Essentials of Hypothermia

Posted Posted in Continuing Education, Homestudy, Pain


tyrol-69661_640Surviving hypothermia after being left for dead in the wilderness makes an interesting story line in the movies.  In real life, hypothermia kills over a thousand people each year in the United States alone.  Knowing how to recognize it and treat it (or better yet, prevent it) can save lives.

Systemic hypothermia involves a core body temperature below 35 degrees Celsius.  Accurate measurement is crucial and the core temperature probe must be able to measure as low as 25 degrees Celsius.  Resuscitative measures must always be continued until the patient’s core temperature is clearly over 32 degrees Celsius (unless there are obvious fatal injuries).  As every physician, nurse, and first responder has been taught, “you’re not dead until you’re warm and dead.”

Susceptibility to hypothermia is increased by extremes of age, heart disease, exhaustion, hunger or malnutrition, dehydration, hypoxia, immobility, intoxication with drugs or alcohol, low body mass, contact with moisture or metal, and loss of consciousness.  Even in the movies, victims of hypothermia try desperately to stay awake and keep moving.

Clinical signs and symptoms of hypothermia vary based on the patient’s underlying status.  In general, however, there are four stages:

  • Stage I- CBT (core body temperature) is between 32 degrees Celsius and 35 degrees Celsius.  The patient is shivering and may be losing good judgement and coordination; still conscious and hemodynamically stable.
  • Stage II – CBT is between 28 degrees Celsius and 32 degrees Celsius.  Shivering stops, pulse slows, and pupils dilate.  Reflexes slow and “cold diuresis” develops as a result of renal dysfunction and low levels of ADH (antidiuretic hormone). Eventually, this will lead to hypovolemia and shock.  The patient becomes increasingly confused and lethargic.
  • Stage III-CBT is between 24 degrees Celsius and 28 degrees Celsius. Vital signs may still be present, but the risk of cardiac arrest increases dramatically, and the patient is now unconscious.
  • Stage IV – CBT is less than 24 degrees Celsius.  Vital signs are absent.  There is coma, loss of reflexes, asystole or ventricular fibrillation and rigor mortis. The patient appears dead but may still be salvageable.

The cornerstone of treatment in hypothermia is rewarming.  Rapid assessment with support of airway, breathing, and circulation must occur almost simultaneously.  All cold, wet clothing should be removed and replaced with warm, dry clothing and blankets.  The patient’s head should be covered and every effort must be made to prevent additional heat loss.  In general, raising core body temperature by 1 degree Celsius per hour is safe.  Giving warmed IV fluids (normal saline at 45 degrees Celsius) may be helpful.

Great care and caution must be used when moving or transporting a hypothermic patient.  The combination of vasoconstriction, hypovolemia, and return of cold peripheral blood to the central circulation can cause ”core temperature after drop.”

This phenomenon, combined with lactic acidosis, can precipitate potentially fatal arrhythmias known as “rescue collapse.”  This is where real life must break with the movies.  Dramatic scenes where the rescuer frantically rubs and massages the victim’s extremities may be riveting, but they’re also wrong.

Preventing hypothermia is much easier than treating it.  When in doubt, rely on the old adage: Keep warm, keep dry, and keep moving.


Menopause and the “Change”

Posted Posted in Continuing Education, Elder Care, Homestudy, Psychology

flower-428368_640Menopause, long surrounded by misconception and myth, is actually just one of the major transitions in a woman’s life. Most women go through menopause, whether it is secondary to surgery, a specific medical condition, or as part of the natural course of a woman’s life.

Many women dread the thought of menopause—the night sweats, the hot flashes, the weight gain, the mood changes. However, though menopause may mean a few more graying hairs and wrinkles, it is decidedly not a ticket to emotional problems or physical old age. Many women, in fact, find perimenopause and menopause only mildly problematic, and others discover that their symptoms can often be controlled or alleviated.

Though menopause has often been regarded as a medical illness, it is more accurately described as a life change—one that is often accompanied by a complex set of physical and emotional responses. There are health risks that increase after a woman reaches menopause, such as the risk for heart disease and cancer, but these can be cut drastically by preventive medication, diet, or lifestyle.

Menopause can also be a time of new freedom, new beginnings, and second chances. It’s often a time when women begin to reevaluate their lives. Some may decide to embark on bold new paths in their work or personal lives, while others may rededicate themselves to the lives they have already built.

