Episode 49: PrepperMed 101 - Dealing With Hypothermia

spk_1:   0:00
dude, it's Cole

spk_0:   0:01
happens in winter.

spk_1:   0:02
It's cold. I mean, it's cool. It's cool, Actually, not that bad. Today is as we're driving along down the road, you'll hear the road noise, the background. Sorry about that. Were in the old truck two days. You had to get the truck out and get some miles because it had been running a awhile. So yeah, we're, uh we're driving around in a winter wonderland, except for it's actually warmer today. And not that not that bad weather. I'm salty

spk_0:   0:28
is a spice.

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Where are your listening to the show? The big show, The three Me. Why podcast? The official podcast with beans, bullets, bandages and you project. And today we're cold

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and we're dealing with it we're

spk_1:   0:42
dealing with or dealing with the cold. Some of today's podcast is gonna be hypothermia.

spk_0:   0:49
First thing, there's two major types of cold injury. Frostbite is one bits of you. The most exposed bits of you. Fingers, toes, nose, ear tips are usually what's affected. Just literally freeze solid

spk_1:   1:05
must that

spk_0:   1:06
that's bad. But it's not hypothermia. There is, in fact, a article on three b. Y, with research in it about how to deal. If somebody does get some frostbite the best way to help him recover from that. But that's not today,

spk_1:   1:24
Not today.

spk_0:   1:25
Days about hypothermia and hypothermia is when your entire body, your core temperature drops.

spk_1:   1:33
Now, I don't know much about hypothermia. I'm not. I know when I'm starting to feel it because we're divers and she's gonna get into the fact that water really sucks the heat right out of you. But I will tell you that I do know that hypothermia is one of the fastest killers around. You could you could be killed by hypothermia in a matter of minutes. In certain situations, if you're not in the water, it's gonna be longer. But

spk_0:   2:02
strangely enough, that's not quite true.

spk_1:   2:04
It isn't. I I told him we have access between lying and being wrong.

spk_0:   2:10
Yeah, you could be rendered completely inoperable and apparently dead in mere minutes in cold water with hypothermia. But there are people who have been no pulse, no apparent breathing four hours and been recovered from hypothermia. I've had one E. M. T told me that according to their training, you're not dead until you're warm and dead. That's interesting because the metabolic rate. Your tissues goes down so much when you get cold, they just don't die from lack of oxygen because they don't need much oxygen because they're not doing very much because they're so dangled.

spk_1:   2:56
You become like a turtle. You having to tour poor? No, not really. But

spk_0:   3:02
except they're a lot better at recovering themselves from it than we are recovering ourselves from it. That's the major difference.

spk_1:   3:08
Okay, So hypothermia. And what exactly is it

spk_0:   3:12
right now? Your core body temperatures running about 37 C

spk_1:   3:16
or 98.6 for those of you who are on the heating system.

spk_0:   3:22
Yeah, I'm sorry I haven't done all the conversions to the heating system. Ah, all the research, of course, is in degrees C. And that's the way my brain naturally runs because it makes that hack of a lot more sense

spk_1:   3:34
when it comes to. When it comes to measurements. Though I admit it, I am an unfettered, unbiased. He even I want imperial measurements. Some things are just as long as a foot lose. My foot is

spk_0:   3:50
except everybody has different sized feet. My foot is only one foot.

spk_1:   3:55
My foot is one of my two feet doing slightly short.

spk_0:   4:00
All right, that accounts for 5% of the population. Then there's the rest of us, which is,

spk_1:   4:05
I mean, the important 5%

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of covered. Well, there you are. But anyway, a lot of what I've got isn't a greasy, But right now you're a 37 uh, every two degrees. See, if your round it off to be in about five degrees Fahrenheit, you won't be too terribly far off, so that will help you keep track here. If your body temperature drops a little bit like the 35 degrees see, you start to be mildly hypothermic, and at that point you're starting to shiver pretty good, and you are alert your conscious you could deal with yourself. You may have trouble with dexterity and your fingers, because the extremities do chill faster than everything else. You may be starting to get a little bit stupid, but you're still alert and functional and responsive and can make coherent sentences and stuff like that. That's mild hypothermia all the way down to about 32 degrees C, which is Oh what below 90 Fahrenheit You're shivering, gets worse and worse and worse. and it can get. There have been frail. People have actually broken bones from shivering so hard. That's just your muscles that normally move the joint in different directions. They're both contracting at once, so you don't actually change direction. But you have a whole bunch of muscle activity, gives muscle activity heat you up really good.

