Download Hypothermia and cold injuries

Database: MEDLINE <1996 to April Week 3 2002>
Search Strategy: (Hypothermia and cold injuries)
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Hypothermia/ (1208)
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injur$.af. and 1 (163)
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limit 2 to (human and english language) (96)
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*Hypothermia/ and 3 (64)
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limit 4 to review articles (17)
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cold induced injur$.af. (2)
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limit 6 to (human and english language) (2)
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5 or 7 (18)
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exp sports injuries/ or exp sports/ or exp exertion/ (30396)
10
3 and 9 (14)
11
1 and 9 (55)
12
limit 11 to (human and english language) (39)
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10 or 12 (39)
14
8 or 13 (53)
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from 14 keep 1-53 (53)
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from 15 keep 1-53 (53)
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<1>
Unique Identifier
10347389
Medline Identifier
99276737
Authors
Mikhail J.
Institution
Hurley Medical Center, Flint, MI 48503, USA.
Title
The trauma triad of death: hypothermia, acidosis, and coagulopathy.
[Review] [59 refs]
Source
AACN Clinical Issues. 10(1):85-94, 1999 Feb.
Abstract
With the organization of trauma systems, the development of trauma
centers, the application of standardized methods of resuscitation, and
improvements in modern blood banking techniques, the ability to
aggressively resuscitate patients in extremis has evolved. The concept of
the "golden hour" has translated into unprecedented speed and efficiency
of trauma resuscitation with the ultimate goal of short injury-toincision times. As the shift in care of patients in extremis has
continued to move from the street to the emergency department and beyond,
the focus of trauma resuscitation has shifted to the operating room and
ultimately to the intensive care unit. The "new" golden hour may well be
the time in the operating room before the patient reaches the physiologic
limit, defined as the onset of the triad: hypothermia, acidosis and
coagulopathy. Critical care nurses must understand this triad, because it
forms the basis and underlying logic on which the damage control
philosophy has been built. This article explores the pathogenesis and
treatment of acidosis, hypothermia, and coagulopathy as it applies to the
exsanguinating trauma patient. [References: 59]
<2>
Unique Identifier
10347390
Medline Identifier
99276738
Authors
Zacharias SR. Offner P. Moore EE. Burch J.
Institution
Denver Health Medical Center, CO 80204, USA.
Title
Damage control surgery. [Review] [21 refs]
Source
AACN Clinical Issues. 10(1):95-103; quiz 141-2, 1999 Feb.
Abstract
The triad of hypothermia, acidosis, and coagulopathy during initial
operative and resuscitation efforts has been recognized as a significant
cause of death in patients with traumatic injuries. A staged surgical
approach with a brief initial laparotomy, subsequent intensive care unit
resuscitation, and a planned reoperation is an emerging technique used in
trauma surgery, with application to a variety of other surgical
challenges. Successful damage control therapy requires a coordinated
multidisciplinary team effort by a trauma team experienced in the process
of damage control operations, intensive care unit priorities, and
potential complications of this innovative surgical approach.
[References: 21]
<3>
Unique Identifier
10347392
Medline Identifier
99276740
Authors
Aragon D.
Institution
Surgery Trauma ICU, Orlando Regional Healthcare System, Florida 32806,
USA.
Title
Temperature management in trauma patients across the continuum of care:
the TEMP Group. Temperature Evaluation and Management Project. [Review]
[11 refs]
Source
AACN Clinical Issues. 10(1):113-23, 1999 Feb.
Abstract
Hypothermia is a potentially preventable consequence of injury in the
trauma patient. The physiologic aftermath of hypothermia is such that it
is regarded as one of the three components in the trauma triad of death.
A multidisciplinary group at a Level I trauma center was formed to
originate an innovative team approach to managing temperature in trauma
patients. This article describes this unique project to combat a
preventable cause of significant morbidity and mortality. [References:
11]
<4>
Unique Identifier
10888145
Medline Identifier
20344058
Authors
Bernardo LM. Henker R. O'Connor J.
Institution
School of Nursing, University of Pittsburgh, PA, USA.
Title
Treatment of trauma-associated hypothermia in children: evidence-based
practice. [Review] [11 refs]
Source
American Journal of Critical Care. 9(4):227-34; quiz 235-6, 2000 Jul.
Abstract
BACKGROUND: Hypothermia is a serious immediate consequence of traumatic
injury in children. Although numerous studies have addressed the
treatment of hypothermia in adults after trauma or surgery, few have
examined this issue in injured children. OBJECTIVES: To evaluate the
research literature on when and how to treat hypothermia during emergency
care of children with trauma and to apply these findings to clinical
nursing practice. METHODS: Electronic literature searches conducted
periodically for 3 years yielded more than 50 publications on hypothermia
and its treatment in trauma and surgical patients. Publications were
grouped by cause of hypothermia and by warming methods. Single case
reports and publications related to submersion injuries were excluded.
RESULTS: Three clinical trials of patients with head injuries included
adolescents aged 15 years and older. One study compared peripheral and
core warming methods used during operative management of infants and
young children. Only one study evaluated core warming in children with
trauma. DISCUSSION: The treatments examined in the few research-based
studies on the treatment of hypothermia during emergency care of children
with trauma were given low recommendations. Although the warming methods
were successful in selected surgical and adult patients, the methods
cannot be recommended for treating children with trauma because of the
lack of evidence-based findings. CONCLUSIONS: Caution should be used when
extrapolating published data on the treatment of hypothermia in injured
adults to injured children. Ongoing clinical trials should evaluate in
children with trauma those warming methods that have been used
successfully in surgical patients. [References: 11]
<5>
Unique Identifier
11043627
Medline Identifier
20496343
Authors
Nuckton TJ. Claman DM.
Institution
Goldreich D.
Wendt FC.
Nuckton JG.
Division of Pulmonary and Critical Care Medicine, and the
Cardiovascular Research Institute, University of California San
Francisco, 94143-0130, USA. [email protected]
Title
Hypothermia and afterdrop following open water swimming: the
Alcatraz/San Francisco Swim Study.
Source
American Journal of Emergency Medicine. 18(6):703-7, 2000 Oct.
Abstract
To determine whether or not participants in open water swim events
experience hypothermia and afterdrop, rectal temperature was measured for
up to 45 minutes in 11 subjects following the New Year's Day Alcatraz
Swim. This event was held in open water (11.7 degrees C [53.0 degrees F])
in the San Francisco Bay, and participants did not wear wetsuits or other
protective clothing. Biophysical parameters, including surfacelvolume
ratio, body mass index, and percent body fat were measured before the
swim, and statistical analysis was done to determine predictors of
temperature decrease and afterdrop duration. Applying the American Heart
Association definition of hypothermia (less than 36.0 C [96.8 degrees
F]), hypothermia was seen in 5 of the 11 subjects. Using a more rigorous
and traditional definition (less than 35.0 degrees C [95.0 degrees F]),
hypothermia was seen in only one subject. Afterdrop, defined as continued
cooling following removal from cold stress, was seen in 10 of the 11
subjects. Surface/volume ratio (S/V) and body mass index (BMI) predicted
the lowest recorded temperatures (P < .05; r(S/V) = -.71, r(BMI) = .72)
and afterdrop duration (P < .05; r(SN) = -.75, r(BMI) = .69). These
results suggest that hypothermia and afterdrop can occur commonly after
recreational open water swimming, and that participants should be
observed for signs of temperature decrease following removal from cold
stress.
<6>
Unique Identifier
9590198
Medline Identifier
98250080
Authors
Yoshitomi Y. Kojima S. Ogi M. Kuramochi M.
Institution
Department of Clinical Research, Tohsei National Hospital, Shizuoka,
Japan.
Title
Acute renal failure in accidental hypothermia of cold water immersion.
Source
American Journal of Kidney Diseases [computer file]. 31(5):856-9, 1998
May.
Abstract
We report a 27-year-old Japanese man who developed acute renal failure
associated with cold water immersion. The clinical course was consistent
with that of acute renal failure attributable to acute tubular necrosis.
A renal biopsy specimen showed patchy and focal loss of tubule cells,
necrotic epithelium, interstitial edema, and arterial lumina obstructed
by diffuse and severe intimal thickening. Endothelin increased more than
five times in the early phase of the clinical course. Vasoconstriction
and ischemia induced by cold exposure seem to lead to endothelin release.
Endothelin may be related to the development of acute renal failure and
intimal thickening.
<7>
Unique Identifier
11254511
Medline Identifier
21154751
Authors
Gentilello LM. Pierson DJ.
Institution
Departments of Surgery and Medicine, and Division of Pulmonary and
Critical Care Medicine, Harborview Medical Center, and University of
Washington, Seattle, Washington 98104, USA. [email protected]
Title
Trauma critical care. [Review] [27 refs]
Source
American Journal of Respiratory & Critical Care Medicine. 163(3 Pt
1):604-7, 2001 Mar.
Abstract
The surgical approach to the most injured patients has changed in
recent years. Many patients arrive in the intensive care unit with
problems that in the past would have been definitively addressed in the
operating room, or led to the patient's demise due to continued attempts
to complete all surgical procedures, despite deteriorating physiology. As
a result, the triad of hypothermia, acidosis, and coagulopathy, along
with the frequent complication of abdominal compartment syndrome, are
critical factors that require correction in the intensive care
unit.Prompt correction is necessary not only to allow expeditious
completion of required surgical procedures, but because this triad,
unless interrupted, invariably leads to death during resuscitation.
