Hypothermia -- the cold killer
Terry Halifax
Northern News Services
Yellowknife (Jan 08/01) - Each winter, NWT Chief Coroner Percy Kinney adds to the long list of Northerners who die of exposure.
Hypothermia accounted for a third of the 22 accidental deaths in 1999, Kinney said.
Two recent deaths in the illustrate different ways hypothermia can strike.
A Yellowknife woman who crashed through the ice on her snow machine at Prosperous Lake, clung to life for hours before her body temperature dropped too low to support life.
"She was able to crawl out of the ice water and walk for half a mile before collapsing," Kinney said.
In the other recent case, a man fell in freezing cold water while clearing the Lupin ice road and died within minutes. The sudden shock stopped his heart.
"He was only in the water for about 30 seconds before he was pulled out conscious," Kinney said.
"He was only on land, exposed to the cold air in his wet clothes for about a minute, before he was put into the backseat of a warm vehicle and taken about half a mile to a warm building and he still died of exposure."
Kinney said that dying from cold does not require long exposure to the elements.
"Just the shock of being immersed might be enough," he said.
When hypothermia sets in, the heart will eventually stop pumping blood to the extremities and eventually, the brain.
"The body's core temperature lowers; it's the opposite of a fever," Kinney said.
"If they are in the water, they quite often lose consciousness because their heart goes into an abnormal rhythm called arrythmia and they drown; if they are on land, they just die from the arrythmia."
Gene Hachey is the Deputy Fire Chief in Hay River, where they are using some of the most advanced treatments for hypothermia in the territories.
Hachey said the treatment of hypothermia depends on recognizing the stage it has reached.
"Mild hypothermia is simply a matter of getting the person into a warm place," Hachey said. "Take some clothes off of them and let them vent."
With secondary or moderate hypothermia, the patient is not aware that their cognitive functions have deteriorted. They become confused. External circulation decreases and frost nip or frost bite may set in. Slurred speech, a decrease in dexterity and shivering are also symptoms that the person needs attention.
"They start to not think properly," he said. "They'll start doing stupid things, like taking off clothes or lagging behind."
The victim can become argumentative or abusive, and deny their problem.
"They'll argue the fact that there is something wrong with them, much like our heart attack cases," he said.
Hachey said the victim should be warmed gradually, not with hot baths or alcohol, but with a warm, sweet drink like tea to help the body restore lost heat.
In severe hypothermia, shivering stops and the victim is groggy and close to unconsciousness that the body shuts down at the extremities to preserve the heat.
"That's a dire emergency," Hachey said. "The peripheral blood flow has been decreased substantially and now we have acidotic or toxic blood flowing to the extremities."
"In extreme cases you will have no pulse at the extremities and it becomes very, very critical to get to an ambulance or emergency medical service," he said.
Reviving a patient in extreme cases is best left to EMS staff, he said, but mouth-to-mouth is also acceptable in an emergency.
"We revive or treat hypothermia the opposite way in which it occurs," he explained. "If you start re-warming from the outside, you start pushing all that toxic blood to the heart, which causes heart attacks and after-drops to the core."
Restoring heat from the inside out begins in the patient's lungs, he said, with heated oxygen.
"It allows the body to re-warm itself and re-establishing blood flow at its own rate as opposed to us pushing it in," he said.
Northerners are exposed almost daily in winter to the possibility hypothermia. Hachey said risk can be reduced by travelling on the land with a buddy, dressing properly for conditions and recognizing the signs of the silent killer.
"If you live up here, you are going to experience hypothermia if you go outside -- it's a fact of life," he said. "Generally it's mild and our bodies adapt and compensate for it; the best way to deal with it is through prevention."