spk_1:   5:38
Is that why we shiver?

spk_0:   5:39
That's why we shiver, shiver to warm ourselves. So all the way down to 32 c shivering tends to get worse and worse and worse if your body cools. Blow that the shivering fates off and by about 30 degrees centigrade or so. Ah, that's a mild summer day temperature. We're talking. Oh, maybe mid eighties body temperature. By then, shivering actually goes away. But that's not a good sign. It's just a sign that your brain has become so chilled it's not able to manage that job anymore. And if you've dropped below the stage where you are shivering, you will no longer be capable of warming yourself back up. So once you pass the shivering stage, you better have help warming yourself up or

spk_1:   6:34
it's lingered, blankets, heating.

spk_0:   6:36
We'll get there.

spk_1:   6:37
Okay, we'll get there we're getting there? Yeah, I'm jumping. Jumping the gun.

spk_0:   6:42
If you get colder than that, your heart heart beat gets really slow. Your breathing gets really slow. You're really stupid. You're really clumsy. Year can't help yourself anymore After you stop shivering. Basically, you're done helping yourself. You go unconscious and you can appear to be dead and even have no cardiac activity for more than an hour on end and still be recoverable if you're warmed up carefully

spk_1:   7:08
because you're nice. Cute. Well, I mean, yeah, you're in 80 degree ice.

spk_0:   7:13
Yeah, but you're nice. You're not frozen, but you're too cold to function. And that's not dead yet. What you want to avoid is having the heart just failing. Stop going to fib. Relation is what it's called.

spk_1:   7:26
So my question for you is going back to basing everything. Our entire lives and existence are based on the movie Princess Bride time. You're just mostly dead sleep debt, but not entirely dead.

spk_0:   7:39
Everybody to see that movie knows that mostly dead is not the same is completely dead.

spk_1:   7:43
Yeah, so mostly because the guy with the bellows, you know, you know you need the magical pill in the guy with the bellows toe. Yeah, I know Billy Crystal's around anyway, Go right in.

spk_0:   8:00
So, basically, if the person still shivering there ableto help form themselves up and if you're trying to help him out, you try and get him somewhere that's gonna make that happen. You want a moisture barrier autumn because you do not want their body water evaporate ings that chills them down so very effectively. Water steals heat from the body 25 times faster than air steals heat from the body. That's why you get hypothermic so quickly. People have died of hypothermia diving an 85 degree water,

spk_1:   8:32
and that's why I also you know, you could go into a swimming pool on 100 degree day in the water's 80 degrees. But you really can't stay in it forever because you start getting cold, even though it seems like when you get in, the water seems warm.

spk_0:   8:47
Yeah, and the kids were having a great time. Can actually try themselves Hypothermic

spk_1:   8:51
is you. Let's start school. Oh, yeah,

spk_0:   8:54
that's bad. Blood flow. That's a sign.

spk_1:   8:57
Yeah, and then that that's actually a a point in time. Now, this is kind of a different podcast, a different thing. But that's actually a point in time when some people become in danger of drowning because they start to lose their their mental capacities, they start to shift into this other mode. And even if they're swimming, is so that's one of the things that will go away. And drowning doesn't look like drowning. But we'll get back to that in another podcast

