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http://www.mayoclinic.com/invoke.cfm?id=DS00333
Hypothermia

Overview

Unlike warmblooded animals that have a layer of hair or blubber to keep them
warm, you need an extra layer of clothing to keep you warm when it's cold
outside. Without that extra layer of clothing, more heat escapes from your
body than your body can produce. If too much heat escapes, the result is
hypothermia. Exposure to cold water and certain medical conditions also can
cause hypothermia.

Hypothermia occurs when your body's control mechanisms fail to maintain a
normal body temperature. Your normal core body temperature is usually right
around 98.6 F. An internal body temperature of 95 F or lower signals
hypothermia.

Signs and symptoms that may develop include gradual loss of mental and
physical abilities. Severe hypothermia can lead to death. For most
Americans, hypothermia isn't a serious risk. Still, each year nearly 700
Americans die of hypothermia. Those at greatest risk are older adults,
children, people who are mentally ill or have Alzheimer's disease and lose
their judgment about when to seek shelter, and people who are intoxicated,
homeless or caught in cold weather because their vehicle has broken down.

Wearing protective clothing and taking other precautions can ensure that
your body temperature doesn't drop to deadly levels. Paying attention to
what may be early signs and symptoms of hypothermia also is important.

When you're outdoors enjoying such activities as camping, hunting, fishing,
boating and skiing, be aware of weather conditions and whether you or others
with you are wet and cold. When the water evaporates, it further cools your
skin, dropping your internal temperature. A wind blowing over the wet parts
of your body greatly increases evaporation and cooling. The best approach to
being cold and wet is to move indoors and get warm and dry early - before
you encounter serious hypothermia.


Signs and symptoms

A drop in your body's normal core temperature to 95 F or below is the key
sign of hypothermia. The condition usually comes on gradually. Often, people
aren't aware that they need medical attention. Common signs to look for are
shivering, which is your body's attempt to generate heat through muscle
activity, and the "umbles" - stumbles, mumbles, fumbles and grumbles. These
behaviors may be a result of changes in motor coordination and levels of
consciousness caused by hypothermia.

Other signs and symptoms may include:

  a.. Slurred speech
  b.. Abnormally slow rate of breathing
  c.. Cold, pale skin
  d.. Fatigue, lethargy or apathy
The severity of hypothermia can vary, depending on how low your core body
temperature goes. Severe hypothermia will eventually lead to cardiac and
respiratory failure, then death.


Causes

The cause of hypothermia usually is extended exposure to cold temperatures
or a cool, damp environment. Other contributing causes include inadequate
clothing and neglecting to cover your head, hands and feet. Normally, a
disproportionate amount of heat is lost through your head. Hypothermia can
happen not just in cold winter weather, when there are low temperatures or
low windchill factors, but under more mild conditions as well. A rain shower
that soaks you to the skin on a cool day can lead to hypothermia if you
don't move inside to warm up and dry off.

An accidental fall into cold water also may be a cause. Hypothermia may
develop within a few minutes after you're exposed to cold water or it may
take several hours, depending on the water temperature. Water doesn't have
to be icy cold to cause hypothermia. Your body loses heat more quickly in
water than in air. Any water temperature lower than body temperature will
cause your body to lose some heat.


Risk factors

Extreme cold, wet clothes - especially in the presence of wind - and being
in cold water can all play a part in increasing your chances of hypothermia.
People who are elderly, very young or have certain health issues are
especially vulnerable.

Risks to older adults
People age 65 and older are especially vulnerable because they may have
other illnesses or take medications that can interfere with the body's
ability to regulate temperature.

Risks to the very young
Children can lose heat faster than adults do. Children have a larger
head-to-body ratio than adults do, making them more prone to heat loss
through the head. Children may also ignore the cold because they're having
too much fun to think about it. And they may not have the judgment to dress
properly in cold weather or to get out of the cold when they feel cold.
Infants may have a special problem with the cold because they have less
efficient mechanisms for generating heat.

