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Savioli G, Ceresa IF, Bavestrello Piccini G, Gri N, Nardone A, La Russa R, Saviano A, Piccioni A, Ricevuti G, Esposito C. Hypothermia: Beyond the Narrative Review-The Point of View of Emergency Physicians and Medico-Legal Considerations. J Pers Med 2023; 13:1690. [PMID: 38138917 PMCID: PMC10745126 DOI: 10.3390/jpm13121690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/14/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Hypothermia is a widespread condition all over the world, with a high risk of mortality in pre-hospital and in-hospital settings when it is not promptly and adequately treated. In this review, we aim to describe the main specificities of the diagnosis and treatment of hypothermia through consideration of the physiological changes that occur in hypothermic patients. Hypothermia can occur due to unfavorable environmental conditions as well as internal causes, such as pathological states that result in reduced heat production, increased heat loss or ineffectiveness of the thermal regulation system. The consequences of hypothermia affect several systems in the body-the cardiovascular system, the central and peripheral nervous systems, the respiratory system, the endocrine system and the gastrointestinal system-but also kidney function, electrolyte balance and coagulation. Once hypothermia is recognized, prompt treatment, focused on restoring body temperature and supporting vital functions, is fundamental in order to avert preventable death. It is important to also denote the fact that CPR has specificities related to the unique profile of hypothermic patients.
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Affiliation(s)
- Gabriele Savioli
- Emergency Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Iride Francesca Ceresa
- Emergency Department and Internal Medicine, Istituti Clinici di Pavia e Vigevano, Gruppo San Donato, 27029 Vigevano, Italy;
| | | | - Nicole Gri
- Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Alba Nardone
- Emergency Department, Ospedale Civile, 27058 Voghera, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, 71122 Foggia, Italy
| | - Angela Saviano
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.S.); (A.P.)
| | - Andrea Piccioni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.S.); (A.P.)
| | - Giovanni Ricevuti
- Department of Drug Science, University of Pavia, 27100 Pavia, Italy;
| | - Ciro Esposito
- Nephrology and Dialysis Unit, ICS Maugeri, University of Pavia, 27100 Pavia, Italy;
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Wang J, Jiang C, Yang G, Bai G, Yu S. Study on thermal health and its safety management mode for the working environment. Front Public Health 2023; 11:1227630. [PMID: 37670839 PMCID: PMC10475595 DOI: 10.3389/fpubh.2023.1227630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Thermal health concerns have gained significant attention due to the heightened health risks faced by workers who are exposed to extreme thermal environments for prolonged periods. To ensure the occupational health and safety of such workers, and to enhance work efficiency, it is imperative to examine the characteristics of thermal health in the working environment. This study proposes three key elements of thermal health in the working environment, namely thermal health states, absence of heat-related illnesses, and heat adaptability, which can be used to develop a safety management framework for thermal health. By exploring the interconnections between these elements, the study summarizes their features and outlines the necessary precautions to safeguard them. The PDCA (plan/do/check/action) cycle management mode is utilized as a framework, with the three components of thermal health forming the core, to establish a safety management mode for thermal health. To ensure that employees work in a safe, healthy, comfortable, and productive environment, the assessment and control objectives of the thermal environment are regularly revised through the use of labor protection technology and thermal environment control technology. This paper presents a PDCA cycle safety management mode based on the characteristics of thermal health, which offers novel insights and approaches for assessing and managing workers' thermal health.
