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- Brändström, Helge, et al.
(författare)
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Accidental cold-related injury leading to hospitalization in northern Sweden : an eight-year retrospective analysis
- 2014
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 22, s. 6-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cold injuries are rare but important causes of hospitalization. We aimed to identify the magnitude of cold injury hospitalization, and assess causes, associated factors and treatment routines in a subarctic region. Methods: In this retrospective analysis of hospital records from the 4 northernmost counties in Sweden, cases from 2000-2007 were identified from the hospital registry by diagnosis codes for accidental hypothermia, frostbite, and cold-water drowning.Results were analyzed for pre-hospital site events, clinical events in-hospital, and complications observed with mild (temperature 34.9 - 32 degrees C), moderate (31.9 - 28 degrees C) and severe (<28 degrees C), hypothermia as well as for frostbite and cold-water drowning. Results: From the 362 cases, average annual incidences for hypothermia, frostbite, and cold-water drowning were estimated to be 3.4/100 000, 1.5/100 000, and 0.8/100 000 inhabitants, respectively. Annual frequencies for hypothermia hospitalizations increased by approximately 3 cases/year during the study period. Twenty percent of the hypothermia cases were mild, 40% moderate, and 24% severe. For 12%, the lowest documented core temperature was 35 degrees C or higher, for 4% there was no temperature documented. Body core temperature was seldom measured in pre-hospital locations. Of 362 cold injury admissions, 17 (5%) died in hospital related to their injuries. Associated co-factors and co-morbidities included ethanol consumption, dementia, and psychiatric diagnosis. Conclusions: The incidence of accidental hypothermia seems to be increasing in this studied sub-arctic region. Likely associated factors are recognized (ethanol intake, dementia, and psychiatric diagnosis).
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| 2. |
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| 3. |
- Brändström, Helge, et al.
(författare)
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Fatal hypothermia : an analysis from a sub-arctic region
- 2012
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Ingår i: International Journal of Circumpolar Health. - : Informa UK Limited. - 1239-9736 .- 2242-3982. ; 71:0, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To determine the incidence as well as contributing factors to fatal hypothermia.Study design. Retrospective, registry-based analysis.Methods. Cases of fatal hypothermia were identified in the database of the National Board of Forensic Medicine for the 4 northernmost counties of Sweden and for the study period 1992-2008. Police reports, medical records and autopsy protocols were studied.Results. A total of 207 cases of fatal hypothermia were noted during the study period, giving an annual incidence of 1.35 per 100,000 inhabitants. Seventy-two percent occurred in rural areas, and 93% outdoors. Many (40%) were found within approximately 100 meters of a building. The majority (75%) occurred during the colder season (October to March). Some degree of paradoxical undressing was documented in 30%. Ethanol was detected in femoral vein blood in 43% of the victims. Contributing co-morbidity was common and included heart disease, earlier stroke, dementia, psychiatric disease, alcoholism, and recent trauma.Conclusions. With the identification of groups at high risk for fatal hypothermia, it should be possible to reduce risk through thoughtful interventions, particularly related to the highest risk subjects (rural, living alone, alcohol-imbibing, and psychiatric diagnosis-carrying) citizens.
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| 4. |
- Brändström, Helge, et al.
(författare)
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Hand cold recovery responses before and after 15 months of military training in a cold climate
- 2008
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Ingår i: Aviation, Space and Environmental Medicine. - 0095-6562 .- 1943-4448. ; 79:9, s. 904-908
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The ability of fingers to rapidly rewarm following cold exposure is a possible indicator of cold injury protection. We categorized the post-cooling hand-rewarming responses of men before and after participation in 15 mo of military training in a cold environment in northern Sweden to determine: 1) if the initial rewarming category was related to the occurrence of local cold injury during training; and 2) if cold training affected subsequent hand-rewarming responses. METHODS: Immersion of the dominant hand in 10 degrees C water for 10 min was performed pre-training on 77 men. Of those, 45 were available for successful post-training retests. Infrared thermography monitored the dorsal hand during 30 min of recovery. Rewarming was categorized as normal, moderate, or slow based on mean fingertip temperature at the end of 30 min of recovery (TFinger,30) and the percentage of time that fingertips were vasodilated (%VD). RESULTS: Cold injury occurrence during training was disproportionately higher in the slow rewarmers (four of the five injuries). Post-training, baseline fingertip temperatures and cold recovery variables increased significantly in moderate and slow rewarmers: TFinger30 increased from 21.9 +/- 4 to 30.4 +/- 6 degrees C (Moderate), and from 17.4 +/- 0 to 22.3 +/- 7 degrees C (Slow); %VD increased from 27.5 +/- 16 to 65.9 +/- 34% (Moderate), and from 0.7 +/- 2 to 31.7 +/- 44% (Slow). CONCLUSIONS: Results of the cold recovery test were related to the occurrence of local cold injury during long-term cold-weather training. Cold training itself improved baseline and cold recovery in moderate and slow rewarmers.