[References: 27]
<8>
Unique Identifier
8839527
Medline Identifier
96436711
Authors
Roth RN. Verdile VP. Grollman LJ. Stone DA.
Institution
Division of Emergency Medicine, University of Pittsburgh School of
Medicine, Pennsylvania, USA.
Title
Agreement between rectal and tympanic membrane temperatures in marathon
runners. [see comments.].
Comments
Comment in: Ann Emerg Med. 1997 May;29(5):693 ; 9140258
Source
Annals of Emergency Medicine. 28(4):414-7, 1996 Oct.
Abstract
STUDY OBJECTIVE: To determine the agreement between rectal temperature
and infrared tympanic membrane temperatures in marathon runners
presenting to a field hospital at the finish line. METHODS: The subjects
of this prospective, blinded, controlled study were runners 18 years or
older who were triaged to the acute care medical area at the finish line
for suspected hypothermia, hyperthermia, dehydration, or altered mental
status. Rectal and tympanic temperatures were measured simultaneously in
all subjects for whom rectal temperature measurement had been deemed
necessary and recorded on separate data cards. RESULTS: Of the 239
runners treated in the acute care medical area, 37 required rectal
temperature measurement and were enrolled in the study. The mean rectal
temperature was 38.45 degrees +/- 1.20 degrees C (range, 35.9 degrees to
41.5 degrees C). The mean tympanic membrane temperature was 37.81 degrees
+/- 95 degrees C (range, 36.3 degrees to 40.4 degrees C). Pearson's
correlation coefficient revealed a moderate correlation (r = .6902, P =
.00023). The mean temperature difference between the two thermometers,
mean rectal minus mean tympanic membrane, was .64 degrees C (95%
confidence interval, .35 degrees to .93 degrees C). Sixty-Two percent of
the tympanic membrane readings were within 1 degree C of their rectal
counterparts. Agreement ranged from 1.16 degrees (+2 SD) to -2.95 degrees
(-2 SD). The 95% confidence interval was 1.67 degrees to -2.95 degrees C.
CONCLUSION: We were able to demonstrate only a moderate correlation
between the two thermometer readings, with a wide spread between the
limits of agreement. This spread could be clinically significant and
therefore limits the usefulness of tympanic temperature in the marathon
race setting. Because of the potentially large and clinically significant
differences in rectal and tympanic temperatures and the limitations
inherent in our study, we cannot endorse the use of tympanic temperature
in the setting of a marathon event.
<9>
Unique Identifier
10685594
Medline Identifier
20148021
Authors
Young AJ. O'Brien C. Sawka MN. Gonzalez RR.
Institution
Thermal and Mountain Division, U.S. Army Research Institute of
Environmental Medicine, Natick, MA 01760, USA. [email protected]
Title
Physiological problems associated with wearing NBC protective clothing
during cold weather. [Review] [19 refs]
Source
Aviation Space & Environmental Medicine. 71(2):184-9, 2000 Feb.
Abstract
This report considers how thermal balance of soldiers wearing nuclear,
biological and chemical (NBC) protective clothing in combination with the
Extreme Cold Weather Clothing System (ECWCS) is affected during work in
cold weather. A review of published reports concerning physiological
consequences of wearing NBC protective clothing during cold exposure was
completed. The findings reported in the experimental literature were too
limited to adequately forecast the effects of adding NBC clothing to
ECWCS. To remedy the information gap, simulation modeling was employed to
predict body temperature changes during alternating bouts of exercise and
rest throughout 8 h of exposure to three different severely cold
conditions. Published findings indicate that NBC protective clothing may
inadequately protect against hand and finger cooling, especially during
rest following strenuous activity. No evidence substantiates suggestions
that wearing NBC protective masks increases susceptibility to facial
frostbite. Collectively, the limited experimental work and the results of
simulation modeling argue against any increased risk of hypothermia
associated with wearing NBC protective clothing while working in the
cold. However, wearing NBC protective clothing during strenuous activity
in cold weather may increase the risk of hyperthermia, and cause sweat
accumulation in clothing which may compromise insulation and increase the
risk of hypothermia during subsequent periods of inactivity. [References:
19]
<10>
Unique Identifier
9451529
Medline Identifier
98113489
Authors
Giesbrecht GG. Bristow GK.
Institution
Laboratory for Exercise and Environmental Medicine, Health, Leisure and
Human Performance Research Institute, Faulty of Physical Education and
Recreation Studies, Manitoba, Canada.
Title
The convective afterdrop component during hypothermic exercise
decreases with delayed exercise onset.
Source
Aviation Space & Environmental Medicine. 69(1):17-22, 1998 Jan.
Abstract
HYPOTHESIS: Following cold water immersion, the post-cooling decrease
in esophageal temperature (Tes) (i.e., afterdrop) is 3 times greater
during exercise than during shivering, presumably due to increased
muscular blood flow and convective core-to-periphery heat loss with
exercise (J. Appl. Physiol. 63:2375, 1987). We felt that if exercise were
to commence once the afterdrop period during shivering is complete, the
threat of a further decrease in Tes (i.e., a second afterdrop) during the
subsequent exercise would be minimized because much of the convective
capacity for core cooling would already be dissipated. METHODS: Six
subjects were each cooled three times in 8 degrees C water, until Tes
decreased to 35.3 +/- 0.7 degrees C, and rewarmed by either shivering
alone, exercise, or exercise commencing once a shivering afterdrop period
was complete. RESULTS: The initial afterdrop was greater during Exercise
only (1.1 +/- 0.4 degrees C) than Shivering only (0.35 +/- 0.3 degrees C)
and Shivering-Exercise (0.45 +/- 0.2 degrees C) (p < 0.05). In contrast,
exercise caused a secondary afterdrop of only 0.38 +/- 0.3 degrees C
during Shivering-Exercise (p < 0.05). The initial rewarming rate during
Exercise only (3.45 degrees C.h-1) was greater than the initial (2.7
degrees C.h-1) and second (2.4 degrees C.h-1) rewarming rates during
Shivering-Exercise (p < 0.05), but not significantly greater than during
Shivering only (2.99 degrees C.h-1) (p < 0.1). DISCUSSION: It is likely
that during the Shivering-Exercise protocol, continued blood flow to
shivering muscles: a) contributes to the initial afterdrop, and thus b)
diminishes the convective capacity (or heat sink) available for further
cooling during subsequent exercise.
<11>
Unique Identifier
9349132
Medline Identifier
98009845
Authors
Golden FS. Tipton MJ. Scott RC.
Institution
Robens Institute, University of Surrey, Guildford.
Title
Immersion, near-drowning and drowning. [Review] [102 refs]
Source
BJA: British Journal of Anaesthesia. 79(2):214-25, 1997 Aug.
<12>
Unique Identifier
11579073
Medline Identifier
21462432
Authors
Keatinge WR. Khartchenko M. Lando N. Lioutov V.
Institution
Division of Basic Medical Sciences, St. Bartholomew's and The Royal
London School of Medicine and Dentistry, Queen Mary and Westfield
College, University of London, London, UK. [email protected]
Title
Hypothermia during sports swimming in water below 11 degrees C.
Source
British Journal of Sports Medicine. 35(5):352-3, 2001 Oct.
Abstract
OBJECTIVES: To assess precautions needed to avoid dangerous hypothermia
in endurance sports swims in water below 11 degrees C, using rectal
temperature, anthropometric measurements, and voluntary swim times during
a six day marathon relay swim. METHODS: The time in the water and the
decrease in rectal temperature were measured during the longest of three
to five relay swims by each of eight experienced swimmers in 9.4-11.0
degrees C water. Height, weight, and four skinfold thicknesses were
measured. RESULTS: Swimmers with less subcutaneous fat terminated their
swims after significantly less time in the water than those with thicker
skinfold thickness, even though their rectal temperatures were not
significantly lower. The lowest rectal temperature recorded was 34.3
degrees C. CONCLUSIONS: Subjective sensation in these experienced
swimmers gave reliable guidance on safe durations for swims, and all
voluntarily left the water with rectal temperatures that present no
threat to people able to rewarm in safe surroundings. Endurance swims in
highly competitive conditions or water below 9 degrees C may require
continuous temperature monitoring for safety.
<13>
Unique Identifier
10526517
Medline Identifier
99455437
Authors
Kirkpatrick AW. Chun R. Brown R. Simons RK.
Institution
Section of Trauma Services, Vancouver Hospital, BC. [email protected]
Title
Hypothermia and the trauma patient. [Review] [83 refs]
Source
Canadian Journal of Surgery. 42(5):333-43, 1999 Oct.
