Case Study of Severe Accidental Hypothermia with Rapid Cooling, Preserved Shivering, and Consciousness with a Summary of Similar Case Reports.

IF 1.4 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Wilderness & Environmental Medicine Pub Date : 2024-12-01 Epub Date: 2024-10-03 DOI:10.1177/10806032241272127
Alana C Hawley, Gordon G Giesbrecht, Douglas J A Brown, Matthew D White
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引用次数: 0

Abstract

We describe a case of severe accidental hypothermia of a kayaker with preserved consciousness and shivering despite a rectal temperature of 22.9°C following a 50-min immersion in 3°C water with an estimated core temperature cooling rate of 10.6°C/h. Based on survival at sea prediction curves and cooling rates from physiology studies, cold water (eg, 0-5°C) immersion is expected to drop core temperature by 2 to 4°C/h. Furthermore, accidental hypothermia classification systems predict that severely hypothermic patients are usually unconscious and not shivering. The patient in this report rewarmed rapidly at 3.6°C/h with only minimally invasive measures and was discharged fully neurologically intact. In 41 similar cases of survival in moderate to severe hypothermia with core temperatures <32°C due to cold water immersion, cold air exposure, or avalanche burial, mean cooling rates were 4.3±3.3°C/h (range 0.4-10.6°C/h). Including the current patient, shivering was reported in only four cases. We found several other cases of rewarming from moderate to severe hypothermia with only minimally invasive measures. The current and summarized cases lead us to conclude that patients may be at risk of severe hypothermia in <60 min of cold water immersion and that it is possible for severely hypothermic patients to have preserved consciousness, close to normal vital signs, and shivering. Minimally invasive or noninvasive rewarming of patients with severe hypothermia is also possible, especially in those who continue to shiver. Hypothermia management should not necessarily be guided by classification systems or core temperature alone but rather by a careful consideration of the entire clinical picture.

严重意外低体温症病例研究:快速降温、保持哆嗦和意识,以及类似病例报告摘要。
我们描述了一例皮划艇运动员在 3°C 的水中浸泡 50 分钟后,尽管直肠温度为 22.9°C,但意识仍保持清醒,并伴有哆嗦的严重意外低体温症病例,估计核心温度冷却速度为 10.6°C/h。根据海上生存预测曲线和生理学研究得出的降温速率,冷水(例如 0-5°C)浸泡预计会使核心温度每小时下降 2 到 4°C。此外,根据意外低体温分类系统的预测,严重低体温患者通常会失去知觉,而且不会发抖。本报告中的患者仅采取了微创措施,就以 3.6°C/h 的速度迅速恢复体温,出院时神经系统完好无损。在 41 例类似的中度至重度低体温存活病例中,核心温度为
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来源期刊
Wilderness & Environmental Medicine
Wilderness & Environmental Medicine 医学-公共卫生、环境卫生与职业卫生
CiteScore
2.10
自引率
7.10%
发文量
96
审稿时长
>12 weeks
期刊介绍: Wilderness & Environmental Medicine, the official journal of the Wilderness Medical Society, is the leading journal for physicians practicing medicine in austere environments. This quarterly journal features articles on all aspects of wilderness medicine, including high altitude and climbing, cold- and heat-related phenomena, natural environmental disasters, immersion and near-drowning, diving, and barotrauma, hazardous plants/animals/insects/marine animals, animal attacks, search and rescue, ethical and legal issues, aeromedial transport, survival physiology, medicine in remote environments, travel medicine, operational medicine, and wilderness trauma management. It presents original research and clinical reports from scientists and practitioners around the globe. WEM invites submissions from authors who want to take advantage of our established publication''s unique scope, wide readership, and international recognition in the field of wilderness medicine. Its readership is a diverse group of medical and outdoor professionals who choose WEM as their primary wilderness medical resource.
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