Treatment Guide for IMMERSION HYPOTHERMIA

If the victim has drowned, attempts should be made to quickly drain the water from his lungs and clear the mouth and throat. This is followed by mouth-to-mouth resuscitation. The core tem­perature may fall as much as an additional 4 C after the victim is'removed from the water, and this "after-drop" (due to dilation of surface blood vessels, which increases the return of cold blood to the heart and core of the body) may prove fatal. If the victim has suffered only mild immersion hypothermia, he should have his wet clothes removed and be placed in a shelter and wrapped with blankets or a sleeping bag. Rewarming from his own meta­bolism should be adequate.

More severely affected persons are best aided by rapid rewarm­ing. The victim should be placed in a tub of water that is about 4l C if he is conscious or naked, or 45 C if he is unconscious or clothed. The body should be submerged but the limbs kept out of the bath to decrease the "after-drop" in body temperature. Unconscious victims with core temperatures below 28 C (82.4 F) develop cardiac arrest very easily; unnecessary manipulation of the victim should be minimized because of this. If the victim is conscious, he should be removed from the bath when he feels warm and placed in a warmed bed for further rewarming. If he is left in the hot bath until his body temperature is normal, it may then "overshoot" the normal temperature level. When the victim's heart beat and respirations are regular and increasing, or his deep body temperature is 33 C (9l.4 F) and rising, he should be removed from the bath. Again, it must be remembered that a victim who appears dead, with fixed, dilated, pupils and no pulse or respirations, may survive if rewarmed and handled properly. Death is not certain until rew;uming has failed to revive the victim.

There is some disagreement as to whether active rewarming (hot baths, heating blankets) or passive rewarming (blankets, bed­clothes) at room temperature should be used for hypothermia victims. Many authorities feel that rapid rewarming is the treat­ment of choice for young, healthy individuals, especially if they are suffering from severe hypothermia. Rapid rewarming minimizes after-drop. In the case of elderly victims, however, it is not at all clear if rewarming should be rapid or slow. It is feared that more complications, such as heart problems and shock, may occur with rapid rewarming.