Hypothermia on Eisenhower

[David Metsky]

So the Fishermen probably died from a rapid increase in exterior heat, not the hot drinks.

Yes, the hot driinks are not enough to raise core temperature by any appreciable degree. The fishermen story was told in my WFA course two weeks ago and the moral was slow warming and prevent any rough handling/shocks, not prevent warm drinks.

As to getting into a sleeping bag, if the person can drink and eat and move, that is orders of magnitude more effective than external warming via body heat. All getting into a sleeping bag will do is warm the external layers, and you want to warm from the inside out. If the person is so cold that they can't contribute to their own rewarming then they're too far gone for the poor body to body heat transfer to any appreciable good.

As a last resort, maybe. But putting the person in a thermal wrap is much more likely to have a positive outcome without exposing the rescuer to potential hypothermia. All external warming was treated this way, heat packs, hot water bottles, human bodies; not something that is likely to help much. This is all straight from SOLO, and has been their message for the past 3 years at least.

-dave-

 

[Maddy]

I'm going to take a stab at this.
Decreased body temps is a major insult to your vital organs.
Brain does not get as much oxygen because the blood is slower to circulate. Shivering is your body's attempt to warm itself. You extremities will get cold faster because the core is trying to preserve itself. Heart,lungs, and other major organs.
Shivering consumes oxygen and calories thus depleting your energy stores even further. So...if you don't keep your calories up and stay hydrated in the winter, you will get cold faster because your body cannot produce heat. If you get hypothermic you need fluid and calories to help reverse this condition.
Now...in hospitals we see a good number of hypothermic patients. They might come in off the street, or it is a direct result of major trauma, or major surgery. They are warmed from the inside out because it is the most effective way to treat hypothermia. We give them warmed IV fluids and blood if needed, via special warming machines.We warm their oxygen so they are inhaling warm air, not room air
We use large electric heating pads over them, but if used by themselves, they are never as effective as warming someone from the inside out concurrently with the heating blankets. IT takes much longer and you don't want to stress the heart, the brain, etc more than you have to. It's already taxed to the max.
Initially the BP and heart go up trying to compensate for the stress on the body. It tries to get more blood circulating to vital organ. If the process goes on too long and the patient is dying of hypothermia the heart slows way down, and the BP drops because it cannot maintain itself. Respirations slow and become agonal. In a hospital setting we would give drugs to help you reverse this and place the patient on a ventilator but your buddy won't have those items in his/her backpack.
Glucose and electrolyte solutions are given IV and their lab work is monitored carefully.
There is a policy that you never pronounce a hypothermic victim dead until you have raised their temps to normal. You continue to ressucitate and do whatever it takes to keep them going. Unfortunately this would be an impossible task on a mountain.
In the field warm fluids are used to warm from the inside out providing they are available. They do have to be conscious enough to drink and not aspirate all into their lungs.
Over the years I have cared for lots of people who were seriously hypothermic but I never saw any go into VFib because of administering warm fluids. Some went into it because of electrolyte imbalance, like a low potassium level, but not because of warming them from the inside out. Lots of IV lines are large bore catheters close to heart so this hot chocolate down the esophagus is a bit perplexing.
I should definitely be dead because I have arrythmias anyway and I survived the hot chocolate and the hot lime jello.
Would like to hear more on this.

 

[Sheomet]

Incredible story, glad you made it out alright.

 

[Jason Berard]

SOLO courses

if anyone in the VT/NH area is interested in taking some wilderness first aid training here is a link to some upcoming classes in the Upper Valley area.



http://www.alohafoundation.org/article/view/7123/1/949/

 

[BorealChickadee]

The OA site in chip's post stresses to use diluted jello.
What is the correct ratio of jello to water? Assuming the jello is carried in its original pouch (assuming small box), what amount of water should it be added to?

 

[Steve-o]

I'm not an engineer and I thought that was well written.
I was rivited and learned something too.
You should submit that to yankee magazine or something.

humuhumunukunuku apua' a !!!

 

[Klutz]

I'm glad to hear that everything worked out alright. All the more reason that I wouldn't solo hike anytime, not just in the winter, but anytime. All I could think of, is what would happen if I got hurt alone.....

Wait what am I saying, I have hiked alone, well with my dog, but it was end of summer and these were just baby trails anyway.... No seriously though, I probably wouldn't go alone in the winter too far anyway.