There are many kinds of treatment available to help with perimenopausal and menopausal symptoms, from hormone replacement therapy to nutritional supplements. Physicians can discuss options with their patients, and together they can decide what course would suit them best. An increasing amount of research is available on this phase of life, and better drugs and treatment for menopausal symptoms continue to be discovered.

At one time, menopause was simply referred to as “the change,” a time of life to be dreaded. With an average life expectancy of 79 years of age, most women have at least one third and probably more of their lives ahead of them by the time they reach menopause. And those remaining years are free of menstrual periods, the possibility of pregnancy, and, in most cases, childcare responsibilities.

The “change” can actually be a positive time in a woman’s life. It’s a time when a woman and her partner can recreate their life together, or she can pursue new dreams, and decide how she wants to spend the second half of her life. On the job front, too, it is an ideal time to look at what has been accomplished, and evaluate whether making any changes is desirable. It’s a time to think about where a woman‘s journey in life has taken her, and decide how she wants to spend the years ahead.


Is The Paleo Diet Healty? Arguments Against The Paleo Diet

Posted Posted in Continuing Education, Homestudy, Nutrition

sandwich-498379_640By Barbara Boughton

It’s not surprising that the Paleo diet has health benefits that derive from weight loss, according to its critics. Any diet that restricts calories will lead to weight loss—no matter if it eliminates some food groups as in the Paleo diet, or if it replaces processed foods and sweets with healthy vegetables, lean proteins, and whole grains.

The more important question is whether low-carb weight loss plans, such as the Paleo diet, can result in long-term weight loss and health benefits. It’s difficult to stick with the Paleo eating plan over many months or years because it’s so restrictive, according to the diet’s critics. As a result, its weight loss benefits – and the healthful effects of weight loss—are soon lost.

Good nutrition relies on variety, balance and moderation, according to Marion Nestle, PhD, director of nutrition, food, and public health at New York University, who also wrote an editorial on the Paleo Diet for the Wall Street Journal in March 2015. When one restricts entire food groups, as in the Paleo diet, the risk for nutrient deficiencies greatly increases, according to Dr. Nestle.

A diet that is too restrictive can also take away the joy of eating one’s favorite foods. And while highly processed “junk foods” should be kept to a minimum, a healthy diet can include moderate amounts of your favorite pasta or even an occasional chocolate.

A diet high in saturated fats such as the Paleo diet can lead to obesity as well as health risks such as cardiovascular disease and some cancers, such as colon cancer, according to Paleo diet critics. A diet rich grains and legumes can also be quite healthy and reduce one’s risk morbidity and mortality, according to Dr. Nestle. In fact, many studies show that Asian and Mediterranean diets—rich in carbohydrates and healthy fats such as olive oil, and low in meats and saturated fats—promote health and longevity.

The Paleo diet does get kudos even from its critics for cutting down on processed foods like white bread, artificial cheeses, cold cuts, processed meats, and sugary cereals. These processed foods contain less protein, fiber and iron than their natural counterparts, and are high in sodium and preservatives that increase the risk for heart disease and some cancers.

The Paleo diet is also based on some fallacies, its critics say. Although Paleo diet proponents say Paleolithic hunter-gatherers did not experience cardiovascular disease, signs of atherosclerosis have been found in the Paleolithic era remains. Paleolithic hunter-gatherers were less likely than modern man to succumb to cancer, obesity, and diabetes—but it may not have been because of their diet. Paleolithic people also did not live long enough to acquire these diseases since they were at great risk for morbidity and mortality from infections and parasites.

The Paleolithic diet was not uniform either. It varied greatly based on geography, season, and opportunity. Our Paleolithic ancestors may have evolved and survived, not because of their reliance on a single type of diet, but because they were flexible eaters—a trait that helped them endure in changing times and conditions.

  1. Petrucci K. and Nestle M. Is a Paleo Diet Healthy? The Wall Street Journal. March 23, 2015.
  2. Jabr F. How to Really Eat like a hunger-gatherer: Why the Paleo Diet is Half-Baked. Scientific American. June 3, 2013.
  3. Hamblin J. Science Compared Every Diet, and the Winner Is Real Food. The Atlantic. March 24, 2014.