Total cooling of the body
Last reviewed: 19.11.2021
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Total cooling of the body - a violation of the heat balance, accompanied by a decrease in body temperature below normal values. This state of the body, resulting from exposure to cold and lower body temperature below 34 ° C.
Total cooling has three degrees of gravity - light, medium and heavy.
Symptoms of total cooling
The overall cooling of a light degree of severity is characterized by a body temperature in the rectum of 35-32 ° C. Consciousness is preserved or clouded, the skin is pale or cyanotic, a certain decrease in pulse in some patients up to 60 per minute, normal or moderately elevated blood pressure is characteristic. Patients complain of weakness, drowsiness, fatigue, dizziness, headache. Their speech is quiet and slow. They are inhibited, adynamic.
Total cooling of the middle (stuporous) degree of severity develops when the body temperature drops to 32-26 ° C. For this stage, pronounced drowsiness, oppression of consciousness, speech impairment, lack of facial expression are characteristic. The skin is cold, pale, sometimes with a cyanotic shade or a marble color. There is a bradycardia (pulse 52-32 per minute of weak filling and tension), blood pressure is normal or slightly reduced, the number of respiratory cycles does not exceed 12 per minute, breathing is superficial.
General cooling of severe (convulsive) degree occurs at body temperature below 28-26 ° C. Consciousness is completely absent, the skin is cold, pale, with a cyanotic shade. Muscles are tense, perhaps a convulsive contraction of the chewing muscles, often with a bite of the tongue. The upper limbs are bent in the elbow joints, it is not possible to unbend them in many patients. The lower extremities are half-bent, sometimes elongated. The abdominal muscles are also strained. Breathing is superficial, often snoring, rare (up to 3-4 respiratory cycles per minute). Pulse of weak filling, palpable only on large arteries, rare (no more than 32-34 per minute). BP is reduced or not detected. Pupils are narrowed, their reaction to light is weak or completely absent. Perhaps involuntary urination. With a decrease in body temperature below 25-23 ° C, the victim dies from cardiac arrest, cerebral edema or lung.
This is the clinical picture of general cooling during hypothermia. After warming, many patients develop a feeling of fatigue, a headache. Catarrhal phenomena in the nasopharynx, throat, sometimes bronchitis, tracheobronchitis, pneumonia join. Some patients develop hyperthermia, neuropsychic disorders (delirium, inhibition, hallucinations), violations of the cardiovascular system (arrhythmia, tachycardia). The most severe complications of this period are edema of the brain, lungs, arthritis.
General cooling treatment
Treatment of the victim with general cooling aims at the fastest warming and recovery of normal body temperature.
Non-drug treatment
The patient is placed in a warm bath with a water temperature of 35 ° C. Gradually, the water is heated to 38-40 ° C (not higher!) And maintain it at this level before the patient warms up. The procedure of warming takes from 30 minutes to 2 hours with mandatory constant monitoring of the body temperature of the victim. Warming is carried out until the temperature in the rectum is raised to 35 ° C. During the procedure, massage the patient's body with lather or sponge. The victim must drink hot tea or coffee.
Medication
The infusion of glucose solution 40% - 40-60 ml with ascorbic acid, heated to 35-40 ° C. In order to accelerate warming and desensitization, it is advisable to intravenous calcium chloride 10% - 5-10 ml. To eliminate acidosis, a solution of sodium bicarbonate 5% - 200-300 ml is injected. With hypotension, infusions of dextrans (polyglucin) at a dose of 400-800 ml, cardiovascular agents [lily of the grass glycoside (korglikon), inosine (riboxin), cocarboxylase, caffeine], are prescribed analgesics and antihistamines, dezagreganty [pentoksifillin (trental) dipyridamole (quarantil)], vitamins C, B, PP, anticoagulants [heparin sodium (heparin) 100-200 U / kg x day)]. When breathing is compromised, ventilation is used. After the removal of the patient from the state of hypothermia, the treatment is aimed at preventing possible complications (bronchitis, tracheobronchitis, pneumonia, nephritis). With the development of edema of the brain and lungs, corticosteroid hormones (hydrocortisone, prednisolone), osmotic diuretics [furosemide (lasix), mannitol] are used.
What forecast has the general cooling?
The general cooling has a favorable prognosis, the patients return to work. With deep frostbites with the defeat of large segments of the limbs - persistent disability.