Abstract
Hypothermia has profound effects on every system in the body, causing
an overall slowing of enzymatic reactions and reduced metabolic
requirements. Hypothermic, acutely injured patients with multisystem
trauma have adverse outcomes when compared with normothermic control
patients. Trauma patients are inherently predisposed to hypothermia from
a variety of intrinsic and iatrogenic causes. Coagulation and cardiac
sequelae are the most pertinent physiological concerns. Hypothermia and
coagulopathy often mandate a simplified approach to complex surgical
problems. A modification of traditional classification systems of
hypothermia, applicable to trauma patients is suggested. There are few
controlled investigations, but clinical opinion strongly supports the
active prevention of hypothermia in the acutely traumatized patient.
Preventive measures are simple and inexpensive, but the active reversal
of hypothermia in much more complicated, often invasive and
controversial. The ideal method of rewarming is unclear but must be
individualized to the patient and institution specific. An algorithm
reflecting newer approaches to traumatic injury and technical advances in
equipment and techniques is suggested. Conversely, hypothermia has
selected clinical benefits when appropriately used in cases of trauma.
Severe hypothermia has allowed remarkable survivals in the course of
accidental circulatory arrest. The selective application of mild
hypothermia in severe traumatic brain injury is an area with promise.
Deliberate circulatory arrest with hypothermic cerebral protection has
also been used for seemingly unrepairable injuries and is the focus of
ongoing research. [References: 83]
<14>
Unique Identifier
10640048
Medline Identifier
20104294
Authors
Laskowski-Jones L.
Institution
Christiana Hospital, Newark, Del., USA.
Title
Responding to winter emergencies. [Review] [16 refs]
Source
DCCN - Dimensions of Critical Care Nursing. 18(6):13-22, 1999 Nov-Dec.
Abstract
Nurses need to know how to provide emergency care to victims of
wintertime injuries and illnesses--and how to survive such circumstances
themselves. In this article, the author, a ski patrol member, describes
cold-weather strategies and how to respond to hypothermia, frostbite,
winter sports injuries, and avalanches. [References: 16]
<15>
Unique Identifier
9442757
Medline Identifier
98104968
Authors
Leikin JB. Aks SE. Andrews S. Auerbach PS. Cooper MA. Jacobsen TD.
Krenzelok EP. Shicker L. Weiner SL.
Institution
Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA.
Title
Environmental injuries. [Review] [257 refs]
Source
Disease-A-Month. 43(12):809-916, 1997 Dec.
Abstract
Environmental injuries and illnesses can happen in home, work, or
recreational settings. The variety and severity of these injuries might
require the clinician to call on skills from internal medicine, emergency
medicine, and toxicology. Diseases of thermoregulation are hypothermia
and hyperthermia. In each instance, treatment is based on the need to
restore the patient's core temperature to normal and on monitoring for
complications. The victim of a fire might suffer inhalation injury in
addition to burns, and it is more likely that the inhalation injury will
be fatal. Oxygen deprivation and inhalation of irritant or asphyxiant
chemicals contribute to injury. Toxic plants can be the source of
poisoning emergencies, especially in children. Misinformation and myths
that surround common plants can create diagnostic problems (i.e., which
plants really are toxic and require emergency measures). Venomous marine
organisms can cause a wide range of injury, from cutaneous eruption to
fatal envenomation. Most are encountered in a recreational setting, such
as water sports, but keepers of home aquariums are subject to stings from
venomous fish. Lightning injury can present many diagnostic and treatment
dilemmas. An important point in this regard is that lightning injury and
high-voltage electrical injury are different in pathology and require
different approaches for treatment. A discussion of electrical, chemical,
and thermal burns makes such differences apparent. [References: 257]
<16>
Unique Identifier
11476412
Medline Identifier
21368638
Authors
Rogers IR.
Institution
Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth,
Western Australia, Australia.
Title
Wilderness and environmental medicine: another subspecialty for
emergency medicine? [letter; comment.].
Comments
Comment on: Emerg Med (Fremantle). 2001 Mar;13(1):17-27 ; 11476407,
Comment on: Emerg Med (Fremantle). 2001 Mar;13(1):28-36 ; 11476408,
Comment on: Emerg Med (Fremantle). 2001 Mar;13(1):9-16 ; 11476420
Source
Emergency Medicine (Fremantle, W.A.). 13(1):5-6, 2001 Mar.
<17>
Unique Identifier
11083128
Medline Identifier
20534099
Authors
Noakes TD.
Institution
Research Unit for Exercise Science and Sports Medicine of the Medical
Research Council and the University of Cape Town, Sports Science
Institute of South Africa, Newlands. [email protected]
Title
Exercise and the cold. [Review] [34 refs]
Source
Ergonomics. 43(10):1461-79, 2000 Oct.
Abstract
The generation of heat by the human body has been likened to that of a
furnace. In response to winter conditions or prolonged immersion in cold
water, heat may be lost from the body more quickly than it is produced
leading to hypothermia. Various factors, environmental and individual,
predispose a person to hypothermia when walking on dry land or during
cold water immersion. Retention of the insulating properties of the
clothing worn is of crucial importance in protecting against cold injury
both on land and in water. Anthropometric characteristics and behavioural
and physiological responses also influence the probability of survival
under these conditions. Practical recommendations for behaviour that will
enhance survival during prolonged exposure to cold on land or to
immersion in cold water are considered. [References: 34]
<18>
Unique Identifier
11513305
Medline Identifier
21404225
Authors
Tetzlaff K. Friege L. Koch A. Heine L. Neubauer B. Struck N.
Mutzbauer TS.
Institution
Boehringer Ingelheim Pharma KG, Biberach, Germany.
[email protected]
Title
Effects of ambient cold and depth on lung function in humans after a
single scuba dive.
Source
European Journal of Applied Physiology. 85(1-2):125-9, 2001 Jul.
Abstract
This study evaluated the subacute respiratory effects of diving, to try
to separate the effects of ambient temperature from those of depth. In
the first experiment 10 healthy men made a compressed-air dive to 50 m
that exposed them to cold. They were compared with 10 matched control
subjects who underwent the same dive profile but were exposed to a
comfortable temperature. In the second experiment 16 healthy subjects
made randomized cold dives to both 50 m and 10 m. Pulmonary function
tests were made before, after 1 h, and 24 h after the dives. In the first
experiment there was an increase in residual volume (P < 0.05) and a
decrease in forced expiratory volume at 1 s (FEV1), in forced vital
capacity (FVC) and in mid-expiratory flow at 75% of FVC (MEF75) 1 h after
the cold dives (P < 0.05). In the second experiment significant increases
in specific airways resistance (sR(AW)) (P < 0.05) and decreases in FEV1
(P<0.01), in MEF75 (P<0.05), and in mid-expiratory flow at 25% of FVC
(P<0.05), were obtained after the 50 m-dives, whereas SR(AW) increased
after the 10 m-dives (P<0.05). The respiratory pattern observed 1 h after
cold dives to 50 m indicated airway narrowing. The changes after cold
dives to 10 m, however, were of minor magnitude. Both cold and depth
seemed to contribute to the adverse effects of a single compressed-air
dive on pulmonary function.
<19>
Unique Identifier
11443009
Medline Identifier
21336357
Authors
Marsigny B.
Title
Highlights of the Congress on Hypothermia and Cold Injuries: Brunico
(Bruneck), Italy; September 21-24, 2000.
Source
High Altitude Medicine & Biology. 2(2):297-300, 2001 Summer.
<20>
Unique Identifier
11258635
Medline Identifier
21156052
Authors
Rollnik JD. Witt K.
Hanert W.
Rix W.
Schwindt M.
Institution
Medical School of Hannover, Dept of Neurology, Germany.
[email protected]
Title
Rescue lifting system (RLS) might help to prevent death after rescue
from immersion in cold water.
Source
International Journal of Sports Medicine. 22(1):17-20, 2001 Jan.
Abstract
OBJECTIVE: In order to prevent sudden death after rescue from immersion
in cold water, victims should be handled carefully avoiding additional
cardiovascular stress. In this study we investigated if a new doublesling rescue system ("Rescue Lifting System-RLS) was superior to
conventional single-sling techniques. METHODS: We studied 14 healthy male
subjects in good physical condition aged 21 to 40 years. They were lifted
up from the ground with the new RLS and two conventional techniques
("Lifesling" and a navy rescue system used in SAR helicopters). Heart
rate was determined by QRS detection (Polar Precision Performance device;
Polar Electro Oy, Kempele, Finland) and blood pressure by
sphygmomanometry. RLS and "Lifesling" were tested under conditions of dry
land and immersion in 18 degrees C water. RESULTS: Rescue with RLS
induced only moderate heart rate changes which were significantly lower
(about 30 bpm) than with conventional techniques. These findings could be
reproduced under "wet" condition. DISCUSSION: RLS enables rescue in a
supine position avoiding extensive orthostatic stress. It might therefore
be favourable in preventing sudden death after rescue from immersion in
cold water.
<21>
Unique Identifier
11174763
Medline Identifier
21110734
Authors
Cochrane DA.
Institution
Alberta Centre for Injury Control and Research, Dept of Public Health
Sciences, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada.
[email protected]
Title
Hypothermia: a cold influence on trauma. [Review] [31 refs]
Source
International Journal of Trauma Nursing. 7(1):8-13, 2001 Jan-Mar.
