WEBVTT - Ep 186 Hypothermia Part 1: How it hurts

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<v Speaker 1>The cold was so intense. One constantly found men who,

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<v Speaker 1>overcome by the cold, had been forced to drop out

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<v Speaker 1>and had fallen to the ground, too weak or too

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<v Speaker 1>numb to stand. Ought one to help them along, which

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<v Speaker 1>practically meant carrying them. They begged one to let them alone.

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<v Speaker 1>There were bivouacs all along the road, ought one to

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<v Speaker 1>take them to a campfire. Once these poor wretches fell asleep,

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<v Speaker 1>they were dead. If they resisted the craving for sleep,

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<v Speaker 1>another passerby would help them along a little farther, thus

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<v Speaker 1>prolonging their agony for a short while, but not saving them.

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<v Speaker 1>For in this condition, the drowsiness engendered by cold is

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<v Speaker 1>irresistibly strong. Sleep comes inevitably, and to sleep is to die.

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<v Speaker 1>I tried in vain to save a number of these unfortunates.

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<v Speaker 1>The only words they uttered were to beg me for

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<v Speaker 1>the love of God, to go away and let them sleep.

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<v Speaker 1>To hear them, would have thought sleep was their salvation. Unhappily,

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<v Speaker 1>it was a poor wretch's last wish. But at least

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<v Speaker 1>he ceased to suffer without pain or agony. Gratitude and

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<v Speaker 1>even a smile was imprinted on his discolored lips. What

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<v Speaker 1>I have related about the effects of extreme cold and

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<v Speaker 1>of this kind of death by freezing is based on

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<v Speaker 1>what I saw happen to thousands of individuals. The road

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<v Speaker 1>was covered with their corpses.

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<v Speaker 2>What Aaron is that from?

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<v Speaker 1>That is from Napoleon's close advisor Armand de Callancourt about

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<v Speaker 1>the retreat from Moscow. And I'll talk a little bit

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<v Speaker 1>more about it, but it is it is horrific. Yeah,

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<v Speaker 1>the words can't adequately describe. Yeah. Hi, I'm Aaron Welsh.

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<v Speaker 2>And I'm Erin on Updyke.

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<v Speaker 1>And this is this podcast will kill You.

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<v Speaker 2>Today's very uplifting episode. It's going to be about hypothermia.

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<v Speaker 1>It is about hypothermia. And it's one of two parts

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<v Speaker 1>because as we kind of were talking about hypothermia and

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<v Speaker 1>the effects of cold, and we thought, well, it's it's

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<v Speaker 1>unfair to paint cold in just one light. It's this

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<v Speaker 1>bad thing and hypothermia. So this is a two parter.

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<v Speaker 1>Part one is cold is bad and part two is

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<v Speaker 1>cold can be Good? Right?

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<v Speaker 2>Are those our titles? Because I love it. Part one

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<v Speaker 2>hypothermia cold is bad. Part two Cold is not always bad?

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<v Speaker 1>Yeah, Yeah, there's nuance even to cold. How about that?

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<v Speaker 1>I am excited. There's I feel like this is a

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<v Speaker 1>topic that we have not really I mean, I guess

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<v Speaker 1>we've done fever, but it's like so related to infection,

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<v Speaker 1>whereas this is just like what happens when your body

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<v Speaker 1>is stretched beyond its physiological lembits. I know.

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<v Speaker 2>And it's interesting because especially like, well at least you

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<v Speaker 2>live somewhere where you probably are people are seeing hypothermia

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<v Speaker 2>more than like where I live. I'm like, how come

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<v Speaker 2>we didn't choose heat stress as our first temperature because.

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<v Speaker 1>It is July. We're recording this quite early. It is July.

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<v Speaker 1>Like the heat. The heat is so strong. I am

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<v Speaker 1>in a long sleeve wool sweater with skiers on it.

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<v Speaker 1>You've got some deer also wool. Are they elk?

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<v Speaker 2>Not sure they're sweaty? You're sweat they are.

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<v Speaker 1>They're sweaty. Yeah, we are sweaty sweaters. But it also

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<v Speaker 1>was reading about hypothermia now and about the cold was

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<v Speaker 1>kind of like, oh, yeah, there is another temperature besides

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<v Speaker 1>besides heat ninety one degrees. Yeah.

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<v Speaker 2>Yeah, Well we'll get into all of it, but first,

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<v Speaker 2>it's quarantine time.

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<v Speaker 1>What are we drinking this week? The uncommon cold? I

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<v Speaker 1>mean hypothermia is I'm sure you'll have stats later. It's not.

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<v Speaker 2>Yeah, I don't many stats honestly, but it's not that.

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<v Speaker 2>It just very much depends on where you live.

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<v Speaker 1>But right right, yeah, it's not that's more uncommon than

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<v Speaker 1>the common cold. Yeah, okay, definitely, And we thought, in

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<v Speaker 1>light of the fact that cold can be bad and good,

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<v Speaker 1>we're going to do a cold blended drink, but that

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<v Speaker 1>also has heated elements into it. Spicy. Yeah, so it's

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<v Speaker 1>like have an arrow margarita.

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<v Speaker 2>Yeah, blended blended, which is not my favorite kind of margarita.

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<v Speaker 2>So if you don't want that, don't do that.

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<v Speaker 1>Yeah, you do whatever you want.

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<v Speaker 2>Listen. We'll post the full recipe on our website, this podcast,

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<v Speaker 1>You I can't bring myself to say that, but yes

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<v Speaker 1>we are.

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<v Speaker 2>I can't not say it that way. Go to the.

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<v Speaker 2>Okay, moving on, Erin, tell me about the history of hypothermia.

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<v Speaker 2>What I mean, listen, I'm assuming we've always frozen.

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<v Speaker 1>Yeah, that's true, but we'll get into a little bit

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<v Speaker 1>more of that good right after this break. Humans have

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<v Speaker 1>existed thrived, even on the farthest reaches of the Earth,

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<v Speaker 1>for tens of thousands of years.

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<v Speaker 2>True.

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<v Speaker 1>The earliest evidence of humans in the European Arctic, for example,

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<v Speaker 1>dates back forty thousand years.

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<v Speaker 2>Wow. Yeah, that's a long time.

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<v Speaker 1>There were It is a long time. There were mammoth

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<v Speaker 1>tusks with human made cuts, sliced wolf bones, stone artifacts,

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<v Speaker 1>and other animal bones with like clear human you know,

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<v Speaker 1>manipulation or whatever found above the Arctic Circle.

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<v Speaker 2>Pretty cool.

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<v Speaker 1>That means that, like only a few thousand years after

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<v Speaker 1>humans reached Europe, they just kept right on heading north.

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<v Speaker 2>Okay, why just looking for something new? I guess by amos.

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<v Speaker 1>But I feel like if you have spent a winter

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<v Speaker 1>in or close to the Arctic, it might be like

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<v Speaker 1>which you have it's cut I have. Yeah, it's a

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<v Speaker 1>natural question to ask. Even if you absolutely love the

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<v Speaker 1>winter and you long for the days to get shorter

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<v Speaker 1>so that you can break out your favorite pomp pom

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<v Speaker 1>wool hat and cozy sweaters, or even if you get

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<v Speaker 1>to see the southern or northern lights in the winter

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<v Speaker 1>and you love to snowshoe or ski, you have to

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<v Speaker 1>admit that the polar regions are not an easy place

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<v Speaker 1>to live, and they don't let you forget it. Grabbing

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<v Speaker 1>the wrong jacket before you step outside, losing a glove,

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<v Speaker 1>a window that's lost its insulating ability. These things don't

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<v Speaker 1>go unnoticed, at least not for very long. Whether immediately

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<v Speaker 1>or eventually, the cold makes itself known. It insinuates itself

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<v Speaker 1>into the nooks and crannies of your jacket, of your body,

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<v Speaker 1>the tips of noses, toes, fingers, and it settles into

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<v Speaker 1>your bones until you feel like you'll never be warm again.

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<v Speaker 2>That is the exact way that I would describe living

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<v Speaker 2>in Illinois.

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<v Speaker 1>Will I ever be warm against any like?

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<v Speaker 2>So many memories of that feeling of like your bones

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<v Speaker 2>being so cold, which I know they're not really, but

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<v Speaker 2>your bones being so cold that you don't it is

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<v Speaker 2>impossible to remember warmth.

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<v Speaker 1>Yeah, right now, it's impossible for me to remember cold,

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<v Speaker 1>even though I'm talking about it. I'm so so witty.

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<v Speaker 1>I'll have to try to remember this moment come February exactly. Yeah.

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<v Speaker 1>But I think that many of us lower latitude dwellers

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<v Speaker 1>have kind of a sense of awe, at least I

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<v Speaker 1>do for those living in the Antarctic and Arctic regions

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<v Speaker 1>of the world, because even with the warmest of jackets

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<v Speaker 1>and the most insulated of shelters, polar life exists on

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<v Speaker 1>a knife edge, where even the tiniest thing can tip

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<v Speaker 1>the scales, turning a minor mistake or a minor accident

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<v Speaker 1>into a fatal outcome. I cruised the Wikipedia page for

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<v Speaker 1>hypothermia related deaths, which is quite morbid, I know, and

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<v Speaker 1>the one thing that really stuck out to me was

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<v Speaker 1>just how easily it can happen. I went through and

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<v Speaker 1>I like read different people's stories and it was just

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<v Speaker 1>like and then on one wrong step, yeah, and that

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<v Speaker 1>was it. That was it. And how powerless you are

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<v Speaker 1>when the cold really sets in. And yet many species

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<v Speaker 1>call these polar regions their home, not just humans. Why

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<v Speaker 1>would an animal live in a place that is so brutal,

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<v Speaker 1>so unforgiving, although not all the time, as we'll see,

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<v Speaker 1>there are all sorts of reasons. Maybe it's more available, habitat,

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<v Speaker 1>less competition for resources, escape from predators, escape from parasites,

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<v Speaker 1>a combination, or something else entirely, But for this episode,

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<v Speaker 1>the why isn't as interesting to me as the how,

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<v Speaker 1>Like how can species live at the ends of the earth,

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<v Speaker 1>not just like eking out a meager existence, but flourishing

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<v Speaker 1>despite the deadly cold. Humans have innovated incredible clothing, shelter, transportation,

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<v Speaker 1>and tools to help protect from freezing temperatures, and animals

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<v Speaker 1>have evolved a vast array of strategies anatomical, physiological behavioral

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<v Speaker 1>to resist hypothermia and other harmful consequences of cold, like frostbite.

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<v Speaker 1>Would you like to learn about some of these thrilled?

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<v Speaker 1>Thrilled to learn about these one way is just to

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<v Speaker 1>avoid it. Just migrate the heck out of it. Birds.

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<v Speaker 1>Birds love this, they're big fans of the migration.

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<v Speaker 2>Yeah.

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<v Speaker 1>And some bats and you know, other things, but way

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<v Speaker 1>big for birds. Yeah. And then there's torpor, which includes

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<v Speaker 1>hibernation and dormancy. Basically, an animal just turns down the

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<v Speaker 1>dials on body temperature, activity and metabolism to get through

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<v Speaker 1>the winter. Bears, ground squirrels, bats, some frogs. And then

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<v Speaker 1>there's cold resistance, so like you keep operating mostly as

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<v Speaker 1>normal during the cold months, but you just bump up

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<v Speaker 1>your your own systems, your defense against Yeah, and that

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<v Speaker 1>would be something like arctic foxes, polar bears and so on.

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<v Speaker 1>And these strategies they're not mutually exclusive. You can have

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<v Speaker 1>a little bit of this and a little bit of that.

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<v Speaker 1>And there's also a great variation within some of these,

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<v Speaker 1>So like hibernating black bears only drop their body temperature

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<v Speaker 1>by a few degrees celsius, while some mammals, small mammals

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<v Speaker 1>drop temperatures twenty to thirty degrees celcish body temperatures. What

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<v Speaker 1>oh it gets it gets better. Wood frogs, Oh, do

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<v Speaker 1>you know about wood? Yes, I know about wood. Frogs.

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<v Speaker 1>Who does it? But no, lots of people don't. I

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<v Speaker 1>had I had to refresh my memory because the stats

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<v Speaker 1>are I was like, this can't be. I was like,

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<v Speaker 1>I need to fact check this right multiple places.

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<v Speaker 2>I love this real.

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<v Speaker 1>They're the Hall of Famers for dormancy. They survive freezing

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<v Speaker 1>temperatures below minus twenty celsius for months on end, like

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<v Speaker 1>seven months, seven merely freezing, Yeah, nearly freezing solid. Fifty

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<v Speaker 1>to sixty five percent of their body water is frozen. Wow,

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<v Speaker 1>just frozen. Yeah. These are frogs that live above the

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<v Speaker 1>Arctic circle. What what Like? I just can't get over it.

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<v Speaker 1>And then you've got the fish that avoid freezing in

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<v Speaker 1>Antarctic waters by using anti freeze proteins that let them

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<v Speaker 1>keep swimming around. Other animals like polar bears, ptarmigan wolves

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<v Speaker 1>and hares make simple burrows in the snow to help

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<v Speaker 1>with insulation.

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<v Speaker 2>Question, which is, yeah, what's a ptarmagan?

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<v Speaker 1>It's a bird? Okay, thank you. Yeah, they're really cute. Yes,

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<v Speaker 1>or sometimes they'll employ bagel formation, which is not the

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<v Speaker 1>technical term, but I love those. Okay. It's like where

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<v Speaker 1>you make yourself into a tiny ball, like a little

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<v Speaker 1>ball to trap heat like the doggies do you Yeah, okay, exactly,

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<v Speaker 1>you just tuck your little nose and you're in bagel formation.

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<v Speaker 1>Bagel formation. And then other animals that live in colonies,

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<v Speaker 1>like walruses and penguins, they'll huddle together for warmth, especially

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<v Speaker 1>baby emperor penguins.

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<v Speaker 2>Yes, they're very cute.

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<v Speaker 1>They're very cute. Thick fur and blubber help to reduce

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<v Speaker 1>heat loss, as do changes in the circulatory system or

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<v Speaker 1>even the type of hemoglobin that an animal has, So

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<v Speaker 1>like pretty cool, yeah, because of and then there's like

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<v Speaker 1>circulatory changes, so because there are these specialized changes in

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<v Speaker 1>blood flow in pawpads of Arctic wolves and foxes that

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<v Speaker 1>allows them to stand on the ground that has a

0:14:51.000 --> 0:14:54.560
<v Speaker 1>temperature of minus fifty celsius but their feet don't freeze

0:14:54.640 --> 0:14:59.960
<v Speaker 1>or become damaged. What I don't know. And then nasal cavities.

0:15:00.000 --> 0:15:02.680
<v Speaker 1>I didn't realize that, like the shape of a nasal

0:15:02.760 --> 0:15:05.320
<v Speaker 1>cavity could be so important, but it is.

0:15:05.360 --> 0:15:07.440
<v Speaker 2>I feel like I remember learning this at some point.

0:15:07.480 --> 0:15:11.280
<v Speaker 1>Tell me about it, Aaron, Okay, okay, So reindeer have

0:15:11.400 --> 0:15:15.360
<v Speaker 1>nasal cavities that warm the air before it enters the

0:15:15.400 --> 0:15:17.720
<v Speaker 1>body and it sort of like warms it and then

0:15:17.800 --> 0:15:21.800
<v Speaker 1>there's like water condensation, right, But then instead of losing

0:15:21.840 --> 0:15:27.160
<v Speaker 1>that heat and water to the environment, they also somehow

0:15:27.240 --> 0:15:30.360
<v Speaker 1>cool the air before it leaves, and so you're basically

0:15:30.400 --> 0:15:33.160
<v Speaker 1>conserving heat and water because of the way that they're

0:15:33.240 --> 0:15:39.520
<v Speaker 1>nasal cavities. Oh that's fascinating. Yeah. Babies of Arctic animals

0:15:39.520 --> 0:15:43.320
<v Speaker 1>are born well equipped with extra warm fur or feathers

0:15:43.440 --> 0:15:46.960
<v Speaker 1>or brown adipose tissue that keeps them super warm, and

0:15:47.400 --> 0:15:52.440
<v Speaker 1>mom will also often provision them with super fatty milk.

0:15:53.960 --> 0:15:57.040
<v Speaker 1>One of my go to fun facts to share at

0:15:57.080 --> 0:16:00.800
<v Speaker 1>a cocktail party is that some whale milk is so fatty,

0:16:00.880 --> 0:16:03.600
<v Speaker 1>like thirty to sixty percent fat, that it has the

0:16:03.640 --> 0:16:08.120
<v Speaker 1>consistency of toothpastete. That's one of my favorite things too. Yeah,

0:16:08.240 --> 0:16:08.800
<v Speaker 1>just I love it.

0:16:09.240 --> 0:16:11.560
<v Speaker 2>Baby whales lap it up toothpaste in the ocean.

0:16:12.560 --> 0:16:14.600
<v Speaker 1>I mean, I think it also must help with like

0:16:15.040 --> 0:16:19.640
<v Speaker 1>not just just diluting into the environment. Yeah, so they

0:16:19.680 --> 0:16:23.920
<v Speaker 1>can kind of like yeah, get it. Yeah, But for comparison,

0:16:24.040 --> 0:16:27.480
<v Speaker 1>human breast milk is like four percent fat compared to

0:16:27.520 --> 0:16:29.720
<v Speaker 1>thirty to sixty for some whales.

0:16:29.840 --> 0:16:32.640
<v Speaker 2>Like imagine the lipped cream you could make oh my, I.

0:16:32.640 --> 0:16:35.520
<v Speaker 1>Mean it's already whipped, right, it's like solid, Like, what

0:16:35.520 --> 0:16:37.280
<v Speaker 1>do you do, It's like butter, It's just butter. Yeah,

0:16:37.440 --> 0:16:43.200
<v Speaker 1>it's actually just butter. Okay, So one last fun fact

0:16:43.240 --> 0:16:46.240
<v Speaker 1>before I get to humans. One of the major challenges

0:16:46.320 --> 0:16:49.240
<v Speaker 1>with living in polar regions is food availability. It's not

0:16:49.560 --> 0:16:52.880
<v Speaker 1>always reliable, and in those times of scarcity, you're not

0:16:52.920 --> 0:16:56.440
<v Speaker 1>only expending energy trying to find food, you're also using

0:16:56.480 --> 0:17:00.320
<v Speaker 1>more energy staying warm. And some Arctic species deal with

0:17:00.360 --> 0:17:03.240
<v Speaker 1>this by cashing food. So like one arctic fox hoard

0:17:03.360 --> 0:17:07.320
<v Speaker 1>had one hundred and thirty six seabirds and then yeah.

0:17:07.320 --> 0:17:10.119
<v Speaker 2>It was just like little He's like, listen, they're frozen.

0:17:10.119 --> 0:17:12.080
<v Speaker 2>They're going to keep don't worry about it. Yeah, I

0:17:12.080 --> 0:17:14.360
<v Speaker 2>feel through the wind chest freezer.

0:17:14.680 --> 0:17:21.119
<v Speaker 1>This is my cost code. Yeah. And an ermine was

0:17:21.160 --> 0:17:23.840
<v Speaker 1>found to have hidden over one hundred and fifty lemmings

0:17:25.760 --> 0:17:26.240
<v Speaker 1>as white.

0:17:26.280 --> 0:17:27.880
<v Speaker 2>You know, I still like, I know that a lemming

0:17:27.960 --> 0:17:29.600
<v Speaker 2>is an animal, but I have no idea what they

0:17:29.600 --> 0:17:33.080
<v Speaker 2>look like. I cannot picture a lemming.

0:17:32.960 --> 0:17:35.199
<v Speaker 1>Little rodenty things. I only do you.

0:17:35.200 --> 0:17:38.760
<v Speaker 2>Remember that game the lemmings going over a cliff?

0:17:39.280 --> 0:17:41.760
<v Speaker 1>You don't remember this game? No, there was it was

0:17:42.160 --> 0:17:44.679
<v Speaker 1>on what hard on what device?

0:17:44.720 --> 0:17:48.320
<v Speaker 2>Computer computer? It was a computer game where there's I

0:17:48.320 --> 0:17:50.560
<v Speaker 2>think they were they were called lemmings, but they were

0:17:50.600 --> 0:17:54.080
<v Speaker 2>like little people looking things and they just were going.

0:17:53.840 --> 0:17:56.399
<v Speaker 1>Over a cliff. If you, oh, no, I'm going to

0:17:56.440 --> 0:18:00.000
<v Speaker 1>need to look this up. I feel great. I feel wow. Yeah.

0:18:00.080 --> 0:18:02.440
<v Speaker 1>Is it like Ski Free era? You remember that game

0:18:02.560 --> 0:18:04.720
<v Speaker 1>with the Yes?

0:18:04.960 --> 0:18:07.119
<v Speaker 2>Okay, I don't know if it was same era. I

0:18:07.160 --> 0:18:07.760
<v Speaker 2>have no idea.

0:18:07.800 --> 0:18:12.080
<v Speaker 1>Okay, sorry, we'll have to We'll have to find it.

0:18:12.240 --> 0:18:13.800
<v Speaker 2>That's what I think of when I think of vings,

0:18:13.880 --> 0:18:15.760
<v Speaker 2>and that's why I can't like picture that there's an

0:18:15.800 --> 0:18:16.920
<v Speaker 2>animal called letting.

0:18:16.880 --> 0:18:23.080
<v Speaker 1>Just pictured tiny humans just okay, I don't think they

0:18:23.160 --> 0:18:27.880
<v Speaker 1>look like miniature humans with little like gnome hats on. No,

0:18:27.960 --> 0:18:36.320
<v Speaker 1>I don't believe that they have constructed nome hats irl okay, okay.

0:18:36.359 --> 0:18:40.119
<v Speaker 1>So another besides casing food and lemmings uh not with

0:18:40.200 --> 0:18:44.560
<v Speaker 1>no mats, another approach is storing extreme amounts of fat,

0:18:44.720 --> 0:18:48.720
<v Speaker 1>so seal pups undergo something called catastrophic molting, which sounds

0:18:48.760 --> 0:18:51.480
<v Speaker 1>a lot scarier than it actually is. They just lose

0:18:51.600 --> 0:18:53.600
<v Speaker 1>all their fur at once, and then they have to

0:18:53.640 --> 0:18:56.359
<v Speaker 1>wait a while to grow back a new layer, and

0:18:56.400 --> 0:18:58.200
<v Speaker 1>so during that time they can't go in the water

0:18:58.280 --> 0:19:03.000
<v Speaker 1>for food because they'll get hypothermia, so they don't eat. Oh,

0:19:03.040 --> 0:19:06.560
<v Speaker 1>they can go fifty two days without food or water.

0:19:07.880 --> 0:19:11.080
<v Speaker 2>Wow, and that Wow, it's a really long time.

0:19:11.440 --> 0:19:14.879
<v Speaker 1>It's a really long time. And so my point with

0:19:15.000 --> 0:19:18.040
<v Speaker 1>all of this, besides being able to share with everyone

0:19:18.280 --> 0:19:20.879
<v Speaker 1>the whale milk toothpaste fun fact, so that you have

0:19:20.960 --> 0:19:23.800
<v Speaker 1>something to share at like, you know, the next round

0:19:23.880 --> 0:19:25.879
<v Speaker 1>table ice breaker type thing.

0:19:25.760 --> 0:19:28.400
<v Speaker 2>And the wood frogs icebreaker, but wood.

0:19:28.240 --> 0:19:31.200
<v Speaker 1>Frogs, my god, icebreaker would also have been a good quarantine.

0:19:31.240 --> 0:19:31.440
<v Speaker 2>Wow.

0:19:31.640 --> 0:19:37.760
<v Speaker 1>Anyway, Yeah, that animals have evolved. My whole point is

0:19:37.760 --> 0:19:40.960
<v Speaker 1>that animals have evolved an incredible array of ways to

0:19:41.040 --> 0:19:45.760
<v Speaker 1>deal with the cold, and unfortunately humans lag behind in

0:19:45.840 --> 0:19:49.400
<v Speaker 1>this respect. And so under the right set of circumstances,

0:19:50.040 --> 0:19:53.280
<v Speaker 1>our body struggles to warm itself, our temperature drops and

0:19:53.359 --> 0:19:57.479
<v Speaker 1>we slip into hypothermia, which is something that we've been

0:19:57.480 --> 0:20:00.280
<v Speaker 1>doing for as long as we've been human. So even

0:20:00.320 --> 0:20:01.879
<v Speaker 1>though I just spent a good deal of time in

0:20:01.920 --> 0:20:05.680
<v Speaker 1>the polar regions with polar animals, you can get hypothermia

0:20:05.720 --> 0:20:09.880
<v Speaker 1>anywhere on Earth. Some of the earliest references to hypothermia

0:20:09.920 --> 0:20:14.040
<v Speaker 1>come from ancient Greece, which is certainly not arctic. Hippocrates,

0:20:14.320 --> 0:20:17.560
<v Speaker 1>of course, noted the benefits of cold, but also the

0:20:17.640 --> 0:20:21.879
<v Speaker 1>dangers quote cold is bad for the bones, teeth, nerves, brain,

0:20:22.000 --> 0:20:25.600
<v Speaker 1>and the spinal cord. In four point fifty BCE, the

0:20:25.680 --> 0:20:30.399
<v Speaker 1>Greek historian Herodotus wrote about soldiers dying in a sea expedition.

0:20:30.840 --> 0:20:35.160
<v Speaker 1>Quote some were seized by these sea monsters and so perished,

0:20:35.320 --> 0:20:38.040
<v Speaker 1>while others were dashed against the rocks, and some of

0:20:38.080 --> 0:20:40.280
<v Speaker 1>them did not know how to swim, and perished for

0:20:40.359 --> 0:20:46.040
<v Speaker 1>that cause, others again by reason of cold end quote seamusters.

0:20:46.080 --> 0:20:50.720
<v Speaker 1>War has always been a bad spot for hypothermia. In fact,

0:20:50.880 --> 0:20:55.639
<v Speaker 1>most historical records of hypothermia come from various wars throughout history.

0:20:55.720 --> 0:21:00.480
<v Speaker 1>In two eighteen BCE, Hannibal's army of twelve thousand cavalry,

0:21:01.040 --> 0:21:04.800
<v Speaker 1>ninety thousand infantry, and forty elephants was cut down to

0:21:05.000 --> 0:21:09.480
<v Speaker 1>nineteen thousand men and some uncertain number of elephants during

0:21:09.520 --> 0:21:11.800
<v Speaker 1>their march over the Alps, with many of them dying

0:21:11.800 --> 0:21:18.440
<v Speaker 1>of cold. During the American Revolutionary War, countless soldiers suffered

0:21:18.480 --> 0:21:22.359
<v Speaker 1>frostbite and hypothermia, especially during the winter of seventeen seventy

0:21:22.400 --> 0:21:25.480
<v Speaker 1>seven seventeen seventy eight, when nearly a fifth of the

0:21:26.160 --> 0:21:29.680
<v Speaker 1>eleven thousand men who retreated into Valley Forge did not

0:21:29.840 --> 0:21:33.159
<v Speaker 1>have shoes or boots at all. Oh, I just imagine

0:21:33.160 --> 0:21:36.560
<v Speaker 1>that in the winter. No, I can't imagine that. And

0:21:36.600 --> 0:21:41.240
<v Speaker 1>then there's Napoleon's army, this retreat from Moscow in eighteen twelve.

0:21:41.680 --> 0:21:45.840
<v Speaker 1>So he this is like where this is infamous, and

0:21:45.840 --> 0:21:48.120
<v Speaker 1>we've talked about this in several other times of the podcast.

0:21:49.119 --> 0:21:52.359
<v Speaker 1>Napoleon and his army started out in June with nearly

0:21:52.440 --> 0:21:56.480
<v Speaker 1>half a million soldiers. By the time they had gotten

0:21:56.560 --> 0:22:00.960
<v Speaker 1>to Moscow in late fall, numbers had dwindled pretty substantially

0:22:01.000 --> 0:22:05.000
<v Speaker 1>by at least one hundred thousand. But when they arrived,

0:22:05.240 --> 0:22:10.359
<v Speaker 1>they found a burned out, abandoned city, no opportunity to restock,

0:22:10.560 --> 0:22:15.680
<v Speaker 1>to refuel, no food, nothing. The Russian forces had adopted

0:22:15.680 --> 0:22:18.240
<v Speaker 1>this like scorched earth tactic, and that would prove to

0:22:18.280 --> 0:22:21.320
<v Speaker 1>be Napoleon's downfall. So he waited around a bit just

0:22:21.320 --> 0:22:23.040
<v Speaker 1>trying to figure out what do I do here? Do

0:22:23.119 --> 0:22:23.520
<v Speaker 1>we stay?

0:22:23.560 --> 0:22:24.000
<v Speaker 2>Do we go?

0:22:24.560 --> 0:22:25.879
<v Speaker 1>And then was like, you know what, we should just

0:22:26.000 --> 0:22:28.560
<v Speaker 1>get back to France. So a retreat to France. That

0:22:28.680 --> 0:22:32.240
<v Speaker 1>was the move. The army started back in October, still

0:22:32.359 --> 0:22:35.800
<v Speaker 1>dressed in their summer uniforms, and they pushed through the

0:22:35.840 --> 0:22:39.840
<v Speaker 1>snow and ice and frozen rivers in November through December

0:22:39.880 --> 0:22:45.399
<v Speaker 1>and even into January. Count Philippe Paul de Segur, a

0:22:45.440 --> 0:22:49.439
<v Speaker 1>brigadier an aid to Napoleon, wrote, quote, Russian winter in

0:22:49.480 --> 0:22:53.160
<v Speaker 1>this new guy's attacked them on all sides. It cut

0:22:53.200 --> 0:22:56.760
<v Speaker 1>through their thin uniforms and worn shoes. Their wet clothing

0:22:56.880 --> 0:23:00.159
<v Speaker 1>froze on them, and this icy shroud molded them their

0:23:00.200 --> 0:23:03.840
<v Speaker 1>bodies and stiffen their limbs. The sharp wind made them

0:23:03.960 --> 0:23:07.040
<v Speaker 1>gasp for breath and froze the moisture from their mouths

0:23:07.040 --> 0:23:11.840
<v Speaker 1>and nostrils into icicles on their beards end. Quote. By

0:23:11.880 --> 0:23:14.640
<v Speaker 1>the time they got back to France, all that remained

0:23:14.680 --> 0:23:18.960
<v Speaker 1>of Napoleon's five hundred thousand troops was ten thousand. Oh

0:23:19.000 --> 0:23:24.640
<v Speaker 1>my gosh. Yeah, some died in battle, others from their

0:23:24.680 --> 0:23:28.040
<v Speaker 1>injuries or infections. If you remember back to our Typhus episode,

0:23:28.080 --> 0:23:32.639
<v Speaker 1>that was a major, major killer, but many succumbed to

0:23:32.680 --> 0:23:37.320
<v Speaker 1>the cold. A frost bitten and constantly water logged foot

0:23:37.480 --> 0:23:40.200
<v Speaker 1>turned gangrenous with the infections spreading to the rest of

0:23:40.240 --> 0:23:43.879
<v Speaker 1>the body. A raid on a liquor store allegedly killed

0:23:43.880 --> 0:23:46.879
<v Speaker 1>eight hundred soldiers who imbibed a bit too much and

0:23:46.920 --> 0:23:49.320
<v Speaker 1>fell asleep in the snow. At the time, it was

0:23:49.359 --> 0:23:52.199
<v Speaker 1>thought that alcohol was warming and helped stave off the

0:23:52.240 --> 0:23:54.919
<v Speaker 1>negative effects of the cold, although I'm not sure they

0:23:54.960 --> 0:23:58.119
<v Speaker 1>were drinking it as medicine. And by the way, it

0:23:58.200 --> 0:24:01.400
<v Speaker 1>is not warming. It is not what you should use

0:24:01.520 --> 0:24:03.920
<v Speaker 1>to treat someone suffering from hypodermy.

0:24:03.960 --> 0:24:06.919
<v Speaker 2>Alcohol actually can can There's actually thought that not just

0:24:07.000 --> 0:24:10.600
<v Speaker 2>the risk of you know, drowsiness or falling asleep or

0:24:10.960 --> 0:24:13.560
<v Speaker 2>you know, making decisions about what clothes you might wear

0:24:13.680 --> 0:24:15.720
<v Speaker 2>that are impaired because of the effects of alcohol, there's

0:24:15.760 --> 0:24:18.480
<v Speaker 2>actually thought that the alcohol, the effects of alcohol itself

0:24:18.840 --> 0:24:21.199
<v Speaker 2>also contribute to hypothermia.

0:24:21.440 --> 0:24:25.480
<v Speaker 1>Yeah, so more heat loss exactly, yeah, yeah, yeah yeah.

0:24:25.640 --> 0:24:28.879
<v Speaker 1>And then there was also just poor nutrition and grueling

0:24:28.920 --> 0:24:32.160
<v Speaker 1>conditions that took many others just after they drifted off

0:24:32.200 --> 0:24:36.399
<v Speaker 1>to sleep. One of Napoleon's surgeons wrote quote, the first

0:24:36.440 --> 0:24:40.240
<v Speaker 1>hours of sleep offered deceptive delight, precursor to the grave

0:24:40.320 --> 0:24:43.760
<v Speaker 1>that yawned for them. Far from finding safety in the

0:24:43.800 --> 0:24:47.080
<v Speaker 1>sweets of sleep, they were seized and benumbed by cold,

0:24:47.440 --> 0:24:50.560
<v Speaker 1>and never saw daylight. More along the road, in the

0:24:50.600 --> 0:24:54.680
<v Speaker 1>neighboring ditches of fields were perceived human carcasses, heaped up

0:24:54.760 --> 0:24:59.000
<v Speaker 1>and lying at random in fives, then fifteens, and twenties

0:24:59.640 --> 0:25:04.280
<v Speaker 1>of as had perished during the night end quote. No

0:25:04.320 --> 0:25:07.120
<v Speaker 1>one was spared, not even the surgeons, who wrote how

0:25:07.160 --> 0:25:09.760
<v Speaker 1>their brains had become so dulled by the cold that

0:25:09.800 --> 0:25:14.639
<v Speaker 1>they could barely recognize one another. So many dyed or

0:25:14.720 --> 0:25:17.840
<v Speaker 1>suffered permanent injuries from the cold on this retreat, not

0:25:17.960 --> 0:25:22.000
<v Speaker 1>just because of poor quality clothing and shoes or insufficient food,

0:25:22.359 --> 0:25:25.160
<v Speaker 1>but also because no one really knew how to treat

0:25:25.280 --> 0:25:31.159
<v Speaker 1>hypothermia or frostbite. Those words didn't even exist yet, a

0:25:31.200 --> 0:25:37.520
<v Speaker 1>practical thermometer that could be used clinically was still decades away. Instead,

0:25:37.720 --> 0:25:40.400
<v Speaker 1>the effects of cold were kind of grouped together under

0:25:40.440 --> 0:25:45.800
<v Speaker 1>the term asphyxia, partial asphyxia usually referring to frostbite, and

0:25:45.880 --> 0:25:50.160
<v Speaker 1>general asphyxia referring to hypothermia. Interesting, these were diagnosed from

0:25:50.200 --> 0:25:53.879
<v Speaker 1>like subjective observation, so it was thought that like basically

0:25:53.920 --> 0:25:58.879
<v Speaker 1>there was congealing in your body, fluids were congealing and

0:25:58.920 --> 0:26:01.760
<v Speaker 1>blood in start at the at the extremity, right at

0:26:01.760 --> 0:26:04.760
<v Speaker 1>your flick fingertips and nose, and then yeah, and then

0:26:04.800 --> 0:26:07.359
<v Speaker 1>as it grew your whole if you're so, that was

0:26:07.359 --> 0:26:10.200
<v Speaker 1>like frostbite, so you're like, okay, there's no it's all congealed.

0:26:10.240 --> 0:26:14.320
<v Speaker 1>And then then hypothermia it was like your whole body.

0:26:14.680 --> 0:26:20.240
<v Speaker 1>It's not that far off. Yeah, yeah, I say, yeah

0:26:20.280 --> 0:26:22.639
<v Speaker 1>and so. But because of this, treatment usually took the

0:26:22.680 --> 0:26:26.520
<v Speaker 1>form of slowly rewarming to get everything to re liquefy,

0:26:26.760 --> 0:26:28.679
<v Speaker 1>and you were supposed to start in reverse. So you

0:26:28.680 --> 0:26:33.440
<v Speaker 1>start with snow, rubbing snow on your you know, frostbitten fingers,

0:26:34.080 --> 0:26:37.080
<v Speaker 1>and then yeah, and then cold water and then cool water,

0:26:37.160 --> 0:26:40.399
<v Speaker 1>then tepid water. You get the really okay, interesting go

0:26:40.560 --> 0:26:43.960
<v Speaker 1>slow yeah. Earlier physicians had learned their lesson the hard

0:26:43.960 --> 0:26:48.600
<v Speaker 1>way not to use extreme heat, and revival efforts were

0:26:48.640 --> 0:26:52.480
<v Speaker 1>occasionally successful during Napoleon's retreat, but they often weren't even

0:26:52.520 --> 0:26:57.080
<v Speaker 1>attempted if someone looked dead, and it wasn't widely known

0:26:57.080 --> 0:26:59.400
<v Speaker 1>at the time how many of the signs of hypothermia,

0:26:59.600 --> 0:27:03.840
<v Speaker 1>signs that mimicked death could be reversed. One of the surgeons,

0:27:03.960 --> 0:27:07.719
<v Speaker 1>later learning of this, wrote quote how many resurrections might

0:27:07.760 --> 0:27:11.639
<v Speaker 1>have been made on the retreat from Moscow, probably lots,

0:27:13.280 --> 0:27:17.080
<v Speaker 1>and as later, medical advancements in the late nineteenth but

0:27:17.240 --> 0:27:20.680
<v Speaker 1>especially the first half of the twentieth century revealed hypothermia

0:27:20.760 --> 0:27:23.800
<v Speaker 1>did not always carry with it a death sentence, and

0:27:23.920 --> 0:27:28.440
<v Speaker 1>doctors could more readily measure temperature thresholds beyond which recovery

0:27:28.560 --> 0:27:32.640
<v Speaker 1>was unlikely. And as the term hypothermia came into more

0:27:32.800 --> 0:27:35.919
<v Speaker 1>usage in the first decades of the twentieth century and

0:27:36.000 --> 0:27:41.120
<v Speaker 1>it became a distinct clinical entity, focused interest in prevention

0:27:41.400 --> 0:27:45.200
<v Speaker 1>and treatment of the condition increased, especially during World War Two.

0:27:46.080 --> 0:27:48.800
<v Speaker 1>So I don't know when exactly I tried to find

0:27:48.880 --> 0:27:51.760
<v Speaker 1>when exactly the phrase you're not dead until you're warm

0:27:51.760 --> 0:27:54.960
<v Speaker 1>and dead you originated. Yeah, but it was likely in

0:27:55.000 --> 0:27:58.119
<v Speaker 1>the last few decades of the twentieth century, showing the

0:27:58.240 --> 0:28:02.159
<v Speaker 1>huge amount of progress made understanding hypothermia and reversing it.

0:28:03.160 --> 0:28:05.160
<v Speaker 1>And so before I turn it over to you, Aaron,

0:28:05.200 --> 0:28:07.840
<v Speaker 1>to tell us what exactly is happening when our body

0:28:07.840 --> 0:28:11.640
<v Speaker 1>temperature dropped to dangerous levels and what we do about it,

0:28:11.800 --> 0:28:14.200
<v Speaker 1>I want to end with one of the most amazing

0:28:14.480 --> 0:28:18.239
<v Speaker 1>hypothermia revival stories that shows just how far we've come. Oh,

0:28:18.280 --> 0:28:21.760
<v Speaker 1>I love it. Like Napoleon's surgeon's minds would have been

0:28:21.800 --> 0:28:26.200
<v Speaker 1>absolutely blown by learning of this story. Okay. In nineteen

0:28:26.280 --> 0:28:29.720
<v Speaker 1>ninety nine, a twenty nine year old Swedish woman named

0:28:29.720 --> 0:28:33.000
<v Speaker 1>Anna moved to a small town in northern Norway in

0:28:33.040 --> 0:28:37.600
<v Speaker 1>the Arctic Circle to complete her medical residency or above

0:28:37.640 --> 0:28:39.680
<v Speaker 1>the Arctic Circle, and part of the reason that she

0:28:39.800 --> 0:28:42.080
<v Speaker 1>chose this location was because she was an avid and

0:28:42.240 --> 0:28:46.320
<v Speaker 1>very experienced backcountry skier. In May, she and a couple

0:28:46.360 --> 0:28:49.800
<v Speaker 1>friends who also had medical training, went out skiing for

0:28:49.840 --> 0:28:53.920
<v Speaker 1>the day. At six twenty pm, Anna or Anna maybe

0:28:54.120 --> 0:28:57.560
<v Speaker 1>lost her balance and fell headfirst into a waterfall gully,

0:28:58.080 --> 0:29:01.280
<v Speaker 1>where she became wedged in the ice and water. Her

0:29:01.280 --> 0:29:04.360
<v Speaker 1>friends couldn't get her out. They tried to pull her out,

0:29:04.360 --> 0:29:06.880
<v Speaker 1>and they couldn't get to her, and so they called

0:29:06.880 --> 0:29:10.760
<v Speaker 1>for help, and unfortunately help was slow to arrive. The

0:29:10.800 --> 0:29:14.040
<v Speaker 1>only rescue helicopter available was on its way to transport

0:29:14.080 --> 0:29:18.120
<v Speaker 1>a sick child, which was in the other direction from Anna.

0:29:18.400 --> 0:29:22.240
<v Speaker 1>At seven pm, she stopped moving those forty minutes in

0:29:22.320 --> 0:29:25.760
<v Speaker 1>the ice. At seven point forty a ground rescue team

0:29:25.880 --> 0:29:29.680
<v Speaker 1>arrived and extracted her from the ice. She was clinically dead.

0:29:30.520 --> 0:29:33.640
<v Speaker 1>The helicopter arrived around eight pm and she was loaded

0:29:33.640 --> 0:29:36.400
<v Speaker 1>onto it for transport to Tromso Hospital, which is about

0:29:36.400 --> 0:29:40.360
<v Speaker 1>an hour's flight away, and with the adage you're not

0:29:40.440 --> 0:29:44.080
<v Speaker 1>dead until you're warm and dead in mind, resuscitation efforts

0:29:44.080 --> 0:29:47.800
<v Speaker 1>were started in transit and continued along with rewarming at

0:29:47.800 --> 0:29:50.800
<v Speaker 1>the hospital. When she got there, doctors found that she

0:29:50.880 --> 0:29:54.800
<v Speaker 1>was not breathing, She had no pulse, her pupils were

0:29:55.080 --> 0:29:59.360
<v Speaker 1>widely dilated and unresponsive to light. Her EEG was flatline.

0:30:00.120 --> 0:30:03.800
<v Speaker 1>Nurses and doctors continued their chest compressions in ventilation as

0:30:03.800 --> 0:30:05.640
<v Speaker 1>they prepped to put her on a heart lung machine.

0:30:06.560 --> 0:30:09.040
<v Speaker 1>At nine fifty two pm, so this is three and

0:30:09.080 --> 0:30:12.080
<v Speaker 1>a half hours after she went into the ice, her temperature,

0:30:12.080 --> 0:30:15.760
<v Speaker 1>her body temperature was measured at thirteen point seven degrees

0:30:15.800 --> 0:30:21.600
<v Speaker 1>celsius or fifty six point six degrees fahrenheit. Wow. At

0:30:21.600 --> 0:30:26.360
<v Speaker 1>that point, yeah, she'd been three hours without a heartbeat.

0:30:27.880 --> 0:30:31.120
<v Speaker 1>But then at I guess I kind of spoiled it

0:30:31.120 --> 0:30:33.440
<v Speaker 1>at the beginning by saying revival story, but I mean,

0:30:33.480 --> 0:30:36.640
<v Speaker 1>you know where this is going. But then at ten

0:30:36.800 --> 0:30:41.720
<v Speaker 1>fifteen pm something on the monitor a heart beat, then another,

0:30:42.280 --> 0:30:45.200
<v Speaker 1>then a steady rhythm. She woke up ten days later

0:30:45.280 --> 0:30:47.960
<v Speaker 1>and spent another couple of weeks in the intensive carry unit,

0:30:48.640 --> 0:30:51.960
<v Speaker 1>and initially she showed signs of paralysis below the neck

0:30:52.080 --> 0:30:55.840
<v Speaker 1>and struggled with various organ dysfunctions, but over time she

0:30:56.240 --> 0:30:59.920
<v Speaker 1>made an almost complete recovery. After five months she was

0:31:00.120 --> 0:31:05.200
<v Speaker 1>like basically back to normal, back to skiing. It's an