 

[SAR-EMT40]

The OA site in chip's post stresses to use diluted jello.
What is the correct ratio of jello to water? Assuming the jello is carried in its original pouch (assuming small box), what amount of water should it be added to?

One cup of water for the box is probably fine. They almost certainly need water as well. This isn't a taste test. They should take as much as fast as they can tolerate. Starting with sips and hopfully ending shortly thereafter with gulps. It should also be as warm/hot as they can tolerate as well.

Remember this is just to get them so they can move with purpose down off the mountain and start feeding more food and hydrate them in a less exposed area. You are trying to prevent them from getting worse to the point where they are no longer able to help themselves. That is when it really becomes a disaster.

Keith

 

[darren]

As you read in my story, Jello powder mixed in water worked for me. I do not remember what the mix was. I think it was something like 1 box to 2/3 of a nalgene bottle of water. Dave didn't take the time to get the stove going and heat up the water. He just mixed it and forced me to drink it. I'm certainly not going to second guess his efforts.

I don't remember how well hydrated I was. I do tend to drink a lot of water on the trail though. I think the biggest contributing factor was that I was sweating my butt of getting through the deep power. Once we got onto the icy face I was more exposed to the wind and I wasn't working as hard so I generated less heat. More wind + less heat + wet base layer from previous hard work was enough to do it. Tough to tell, obviously my memory is pretty foggy.

On the plus side to being a safety item, Jello powder or Gatoraid power mixed with hot water is just downright yummy on a cold day. I don't go on many hikes with out a zip lock bag of gatoraid powder anymore.

- darren

 

[Doodles]

Glad to hear you made it out allright.

I think this event really re-enforces how hiking alone during winter conditions could have been fatal.

 

[DougPaul]

Re jello:
Strength according to the direction on the box or weaker is fine.

You might want to test it at home... a rather sweet drink.

Hot jello is also used as a winter camping drink.

Doug

 

[DougPaul]

I’m also not in complete agreement with the notion that you should not try to warm a hypothermic person by getting in a sleeping bag with them, as long as the second person is not in any stages of hypothermia themselves. The second person is generating heat and provides a gradual heat source for the patient.

It is difficult to near impossible to transfer enough heat to the victim this way.

Doug

 

[BorealChickadee]

One cup of water for the box is probably fine. They almost certainly need water as well. This isn't a taste test. They should take as much as fast as they can tolerate. Starting with sips and hopfully ending shortly thereafter with gulps. It should also be as warm/hot as they can tolerate as well.

Remember this is just to get them so they can move with purpose down off the mountain and start feeding more food and hydrate them in a less exposed area. You are trying to prevent them from getting worse to the point where they are no longer able to help themselves. That is when it really becomes a disaster.

Keith

So Keith, if I happened to recognize that myself or my son was starting mild hypothermia, then a good idea would be to mix some jello up with whatever temperature water we had, and while that was taking effect take the time to heat up some water for a second jello box? The asssumption here being that getting in the sugar solution ASAP is wiser, even if the water is cold, than waiting for the warm water which could easily take up to 10 minutes after getting out the stove, setting it up etc. So is this reasoning correct? (Seemed to work for Darren, although his wasn't mild)

 

[Periwinkle]

Thanks for posting that again, Darren. For me, it's hearing first hand accounts of others struggles that makes me think about what I'm doing.

Had I heard this before I headed out with a head cold a few years ago, maybe I could have saved myself a broken butt. I learned that lesson myself the hard way, but will never again go out on a big trip when I'm feeling under the weather.

I known the whole overall point is hypothermia. Very fortunately, I've never been there. And I hope I've learned enough from others lessons that I'll never be there.

 

[David Metsky]

So Keith, if I happened to recognize that myself or my son was starting mild hypothermia, then a good idea would be to mix some jello up with whatever temperature water we had, and while that was taking effect take the time to heat up some water for a second jello box?

Carry a thermos of hot jello or tea with honey. No need to stop and use a stove when this happens. But in general, water and sugar is important, not the heat of the liquids. If you have a stove handy and someone to work it, sure, go for it. But you are better off getting food and liquid (of any temp) into the person, dry clothes, and get them moving. Sitting around waiting for water to boil isn't really the best thing.

