Afterdrop

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Afterdrop is a continued cooling of a patient's core temperature during the initial stages of rewarming from hypothermia.

Afterdrop is attributed to the return of cold blood to extremities from the core due to peripheral vasodilatation, thus causing a further decrease of deep body temperature. [1] [2] However a second theory explains afterdrop as a side effect of conductive heat transfer. "The hypothermic patient cools from the outside in. Consequently, a heat gradient is established from the relatively warm core to the cool periphery. This heat gradient does not reverse immediately upon initiation of rewarming. Until the gradient is reversed, further heat transfer occurs from the warmer core to cooler peripheral tissues." [3]

In severe cases, afterdrop can lead to post-rescue collapse, [4] but has not been shown to be of any clinical importance in rewarming the hypothermic patient. [3] Afterdrop is not observed in the rewarming of all hypothermic patients. It is more common in patients who were rapidly cooled or rewarmed. Afterdrop was less common in patients for whom rewarming was delayed, or when cooling was slow and prolonged. [5]

Related Research Articles

<span class="mw-page-title-main">Hypothermia</span> Human body core temperature below 35.0 °C (95.0 °F)

Hypothermia is defined as a body core temperature below 35.0 °C (95.0 °F) in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe hypothermia, there may be hallucinations and paradoxical undressing, in which a person removes their clothing, as well as an increased risk of the heart stopping.

Diuresis is the excretion of urine, especially when excessive (polyuria). The term collectively denotes the physiologic processes underpinning increased urine production by the kidneys during maintenance of fluid balance.

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Frostbite is a skin injury that occurs when exposed to extremely low temperatures, causing the freezing of the skin or other tissues, commonly affecting the fingers, toes, nose, ears, cheeks and chin areas. Most often, frostbite occurs in the hands and feet. The initial symptoms are typically a feeling of cold and tingling or numbing. This may be followed by clumsiness with a white or bluish color to the skin. Swelling or blistering may occur following treatment. Complications may include hypothermia or compartment syndrome.

<span class="mw-page-title-main">Thermoregulation</span> Ability of an organism to keep its body temperature within certain boundaries

Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when the surrounding temperature is very different. A thermoconforming organism, by contrast, simply adopts the surrounding temperature as its own body temperature, thus avoiding the need for internal thermoregulation. The internal thermoregulation process is one aspect of homeostasis: a state of dynamic stability in an organism's internal conditions, maintained far from thermal equilibrium with its environment. If the body is unable to maintain a normal temperature and it increases significantly above normal, a condition known as hyperthermia occurs. Humans may also experience lethal hyperthermia when the wet bulb temperature is sustained above 35 °C (95 °F) for six hours. Work in 2022 established by experiment that a wet-bulb temperature exceeding 30.55°C caused uncompensable heat stress in young, healthy adult humans. The opposite condition, when body temperature decreases below normal levels, is known as hypothermia. It results when the homeostatic control mechanisms of heat within the body malfunction, causing the body to lose heat faster than producing it. Normal body temperature is around 37°C(98.6°F), and hypothermia sets in when the core body temperature gets lower than 35 °C (95 °F). Usually caused by prolonged exposure to cold temperatures, hypothermia is usually treated by methods that attempt to raise the body temperature back to a normal range. It was not until the introduction of thermometers that any exact data on the temperature of animals could be obtained. It was then found that local differences were present, since heat production and heat loss vary considerably in different parts of the body, although the circulation of the blood tends to bring about a mean temperature of the internal parts. Hence it is important to identify the parts of the body that most closely reflect the temperature of the internal organs. Also, for such results to be comparable, the measurements must be conducted under comparable conditions. The rectum has traditionally been considered to reflect most accurately the temperature of internal parts, or in some cases of sex or species, the vagina, uterus or bladder.

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<span class="mw-page-title-main">Vasodilation</span> Widening of blood vessels

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Deep hypothermic circulatory arrest (DHCA) is a surgical technique in which the temperature of the body falls significantly and blood circulation is stopped for up to one hour. It is used when blood circulation to the brain must be stopped because of delicate surgery within the brain, or because of surgery on large blood vessels that lead to or from the brain. DHCA is used to provide a better visual field during surgery due to the cessation of blood flow. DHCA is a form of carefully managed clinical death in which heartbeat and all brain activity cease.