spk_0:   9:24
but unrelated note while we're here, if somebody is hypothermic and help finally arrives and starts to pull him out of the water, that's actually one of the big danger times. If you were on the verge of dying from hypothermia and the water is shot, one of the reasons there's two major reasons it happens. But one of them is. People are so relieved that help is finally there have been hanging on teeth and toenails. The life hope is finally there. They become less stressed, and that changes their hormonal state, and that changes their blood flow and their body temperature suddenly drops another five degrees. They quit moving in the ground before you can actually drag him out of the water. That's one of reasons. The other main reason relates to one of the big deals about how you go about helping somebody warm up, whether they're still shivering or whether they're not. Still shivering kind of makes a difference if they're alert and they're able, conscious and able to move around than the most effective way to get him. Deep heat up actually is to keep a movement as long as they are still alert and very functional. So you keep a moving that generates a lot of body heat that will help him warm up pretty good. Um, the thing you want to do is feed him a lot of calories, because that's what actually causes people to die of hypothermia. Lot of times when they've shivering has been keeping him warm enough to keep him out of critical danger. And then they run out of energy to do shivering. That's a bad thing. So feeding them lots of nice bring the blood sugar up lots of nice Andy carbohydrates. Of course, they're gonna like it better, and they're gonna eat it better if it's warm. But the actual amount of calories they get from the heat of the drink it's so minor it's not worth worried about, So give it to a warm if you got it. But if you don't get him some nice carbohydrate fast carbs calories. Sugar is good at that point time while there shivering to help support their shivering. You're actually feeding there shivering reaction and hoping to move around. But if the person is not very alert and very functional, if there are more than very mildly hypothermic, you don't want to move in. You don't What? I'm trying to help you. You don't want him trying to help themselves because what that's gonna do is the coldest part of their bodies is gonna be the arms and the legs. So if you make him walk, you make a move around. You make

spk_1:   11:47
a ruling old blood stuff do there.

spk_0:   11:50
When you move muscles, the muscles really signals that make the blood flow to the better. So when they start moving their arms and legs, they get a lot better blood flow to their arms and legs. It brings the colder blood that was out there back to the core, and then the body temperature keeps dropping. So you've actually made the situation worse by your early attempts to rescue and get a movement instead. You want him to lie flat because that gets the least circulation to and from the extremities. You don't want him up right where it drains blood from the top of the body down toward the feet because they get faint. Is there blood pools down there in the legs? And you don't want the to raise the legs like you often do when people feel faint, because that drains blood from the legs back to the core. You want him to be lying flat and you're going to be still. And if you can just pick him up and carry him somewhere warmer so you can take care of him. That's great. A moisture barrier to keep him from evaporating. I started to say that for I got sidetracked and obviously insulation. If you got what clothes on him at this point in time, you put the moisture very are on the outside and more insulation on top.

spk_1:   13:03
Well, the wet clothes at that point in time are not really gonna be drawing the the heat away. If you put a moisture barrier around, yeah, we'll start, actually start big a heat trap. We'll start working in reverse.

spk_0:   13:13
Yeah, and you can use the emergency blankets that a lot of us carry in our kits for that. Those little mile. Our guys are perfect. They're great windshields. That's in fact, one of the major ways. The heat. There he chills. They have no insulating value whatsoever, but they do keep the moisture, and that's a big deal.

spk_1:   13:32
You see. Wrap him up. Grab a piece of duct tape. Tarps,

spk_0:   13:36
work, garbage bags, work.

spk_1:   13:38
Anything will stop.

spk_0:   13:40
Minimize the amount of exposure of the head and neck that whole bit about you lose 90% of the heat from your head. That's only true if you're bundled up from the neck down and running around with a wet head. So that's mostly book. But when you're covering somebody up, you do have toe. Let them breathe so you leave the face open. But the smaller that hole is the veteran conserve their heat. That is a big deal because you do get a lot of blood flow to the head. So put him in a giant garbage bag if you gotta, and don't close it up tight enough around the next. Suffocate him, obviously, but other than that, you want to minimize heat loss around the neck.

spk_1:   14:19
You know, one medical Prue. I was reading about this and just popped in my head. What? Medical crew actually carries body bags for this purpose? Because they they were perfectly air moisture. Pretend they're very light and easy to carry and have them rather than carrying specialized equipment that just put put a person in a body bag and leave, Leave it open. Freeze. Yeah,

spk_0:   14:42
leaving open to the face. And they're good. Creepy, but effective.

spk_1:   14:47
They don't call it a body bag with the person to the person saying they call it a call it a hypothermia back.

