Hypothermia, How cold is too cold?

[Outbac1]

Here is a thought. The other day the police dive team fished a body out of the river. The person had fallen through the ice some 20 - 30 hours before. He was put in a body bag and uncharacteristically taken by our service to the hospital. Apparently the provincial ME didn't want him pronounced dead until he was warm and dead. Our hosp. apparently started to rewarm him and then shipped him off too the major hosp to finish the job. Apparently his core temp, (probably obtained with a rectal probe), was 1.5C,(34F). His death was announced yesterday.

Now I know we have all heard that in hypothermia that you are not dead until you're warm and dead. However I feel this guy was about as alive as a kipper on a cracker and had no chance of being brought back. The best example I could find was " Fully successful clinical recovery has occurred in a patient with an initial core temperature of 15.2°C caused by accidental hypothermia. in a hypothermic child submerged under water for 66 minutes." from an article by Andrew D Weinberg, MD.
http://www.islandnet.com/sarbc/andrew1.html
So how cold is too cold? Where do we draw the line?

I haven't got the whole story yet as I haven't been back to work for a week. I'm back to work tomorrow and will try to find out details.

 

[Ridryder911]

I agree with the old saying "warm & dead" but there has to be some common sense. I still use the same criteria of the body being warm applies.

The point being "20-30 hours" is way over the limit. I have seen documentation of up to possibly one hour without major neuro changes, and that is a rare occurrence.

Sorry, not to work an ice cube. I do realize the "mammalian diving response and the slower metabolic process of hypothermia" but there is an ending point.

Personally, I would call medical control and get a verbal DNR. Case closed.

R/r 911

 

[JPINFV]

While not 20 hours, here's a case report of a women who survived with an initial tympanic temperature of 21 degrees celcius and both arms frozen. Patient arrested upon arrival at the hospital where she was sucessfully resusicated with 20 minutes of down time due (initial rhythm was asystole. Coverted to v-fib after 20 minutes, successfully defibrillated), in large parts, to advanced treatment (ECMO). Patient discharged with good neurological function, but no hands.

http://www.sciencedirect.com/scienc...d=201547&md5=34abf2e3357a41c86307d72dcf47f47c


Another case:
http://www.springerlink.com/content/r64059403574558n/fulltext.pdf

Autistic 4 year-old wondered outside and got lost. 16 hours later and over night (average daytime temps down to -3 degrees Celsius) he was found drowsy. Originally transported to a small time ER and then transfered. Arrested 10 minutes away from the tertiary center and was successfully resuscitated 60 minutes after arrival (70 minute downtime). Rectal temp was 23.3 C on arrival with no cardiac activity (asystole). Discharged with no additional neurological defect.

 

[wolfwyndd]

I was taught in my EMT class several years ago, and have heard in hypothermian CE training that someone's core tempature can drop to about 85 degrees and then can be warmed up and survive. Now what kinda functions they are still going to have after something like that is anyone's guess.

 

[Outbac1]

Well I was back into work today and asked around about what happened.
It was the chief Medical Examiner who wanted him warmed up. So much for medical control. It was a rectal probe that gave a temp of 1.4C. It appears everone but the ME was happy with pronouncement as it was too long too cold.

In our informal round table discussion we came up with about two hours and above 20 C as being highly unlikely but remotely possible to get someone back.

There was some dicussion as to whether or not he could have been an organ donor. Anyone know what the useability of near frozen organs is?

 

[Outbac1]

Wolfwyndd

I know a person can survive a temp of 89f as this happened to my motherin law. She was confused and weak but upright and mobile. There can be several degrees difference between a rectal temp and a core heart temp. I suspect this is what happened in her case. She was warmed up and was back to her prehypothermia self. However we now know her temp regulation is not what it should be. An after effect of the viral encephilitis she had the year before.

 

[Ops Paramedic]

We are not quite there yet when it comes to reviving "cryogenically" frozen patients...(No pun intended)

The crews were correct to place the patient in the body bag, but the hospital starting the rewarming process at that temperature, i am not convinced. I would have sent this patient straight to the morgue.

 

[paramedix]

Judging by the time... I would not have taken the "body" to be rewarmed.

Different Question?

Sorry, not to work an ice cube. I do realize the "mammalian diving response and the slower metabolic process of hypothermia" but there is an ending point.

I have read the links, but how long until the mammalian dive reflex actually doesn't play a part anymore?