Abstract
Hypothermia is a life-threatening condition and can be a significant
comorbid factor in a trauma patient. Certain social and medical
characteristics can put a person at high risk for hypothermia, and
special care must be provided to prevent and treat lower than normal body
temperatures. In this article, a literature review was used to describe
etiologies, assessment, treatment, and complications of hypothermia in
the trauma patient. [References: 31]
<22>
Unique Identifier
8894867
Medline Identifier
97050139
Authors
Cosgrove H. Guly H.
Institution
Accident and Emergency Department, Derriford Hospital, Plymouth, United
Kingdom.
Title
Acute shortness of breath: an unusual cause.
Source
Journal of Accident & Emergency Medicine. 13(5):356-7, 1996 Sep.
Abstract
A case of cold induced pulmonary oedema in a scuba diver is described.
This is rare, but with the increasing popularity of the sport it is
important for accident and emergency staff to be aware of the condition.
Treatment is symptomatic and the outlook is good.
<23>
Unique Identifier
8964720
Medline Identifier
96249574
Authors
Passias TC. Meneilly GS. Mekjavic IB.
Institution
School of Kinesiology, Simon Fraser University, Burnaby, British
Columbia, Canada.
Title
Effect of hypoglycemia on thermoregulatory responses.
Source
Journal of Applied Physiology. 80(3):1021-32, 1996 Mar.
Abstract
The effects of hypoglycemia on sweating, skin blood perfusion, and
shivering responses were investigated in 10 healthy male volunteers. They
exercised on an underwater cycle ergometer while immersed to the neck in
28 degrees C water for 20 min at 50% of their maximal work rate. The
exercise-induced elevation in esophageal temperature (T(es)) initiated
the sweating response (Esw) and increased skin blood perfusion (SkBP) as
measured at the forehead. In the 99-min postexercise immersion period,
the values of T es relative to resting level (delta T(es)) at which Esw
abated, SkBP reached preexercise values, and shivering commenced were
defined as the delta T(es) thresholds for cessation of sweating, passive
vasodilation, and onset of shivering, respectively. Two trials were
conducted 1 wk apart. The subject was hypoglycemic in one trial and
euglycemic in the other (plasma glucose was maintained at 2.8 and 5 mM,
respectively) with the use of the hyperinsulinemic (insulin infusion rate
= 60 mU.m-2.min-1) glucose-clamp technique. Oxygen uptake, Esw, T(es),
mean skin temperature, heat flux from the skin, and SkBP were recorded at
minute intervals. Although heat flux and SkBP attained significantly
higher end-exercise levels during euglycemia, the responses were similar
during the postexercise cooling period. Hypoglycemia did not affect the
Esw response during the exercise and cooling periods. Whereas the
exercise delta T(es) response was unaffected by hypoglycemia, the
decrease in T(es) was greater (P < or = 0.005) during the hypoglycemic
than during the euglycemic condition. Hypoglycemia did not alter the
delta T(es) threshold for cessation of sweating and passive vasodilation
but reduced (P < or = 0.001) the delta T(es) threshold for onset of
shivering (from -0.09 +/- 0.07 degrees C in the euglycemic condition to 0.65 +/- 0.12 degrees C in the hypoglycemic condition). The present
results indicate that hypoglycemia (2.8 mM) does not affect the delta
T(es) threshold for cessation of thermoregulatory sweating or the
threshold for passive vasodilation during recovery from exercise-induced
moderate heat stress but that it decreases the core temperature threshold
for shivering during cold exposure.
<24>
Unique Identifier
10444630
Medline Identifier
99375529
Authors
Brenner IK. Castellani JW. Gabaree C. Young AJ. Zamecnik J.
Shephard RJ. Shek PN.
Institution
Defence and Civil Institute of Environmental Medicine, Toronto, Ontario
M3M 3B9.
Title
Immune changes in humans during cold exposure: effects of prior heating
and exercise.
Source
Journal of Applied Physiology. 87(2):699-710, 1999 Aug.
Abstract
This study examined the immunological responses to cold exposure
together with the effects of pretreatment with either passive heating or
exercise (with and without a thermal clamp). On four separate occasions,
seven healthy men [mean age 24.0 +/- 1.9 (SE) yr, peak oxygen consumption
= 45.7 +/- 2.0 ml. kg(-1). min(-1)] sat for 2 h in a climatic chamber
maintained at 5 degrees C. Before exposure, subjects participated in one
of four pretreatment conditions. For the thermoneutral control condition,
subjects remained seated for 1 h in a water bath at 35 degrees C. In
another pretreatment, subjects were passively heated in a warm (38
degrees C) water bath for 1 h. In two other pretreatments, subjects
exercised for 1 h at 55% peak oxygen consumption (once immersed in 18
degrees C water and once in 35 degrees C water). Core temperature rose by
1 degrees C during passive heating and during exercise in 35 degrees C
water and remained stable during exercise in 18 degrees C water (thermal
clamping). Subsequent cold exposure induced a leukocytosis and
granulocytosis, an increase in natural killer cell count and activity,
and a rise in circulating levels of interleukin-6. Pretreatment with
exercise in 18 degrees C water augmented the leukocyte, granulocyte, and
monocyte response. These results indicate that acute cold exposure has
immunostimulating effects and that, with thermal clamping, pretreatment
with physical exercise can enhance this response. Increases in levels of
circulating norepinephrine may account for the changes observed during
cold exposure and their modification by changes in initial status.
<25>
Unique Identifier
10409582
Medline Identifier
99340460
Authors
Castellani JW. Young AJ. Kain JE. Rouse A. Sawka MN.
Institution
Thermal and Mountain Medicine Division, US Army Research Institute of
Environmental Medicine, Natick, Massachusetts 01760-5007, USA.
[email protected]
Title
Thermoregulation during cold exposure: effects of prior exercise.
Source
Journal of Applied Physiology. 87(1):247-52, 1999 Jul.
Abstract
This study examined whether acute exercise would impair the body's
capability to maintain thermal balance during a subsequent cold exposure.
Ten men rested for 2 h during a standardized cold-air test (4.6 degrees
C) after two treatments: 1) 60 min of cycle exercise (Ex) at 55% peak
O(2) uptake and 2) passive heating (Heat). Ex was performed during a 35
degrees C water immersion (WI), and Heat was conducted during a 38.2
degrees C WI. The duration of Heat was individually adjusted (mean = 53
min) so that rectal temperature was similar at the end of WI in both Ex
(38.2 degrees C) and Heat (38.1 degrees C). During the cold-air test
after Ex, relative to Heat 1) rectal temperature was lower (P < 0.05)
from minutes 40-120, 2) mean weighted heat flow was higher (P < 0.05), 3)
insulation was lower (P < 0.05), and 4) metabolic heat production was not
different. These results suggest that prior physical exercise may
predispose a person to greater heat loss and to experience a larger
decline in core temperature when subsequently exposed to cold air. The
combination of exercise intensity and duration studied in these
experiments did not fatigue the shivering response to cold exposure.
<26>
Unique Identifier
8889744
Medline Identifier
97044673
Authors
Thompson RL. Hayward JS.
Institution
Department of Biology, University of Victoria, British Columbia,
Canada.
Title
Wet-cold exposure and hypothermia: thermal and metabolic responses to
prolonged exercise in rain.
Source
Journal of Applied Physiology. 81(3):1128-37, 1996 Sep.
Abstract
Simulated conditions of hiking in rain, wind, and cold, without
protective rainwear, were used to investigate wet-cold hypothermia in 18
male subjects. Thermal, metabolic, and motor responses were monitored
during an attempted 5-h walk (5.1 km/h) at 5 degrees C, with continuous
exposure to rain (7.4 cm/h) and wind (8.0 km/h) over the final 4 h. The
majority of subjects (11) could not complete the protocol because of
intolerance of wet-cold conditions during the last 2 h. Therefore, data
from 5 subjects who completed the protocol in rain and control conditions
were used to describe the general pattern of response. During the 1st h
of walking, core temperature rose 1 degree C to 38.1 degrees C. The
subsequent 2 h of rain caused substantial cold stress, indicated by a 40%
increase in heat production due to shivering and significant loss of
strength and manual dexterity. However, core temperature only decreased
to 37.1 degrees C, merely eliminating the initial exercise hyperthermia.
Over the last 2 h of rain, core temperature remained relatively stable at
36.8 degrees C, decreasing slightly to 36.4 degrees C by 5 h. Two other
subjects developed significant hypothermia (35 degrees C). One
demonstrated fatigue of shivering after 2.5 h of rain, confirming the
exhaustion hypothesis of wet-cold hypothermia. The older cooled rapidly
when he failed to maintain the walking pace. We conclude that if a person
can tolerate the intense discomfort of prolonged wet-cold exposure, he or
she has the potential to resist significant core hypothermia for at least
4 h of walking under the conditions of this experiment. Exceptions to
this generalization occur, making exposure of < 4 h a hypothermia risk
for some individuals. Exposures > 4 h would involve increasing
probability of rapid decline into hypothermia, associated with exhaustion
of shivering and exercise heat production.
<27>
Unique Identifier
9760307
Medline Identifier
98434468
Authors
Young AJ. Castellani JW. O'Brien C. Shippee RL. Tikuisis P. Meyer
LG. Blanchard LA. Kain JE. Cadarette BS. Sawka MN.