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Affiliation(s)
- Jue Wang
- Key Laboratory of Mine Thermodynamic Disasters and Control of Ministry of Education, Liaoning Technical University, Fuxin, Liaoning, China
- School of Safety Science and Engineering, Liaoning Technical University, Fuxin, Liaoning, China
- School of Civil Engineering, Liaoning Technical University, Fuxin, Liaoning, China
| | - Cheng Jiang
- School of Civil Engineering, Liaoning Technical University, Fuxin, Liaoning, China
| | - Guang Yang
- School of Civil Engineering, Liaoning Technical University, Fuxin, Liaoning, China
| | - Gang Bai
- Key Laboratory of Mine Thermodynamic Disasters and Control of Ministry of Education, Liaoning Technical University, Fuxin, Liaoning, China
- School of Safety Science and Engineering, Liaoning Technical University, Fuxin, Liaoning, China
| | - Shixuan Yu
- School of Civil Engineering, Liaoning Technical University, Fuxin, Liaoning, China
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Takamiya M, Saigusa K, Dewa K. DNA microarray analysis of hypothermia-exposed murine lungs for identification of forensic biomarkers. Leg Med (Tokyo) 2020; 48:101789. [PMID: 33161360 DOI: 10.1016/j.legalmed.2020.101789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
We used DNA microarray technology to analyze the pulmonary transcriptome of mice killed by hypothermia. This analysis identified significant differential regulation of 4094 genes; specifically, 1699 genes were upregulated, and 2395 were downregulated in response to hypothermia. The gene encoding cathelicidin antimicrobial peptide was the most upregulated gene, and that encoding BAI1-associated protein 2-like 1 was the most downregulated. Gene-set analysis identified significant hypothermia-induced variations in 101 pathways, and we discovered that pathways related to immunity are involved in the pulmonary pathogenesis of hypothermia. The present findings demonstrate some of the acute pulmonary responses to hypothermia and indicate several pulmonary genes as candidate forensic biomarkers of hypothermia. Furthermore, the present findings suggest that host defense is induced in hypothermic lungs. The present microarray data may facilitate the development of protein analyses for human forensics by immunohistochemistry, western blotting and enzyme-linked immunosorbent assay and may be beneficial in clinical research of hypothermia.
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Affiliation(s)
- Masataka Takamiya
- Division of Forensic Medicine, Department of Forensic Science, Iwate Medical University, Iwate, Japan.
| | - Kiyoshi Saigusa
- Department of Biology, Iwate Medical University, Iwate, Japan
| | - Koji Dewa
- Division of Forensic Medicine, Department of Forensic Science, Iwate Medical University, Iwate, Japan
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Endocan concentrations in postmortem serum, vitreous humor and urine in victims of lethal hypothermia. J Forensic Leg Med 2017; 50:39-43. [DOI: 10.1016/j.jflm.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/28/2017] [Accepted: 07/02/2017] [Indexed: 12/20/2022]
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Vezzosi T, Tognetti R, Buralli C, Arnaboldi C, Calogero G, Marchesotti F, Domenech O. ECG of the Month. J Am Vet Med Assoc 2017. [PMID: 28621594 DOI: 10.2460/javma.251.1.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cheshire WP. Thermoregulatory disorders and illness related to heat and cold stress. Auton Neurosci 2016; 196:91-104. [DOI: 10.1016/j.autneu.2016.01.001] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/17/2015] [Accepted: 01/05/2016] [Indexed: 01/22/2023]
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Takamiya M, Saigusa K, Dewa K. DNA microarray analysis of the mouse adrenal gland for the detection of hypothermia biomarkers: potential usefulness for forensic investigation. Ther Hypothermia Temp Manag 2014; 3:63-73. [PMID: 23781398 DOI: 10.1089/ther.2013.0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We analyzed the adrenal gland transcriptome of mice killed by hypothermia using DNA microarray technology. A total of 4051 significantly expressed genes were identified; 2015 genes were upregulated and 2036 were downregulated.The FBJ osteosarcoma oncogene was the most upregulated,whereas stearoyl coenzyme A desaturase 3 was the most downregulated. Validation by quantitative polymerase chain reaction revealed that results obtained by both methods were consistent. In the gene set analysis, significant variations were found in nine pathways, and we suggest that transforming growth factor β and tumor necrosis factor α would be involved in the pathogenesis of hypothermia. Gene functional category analysis demonstrated the most overexpressed categories in upregulated and downregulated genes were cellular process in biological process, binding in molecular function, and cell and cell part in cellular component. The present study demonstrated acute adrenal responses in hypothermia, and we suggest that understanding adrenal mRNA expression would be useful for hypothermia diagnosis. Furthermore, the present microarray data may also facilitate development of immunohistochemical analysis of human cases. In forensic practice, the combination of macroscopic and microscopic observations with molecular biological analyses would be conducive to more accurate diagnosis of hypothermia. Although this study is aimed at forensic practice, the present data regarding more than 20,000 genes of the adrenal gland would be beneficial to inform future clinical hypothermia research. From the viewpoint of adrenal gene activity, they could contribute to elucidating the pathophysiology of hypothermia.