Contrast bath therapy is a form of treatment where a limb or the entire body is immersed in hot water followed by the immediate immersion of the limb or body in cold ice water. This procedure is repeated several times, alternating hot and cold. The only evidence of benefit is anecdotal and no plausible mechanism has been confirmed.

Targeted temperature management (TTM) previously known as therapeutic hypothermia or protective hypothermia is an active treatment that tries to achieve and maintain a specific body temperature in a person for a specific duration of time in an effort to improve health outcomes during recovery after a period of stopped blood flow to the brain. This is done in an attempt to reduce the risk of tissue injury following lack of blood flow. Periods of poor blood flow may be due to cardiac arrest or the blockage of an artery by a clot as in the case of a stroke.

The Arctic Sun Temperature Management System is a non-invasive targeted temperature management system. It modulates patient temperature by circulating chilled water in pads directly adhered to the patient's skin. Using varying water temperatures and a computer algorithm, a patient's body temperature can be better controlled. It is produced by Medivance, Inc. of Louisville, Colorado.

<span class="mw-page-title-main">Cold injury</span> Medical condition

Cold injury is damage to the body from cold exposure, including hypothermia and several skin injuries. Cold-related skin injuries are categorized into freezing and nonfreezing cold injuries. Freezing cold injuries involve tissue damage when exposed to temperatures below freezing. Nonfreezing cold injuries involve tissue damage when exposed to temperatures often between 0-15 degrees Celsius for extended periods of time. While these injuries have disproportionally affected military members, recreational winter activities have also increased the risk and incidence within civilian populations. Additional risk factors include homelessness, inadequate or wet clothing, alcohol abuse or tobacco abuse, and pre-existing medical conditions that impair blood flow.

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Rewarming shock has been described as a drop in blood pressure following the warming of a person who is very cold. The real cause of this rewarming shock is unknown.

Cold and heat adaptations in humans are a part of the broad adaptability of Homo sapiens. Adaptations in humans can be physiological, genetic, or cultural, which allow people to live in a wide variety of climates. There has been a great deal of research done on developmental adjustment, acclimatization, and cultural practices, but less research on genetic adaptations to colder and hotter temperatures.

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Skin temperature is the temperature of the outermost surface of the body. Normal human skin temperature on the trunk of the body varies between 33.5 and 36.9 °C, though the skin's temperature is lower over protruding parts, like the nose, and higher over muscles and active organs. Recording skin temperature presents extensive difficulties. Although it is not a clear indicator of internal body temperature, skin temperature is significant in assessing the healthy function of skin. Some experts believe the physiological significance of skin temperature has been overlooked, because clinical analysis has favoured measuring temperatures of the mouth, armpit, and/or rectum. Temperatures of these parts typically are consistent with internal body temperature.

Palm cooling is a type of recovery intervention that involves cooling the palm of the hand during rest periods between bouts of strenuous physical activity. The palm cooling modality can be used to moderate increases in core temperature resulting from the level of physical activity, the wearing of protective clothing or a combination of both, for example in the activities of military personnel or firefighters.

References

  1. Savard, G. K.; Cooper, K. E.; Veale, W. L.; Malkinson, T. J. (1985-01-01). "Peripheral blood flow during rewarming from mild hypothermia in humans". Journal of Applied Physiology. 58 (1): 4–13. doi:10.1152/jappl.1985.58.1.4. ISSN   8750-7587. PMID   3968020.
  2. "afterdrop". The Free Dictionary.
  3. 1 2 "Hypothermia And Other Cold-Related Emergencies: Pathophysiology". ebmedicine.net. Retrieved January 16, 2016.
  4. "Hypothermia, Prevention, Recognition, Treating Hypothermia A life saving skill". www.hypothermia.org. Archived from the original on 1998-12-02. Retrieved 2016-01-17.
  5. Webb, P. (1986-02-01). "Afterdrop of body temperature during rewarming: an alternative explanation". Journal of Applied Physiology. 60 (2): 385–390. doi:10.1152/jappl.1986.60.2.385. ISSN   8750-7587. PMID   3949643.