Institution
United States Army Research Institute of Environmental Medicine,
Natick, Massachusetts 01760, USA. [email protected]
Title
Exertional fatigue, sleep loss, and negative energy balance increase
susceptibility to hypothermia.
Source
Journal of Applied Physiology. 85(4):1210-7, 1998 Oct.
Abstract
The purpose of this study was to determine how chronic exertional
fatigue and sleep deprivation coupled with negative energy balance affect
thermoregulation during cold exposure. Eight men wearing only shorts and
socks sat quietly during 4-h cold air exposure (10 degreesC) immediately
after (<2 h, A) they completed 61 days of strenuous military training
(energy expenditure approximately 4,150 kcal/day, energy intake
approximately 3,300 kcal/day, sleep approximately 4 h/day) and again
after short (48 h, SR) and long (109 days, LR) recovery. Body weight
decreased 7.4 kg from before training to A, then increased 6.4 kg by SR,
with an additional 6.4 kg increase by LR. Body fat averaged 12% during A
and SR and increased to 21% during LR. Rectal temperature (Tre) was lower
before and during cold air exposure for A than for SR and LR. Tre
declined during cold exposure in A and SR but not LR. Mean weighted skin
temperature (Tsk) during cold exposure was higher in A and SR than in LR.
Metabolic rate increased during all cold exposures, but it was lower
during A and LR than SR. The mean body temperature (0.67 Tre + 0.33 Tsk)
threshold for increasing metabolism was lower during A than SR and LR.
Thus chronic exertional fatigue and sleep loss, combined with
underfeeding, reduced tissue insulation and blunted metabolic heat
production, which compromised maintenance of body temperature. A short
period of rest, sleep, and refeeding restored the thermogenic response to
cold, but thermal balance in the cold remained compromised until after
several weeks of recovery when tissue insulation had been restored.
<28>
Unique Identifier
10193993
Medline Identifier
99208336
Authors
Tripp HF. Bolton JW.
Institution
Department of Cardiothoracic Surgery, Wilford Hall USAF Medical
Center/MKSC 59th Medical Wing (AETC), Lackland Air Force Base, Texas
78236-5300, USA.
Title
Phrenic nerve injury following cardiac surgery: a review. [Review] [29
refs]
Source
Journal of Cardiac Surgery. 13(3):218-23, 1998 May.
Abstract
Phrenic nerve injury following cardiac surgery is variable in its
incidence depending on the diligence with which it is sought. Definitive
studies have shown this complication to be related to cold-induced injury
during myocardial protection strategies and possibly to mechanical injury
during internal mammary artery harvesting. The consequences are also
variable and depend to a large extent on the underlying condition of the
patient, particularly with regard to pulmonary function. The response of
the patient may range from an asymptomatic radiographic abnormality to
severe pulmonary dysfunction requiring prolonged mechanical ventilation
and other associated morbidities and even mortality. Two cases are
presented to demonstrate the variability in clinical responses to
diaphragmatic dysfunction secondary to phrenic nerve injury from cardiac
surgery. In addition, treatment strategies are reviewed including early
tracheostomy and diaphragmatic plication, which appear to be the most
effective options for patients who are compromised by phrenic injuries.
[References: 29]
<29>
Unique Identifier
8979653
Medline Identifier
97134278
Authors
Shephard RJ.
Institution
School of Physical & Health Education, University of Toronto, Ontario,
Canada.
Title
Asphyxial death of a young skier.
Source
Journal of Sports Medicine & Physical Fitness. 36(3):223-7, 1996 Sep.
Abstract
OBJECTIVE: Review of the cause of death in fatal downhill skiing
accidents is important to prevention: this report concerns a boy found
dead with his head buried in powder snow. EXPERIMENTAL DESIGN: Case
history of an 11-year-old boy who was found dead 4 hours following
descent of a steep ski slope. SETTING: Treatment by mountain rescue team
and hospital emergency room. PATIENT: A boy who was discovered immersed
head first in one meter of powder snow, with no sign of an avalanche or
struggling, and no vital signs. The differential diagnosis included
concussion + asphyxia, cervical injury, loss of consciousness from other
causes, and hypothermia. INTERVENTIONS: Standard cardio-pulmonary
resuscitation, rewarming by bladder irrigation and extracorporeal
circulation. RESULTS: The rectal temperature, initially 29.4 degrees C,
fell further to 23.3 degrees C during evacuation in a heated ambulance.
On hospital admission, a blood sample showed creatine kinase 5306 units,
K+ 16 mM, pH 6.38, PaCO2 223 Torr, and PaO2 67 Torr. There was no ECG
rhythm, and radiography revealed pulmonary edema but no cervical
malignment. Emergency measures normalized blood gases, but did not
restore cardiac action. CONCLUSIONS: Death was caused by asphyxia,
secondary to mild concussion. The public needs education on the dangers
of deep powder snow. Adventurous skiers should wear helmets, and should
not ski alone on steep mountainsides.
<30>
Unique Identifier
9190130
Medline Identifier
97334025
Authors
Acevedo EO. Meyers MC. Hayman M. Haskin J.
Institution
Department of Kinesiology and Health Studies, Southeastern Louisiana
University, Hammond 70402, USA.
Title
Applying physiological principles and assessment techniques to swimming
the English Channel. A case study.
Source
Journal of Sports Medicine & Physical Fitness. 37(1):78-85, 1997 Mar.
Abstract
BACKGROUND: This study presents the use of physiological principles and
assessment techniques in addressing four objectives that can enhance a
swimmer's likelihood of successfully swimming the English Channel. The
four objective were: (1) to prescribe training intensities and determine
ideal swimming pace; (2) to determine the amount of insulation needed,
relative to heat produced, to diminish the likelihood of the swimmer
suffering from hypothermia; (3) to calculate the caloric expenditure for
the swim and the necessary glucose replacement required to prevent
glycogen depletion; and (4) to determine the rate of acclimatization to
cold water (15.56 C/60 F). METHODS: The subject participated in several
pool swimming data collection sessions including a tethered swim
incremental protocol to determine peak oxygen consumption and onset of
lactate accumulation and several steady state swims to determine ideal
swimming pace at 4.0 mM/L of lactate. Additionally, these swims provided
information on oxygen consumption, which in combination with ultrasound
assessment of subcutaneous fat was used to assess heat production and
insulation capabilities. Finally, the subject participated in 18 cold
water immersions to document acclimatization rate. RESULTS: The data
demonstrated the high fitness level of this subject and indicated that at
a stroke rate of 63 stokes/min, HR was 130 heats/min and lactate was 4
mM/L. At this swimming pace the swimmer would need to consume 470 kcal of
glucose/hr. In addition, the energy produced at this swim pace was 13.25
kcal/min while the energy lost at the present subcutaneous fat quantity
was 13.40 kcal/min, requiring a fat weight gain of 6,363.03 g (13.88 lbs)
to resist heat loss. CONCLUSIONS: Finally, the data from the cold water
immersions suggested that acclimatization occurred following two weeks of
immersions. There results were provided to the swimmer and utilized in
making decisions in preparation for the swim.
<31>
Unique Identifier
10230173
Medline Identifier
99246788
Authors
Ashford DA. Knutson RS. Sacks JJ.
Institution
Centers for Disease Control and Prevention (CDC), US Department of
Health and Human Services, US Public Health Service, Atlanta, GA 30333,
USA.
Title
Injury among cavers: results of a preliminary national survey.
Source
Journal of Sports Medicine & Physical Fitness. 39(1):71-3, 1999 Mar.
Abstract
BACKGROUND: To estimate the frequency of and risk factors for cavingassociated injuries. METHODS: A standardized questionnaire covering
demographics, caving exposure, and injury history was distributed to all
members of the National Speleological Society by inclusion in the monthly
newsletter. RESULTS: Of 9,532 members sent a questionnaire, 301 responded
(3.2%). Respondents had an average of 18 years of caving experience, and
37% had sustained one or more injuries while caving. Hypothermia was the
most frequent injury, followed by fractures, animal bites, and
concussions. The rate of injury was about 1 per 1,990 hours in a cave.
Injury rates for females were about twice those of males; older persons
and those with more than 5 years of caving experience seemed to have
lower injury rates. CONCLUSIONS: Many caving injuries appear potentially
preventable. Proper technique for safe climbing should be a part of
exploration training. There is a need for proper belaying or rappelling
for even short ascents or descents. Helmet use should be stressed, as
should adequate protection from hypothermia.
<32>
Unique Identifier
10359364
Medline Identifier
99285897
Authors
Peng RY. Bongard FS.
Institution
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509,
USA.
Title
Hypothermia in trauma patients. [Review] [107 refs]
Source
Journal of the American College of Surgeons. 188(6):685-96, 1999 Jun.
Abstract
Hypothermia occurs commonly in severely injured patients and is
associated with a high mortality rate. It perturbs the normal homeostatic
response to injury and affects multiple organ systems and physiologic
processes. In trauma patients, hypothermia-induced coagulopathy often
leads to marked bleeding diathesis and frequently provides a challenge
for the surgeon. Once hypothermia occurs, it is often difficult to
correct. Efforts to prevent and treat hypothermia in trauma patients
should be instituted in the field and continued as an integral part of
the resuscitation process. Hospital personnel and physicians at various
levels caring for trauma patients from the initial injury and thereafter
should bear in mind that a patient's temperature is as important as any
other vital sign. Appropriate measures for preventing and treating
hypothermia should be instituted promptly and tended to with utmost
vigilance. [References: 107]
<33>
Unique Identifier
9826808
Medline Identifier
99044044
Authors
Hoiness PR. Hvaal K. Engebretsen L.