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Spencer JM, Sheridan SC. Web-based hypothermia information: a critical assessment of Internet resources and a comparison to peer-reviewed literature. Perspect Public Health 2014; 135:85-91. [PMID: 24532173 DOI: 10.1177/1757913913517977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Hypothermia is a medical condition characterized by a drop in core body temperature, and it is a considerable source of winter weather-related vulnerability in mid-/high-latitude areas. Heat vulnerability research, including assessments of internet-based resources, is more thoroughly represented in the peer-reviewed literature than cold-related vulnerability research. This study was undertaken to summarize available web-based hypothermia information, and then determine its scientific validity compared to the peer-reviewed literature. METHODS This research takes a similar approach used by Hajat et al. for web-based heat vulnerability research, and utilizes this framework to assess hypothermia information found on the internet. Hypothermia-related search terms were used to obtain websites containing hypothermia information, and PubMed (medical literature search engine) and Google Scholar were used to identify peer-reviewed hypothermia literature. The internet information was aggregated into categories (vulnerable populations, symptoms, prevention), which were then compared to the hypothermia literature to determine the scientific validity of the web-based guidance. The internet information was assigned a Strength of Recommendation Taxonomy (SORT) grade (developed by the American Academy of Family Practitioners) of A, B, or C based on the peer-reviewed evidence. RESULTS Overall, 25 different pieces of guidance within the three categories were identified on 49 websites. Guidance concerning hypothermia symptoms most frequently appeared on websites, with six symptoms appearing on 50% or greater of websites. No piece of guidance within the vulnerable population categories appeared on greater than 60% of the websites, and prevention-related guidance was characterized by varied SORT grades. CONCLUSIONS Hypothermia information on the internet was not entirely congruent with the information within the peer-reviewed medical literature. Several suggestions for improving web-based hypothermia resources include clearly listing sources for users to see and eliminating guidance with lower SORT grades and replacing with evidence-based information.
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Affiliation(s)
- Jeremy M Spencer
- Department of Geography, Kent State University, Department of Geosciences, The University of Akron Akron, OH
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Hypothalamic transcript profiling in hypothermia using SuperSAGE. J Forensic Leg Med 2012; 19:396-401. [DOI: 10.1016/j.jflm.2012.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 04/21/2012] [Indexed: 11/15/2022]
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The Spectrum of Hypothermia: From Environmental Exposure to Therapeutic Uses and Medical Simulation. Dis Mon 2012; 58:6-32. [PMID: 22221547 DOI: 10.1016/j.disamonth.2011.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lantry J, Dezman Z, Hirshon JM. Pathophysiology, management and complications of hypothermia. Br J Hosp Med (Lond) 2012; 73:31-7. [DOI: 10.12968/hmed.2012.73.1.31] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Jon Mark Hirshon
- Department of Emergency Medicine at the University of Maryland School of Medicine in Baltimore, Maryland, United States 21201
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Successful resuscitation from cardiopulmonary arrest due to profound hypothermia using noninvasive techniques. Pediatr Emerg Care 2011; 27:215-7. [PMID: 21378525 DOI: 10.1097/pec.0b013e31820d8e04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Profound hypothermia is defined as a core body temperature of 20.0 °C or less. Successful resuscitation from this degree of hypothermia is rare. We present a case of successful resuscitation in a 2-year-old boy found in cardiac arrest due to profound hypothermia. Invasive techniques such as cavity lavage, extracorporeal membrane oxygenation, and cardiopulmonary bypass were not used.
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Cappaert TA, Stone JA, Castellani JW, Krause BA, Smith D, Stephens BA. National Athletic Trainers' Association position statement: environmental cold injuries. J Athl Train 2009; 43:640-58. [PMID: 19030143 DOI: 10.4085/1062-6050-43.6.640] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To present recommendations for the prevention, recognition, and treatment of environmental cold injuries. BACKGROUND Individuals engaged in sport-related or work-related physical activity in cold, wet, or windy conditions are at risk for environmental cold injuries. An understanding of the physiology and pathophysiology, risk management, recognition, and immediate care of environmental cold injuries is an essential skill for certified athletic trainers and other health care providers working with individuals at risk. RECOMMENDATIONS These recommendations are intended to provide certified athletic trainers and others participating in athletic health care with the specific knowledge and problem-solving skills needed to address environmental cold injuries. Each recommendation has been graded (A, B, or C) according to the Strength of Recommendation Taxonomy criterion scale.