Other factors that may place you at risk


  a.. Psychiatric disorders. Individuals who have Alzheimer's disease or
another illness that causes mental impairment may not be aware of the risks
of being out in the cold. Wandering away from home is not uncommon among
people with Alzheimer's, and many are unable to find their way back on their
own, leaving them stranded and vulnerable to the weather.
  b.. Alcohol consumption. Alcohol may make your body feel warm inside, but
it lowers your body's ability to retain heat. Don't drink alcohol and
operate a boat or other watercraft. Alcohol can impair your ability to
navigate the waters, increasing your risk of an accident and of falling into
cold water.
  c.. Medical conditions. Some health disorders affect the body's ability to
respond to cold or to produce heat. Examples include untreated underactive
thyroid (hypothyroidism), stroke, severe arthritis, Parkinson's disease,
trauma, spinal cord injuries, burns, blood vessel or nerve disorders that
affect sensation in your extremities (for example, peripheral neuropathy in
people with diabetes), dehydration and any condition that limits activity or
restrains the normal flow of blood. Older adults are more likely to have one
or more of these risk factors.
  d.. Water temperature. Another factor contributing to your risk of
hypothermia is the length of time you're in cold water. Rescue time is
crucial when a person accidentally falls into cold water. Chances of
survival are affected by how cold the water is. The colder the water, the
less the chance of survival.
      Water temperature Time until exhaustion or unconsciousness Expected
time of survival in the water
      Under 32 F Less than 15 minutes Less than 15 to 45 minutes
      32.5 to 40 F 15 to 30 minutes 30 to 90 minutes
      40 to 50 F 30 to 60 minutes 1 to 3 hours
      50 to 60 F 1 to 2 hours 1 to 6 hours
      60 to 70 F 2 to 7 hours 2 to 40 hours
      70 to 80 F 3 to 12 hours 3 hours to indefinite
      More than 80 F Indefinite Indefinite


When to seek medical advice

The signs and symptoms of the person suffering from exposure to the cold are
the strongest indications of hypothermia. Seek immediate medical care for
any person who has been exposed to cold air or water and who is shivering,
appears disoriented, shows a lack of coordination, has cold and pale skin,
appears tired, and is slurring speech. Try to keep the person warm and dry,
preferably indoors or at least out of the wind, until help arrives.


Complications

Complications depend on how low your body temperature falls. If you're in
water, you may lose consciousness and drown before your temperature drops
low enough to cause death by hypothermia. Other complications may include:

  a.. Frostbite
  b.. Loss of limbs
  c.. Coma
The lower your core body temperature, the greater your chance of
complications and permanent damage.


Treatment

Seek immediate medical attention for anyone who appears to be suffering from
hypothermia. Until medical help is available, follow these guidelines for
caring for someone with hypothermia.

What to do

  a.. Move the person out of the cold. Preventing additional heat loss is
crucial. If you're unable to move the person out of the cold, shield the
person from the cold and wind as best as you can.
  b.. Remove wet clothing. If the person is wearing wet clothing, remove it
and replace it with a dry covering. Cover the person's head. Try not to move
the person too much. Cut away clothing if you need to.
  c.. Insulate the person's body from the cold ground. Lay the person faceup
on a blanket or other warm surface.
  d.. Monitor breathing. A person with severe hypothermia may appear
unconscious, with no apparent signs of a pulse or breathing. If the person's
breathing has stopped or appears dangerously low or shallow, begin
cardiopulmonary resuscitation (CPR) immediately if you're trained.
  e.. Share body heat. To warm the person's body, remove your clothing and
lie next to the person skin-to-skin. Then cover both bodies with a blanket.
  f.. Provide warm beverages. If the affected person is alert and is able to
swallow, have the person drink a warm, nonalcoholic beverage to help warm
the body.
What not to do

  a.. Don't apply direct heat. Don't use hot water, a heating pad or a
heating lamp to warm the victim. Instead, apply warm compresses to the neck,
chest wall and groin. Don't attempt to warm the arms and legs. Heat applied
to the arms and legs forces cold blood back toward the heart, lungs and
brain causing the core body temperature to drop. This can be fatal.
  b.. Don't massage or rub the person. Handle people with hypothermia gently
because they're at risk of cardiac arrest.
  c.. Don't provide alcohol beverages. Alcohol lowers the body's ability to
retain heat.
What a doctor may do
A doctor will be able to take steps to warm the body from the inside out, if
necessary. One method may involve giving the person warm fluids
intravenously. In severe cases of hypothermia, hemodialysis may restore
normal body temperatures quickly. Hemodialysis is a medical procedure that
removes extra fluid, chemicals and wastes from the blood by filtering the
blood through an artificial kidney. It's often used in people with kidney
failure. In a hypothermia situation, the blood is removed purely to warm it
rapidly outside the body and then have it returned to the body.