Institution
Orthopaedic Department, Ulleval Hospital, University of Oslo, Norway.
[email protected]
Title
Severe hypothermic injury to the foot and ankle caused by continuous
cryocompression therapy. [Review] [14 refs]
Source
Knee Surgery, Sports Traumatology, Arthroscopy. 6(4):253-5, 1998.
Abstract
Iatrogenic hypothermic injury in the treatment of traumatic disorders
is a rare complication. Cryocompression therapy is widely used in the
treatment of pre- and postoperative pain and swelling, but hypothermic
damage to the soft tissues has not yet been reported. We present a case
in which a patient sustained a hypothermic injury after continuous
preoperative cryocompression therapy of an ankle fracture. The patient
developed skin epidermolysis, partial nerve damage, muscle atrophy and
clawing of the toes. The possible causes of this unusual injury are
discussed. [References: 14]
<34>
Unique Identifier
10466663
Medline Identifier
99394539
Authors
Tipton M. Eglin C. Gennser M. Golden F.
Institution
Department of Sport and Exercise Science, University of Portsmouth, UK.
[email protected]
Title
Immersion deaths and deterioration in swimming performance in cold
water. [see comments.].
Comments
Comment in: Lancet. 1999 Aug 21;354(9179):613 ; 10466657, Comment in:
Lancet. 1999 Nov 13;354(9191):1733 ; 10568604
Source
Lancet. 354(9179):626-9, 1999 Aug 21.
Abstract
BACKGROUND: General hypothermia (deep body temperature <35 degrees C)
has been implicated in immersion-related deaths, but many deaths occur
too quickly for it to be involved. We investigated changes in swimming
capability in cold water to find out whether such changes could lead to
swim failure and drowning. METHODS: Ten volunteers undertook three selfpaced breaststroke swims in a variable-speed swimming flume, in water at
25 degrees C, 18 degrees C, and 10 degrees C, for a maximum of 90 min.
During each swim, we measured oxygen consumption, rectal temperature,
swim speed and angle, and stroke rate and length. Swim failure was
defined as being unable to keep feet off the bottom of the flume.
FINDINGS: All ten swimmers completed 90 min swims at 25 degrees C, eight
completed swims at 18 degrees C, and five at 10 degrees C. In 10 degrees
C water, one swimmer reached swim failure after 61 min and four were
withdrawn before 90 min with rectal temperatures of 35 degrees C when
they were close to swim failure. Swimming efficiency and length of stroke
decreased more and rate of stroke and swim angle increased more in 10
degrees C water than in warmer water. These variables seemed to
characterise impending swim failure. INTERPRETATION: Impaired performance
and initial cardiorespiratory responses to immersion probably represent
the major dangers to immersion victims. Consequently, treatment should be
aimed at symptoms resulting from near-drowning rather than severe
hypothermia.
<35>
Unique Identifier
10568604
Medline Identifier
20033252
Authors
Teramoto S. Ouchi Y.
Title
Swimming in cold water. [letter; comment.].
Comments
Comment on: Lancet. 1999 Aug 21;354(9179):626-9 ; 10466663
Source
Lancet. 354(9191):1733, 1999 Nov 13.
<36>
Unique Identifier
10665559
Medline Identifier
20127325
Authors
Gilbert M. Busund R. Skagseth A. Nilsen PA. Solbo JP.
Title
Resuscitation from accidental hypothermia of 13.7 degrees C with
circulatory arrest.
Source
Lancet. 355(9201):375-6, 2000 Jan 29.
Abstract
In a victim of very deep accidental hypothermia, 9 h of resuscitation
and stabilisation led to good physical and mental recovery. This
potential outcome should be borne in mind for all such victims.
<37>
Unique Identifier
10527306
Medline Identifier
99454430
Authors
Sallis R. Chassay CM.
Institution
Department of Family Medicine, Kaiser Permanente Medical Center,
Fontana, CA, USA. [email protected]
Title
Recognizing and treating common cold-induced injury in outdoor sports.
[Review] [45 refs]
Source
Medicine & Science in Sports & Exercise. 31(10):1367-73, 1999 Oct.
Abstract
We briefly review the physiology of cold exposure, the spectrum and
prevention of common cold-induced injuries (especially in athletes
participating in outdoor sports), and the potentially harmful side
effects of localized cryotherapy. Severe cold affects all organ systems
and especially the central nervous and cardiovascular systems; many
biochemical reactions and pathways become distorted or slowed at low body
core temperatures and can thus affect athletic performance. Low body
shell temperature, too, can interfere with athletic ability by weakening
and slowing muscle contractions, by delaying nerve conduction time, and
by facilitating injury. Cold-induced injuries may be local or systemic,
but they can usually be prevented by knowledge, good physical condition,
appropriate nutrition and equipment, and avoidance of moisture.
[References: 45]
<38>
Unique Identifier
8970149
Medline Identifier
97125045
Authors
Armstrong LE. Epstein Y. Greenleaf JE. Haymes EM. Hubbard RW.
Roberts WO. Thompson PD.
Title
American College of Sports Medicine position stand. Heat and cold
illnesses during distance running. [Review] [97 refs]
Source
Medicine & Science in Sports & Exercise. 28(12):i-x, 1996 Dec.
Abstract
Many recreational and elite runners participate in distance races each
year. When these events are conducted in hot or cold conditions, the risk
of environmental illness increases. However, exertional hyperthermia,
hypothermia, dehydration, and other related problems may be minimized
with pre-event education and preparation. This position stand provides
recommendations for the medical director and other race officials in the
following areas: scheduling; organizing personnel, facilities, supplies,
equipment, and communication; providing competitor education; measuring
environmental stress; providing fluids; and avoiding potential legal
liabilities. This document also describes the predisposing conditions,
recognition, and treatment of the four most common environmental
illnesses: heat exhaustion, heatstroke, hypothermia, and frostbite. The
objectives of this position stand are: 1) To educate distance running
event officials and participants about the most common forms of
environmental illness including predisposing conditions, warning signs,
susceptibility, and incidence reduction. 2) To advise race officials of
their legal responsibilities and potential liability with regard to event
safety and injury prevention. 3) To recommend that race officials consult
local weather archives and plan events at times likely to be of low
environmental stress to minimize detrimental effects on participants. 4)
To encourage race officials to warn participants about environmental
stress on race day and its implications for heat and cold illness. 5) To
inform race officials of preventive actions that may reduce debilitation
and environmental illness. 6) To describe the personnel, equipment, and
supplies necessary to reduce and treat cases of collapse and
environmental illness. [References: 97]
<39>
Unique Identifier
8994207
Medline Identifier
97147302
Authors
Barone FC. Feuerstein GZ. White RF.
Institution
Department of Cardiovascular Pharmacology, SmithKline Beecham
Pharmaceuticals, King of Prussia, PA 19406, USA.
Title
Brain cooling during transient focal ischemia provides complete
neuroprotection. [Review] [148 refs]
Source
Neuroscience & Biobehavioral Reviews. 21(1):31-44, 1997 Jan.
Abstract
A review of the effects of reducing brain temperature on ischemic brain
injury is presented together with original data describing the systematic
evaluation of the effects of brain cooling on brain injury produced by
transient focal ischemia. Male spontaneously hypertensive rate were
subjected to transient middle cerebral artery occlusion (TMCAO; 80, 120
or 160 min) followed by 24 h of reperfusion. During TMCAO, the exposed
skull was bathed with isotonic saline at various temperatures to control
skull and deeper brain temperatures. Rectal temperature was always
constant at 37 degrees C. Initial studies indicated that skull
temperature was decreased significantly (i.e. to 32-33 degrees C) just as
a consequence of surgical exposure of the artery. Subsequent studies
indicated that maintaining skull temperature at 37 degrees C compared to
32 degrees C significantly (p < 0.05) increased the infarct size
following 120 or 160 min TMCAO. In other studies, 80 min TMCAO was held
constant, but deeper brain temperature could be varied by regulating
skull temperature at different levels. At 36-38 degrees C brain
temperature, infarct volumes of 102 +/- 10 to 91 +/- 9 mm3 occurred
following TMCAO. However, at a brain temperature of 34 degrees C, a
significantly (p < 0.05) reduced infarct volume of 37 +/- 10 mm3 was
observed. Absolutely no brain infarction was observed if the brain was
cooled to 29 degrees C during TMCAO. Middle cerebral artery exposure and
maintaining brain temperature at 37 degrees C without artery occlusion
did not produce any cerebral injury. These data indicated the importance
of controlling brain temperature in cerebral ischemia and that reducing
brain temperature during ischemia produces a brain temperature-related
decrease in focal ischemic damage. Brain cooling of 3 degrees C and 8
degrees C can provide dramatic and complete, respectively,
neuroprotection from transient focal ischemia. Multiple mechanisms for
reduced brain temperature-induced neuroprotection have been identified
and include reduced metabolic rate and energy depletion, decreased
excitatory transmitter release, reduced alterations in ion flux, and
reduced vascular permeability, edema, and blood-brain barrier disruption.