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Konopova P, Janota J, Termerova J, Burianova I, Paulova M, Zach J. Successful treatment of profound hypothermia of the newborn. Acta Paediatr 2009; 98:190-2. [PMID: 19006529 DOI: 10.1111/j.1651-2227.2008.01052.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED We report a case of a profoundly hypothermic newborn with a core temperature of 25 degrees C with a successful recovery and normal neurological outcome at 3 and 6 months. This term male infant had been exposed to a temperature of -3 degrees C for approximately 30 min. Slow re-warming, using external modalities was used in addition to volume expansion, heparinization, antibiotics and sedation. There is limited information available concerning the safest and most effective method of re-warming hypothermic newborns. Slow re-warming has been advocated as it replicates the normal physiological process in a neonate, which minimizes a negative therapy impact. CONCLUSION The most significant decision regarding treatment is the identification of the most appropriate method and speed of re-warming. This report supports recommendations for gradual re-warming of a severely hypothermic newborn. Physiological cardiovascular mechanisms seemed to be intact during slow re-warming; this might be applicable to the treatment of profound hypothermia of the newborn.
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Affiliation(s)
- P Konopova
- Department of Neonatology, Thomayer, University Hospital, Videnska 800, Prague 4, Czech Republic.
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Abstract
As outdoor sports continue to gain popularity, understanding the environmental factors that may influence athletes is becoming a more important aspect of medical care for team physicians. Temperature, ultraviolet light, lightning, and altitude are some of the most common elements that cause illness. Understanding how to prevent, diagnose, and promptly treat conditions caused by environmental factors is essential to optimizing athletic performance in outdoor sports and avoiding morbidity.
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Baumgartner EA, Belson M, Rubin C, Patel M. Hypothermia and Other Cold-Related Morbidity Emergency Department Visits: United States, 1995–2004. Wilderness Environ Med 2008; 19:233-7. [DOI: 10.1580/07-weme-or-104.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nixdorf-Miller A, Hunsaker DM, Hunsaker JC. Hypothermia and Hyperthermia Medicolegal Investigation of Morbidity and Mortality From Exposure to Environmental Temperature Extremes. Arch Pathol Lab Med 2006; 130:1297-304. [PMID: 16948514 DOI: 10.5858/2006-130-1297-hahmio] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2006] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—The determination of the cause of death from exposure to extreme temperatures is a diagnosis of exclusion. Because both clinical and autopsy findings are nonspecific, a thorough investigation of the background and scene, evaluation of temporally relevant environmental conditions, and assessment of the victim's underlying state of health with appropriate laboratory studies, which frequently include autopsy, are essential to establish the cause of injury and/or death with reasonable medical probability. Individuals may encounter environmental extremes in many settings during any season. Both constitutional and external factors exacerbate the stress brought about by extreme temperature.
Objective.—This article reviews guidelines for forensic investigation into environmental temperature extremes that contribute to an important seasonal grouping of morbidity and mortality in the United States.
Data Sources.—Articles on clinical and pathologic aspects of hyperthermia and hypothermia were collected and reviewed.
Conclusions.—Recognition of multiple risk factors predisposing humans to both cold-related and heat-related morbidity and mortality enhances prevention. Awareness of the susceptibility of these exposed at-risk individuals is crucial to investigations by both clinicians and medicolegal death investigators.
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Affiliation(s)
- Allison Nixdorf-Miller
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, USA
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García del Moral R, Soto Blanco JM, Barranco Ruiz F. [Pathology related to altitude: the experience on K2]. Med Intensiva 2006; 30:232-5. [PMID: 16938197 DOI: 10.1016/s0210-5691(06)74512-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The pathology related with the altitude is a common entity above 3000 m. It includes mild symptoms to severe illness such as cerebral or pulmonary edema. Cold-induced injuries may produce permanent tissue loss and surgical amputation. Recognition is made mainly through symptoms. Adequate treatment of these patients allows for rapid resolution of the symptoms and improves outcome.
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Affiliation(s)
- R García del Moral
- Servicio de Cuidados Críticos y Urgencias, Hospital Clínico Universitario San Cecilio, Granada, España.
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