Prevention

For people most at risk of hypothermia - such as those who are older, have
mental or physical impairments or who are homeless - community outreach
programs and medical and social support services can be of great help.
Identifying and checking in on vulnerable individuals and groups, preventing
prolonged exposure to the cold and ensuring adequate heating are ways to
help reduce the number of hypothermia deaths. Monitoring bracelets may
provide assistance for those who have problems with wandering from home. In
addition, public health prevention strategies can help educate people about
the dangers of prolonged exposure to cold.

Staying healthy in cold weather
Before you or your children step out into cold air, remember the advice that
follows with the simple acronym COLD:

  a.. C for Cover. Wear a hat or other protective covering to prevent body
heat from escaping from your head, face and neck. Cover your hands with
mittens instead of gloves. Mittens are more effective than gloves are
because mittens keep your fingers in closer contact with one another.
  b.. O for Overexertion. Avoid activities that would cause you to sweat a
lot. The combination of wet clothing and cold weather can give you chills.
  c.. L for Layers. Wear loose-fitting, layered, lightweight clothing. Outer
clothing made of tightly woven, water repellent material is best for wind
protection. Wool, silk or polypropylene inner layers hold more body heat
than cotton does.
  d.. D for Dry. Stay as dry as possible. In the winter, pay special
attention to places where snow can enter, such as in loose mittens or snow
boots.
During cold-weather months, keep emergency supplies in your car in case you
get stranded. Supplies may include several blankets, matches, candles and
some foodstuffs, such as granola bars or crackers. A cell phone also can
come in handy. If your car is stuck in a snowbank, be careful about leaving
the engine running, as infiltration of carbon monoxide inside the car may
pose a silent danger.

Cold-water cautions
Water doesn't have to be extremely cold to cause hypothermia. Any water
that's colder than body temperature causes heat loss. Water that's colder
than 70 F can quickly begin to cause hypothermia. The following tips may
increase your survival time in cold water, if you accidentally fall in:

  a.. Wear a life jacket. If you plan to ride in a watercraft, wear a life
jacket. A life jacket can help you stay alive longer in cold water by
allowing you to float without using energy and providing some insulation.
  b.. Don't panic. If you're unable to swim to safety, stay calm.
Unnecessary movements require you to exert extra energy and lose body heat.
  c.. Position your body to minimize heat loss. Use a body position known as
HELP (Heat Escape Lessening Position) to reduce heat loss while you wait for
help. Hold your knees to your chest to protect the trunk of your body. If
you're wearing a life jacket that turns your face down in this position,
bring your legs tightly together, your arms to your sides and your head
back.
  d.. Huddle with others. If you've fallen into cold water with other
people, keep warm by facing each other in a tight circle.
  e.. Don't remove your clothing. Buckle, button and zip up your clothes.
Cover your head if you have a hood. The layer of water between your clothing
and your body will be warmed and help insulate you.
  f.. Don't attempt to swim unless you're close to safety. Unless a boat,
another person or a life jacket is close by, stay put. Swimming expends
extra energy, lowers body temperature and can shorten survival time by more
than 50 percent.


By Mayo Clinic staff

> >Udah 2 malem ini anak saya (9 bln) sekitar jam 9/10 malem suhu
> >tubuhnya mendadak turun jadi 34 derajat C. Anaknya gak rewel, minum
> >masih mau. Dokternya hanya menyarankan utk di'buntel', dikasih minum,
> >dan di'lampu'. Wkt yg pertama memang hawa sedang dingin, tapi yg
> >kedua hawa ga sedang dingin kok.
> >

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