Cerebral hypothermia is clearly the most potent therapeutic approach to
reducing experimental ischemic brain injury identified to date, and this
is emphasized by the present data which demonstrate complete
neuroprotection in transient focal stroke. Certainly all available
information warrants the evaluation of brain cooling for potential
implementation in the treatment of human stroke. [References: 148]
<40>
Unique Identifier
9366581
Medline Identifier
98026766
Authors
Walpoth BH. Walpoth-Aslan BN. Mattle HP. Radanov BP. Schroth G.
Schaeffler L. Fischer AP. von Segesser L. Althaus U.
Institution
Department of Thoracic and Cardiovascular Surgery, University of Bern,
Inselspital, Switzerland.
Title
Outcome of survivors of accidental deep hypothermia and circulatory
arrest treated with extracorporeal blood warming. [see comments.].
Comments
Comment in: N Engl J Med. 1997 Nov 20;337(21):1545-7 ; 9366589, Comment
in: N Engl J Med. 1998 Apr 16;338(16):1160-1; discussion 1161-2 ;
9547154, Comment in: N Engl J Med. 1998 Apr 16;338(16):1160; discussion
1161-2 ; 9547153, Comment in: N Engl J Med. 1998 Apr 16;338(16):1161;
discussion 1161-2 ; 9547155
Source
New England Journal of Medicine. 337(21):1500-5, 1997 Nov 20.
Abstract
BACKGROUND: Cardiopulmonary bypass has been used to rewarm victims of
accidental deep hypothermia. Unlike other rewarming techniques, it
restores organ perfusion immediately in patients with inadequate
circulation. This study evaluated the long-term outcome of survivors of
accidental deep hypothermia with circulatory arrest who had been rewarmed
with cardiopulmonary bypass. METHODS: Deep hypothermia (core temperature,
<28 degrees C) with circulatory arrest was found in 46 of 234 patients
with accidental hypothermia. In 32 of the 46 patients, rewarming with
cardiopulmonary bypass was attempted, resulting in 15 long-term
survivors. In most of these patients, deep hypothermia developed after
mountaineering accidents or suicide at tempts. After an average (+/-SD)
of 6.7+/-4.0 years of follow-up, we obtained the patients' medical
histories and performed neurologic and neuropsychological examinations,
neurovascular ultrasound studies, electroencephalography, and magnetic
resonance imaging of the brain. RESULTS: The average age of the patients
was 25.2+/-9.9 years; seven were female and eight were male. The mean
interval from discovery of the patient to rewarming with cardiopulmonary
bypass was 141+/-50 minutes (range, 30 to 240). At follow-up there were
no hypothermia-related sequelae that impaired quality of life. Neurologic
and neuropsychological deficits observed in the early period after
rewarming had fully or almost completely disappeared. One patent had
cerebellar atrophy on magnetic resonance imaging with mild clinical
signs, a condition that may have been caused by hypothermia. Other
clinical abnormalities were either preexisting or due to injuries not
related to hypothermia CONCLUSIONS: This clinical experience demonstrates
that young, otherwise healthy people can survive accidental deep
hypothermia with no or minimal cerebral impairment, even with prolonged
circulatory arrest. Cardiopulmonary bypass appears to be an efficacious
rewarming technique.
<41>
Unique Identifier
10696218
Medline Identifier
20161208
Authors
Laskowski-Jones L.
Institution
Christiana Hospital, Newark, Del., USA.
Title
Responding to winter emergencies.
Source
Nursing. 30(1):34-9; quiz 40, 2000 Jan.
<42>
Unique Identifier
9924494
Medline Identifier
99123569
Authors
Kanzenbach TL. Dexter WW.
Institution
Minnesota State University, Mankato 56002, USA.
Title
Cold injuries. Protecting your patients from the dangers of hypothermia
and frostbite. [Review] [8 refs]
Source
Postgraduate Medicine. 105(1):72-8, 1999 Jan.
Abstract
Hypothermia may occur in any part of the country but is an especially
important concern among people who enjoy cold weather sports. Prompt
recognition and treatment are paramount, since many hypothermia victims
have recovered from very low body temperatures. Therefore, even if
someone appears to be dead from exposure to cold, resuscitative efforts
should be started and continued until the proper core body temperature is
reached. Although frostbite is often considered minor, it can cause
permanent tissue damage. Preparation is the key to protecting patients
from the effects of cold weather, and frostbite, frostnip, and
hypothermia should always be taken seriously. Treatment in a medical
facility can make the difference between full recovery and lifelong
problems. [References: 8]
<43>
Unique Identifier
9799014
Medline Identifier
99013358
Authors
White LJ. Jackson F. McMullen MJ. Lystad J. Jones JS. Hubers RH.
Institution
Emergency Medicine Residency Program, Akron General Medical Center,
Ohio 44307, USA. [email protected]
Title
Continuous core temperature monitoring of search and rescue divers
during extreme conditions. [see comments.].
Comments
Comment in: Prehosp Emerg Care. 1998 Oct-Dec;2(4):330-3 ; 9799025
Source
Prehospital Emergency Care. 2(4):280-4, 1998 Oct-Dec.
Abstract
OBJECTIVES: To study the feasibility of continuously monitoring core
temperatures of search and rescue divers, to compare core temperature
gradients occurring during warm and cold diving events, and to identify
conditions under which divers are subjected to extreme temperatures.
METHODS: Between June 1994 and March 1995, emergency medical technicians
(EMTs) from two midwestern dive teams volunteered to ingest an
encapsulated temperature sensor developed for the National Aeronautics
and Space Administration. The capsule monitored continuous core
temperatures and transmitted the data to a recorder worn under the
divers' dry suits. RESULTS: Twenty male EMTs, mean age 34 years and mean
body weight 184 pounds, were monitored during training. Nine dives were
ice dives, with ice thickness averaging 9 inches, and mean ambient
temperatures of 33 degrees F. Eleven dives were warm-water dives; average
water temperature was 70 degrees F and mean ambient temperature was 74
degrees F. The average time spent in the dry suit was 95 minutes, and the
mean total bottom time was 15 minutes. The ice divers showed a mean
increase in core temperature of 1.0 degrees C, while the warm-water
divers showed a mean increase of 1.2 degrees C. Divers experiencing the
most extreme fluctuations were those in the role of safety diver,
regardless of the season. Divers reported more subjective discomfort
during ice dives than during warm-water dives. CONCLUSIONS: Continuous
monitoring of body temperature during the duration of dive operations is
possible, but labor-intensive. Safety measures to protect divers from
extreme core temperature fluctuations should focus on the safety diver as
well as the active diver.
<44>
Unique Identifier
10225652
Medline Identifier
99240182
Authors
Braude D. Shalit M.
Institution
UCSF-Fresno Emergency Medicine Residency Program, California, USA.
[email protected]
Title
The Mt. Tyndall incident.
Source
Prehospital Emergency Care. 3(2):167-9, 1999 Apr-Jun.
Abstract
The authors describe the 53-hour rescue of a 6-foot, 1-inch tall, 250pound hiker in the face of harsh environmental conditions in Sequoia
National Park. This 43-year-old man fell 25 feet, injured his leg, and
was noted to be hypothermic and hypovolemic. Weather, altitude, and the
patient's size delayed and complicated his evacuation. After being
carried down 1,500 vertical feet, he was hoisted into a hovering
helicopter and flown to University Medical Center in Fresno, California.
On arrival, the patient was determined to have a comminuted
subtrochanteric right femur fracture, which was ultimately repaired
surgically. The authors also discuss some of the unique aspects of
wilderness and National Park Service EMS.
<45>
Unique Identifier
9000302
Medline Identifier
97152801
Authors
Gordon CJ.
Institution
Neurotoxicology Division, U.S. Environmental Protection Agency,
Research Triangle Park, North Carolina 27711, USA.
Title
Thermoregulatory aspects of environmental exposure to
anticholinesterase agents. [Review] [72 refs]
Source
Reviews on Environmental Health. 11(3):101-17, 1996 Jul-Sep.
Abstract
Anticholinesterase (antiChE) agents can be highly toxic to birds and
mammals and constitute a major proportion of the pesticides used
throughout the world. AntiChEs consist of the organophosphates (OP),
which irreversibly inhibit the enzyme acetylcholinesterase (AChE), and
the carbamates (CB), which reversibly inhibit AChE. AChE inhibition
elicits cholinergic stimulation in the central nervous system and in
peripheral tissues and organs, which can lead to marked dysfunction of
homeostatic systems, including temperature regulation. The control of
body temperature uses cholinergic pathways in the integration and central
processing of thermal information, as well as in the control of
thermoeffector responses. Hence, the cholinergic stimulation elicited
from exposure to antiChEs has profound effects on body temperature at
rest as well as during exercise. Ambient heat and cold stress can also
modulate the animal's sensitivity to antiChE exposure. After exposure to
most OPs, rodents and other small species undergo a marked hypothermic
response lasting up to 24 hours. On the other hand, humans exposed to OP
pesticides rarely become hypothermic but rather experience a fever that
may last many days. Recent studies monitoring body temperature in OPexposed, telemetered rats demonstrated that the initial hypothermic
response is followed by a period of hyperthermia lasting several days.
