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can arrest the fall in core temperature in factors occur at the local level (i.e., within
warm and cool water (B and C). However, each body cylinder; upper leg, lower leg etc.).
if the cold stress is great enough (D) cooling First, conductive cooling occurs based on
may be retarded but will continue. The temperature gradients that depend on the
power of shivering is especially important in extent of the cold exposure. These gradients
the consideration of classification of mainly promote radial surface-to-center
hypothermia and eventual treatment because cooling (1) although some longitudinal distal-
this valuable heat source is efficient at to-proximal gradients may also exist (3).
rewarming the core post-cooling. Second, local tissue heat production will, to
some extent, offset the physical effect of
Post-cooling
conductive cooling. Finally, local tissue
Following cooling the body core continues blood flow will be affected by the
to drop. This afterdrop is a function of a temperature and flow rate of incoming
dynamic combination of mechanisms. Two blood. Although conductive cooling is
Hypothermia Giesbrecht
indisputable, the only way that cooling in collapse with symptoms ranging from
any body cylinder (other than the trunk) can syncope to ventricular fibrillation and
affect core temperature is by convective cardiac arrest. There are 3 probable factors
transfer via blood flow from these distal that generally lead to rewarming shock: 1)
areas to the heart. If peripheral blood flow hypovolemia, hypotension and decreased
is similar before and after cooling, the brain blood flow; 2 humoral factors such as
conductive component of afterdrop an increase in metabolic byproducts and
predominates. If however, peripheral catecholamines); and 3) a significant
vasodilation occurs, the increased blood afterdrop in core temperature. It is likely
flow will cause a redistribution of heat from that the afterdrop in core temperature is an
the core to the periphery much like occurs important factor because decreased
immediately following induction of myocardial temperature precipitates
anesthesia (4). The contribution of the ventricular fibrillation or asystole. Also, a
convective mechanism will be proportional secondary effect of cooling the myocardium
to the relative increase in peripheral blood may be hypersensitization of the heart to
flow. This also has important implications humoral factors (i.e., catecholamines and
in the handling and treatment of victims metabolic byproducts) and mechanical
post-cooling. Several clinical case reports stimulation (i.e., intubation). The
indicate afterdrop values ranging between importance of the phenomenon is shown in a
1.3 to 6.4 C (2). review of 21 patients with initial core
temperatures between 14 and 28 C, initial
There are many clinical examples of
functional cardiac rhythms and who were
victims being removed from a cold exposure
eventually treated with cardiopulmonary.
in an apparently stable and conscious
Five of the 21 patients developed ventricular
condition only to degenerate from one level
fibrillation or asystole after rescue and
of hypothermia to another. This can result in
commencement of treatment (2).
rewarming shock or post-rescue
Hypothermia Giesbrecht