-dave-

 

[Paul the Explorer]

usually long posts dont hold my interest, I scan and move on...not this time!! Hypothermia...it can happen to anybody,anywhere...even on a dinky 4K...I got hypothermia many years ago while ice skating in a tree swamp bhind my home. I fell thru some weak ice and shortly after got nauseuos and "lost" 300 yds from home. I st"umbled"the final 100 yds,over a stony field, still in my skates, because I wasnt able to untie them.

Darren, after reading your story, I find I now suffer from a shriveled bravado!!

 

[DougPaul]

Carry a thermos of hot jello or tea with honey. No need to stop and use a stove when this happens. But in general, water and sugar is important, not the heat of the liquids.-

The heat could be some help: 1Kg of water 50C warmer than a 100Kg person will warm him aout .5C or about 1F. The equivalent of 50 Kcal. Certainly better than drinking cold water.

The sugar or simple carb fuel is certainly more useful in the long run.

Doug

 

[gram]

a great thread

Me hiking in chest deep snow on Eisenhower- NO!

But as SAR-EMT said,

If I remember correctly most cases of hypothermia occur at temps between 30F and 50F with rain. That is an excellent recipe for hypothermia.

That could be me. I learned a lot here, jello goes in the backpack!

Two years ago I had a moderate cough, but we had planned a day of snowshoeing. Lots of huffing and puffing, but I felt ok. Two days later I was in my PCP's office with pneumonia! Out of commission for a week. Won't do that again.

 

[SAR-EMT40]

So Keith, if I happened to recognize that myself or my son was starting mild hypothermia, then a good idea would be to mix some jello up with whatever temperature water we had, and while that was taking effect take the time to heat up some water for a second jello box? The asssumption here being that getting in the sugar solution ASAP is wiser, even if the water is cold, than waiting for the warm water which could easily take up to 10 minutes after getting out the stove, setting it up etc. So is this reasoning correct? (Seemed to work for Darren, although his wasn't mild)

Sorry it took so long to answer.

I need to thank Darren for splitting this thread and making it twice as difficult to track.

I agree in general with what has been said. I would not stop and break out the stove to heat the liquid, unless:
The person could not or should not be moving because they are acting reckless or it is too dangerous for them because of the way they are acting like they have some sort of altered mental status. If you have stopped and are trying to warm them up and they are in a sleeping bag or better yet a hypothermia wrap. Then at that point I would be trying to get the jello mix in them cold but would also be trying to heat up jello as well as probably other things. There is also a very definite physiological component to this as well. I have been very chilled in the army and 20 years later I still remember some hot soup with noodles. Eating that with those noodles sitting in my stomach I could actually feel it making me warmer. This is no exaggeration. I still remember that very clearly. I still think that heavy starches like noodles hold a lot of heat that transfer to the body. They obviously hold lots more heat than water. I assume that they have a specific heat many, many, times higher than water.

And of course Daves thermos idea works great for day hikes or filling at the campfire in the morning. I use it myself all the time crosscountry sking with the wife. Hot coco. Hmmmmmmmmmm coco

Keith

 

[JohnL]

It is difficult to near impossible to transfer enough heat to the victim this way.

Doug

Doug,
I’m disappointed. No formulas? Seriously though and no disrespect intended but you better tell Backpacker Magazine, the Mayo Clinic, the Lahey Clinic, the Center for Disease Control, Oregon Health & Science University, Princeton University, Walter Reed Army Medical Hospital, Baptist Health Systems, the US Coast Guard, Wavelength Magazine (for paddlers), US Dep’t of Health & Human Services, the State of Alaska – Cold Injury Guidelines, Dr James Wilkerson (Medicine for Mountaineering author) and Dr. Gordon Giesbrecht, one of the leading authorities on hypothermia effects and treatment. They all recommend it.

Chip,
Perhaps I mumbled and stumbled over my words on the definition of afterdrop but with regards to heating the core I think I said it clearly, “A key to survival is gradual warming of the body’s core.”

Keith, Dave,
While there may be an advantage to using warm blankets and adding hot water bottles or heat packs to a hypothermic victim while in a sleeping bag, those items are not always available. As I’ve indicated above, many reputable medical authorities recommend human to human contact to warm the victim to stabilize or increase their temperature. If conditions permit then this would be an effective treatment followed by liquids and sugars.

JohnL