The basic cause of hypothermia is a lack of external heat combined with an inability to maintain sufficient insulation. The heat loss from the body is greater than the heat produced and the body temperature falls abnormally low. Shivering occurs and the muscular activity produces heat. The heart rate increases, the peripheral blood vessels constrict and therefore the blood pressure rises. If this fails to compensate and the body temperature continues to fall, shivering is replaced by muscular rigidity, and falling pulse rate and blood pressure; consciousness is impaired and reflexes are slow. If the temperature continues to fall, coma is followed by death.
Young, fit adults exposed to extremely low temperatures can die from hypothermia if they are inadequately clothed, sheltered and fed; every year a handful of walkers and climbers die from exposure – the effects of extreme cold and inadequate clothing. In the home, it is young babies and the elderly who are chiefly at risk from hypothermia. If it is suspected, a special low reading thermometer (30-38°C) must be used.
Dealing with a low temperature
The newborn baby
The heat-regulating mechanism in the brain of a newborn baby is not yet working efficiently, so he relies on his surroundings to maintain his temperature. It is therefore essential to make sure that a baby is kept in a warm room, possibly with additional heat at night. If the baby’s room seems cold when you enter it and there is no evidence of extra heating, take a look at the baby. A chilled baby will probably have red cheeks and look healthy. This is deceptive. His hands and feet may be red and swollen and feel cold. His movements will be reduced and he will be too lethargic to suck.
If you come across a baby in this condition, ring for the doctor. Warm the baby gradually against your skin, perhaps by taking him into bed with you, while you wait for the help to arrive.
The elderly patient
If when you arrive at the home of an elderly person, you find he is pale and his skin is cold to the touch, even where covered by clothing, suspect hypothermia. He may also be rather unsteady, he may be slower and more confused than usual and his speech may be slurred. His pulse will be slow and weak and his breathing slow and shallow. If you have a low-reading thermometer, take his temperature. Send immediately for the doctor. In the meantime, wrap him in blankets and give him a hot drink to prevent him losing more heat. Do not use hot water bottles or electric blankets unless instructed by the doctor. If you do, the sudden heat may make the surface blood vessels dilate and draw blood away from the deep tissues and vital organs, leading to a fatal collapse caused by a sudden fall in blood pressure.
Many elderly people say they do not feel cold when in reality they cannot afford adequate heating. If this is the case, you should persuade the person to get help from the Social Security Department. At the same time encourage the wearing of shawls, cardigans, mittens, bedsocksand for both sexes some kind of hat, especially if the hair is thinning: it is surprising how much heat is lost from a bald head. Exercise will help blood circulate and tone up the muscles, even if it only consists of walking with you several times around the room. Since room temperatures always fall during the night, try to provide some kind of extra heating: the ideal temperature is around 18°C. If there is financial need, you can suggest that the person uses one room only for living and sleeping, rather than heating two rooms or leaving a heated living room for a cold bedroom at night.
The elderly person should also be encouraged to eat a well-balanced diet; if necessary Meals on Wheels can be arranged, thus ensuring a hot meal at regular intervals. Persuade him to take hot drinks during the day; perhaps you can leave a vacuum flask of hot fluid ready within his reach so that even if he is not very mobile he can drink frequently.
If an elderly person falls at night and is unable to summon help, his temperature may drop dangerously low and hypothermia may occur. Always suspect this if you are the one to find a fallen patient, and take steps to counteract it. Where possible make sure that someone looks in on an elderly person each morning to see that all is well.
