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M.A. Stroud

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date: 16 October 2021

Humans are poorly adapted to cold, which can cause hypothermia, nonfreezing cold injury, and frostbite.

This occurs especially with wind and wetting, and is seen indoors in older people and those who are thin. At a core temperature of 35 °C, victims complain of cold, act appropriately, shiver, and are peripherally vasoconstricted, but with further cooling they may become confused or drowsy and appropriate physiological responses disappear. Coma occurs at 26 to 32 °C, and death typically at 17 to 26 °C. General investigation and management is as for any comatose patient, but specific issues include (1) accurate measurement of core temperature requires a low-reading rectal thermometer; (2) measurement of serum amylase (risk of pancreatitis) and creatine kinase (risk of rhabdomyolysis); (3) rewarming—if onset of cooling was prolonged, rewarming should generally be slow; (4) diagnosis of death—apparently dead victims should be rewarmed whenever possible before resuscitation is abandoned....

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