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| 5. |
- Henriksson, Otto, 1976-, et al.
(författare)
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Protection against cold in prehospital care : wet clothing removal or addition of a vapor barrier
- 2015
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Ingår i: Wilderness & environmental medicine (Print). - : Elsevier. - 1080-6032 .- 1545-1534. ; 26:1, s. 11-20
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The purpose of this study was to evaluate the effect of wet clothing removal or the addition of a vapor barrier in shivering subjects exposed to a cold environment with only limited insulation available.METHODS: Volunteer subjects (n = 8) wearing wet clothing were positioned on a spineboard in a climatic chamber (-18.5°C) and subjected to an initial 20 minutes of cooling followed by 30 minutes of 4 different insulation interventions in a crossover design: 1) 1 woolen blanket; 2) vapor barrier plus 1 woolen blanket; 3) wet clothing removal plus 1 woolen blanket; or 4) 2 woolen blankets. Metabolic rate, core body temperature, skin temperature, and heart rate were continuously monitored, and cold discomfort was evaluated at 5-minute intervals.RESULTS: Wet clothing removal or the addition of a vapor barrier significantly reduced metabolic rate (mean difference ± SE; 14 ± 4.7 W/m(2)) and increased skin temperature rewarming (1.0° ± 0.2°C). Increasing the insulation rendered a similar effect. There were, however, no significant differences in core body temperature or heart rate among any of the conditions. Cold discomfort (median; interquartile range) was significantly lower with the addition of a vapor barrier (4; 2-4.75) and with 2 woolen blankets (3.5; 1.5-4) compared with 1 woolen blanket alone (5; 3.25-6).CONCLUSIONS: In protracted rescue scenarios in cold environments with only limited insulation available, wet clothing removal or the use of a vapor barrier is advocated to limit the need for shivering thermogenesis and improve the patient's condition on admission to the emergency department.
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| 7. |
- Kuklane, Kalev, et al.
(författare)
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Change of footwear insulation at various sweating rates
- 1999
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Ingår i: Applied human science : journal of physiological anthropology. - : Japan Society of Physiological Anthropology. - 1341-3473. ; 18:5, s. 161-168
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Tidskriftsartikel (refereegranskat)abstract
- Moisture inside the footwear can considerably affect the thermal insulation. In this study with a thermal foot model there was simulated three sweat rates (3, 5 and 10 g/h). Five types of footwear with various insulation levels (dry insulation from 0.19 to 0.50 m2. K/W) were tested. The footwear insulation reduction was calculated for 1.5 hour period. The reduction in insulation was related to sweating rate and initial insulation. The footwear with high insulation lost even in percentile more insulation than thin boots under the same conditions (9-19% at 3 g/h, 13-27% at 5 g/h and 19-36% at 10 g/h). A relationship between insulation decrease and sweating rate was established. An 8-hour sweating test (5 g/h) and a test for determining evaporative heat, losses were carried out in addition. The insulation reduction during the first 1.5 hours of the 8-hour test answered for more than half of the total reduction.
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| 9. |
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| 10. |
- Lundgren, Peter, et al.
(författare)
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Field torso-warming modalities : a comparative study using a human model
- 2009
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Ingår i: Prehospital Emergency Care. - : Informa Healthcare. - 1090-3127 .- 1545-0066. ; 13:3, s. 371-378
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare four field-appropriate torso warming modalities, that do not require AC electrical power, using a human model of non-shivering hypothermia. Methods: Five subjects, serving as their own controls, were cooled four times in 8ºC water, for 10-30 minutes. Shivering was inhibited by Buspirone (30 mg) taken orally prior to cooling and IV Meperidine (1.25 mg/kg) at the end of immersion. Subjects were hoisted out of the water, dried, insulated and then underwent 120 min of either: spontaneous warming only; a charcoal heater on the chest; two flexible hot water bags (total4 liters of water at55°C, replenished every 20 minutes) applied to the chest and upper back; or two chemical heat pads applied to the chest and upper back. Supplemental meperidine (maximum cumulative dose of 3.5 mg/kg) was administered as required to inhibit shivering. Results: Post-cooling afterdrop was compared to spontaneous warming (2.2°C) less for chemical heat pads (1.5°C) and hot water bags (1.6°C, p < 0.05), and was1.8°C with the charcoal heater. Subsequent core rewarming rates, the hot water bags (0.7°C/h) and the charcoal heater (0.6°C/h), tended to be higher than chemical heat pads (0.2°C/h, p = 0.055) and was significantly greater than spontaneous warming (0.1°C/h, p < 0.05). Conclusion: In subjects with shivering suppressed, greater sources of external heat were effective in attenuating core temperature afterdrop whereas sustained sources of external heat effectively established core rewarming. Depending on scenario and available resources, we advice to use charcoal heaters, chemical heat pads or hot water bags as effective means for treating cold patients in the field or during transport to definitive care.
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