That the hyperthermia can be blocked with administration of sodium
salicylate suggests that the hyperthermia is a fever. Thus, the antiChEinduced effects on body temperature and other physiological systems
cannot be explained solely by the immediate consequences of AChE
inhibition and stimulation of cholinergic systems. Research into the
mechanisms of action of antiChE toxicity will be improved with a better
understanding of their effects on temperature regulation. [References:
72]
<46>
Unique Identifier
9717200
Medline Identifier
98382928
Authors
Grant P. Snadden D. Syme D. Walker T.
Institution
The Health Centre, Grantown-on-Spey.
Title
Freezing to death--the treatment of accidental hypothermia in the
Scottish mountains. [Review] [4 refs]
Source
Scottish Medical Journal. 43(2):36-7, 1998 Apr.
<47>
Unique Identifier
8857703
Medline Identifier
97010665
Authors
Chatard JC. Millet G.
Institution
Laboratoire de Physiologie, GIP Exercice, Faculte de Medecine de SaintEtienne, France.
Title
Effects of wetsuit use in swimming events. Practical recommendations.
[Review] [26 refs]
Source
Sports Medicine. 22(2):70-5, 1996 Aug.
<48>
Unique Identifier
11708400
Medline Identifier
21564722
Authors
Moran DS.
Institution
Heller Institute of Medical Research, Sheba Medical Center, Tel
Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Title
Potential applications of heat and cold stress indices to sporting
events. [Review] [73 refs]
Source
Sports Medicine. 31(13):909-17, 2001.
Abstract
Many recreational and elite athletes participate in sporting events
every year. However, when these events are conducted under hostile
environmental conditions, whether in cold or hot climates, the risk for
environmental illnesses increases. The higher the stress, the greater is
the potential for performance decrements, injuries and illnesses. The
most common expected heat illnesses are heat exhaustion and heatstroke,
whereas hypothermia and frostbite are the most common cold injuries.
However, heat and cold stress indices can minimise the risk for
environmental illnesses and dehydration by following the recommendations
and guidelines which accompany these indices. Stress indices should be
used by athletes, coaches and officials to prevent injury and improve
safety conditions for competitors and participants in recreational
activities. All participants should be made aware of warning signs,
susceptibility and predisposing conditions. Coaches should be aware of
their responsibility with regard to the safety of their trainees, and
officials should organise and plan events at times that are likely to be
of low environmental stress. However, they must also be prepared and
equipped with the means necessary to reduce injuries and treat cases of
collapse and environmental illnesses. The lack of a friendly, small and
simple device for environmental stress assessment is probably the main
reason why stress indices are not commonly used. We believe that
developing a new portable heat and cold stress monitor in wristwatch
format for use by those exposed to environmental stress could help in the
decision making process of expected hazards caused by exercising and
working in hostile environments, and might help prevent heat and cold
illnesses. [References: 73]
<49>
Unique Identifier
9291980
Medline Identifier
97437447
Authors
Burch JM. Denton JR. Noble RD.
Institution
Denver Health Medical Center, Department of Surgery, University of
Colorado Health Sciences Center, USA.
Title
Physiologic rationale for abbreviated laparotomy. [Review] [11 refs]
Source
Surgical Clinics of North America. 77(4):779-82, 1997 Aug.
Abstract
Trauma patients who succumb to their injuries do so by one of several
mechanisms discussed in this article. The most common include head
injury, exsanguination, sepsis, and multiple organ failure. The article
also discusses adverse consequences of hypothermia, including a model for
calculating total heat loss. [References: 11]
<50>
Unique Identifier
10897264
Medline Identifier
20355455
Authors
Eddy VA. Morris JA Jr. Cullinane DC.
Institution
Department of Surgery, Vanderbilt University Medical Center, Nashville,
Tennessee, USA.
Title
Hypothermia, coagulopathy, and acidosis. [Review] [40 refs]
Source
Surgical Clinics of North America. 80(3):845-54, 2000 Jun.
Abstract
The management of patients requiring a damage control approach taxes
the abilities of the best equipped trauma center. These patients present
with severe metabolic abnormalities, most notably characterized by a
deadly triad of hypothermia, coagulopathy, and acidosis. Using
volumetric, oxymetric pulmonary artery catheters, hypothermia and any
ongoing cardiovascular abnormalities can be identified quickly and
treatment can be monitored. External, forced air rewarming is a valuable
technique in treating the patient with hypothermia, as are more invasive
modalities, including body cavity lavage. Although there is no shotgun
approach to blood component transfusion therapy, the coagulopathy shown
by these patients has a time course that is more rapid than stat
laboratories can presently keep up with. Given the fulminant nature of
this coagulopathy, the authors feel justified in empirically initiating
platelet and plasma or cryoprecipitate transfusion on identification of
visible coagulopathy. The willingness of trauma surgeons to push the
envelope in treating these most severely afflicted patients has allowed
patients who once would have certainly died to lead meaningful lives.
[References: 40]
<51>
Unique Identifier
10560318
Medline Identifier
20024108
Authors
Duff J.
Title
The "Tibetan tuck": a dry land-cold conditions survival position
equivalent to that used in cold water.
Source
Wilderness & Environmental Medicine. 10(3):206-7, 1999 Autumn.
<52>
Unique Identifier
10560308
Medline Identifier
20024098
Authors
Marsigny B. Lecoq-Jammes F.
Cauchy E.
Institution
Emergency Unit, Chamonix Hospital, France.
Title
Medical mountain rescue in the Mont-Blanc massif.
Source
Wilderness & Environmental Medicine. 10(3):152-6, 1999 Autumn.
Abstract
Because of its peculiar geographic location beneath Mont-Blanc, the
Chamonix Hospital plays an important role in the management of
mountaineering- and skiing-related traumatic injuries. The authors,
thanks to the study of 5200 mountain rescue medical reports, set out to
explain the different aspects of this activity: epidemiology, specific
equipment, care in the field, reception and primary survey, dispatching,
common therapeutic attitudes, progress, and results. In the dangerous
environment of the high mountains, emphasis is put on the physicians'
experience, allowing an early evacuation in the best conditions to the
hospital. Diagnosis at the scene of the accident is very basic, and the
initial treatment is based on immobilization, analgesia, and sedating. In
the case of resuscitation, only the vital maneuvers are performed; these
actions are carried on during the short flight and improved in the crash
rooms. Finally, different specific pathologies are mentioned, including
cold- or heat-related injuries, exhaustion, lightning strikes, and
mountain sickness.
<53>
Unique Identifier
10628282
Medline Identifier
20093769
Authors
Beilman GJ. Brasel KJ. Dittrich K. Seatter S. Jacobs DM. Croston
JK.
Institution
North Memorial Health Care, Robbinsdale, MN 55422-2900, USA.
[email protected]
Title
Risk factors and patterns of injury in snowmobile crashes.
Source
Wilderness & Environmental Medicine. 10(4):226-32, 1999 Winter.
Abstract
OBJECTIVE: To evaluate risk factors for snowmobile injury and patterns
of injury. METHODS: We performed a retrospective analysis of patients
with snowmobile injury at three trauma centers. Data were collected from
trauma databases and patients charts from January 1988 through April
1996; we obtained statistics from the Minnesota Department of Natural
Resources for comparison purposes. RESULTS: There were 274 patients
identified. The average age was 29 years (SD 12, range 1.6-77). The
male:female ratio was 6.6:1. Helmets were used in 35%, not used in 10%,
and not reported in 55%. Ethanol consumption was reported in 44% of
patients. The average speed of the snowmobile at the time of the
accident, when reported, was 47 mph/75 kph (n = 103, range 10-100 mph/16166 kph). Of these patients, 26% (n = 27) reported a speed in excess of
the legal limit (55 mph/88 kph). Accidents were more common in the
afternoon and evening hours, and most accidents were caused by the
snowmobile striking terrain or man-made objects. Mortality rate was 3.6%
for this patient group (10 of 274). The average injury severity score
(ISS) was 15 (SD 11). The average Glasgow Coma Score (GCS) was 14. The
average number of patients who went to the intensive care unit and the
total lengths of stay were 2 +/- 5 and 8 +/- 9 days, respectively.
Neither GCS nor ISS correlated with reported speed. The frequencies of
different types of injuries are as follows: fractures of upper and lower
extremities (n = 184), serious head injury (n = 92), facial fractures or
soft tissue injury to head or neck (n = 88), thoracic injury (n = 80),
spine injuries (n = 50), intraabdominal injuries (n = 41), and pelvic
fractures (n = 31). CONCLUSIONS: Snowmobile injuries are related to
ethanol use and the high speed attained by the newer generation of
snowmobiles. Extremity fractures were a common component of snowmobile
injury in this series, and rates of such injuries are similar to rates
injuries in motorcycle accidents in states with helmet laws. Efforts at
prevention of snowmobile injuries should be targeted at rider education
and enforcement of alcohol restrictions.