We are currently also conducting studies to determine whether hypothermia also improves the chances of recovery for stroke patients.

Hypothermia - when to see a doctor?

The effects of hypothermia are quickly underestimated. It is therefore important that a doctor assesses the person concerned.

Medical treatment for hypothermia is given in a hospital. In the case of severe hypothermia, the patient is preferably transported to a so-called ECLS center (ECLS - Extra Corporeal Life Support). There it is treated as required, for example: