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#107730 - 12/08/08 09:58 AM Hypothermia
midnightsun03 Offline
member

Registered: 08/06/03
Posts: 2936
Loc: Alaska
Hi y'all...

This weekend I had the opportunity to give a presentation on cold weather injuries to a large group of Boy Scout leaders and a smaller number of older scouts. I used the same slides that I used for my presentation last year, but this year I spent a great deal more time talking about hypothermia and it's prevention. The message that I really wanted to impress in their minds was that hypothermia is not so much about being exposed to cold as it is a caloric deficit.

When I participated in that hypothermia experiment last spring, what really caught my attention was that my subject began showing significant signs of mental deficits, poor decision making, and a frighteningly sudden comfort level with the extreme cold he was experiencing (he was wet, laying almost naked in the snow) and yet his core temperature had only dropped to 97.2. Technical hypothermia does not begin until the body reaches a core temperature of 95 (characterized by the "umbles", intense shivering, poor decision making), so why did our subject show signs of mild to moderate hypothermia (shivering mechanism was begining to fail, poor judgement, comfortable in the cold) when he was still so warm? The quick and easy answer is that he had shivered through his readily available muscle glycogen stores and his brain no longer had the glycogen it needed to function optimally. The caloric cost of intense shivering is 220 kCal/hr, and our guy was shivering hard for at least an hour, if not more. That is on top of the ~70kCal/hr or so he needed for his basal metabolism, and the maybe 10-15 kCal/hr he needed to warm the air he was breathing in.

So, to me, the most important take home point is that not only does the body need readily available calories to function at rest, but it also needs calories to provide warmth to the extremities (the heart is a muscle, afterall), and allow the brain to function optimally. Combine the cold with heavy winter exercise (everything you do in winter takes more energy) and you can see how the need for readily available calories (i.e. carbs) increases dramatically... i.e. you can easily double your caloric need when winter camping/hiking/snowshoeing, etc. When you don't take in enough calories, the body doesn't have the tools it needs to avoid the caloric-draining effects of the cold. Hypothermia happens when the brain stops being able to make clear decisions (i.e. move around, eat, put on more clothing, get out of the elements), and that is more dependent on calories than cold.

Bottom line... EAT! Drink too... hydration is at least as important as food.

MNS
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#107731 - 12/08/08 10:40 AM Re: Hypothermia [Re: midnightsun03]
JAK Offline
member

Registered: 03/19/04
Posts: 2569
That's very interesting Midnight. I've known for some time, from other research your post last year, that hypothermia comes sooner if you are already calorie depleted, but I think what you are saying here is that it not only comes sooner because you have less energy to stop the heat loss, but even sooner than that because the core temperature and brain temperature doesn't have to drop as far to start malfunctioning. So we should constantly asks ourselves not only is our core temperature warm enough, but also do we have enough glycogen stores and hydration level, since bonking and dehydration and hypothermia are all so closely related.

I think the other thing to keep in mind it how much of a reserve we have for what ever situation might hit us, like falling through ice, or being exposed to cold wind after hiking up a long hill, or just gradually getting cold and tired and stupid. Our short-term reserve, like within the hour, is probably a function of stuff like our glycogen levels in our muscles and liver, but also such things as how much reserve heat is stored in our outer layer of skin and our clothing, and how much moisture our clothing can absorb before it becomes saturated. Those three things are our short term heat tank. We can speed up our activity to reduce our heat loss, but ultimately its all coming out of the same tank. Sometimes you need to stop and eat and dry clothes and warm up in a sleeping bag, especially if your in really bad shape and conditions are deterirating. Other times it might be sufficient to slow down to a slow but steady trudge with enough extra layers that you are warming up but not sweating. When in doubt, especially after you discover a lapse of judgement or clear thinking or balance, its probably best to stop and eat and get warm and rest up and reassess the situation before continuing. Sometimes you have to walk a little ways to find a place to take a break, but putting on extra layers and trudging there is probably better than going in a hurry. That allows you to burn more fat and save your carbs, and even make a few carbs from muscle. If you fall through the ice or something like that it can be a little different, as you can get into a race against time. I guess in Iceland if your rowboat flips over the rule is to swim for shore as fast as you can, rather than to stay with the boat. Different strokes for different folks. I think the idea is to try and stay topped up, especially as conditions deteriorate, and always try to avoid situations that would require more effort than a stop for the night or a slow steady trudge to get yourself out of trouble when things go badly.

Just my thoughts.

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#107732 - 12/08/08 01:06 PM Re: Hypothermia [Re: JAK]
midnightsun03 Offline
member

Registered: 08/06/03
Posts: 2936
Loc: Alaska
Exactly... without adequate fuel intake you will be fighting and uphill battle in thigh deep snow against the effects of cold exposure. Obviously having appropriate clothing is important for keeping the heat in, but a 10 inch thick parka isn't going to make you warm if you aren't generating heat from the inside. And food is necessary to generate heat.

You're really up against the odds in the cold. There's always lots of emphasis on having the right equipment, but equipment isn't going to do you a hill of beans if you're energy deprived. Lots of people die of exposure with backpacks full of 'appropriate' gear strapped to their backs, and lots of knowledge and experience behind them, because they were calorie deprived before they got into the situation they thought they were trying to get away from. Hikers caught in sudden snowstorms, for example, likely aren't calorically prepared to survive unexpected cold and poor conditions.

I know we've had the discussion about how difficult it is to eat 5,000 calories or more a day, But I've gained a new appreciation for the reason why it is so important that all attempts be made to eat as much as possible. Even if you consider yourself "overweight" or at least "overfat", you still need to take in the type of calories that your body can use rapidly. Don't expect your body to suddenly decide to use your fat stores for energy, the exposure will get you before your body makes that adaptation.

MNS
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#107733 - 12/08/08 03:50 PM Re: Hypothermia [Re: midnightsun03]
Rick Offline
member

Registered: 05/10/04
Posts: 708
Loc: Ontario, Canada
Good work MNS. Keep educating folks. Sooner, rather than later, it will save a life.

Feed that engine !! <img src="/forums/images/graemlins/smile.gif" alt="" />

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#107734 - 12/08/08 07:28 PM Re: Hypothermia [Re: midnightsun03]
Tango61 Offline
member

Registered: 12/27/05
Posts: 931
Loc: East Texas Piney Woods
Hey MNS - Thanks for the work with the Scouts! I truly appreciate it. How was it received?

Per my resident expert (ie my wife the RN), "the brain rules"!
This, coming from one in the medical profession whose specialty was brain injuries. Ya'll can get together and talk shop sometime.

She also mentioned that the brain can "survive" for a while with ketones once the calories run low but not for long. I'll let her provide the technical info if you're interested.


Quote:
equipment isn't going to do you a hill of beans if you're energy deprived


What if that "equipment" IS beans, cooked and ready to eat. <img src="/forums/images/graemlins/smile.gif" alt="" />

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#107735 - 12/08/08 07:48 PM Re: Hypothermia [Re: Tango61]
midnightsun03 Offline
member

Registered: 08/06/03
Posts: 2936
Loc: Alaska
Hey Tango...

It was really well received... better than last year actually, but then this year I had the story of my poor TV fella to tell, and that had them quite enthralled. Last year I had a few people nodding off on me, but this year I only lost one or two. My session is the only "mandatory" session. I did have several people tell me they learned something new this year.

The beans will do you good if you have enough cognitive power to realize you need to eat them! I tend to forget to eat when I'm cold...

The brain will certainly survive a long time hypothermic and with low sugar... in fact cooling the body is a new preferred pre-hospital treatment for traumatic brain injury, stroke, and now post cardiac arrest patients. The question is whether the brain can make good decisions while essentially bonking. This is really the critical point... and why so many people start slipping down that slippery slope of hypothermia.

MNS
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#107736 - 12/08/08 07:52 PM Re: Hypothermia [Re: midnightsun03]
hikerduane Offline
member

Registered: 02/23/03
Posts: 2123
Loc: Meadow Valley, CA
You start getting impaired thinking? I think the decision to go out in January, with temps below zero, involve impaired thinking from the get go.:) Not that I would do that solo in CA.

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#107737 - 12/08/08 07:54 PM Re: Hypothermia [Re: midnightsun03]
Jimshaw Offline
member

Registered: 10/22/03
Posts: 3938
Loc: Bend, Oregon
Midnight

Nice work mam <img src="/forums/images/graemlins/wink.gif" alt="" />

Hey did you read about the three year old that wondered off with his two puppies? Spent a night out that droped to 17 degrees snuggled with the puppies. I'm sure the puppies were scared to death and wanted to cuddle with their pack leader. ANyway I have no details, don't know how he was clothed, but supposedly the puppies saved his life. <img src="/forums/images/graemlins/grin.gif" alt="" />
Jim <img src="/forums/images/graemlins/cool.gif" alt="" />
_________________________
These are my own opinions based on wisdom earned through many wrong decisions. Your mileage may vary.

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#107738 - 12/08/08 08:59 PM Re: Hypothermia [Re: hikerduane]
TomD Offline
Moderator

Registered: 10/30/03
Posts: 4963
Loc: Marina del Rey,CA
Quote:
You start getting impaired thinking? I think the decision to go out in January, with temps below zero, involve impaired thinking from the get go.:) Not that I would do that solo in CA.


You need to look at the wintertrekking website
www.wintertrekking.com

Those guys are out in -40C and think you're a wussy if your limit is -20C. Btw, no UL on that site.

PS. Good job Andi! Really valuable info.


Edited by TomD (12/08/08 09:00 PM)
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#107739 - 12/11/08 11:33 AM Re: Hypothermia [Re: TomD]
JAK Offline
member

Registered: 03/19/04
Posts: 2569
Funny thing was that right after making my post in this thread the other day I jogged the 3.5km down to my daughters school in -12C, -18C with wind chill, in shorts and a wool sweater, then sat and watched her play for another 30 minutes adding just a windbreaker and wool hat and wool blanket from my day pack before walking the extra 1/2 km home. I wasn't uncomfortable, but I knew it wasn't sustainable. What was interesting was how tired and sore I was the next day, not in a bad way, but you really have to get yourself in shape for winter. I think you have to give yourself time to get readjusted to the cold each winter, probably mentally as well as physically, and in terms of digestion as well. I think if you are already active and in good shape at endurance activities you can probably adapt quicker. I'm not in top shape right now, so I was overdoing it for sure. There are other adaptations that take place besides energy metabolism, like lower blood volume in winter, which I thought was interesting. I'm not sure how that plays into altitude conditioning. In some ways cold weather conditioning and altitude/endurance conditioning seem to conflict.

Bottom line is I think it makes sense to give yourself time to work back into things gradually, including cold conditioning and winter activities. Besides physilogical reconditioning, it does hurt to give yourself time to relearn the knowledge and skills. On the subconscious and automatic level also, perhaps, the brain might need some time to get back into the swing of things. Not sure. It's an interesting thought. A little shock treatment don't hurt now and then though. Everything in moderation, including moderation. <img src="/forums/images/graemlins/smile.gif" alt="" />

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#107740 - 12/11/08 07:53 PM Re: Hypothermia [Re: TomD]
hikerduane Offline
member

Registered: 02/23/03
Posts: 2123
Loc: Meadow Valley, CA
Hey Mistah Moderator man,:) my hands and feet get cold, then I am sunk. When out in the winter, especially in the morning, packing up and making breakfast, my hands get cold, because somewhere, you have to take your gloves off to stufff or roll something up, or put something away. I end up stuffing my hands down the front of my pants to warm my hands up. Slow progress, but I am able to get packed up and get home. Of course, on a lot of winter trips, all I have to do is get my snowmobile started and ride like a demon the few miles to my pickup or home, depending. I have never been out in a group setting in temps beyond the 20's, so we shoed out and were comfortable during the trip. You are right no ul on winter trips.

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#107741 - 12/11/08 08:53 PM Re: Hypothermia [Re: hikerduane]
TomD Offline
Moderator

Registered: 10/30/03
Posts: 4963
Loc: Marina del Rey,CA
No UL on trips in really cold weather-the below 0F stuff. You can UL in relatively warmer weather. The Canadians consider it UL if they aren't bringing a stove and big cotton hot tent. UL is all relative.

Tips from Wintertrekking.com:

Get some liner gloves for doing those chores or a pair of leather gloves for cooking. Don't risk melting a synthetic to your hands.

Make sure you have warm enough boots. You can hike out with cold hands, but maybe not with frozen feet.

Layering is the key in really cold weather; you need to keep dry as much as keep warm. Sweat is your enemy as much as anything else.


Edited by TomD (12/13/08 11:11 PM)
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#107742 - 12/13/08 07:14 AM Re: Hypothermia [Re: TomD]
hikerduane Offline
member

Registered: 02/23/03
Posts: 2123
Loc: Meadow Valley, CA
Since I only do a few days in the winter, I am lacking in a full line up of appropriate gear. Kinda like when first starting out bping, you use what you have. I don't have a parka, I slide by with a synthetic Golite jacket and a down vest, powder pants for hiking in and down liner pants now for sitting around camp. I have some ancient Sorel's I have had for over 25 years, nothing keeps my feet warm, except late last winter on a group trip, when I used some chemical packs in my down booties, that was nice. My liner gloves have holes in the tips from lighting my stove or stoking a fire where firewood is dry and plentiful. I visited the WinterTrekking site, small group. I need to pay more attention to lists of clothing for winter trips, then I can work on filling in my gaps.

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#107743 - 12/13/08 09:13 AM Re: Hypothermia [Re: hikerduane]
JAK Offline
member

Registered: 03/19/04
Posts: 2569
Quote:
Since I only do a few days in the winter, I am lacking in a full line up of appropriate gear. Kinda like when first starting out bping, you use what you have. I don't have a parka, I slide by with a synthetic Golite jacket and a down vest, powder pants for hiking in and down liner pants now for sitting around camp. I have some ancient Sorel's I have had for over 25 years, nothing keeps my feet warm, except late last winter on a group trip, when I used some chemical packs in my down booties, that was nice. My liner gloves have holes in the tips from lighting my stove or stoking a fire where firewood is dry and plentiful. I visited the WinterTrekking site, small group. I need to pay more attention to lists of clothing for winter trips, then I can work on filling in my gaps.
Similarly I do alot of 0F to 40F, but very little 0F to -40F. It can be tricky figuring out what to buy and what to bring in the off chance you do get -30F. You don't have to have ideal or expensive or really heavy stuff for those exceptions, but you do need to have some answers, and some practice. My answer thus far is the clothing and sleeping system that works for me down to 0degF without much fuss, plus an extra 1 pound for long wool underwear, and an extra 1 pound for a small hatchet, and alot more fuss. As the temperature drops much below 0degF I am essentially going into survival mode, which generally means a combination of slowly truding back out in all my clothing, sleeping in my sleeping bag often with much of my clothing on, and making a small fire and perhaps enhancing my shelter system in order to get warmed back up and dried back out, and lots of food. All this would need to be practiced, and even then things can go very badly. So in winter I want to be prepared to handle 3 days and nights of -30F and still be able to trudge 8-12 hours a day while doing so, and making a fire when possible and neccessary, because I want to gain and maintain a sense of how much time and energy things take and what my limits are. I do this with security, not by carrying alot of extra clothing and gear, but by doing all of this no more than a single nights rest and a 8-12 hour trudge from home. Winter trips in parallel with roads are good this way. You can also go round and round a loop. If I ever push really deep into the backcountry mid-winter, it would be after some recent training runs, and with better gear and a thicker sleeping bag. The whole system would likely be no heavier than what I do now, but it would have to be somewhat better, and more tested, myself included.

That's what I love about winter. You don't need to go as far, for it to be fun and to test yourself.

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#107744 - 12/13/08 11:41 AM Re: Hypothermia [Re: hikerduane]
TomD Offline
Moderator

Registered: 10/30/03
Posts: 4963
Loc: Marina del Rey,CA
Duane, I have collected my gear over a period of time so my kit, which is listed here in the Winter Forum somewhere wasn't put together at one time as an integrated system. I added items that I thought would fit. I think a lot of people do it that way. I now have a pretty good set of layering for temps down to below 0F, but not for really cold weather. That stuff you can see on wintertrekking.

Don't forget, Mallory and Irvine used 1920's vintage layering and a re-creation of their gear seemed to work quite well on Everest, so don't be fooled that only the latest offering of high tech gear is suitable for winter.

My next purchase would be a really warm bag.


Edited by TomD (12/13/08 11:10 PM)
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#107745 - 12/13/08 04:23 PM Re: Hypothermia [Re: TomD]
hikerduane Offline
member

Registered: 02/23/03
Posts: 2123
Loc: Meadow Valley, CA
Thank you Tom. I have had a WM Antelope SDL for eight years or so now and it has seen me thru -7F and -3F, north of Truckee at Perazzo Meadow a couple times. A few more layering options would be best, I have some heavy wool pants, which I have only used once or twice, too heavy. I have good gloves, Dachstein, and OR mitts which I really like. Clothing is my issue, I just need to check out what is being used during the cold part of the winter, on bp trips by others and write it down, so I can shop later. I have a stack of notes by my computer with weights of gear, company names and stuff. I can get by with what I have snowmobiling, but then, I have heat blowing off my engine. Another problem, I'm the kind of person who can't find the money for a $70 pair of shoes, but will buy a adult toy at many times the price of the shoes. Anyone need an old snowmobile or dirtbike?:) At least the dirtbike was made this century.

Are you a moderator or founder on Wintertrekker?

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#107746 - 12/13/08 04:53 PM Re: Hypothermia [Re: hikerduane]
northernbcr Offline
member

Registered: 05/26/08
Posts: 125
Loc: bc/yukon border area
thats kind of funny ,at least made in this century

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#107747 - 12/13/08 08:10 PM Re: Hypothermia [Re: northernbcr]
kutenay Offline
member

Registered: 10/12/04
Posts: 102
Loc: B.C. Canada
I notice that some here are into using heavier gear in winter than one might expect to find on a light bping site and Tom, at least, needs a heavier bag for colder weather.

It is not really necessary to use heavy, bulky gear in severe cold as IF you can buy the best, it iS lighter and WILL keep you warm in awful conditions. I do not have time right now to do a full list, but, have solo camped in the Kootenay mountains for nearly a week at a time, in temps. recorded to -41*F. In that very damp area, that is truely miserable cold, believe me!

I will recommend a couple of bags for Tom and anyone else interested and some pads as well. I use Evazote under my Exped 9 Deluxe or my Big Agnes Ins. Air Core and the best one I have is a "Roots" in dull black, from Canadian Tire, of all places. It is softer, wider and thicker than most and works very well under the above. I add Gossamer Gear Torsolite pads over it and then my inflatable pad. This is one place where I do believe in carrying a bit more weight to keep warm and can, as I have no fishing gear, hunting stuff or whatever with me and thus am a bit "lighter" over-all.

For a bag, the absolutely FINEST I have EVER had is my Valandre Shocking Blue, good to -15 or -20 and only THREE lbs. total weight. I also have WM, FF, ID and other bags and had an original Marmot Mtn. from Grand Junction and the Valandre beats them all. If, you want something for even colder weather, they have "expedition" models and the WM "Bison" is a fine choice, almost bought one before MEC quit stocking them.

Spending serious coin on a top bag and clothing is worth it for cold camping and being able to be comfortable without a fire is also a wise move, just in case you injure yourself and cannot collect wood. A MSR naptha stove plus Ti pot is a good thing to have for this as well.

Look into Valandre, the bags are just amazing.

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#107748 - 12/13/08 11:08 PM Re: Hypothermia [Re: kutenay]
TomD Offline
Moderator

Registered: 10/30/03
Posts: 4963
Loc: Marina del Rey,CA
Duane, No, I'm not a founder of wintertrekking. It is a Canadian site that I just found out about here actually. Rick posted the link in the thread on his hot tent. It is a really good site, the best I have seen on cold weather camping.

The articles are comprehensive, the trip reports are very detailed and the guys have posted a lot of pictures and tips. I have gotten very detailed answers to the questions I have asked. Cold weather camping (far sub zero) is all new to me, so I am just passing on what I read there.

The idea that they are camping in weather 100 degrees colder than it was today here in LA just boggles my mind. No that isn't a misprint either- +60F in LA today and the guys up North are out in
-40C/F (F & C are the same at -40 by a quirk of the math).

Thanks Kutenay. I know you love that Valandre bag. <img src="/forums/images/graemlins/grin.gif" alt="" />


Edited by TomD (12/13/08 11:13 PM)
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#107749 - 12/14/08 07:33 AM Re: Hypothermia [Re: TomD]
hikerduane Offline
member

Registered: 02/23/03
Posts: 2123
Loc: Meadow Valley, CA
Thank you Tom. I joined yesterday, then realized they don't have an area for California. I read the thread on winter boots, that went on for a bit. looks like my old Sorels are what they preferred to use. I like good gear, so what applies in Canada would work for me. My hands and feet get cold early. Ever try to pee with cold hands? You can't get a grip on the zipper to pull it down, that is the easy part, you have to pull it back up, that takes more effort.

On my really cold weather trips, I know it is cold when my nose hairs get stiff. It is at least in the low single digits then. From experience. Luckily, it only gets below zero here occasionally, then only stays that cold for a day or two. I have to camp in the Truckee area for sub zero temps. About due to go again.

Only in the low 30's here yesterday, trace of snow a little after dark last night. The woodstove feels real good this morning. Should be cold enough this next week where I will have to light my furnace to keep the pipes from freezing while I am at work next week. It's been nice to not have it going to save money. Plugged in a light bulb in my pump house to keep it warm too. I found a plug that turns on at 38, so my light isn't on all the time, in case it warms up. A good feature if used in a house, if neighbors are watching a house and a light turns on, it lerts them that there is no heat in the house.

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#107750 - 12/14/08 08:07 PM Re: Hypothermia [Re: kutenay]
thecook Offline


Registered: 10/03/08
Posts: 541
Loc: Minnesota
Kutenay, what do you use to keep your hands warm, especially for skiing? I have a pair of Steger mitts that are double layer 300 fleece under moose hide mitts and canvas upper that keep my hands warm in almost anything, but I can't use them skiing and have real problems keeping my finger tips warm when skiing. I just about froze my fingers last week out skiing at 6 degrees F.
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