spk_0:   14:55
We're gonna toss blankets on top of it. So now it's a hypothermia bag instead of being a body bag. Works for me. Um, as far as actually heating them up goes, if you don't have anything else body to body contact inside the sleeping bag or whatever. The a warm person has taken one for the team there because they're obviously going to get killed. If the person is shivering vigorously, that actually works just about as good as having a warm body next to him. So if it's let him shiver vigorously while you carry him somewhere warmer, go good. Do that. If it's Hey, we're already in the shelter anyway and I'm not doing anything else. I've stoked up some fuel to get my body thio get myself really well fueled then, yeah, climb in there with him and help warm him up Is they'll certainly be more comfortable while they're warming. If it's being warmed by another body instead of being warmed by their massive shivering. You're no fun at all, by the way, Other than that, you want to heat up the core. You want to eat the back when he chest and you want to heat the armpits. That's a great place for heat exchange. You do not want to specifically eat the extremities because it increases the blood flow from the extremities faster than it warms the extremities. And you get that temperature drop thing going on again.

spk_1:   16:21
So, Carrie, I'm guessing at this point in time, you just care about the core.

spk_0:   16:25
Care about core

spk_1:   16:26
care about

spk_0:   16:26
the tissues aren't freezing. As long as the hands and feet don't free salad. They're gonna recover just fine because they actually are pretty tolerant to getting bad accident were periods of time. They're gonna be all right. It's the core because you don't want heart stop. The heart gets really angry and ready to throw bad rhythms and ready to go on defibrillation and ready to quit pumping blood when it gets cold. And that is the biggest riffs when you're rewarming people you're trying to do it in such a way is to keep the heart from tripping off into some kind of cardiac failure that's gonna kill him. It's cardiac failure that kills him. So what's good for that? If you got heating pads or blankets that worked, you do that. If you've got a big warm heating bottles, big water bombs, stop the water bottles on their chest. First, don't make the water hot enough to burn you. And then also always make sure there's a barrier like a layer of cloth between you and them, because cold skin burns ridiculously easily. So not only will they not know it because the skins to chill for them to be feeling the skin, but they will also burn way easier than you would burn because the heat just sits there the blood's not circulating through the area very well. He just sits there and causes thermal burns to the skin. Even if the water is really only lukewarm, could do it. Is that tissues really sensitive right there, So always have a barrier between it. But warm water bottles work good, and you can stick a couple of warm water bottles underneath their arms so they get the good heat. Exchange there with the armpit.

spk_1:   18:17
She's sticking your model. I looked over there. She's

spk_0:   18:21
I'm sticking my finger under my arm like I got a heating pad on there. Wait, don't go. There is a kid A something that's called something like a heat emergency kit. Uh, the name will be in the associate ID story that goes along with this. The military developed it for helping recover hypothermic patients. It's like a less intense but much bigger chemical heating pack, like the hand or foot warmers, and it's got a heat show in it, like the Mylar blanket kind of deal. So those are really nice, and you can buy those commercially as well. And the place I got all this information from which is the Wilderness society physiciansgroup They did a big peer review of all the medical literature on the subject and came up with a bunch of recommendations. And they told you how much research stood behind each of the recommendations. That's what the whole piece is basically based on. What those guys came up with is you really shouldn't use hand and foot warmers in most cases.

spk_1:   19:32
Do what

spk_0:   19:33
they're too hot. And again, you got the problem of they increase the blood flow before they actually get very much of the tissue heated up. So you get too much cooling of the blood going to and from the limbs.

spk_1:   19:46
I would think you could use a hand and foot warmers in a certain in a certain way. But you would have to definitely, uh, put in several layers worth of thing and just put them inside the thing. Not touching the human. Yeah, I'm just to do it, General overall warming inside the bag, whatever. You have a minute. But don't let him touch the person and just have it as a way to keep keep the heat up in general.

spk_0:   20:12
Yeah, I had a similar thought when I was reading that, and I was imagining getting those hand and foot warmers reprimand, activating them and putting them in socks

spk_1:   20:20
and then just leaving them in the inside. The moisture container.

spk_0:   20:24
Yeah, definitely not. Attentions. Body weight on top, but like layer of blankets, layer of blankets, little hand and foot warmers inside their little socks. Another layer of blankets? Yeah, that's so It's kind of warming up the blankets, which you're warming up person and kind of spreading it around. Kind of the image I came up with for it.

spk_1:   20:46
The one thing that the only thing I like about a hospital, it's when you're cold and they bring you a warm blanket.

spk_0:   20:52
Yeah, you're out of surgery. They bring you the warm blankets. Putting a blanket blanket heater

spk_1:   20:57
is like the rest of it totally stinks. The rest of it is really, really sub optimal,

spk_0:   21:07
except probably the surgery works. So because you're there, so that's plus

spk_1:   21:11
it's up for what

spk_0:   21:12
Surgery probably worked because you're there. So that's a plus. Uh, yeah, that's the idea. You're trying to warm him up, and if you've got an A d and you put the I d on the person in the 80 wants to shock him. You let him shock you. Let it shock them one time, but it at full strength. But if that one time doesn't work and they're really hypothermic, like they're passed out cold, hypothermic, rumbled. Then you don't shock him again until you've warmed him up a few degrees. Then you tried another time. You don't just keep shocking him again and again, even if they do. You think so? If you don't have a nadie

spk_1:   21:49
which

spk_0:   21:50
role are the A. D says this rhythm is not something I'm supposed to shock, but you can't feel a pulse. Pulse is gonna be really hard feel if they're seriously hypothermic, it's gonna be really faint. You gotta feel it up there on the neck on the corroded artery and you gotta actually feel for it for ah whole stinking minute because the heartbreak go so dang slow. Um, if they have ah, palpable pulse, even if it's ridiculously slow, you don't give him CPR. But if you think you might be able to warm him up and you feel no pulse at all, then you give him CPR. And unlike warm people who CPR either works or it doesn't work in a fairly short period of time. There have been people who have had CPR being done on them by a team of people because it's really fatigued for hours on end and recovered once they were warmed.

spk_1:   22:41
No, I'm gonna We're gonna throw up Caveat here. If you haven't had C S C P r training in the last five years, it's time to go back. Not only do you need the refresher, but things have changed. Yeah, recommendations have changed based on research based on actual real world experience. So it's something that might be good to do. And if you get a CPR course, I highly, highly Islay, I highly recommend you get one that has the e d certification included minute automatic defibrillation. These IED's are everywhere in public, and knowing is a very simple to use. We've both been trained on 80.

spk_0:   23:23
Not every emergency is a worldwide s stuff. It's the fan situation. Most of them are not coming to the

spk_1:   23:33
U. Maybe shopping in the farm store and see a guy fall over from a heart attack. You know, you're still gonna need to help it. And if they have an I E. D. Which many of them are many businesses. D'oh! You know, maybe you could say

spk_0:   23:46
life. So it may be these hypothermia is a kid fell through the ice and the kid was stuck under the ice for quite a while. And you pull the kid out and the kid looks dead. The kid is not dead until the kid is warm and dead. So you do the CPR

spk_1:   24:00
and we've heard about these kids.

spk_0:   24:03
Nine hours is the record in the literature for immersed in cold water and came out with no brain damage, not only alive, but with no brain damage.

spk_1:   24:14
So there we are.

spk_0:   24:16
So it's not quite what you'd expect. Although the obvious of heat them up is the thing. How you do it is important. Which is why I basically wanted to do this piece.

spk_1:   24:28
Okay. Well, there you have it. There's the information. We hope it's hope it's useful for you. You might want to read the if you're listening to this straight from the from the pod from the your podcast, accumulate like iTunes or whatever you're using. Stitcher what we're using. We're full. Thank you. Uh,

spk_0:   24:44
welcome.

spk_1:   24:46
And yeah, she she does. Um, but I don't think she listened to us on iTunes. I don't

spk_0:   24:55
listen to myself. If I can avoid it. Some things I need to refresh my memory to write the article part of it. But I don't sound of my voice on tape like many people.

spk_1:   25:03
Good news that she'll probably right thrust this article today so she won't have to listen to herself.

spk_0:   25:07
Yeah, I already made the notes earlier when I was doing the

spk_1:   25:09
research. Okay, So anyway, we're gonna get the article up. It will be on three B y and run the same time. Run. It's like, glorified show notes for this, for this podcast on this podcast is glorified. Uh, well, not that synopsis. It's a synopsis. I give the word synopsis of what's going on in the show Notes. I hope you enjoy it. And stay warm. Stay warm. Yeah, let's not have this. We're gonna actually have more information on this and frostbite in the future. So hang with us tons more medical information as it relates to prepping coming up on three b Y. Because it's part of what we do. It is the bandage is part of our names. So or do you see in your next time and have a great day