0:31:05.200 --> 0:31:09.360
<v Speaker 1>amazing story that shows what both the human body and

0:31:09.600 --> 0:31:14.200
<v Speaker 1>modern medicine are capable of. And that being said, every

0:31:14.360 --> 0:31:17.720
<v Speaker 1>year many people, especially those who are unhoused or struggle

0:31:17.800 --> 0:31:20.040
<v Speaker 1>to keep their homes warm in the winter who can't

0:31:20.080 --> 0:31:23.880
<v Speaker 1>afford to do so, die of hypothermia. And most of

0:31:23.920 --> 0:31:28.640
<v Speaker 1>these deaths are they represent a failure not of modern

0:31:28.680 --> 0:31:31.640
<v Speaker 1>medicine but of our society in providing a safety net

0:31:31.680 --> 0:31:36.280
<v Speaker 1>to prevent death in this way, because like stories like

0:31:36.320 --> 0:31:41.280
<v Speaker 1>Annas show us, it is possible, and it can sometimes

0:31:41.320 --> 0:31:43.400
<v Speaker 1>be reversed. But in a lot of these cases it

0:31:43.440 --> 0:31:47.880
<v Speaker 1>should never have happened in the first place. Yeah, but

0:31:47.920 --> 0:31:50.880
<v Speaker 1>now Erin, I'll turn it over to you to tell

0:31:50.880 --> 0:31:54.720
<v Speaker 1>me more about how we deal with hypothermia today. I

0:31:54.760 --> 0:31:55.640
<v Speaker 1>would love to.

0:32:25.080 --> 0:32:27.080
<v Speaker 2>You mentioned at the top erin the last time that

0:32:27.120 --> 0:32:30.720
<v Speaker 2>we talked about human body temperature was in relation to fevers,

0:32:31.800 --> 0:32:34.760
<v Speaker 2>and we learned in that episode, and maybe everyone forgotten.

0:32:34.840 --> 0:32:37.760
<v Speaker 2>That's fine, I'm gonna tell you again. But we learned

0:32:37.800 --> 0:32:43.120
<v Speaker 2>that a fever is what happens when our temperature set

0:32:43.240 --> 0:32:51.200
<v Speaker 2>point gets moved. Right. Our brain, specifically our hypothalamus controls

0:32:51.240 --> 0:32:53.840
<v Speaker 2>our temperature set point, and so a fever is what

0:32:53.880 --> 0:32:57.720
<v Speaker 2>happens when our hypothalamis is like, we need to get hotter, right,

0:32:58.960 --> 0:33:03.320
<v Speaker 2>But most of the time, outside of a fever, we

0:33:03.600 --> 0:33:08.200
<v Speaker 2>as humans seek to exist at about thirty seven degrees

0:33:08.320 --> 0:33:13.640
<v Speaker 2>celsius ninety six or so fahrenheit, right, And that is

0:33:13.960 --> 0:33:20.160
<v Speaker 2>that particular temperature is what our body is constantly maintaining.

0:33:21.160 --> 0:33:25.240
<v Speaker 2>And because we are endotherms like all mammals, we maintain

0:33:25.520 --> 0:33:30.040
<v Speaker 2>this temperature by physiologic mechanisms within our own body.

0:33:30.120 --> 0:33:30.320
<v Speaker 1>Right.

0:33:30.400 --> 0:33:33.320
<v Speaker 2>We don't rely on the sun or our environment to

0:33:33.480 --> 0:33:38.400
<v Speaker 2>warm us or cool us, right I. And all of this, like,

0:33:38.440 --> 0:33:41.400
<v Speaker 2>all of these processes are basically coordinated in our brain

0:33:41.440 --> 0:33:44.800
<v Speaker 2>by our hypothalmis because this is controlling our temperature set point.

0:33:45.440 --> 0:33:49.320
<v Speaker 2>So hypothermia is like the easiest way to look at

0:33:49.360 --> 0:33:52.680
<v Speaker 2>it is just that this is what happens when we

0:33:52.880 --> 0:33:57.680
<v Speaker 2>can no longer do that, when all of the mechanisms

0:33:57.720 --> 0:34:01.400
<v Speaker 2>that we have to keep our bodies warm and at

0:34:01.400 --> 0:34:07.120
<v Speaker 2>the right temperature fail us. And that happens mostly when

0:34:07.160 --> 0:34:11.960
<v Speaker 2>the environment is either just way too cold or it's

0:34:12.040 --> 0:34:15.319
<v Speaker 2>just a little cold but for way too long for

0:34:15.440 --> 0:34:19.080
<v Speaker 2>us to generate enough heat via our metabolism and all

0:34:19.120 --> 0:34:23.000
<v Speaker 2>the things going on inside of our bodies, okay, and

0:34:23.200 --> 0:34:25.680
<v Speaker 2>the external trappings that we use of course as humans,

0:34:26.760 --> 0:34:30.440
<v Speaker 2>so we can pretty well maintain our body at a

0:34:30.520 --> 0:34:33.520
<v Speaker 2>constant temperature without our bodies having to work very hard

0:34:33.640 --> 0:34:36.759
<v Speaker 2>to do it, even if we were totally naked. If

0:34:36.840 --> 0:34:40.319
<v Speaker 2>we exist between like twenty five and thirty celsius, which

0:34:40.360 --> 0:34:43.719
<v Speaker 2>is like seventy seven to eighty six fahrenheit, that's our

0:34:44.000 --> 0:34:48.520
<v Speaker 2>like thermoneutral zone. Once you get above this or below this,

0:34:49.280 --> 0:34:51.040
<v Speaker 2>our bodies are going to have to work harder to

0:34:51.080 --> 0:34:55.600
<v Speaker 2>maintain our temperature. Now, that's seventy seven fahrenheit twenty five celsius.

0:34:55.960 --> 0:35:00.000
<v Speaker 2>That's not cold, no, it's quite warm, it's quite warm.

0:35:00.640 --> 0:35:04.880
<v Speaker 2>But below around that temperature means that our body is

0:35:04.920 --> 0:35:09.600
<v Speaker 2>having to do something to generate heat. Right if you were,

0:35:09.680 --> 0:35:12.279
<v Speaker 2>if you were totally naked like, but we're off if

0:35:12.320 --> 0:35:16.200
<v Speaker 2>you were totally naked those onto So that's that's behavioral adaptations.

0:35:16.800 --> 0:35:19.200
<v Speaker 2>So what I want to talk about is less about

0:35:19.239 --> 0:35:22.120
<v Speaker 2>the behavioral adaptations because those are obviously important, But I'm

0:35:22.120 --> 0:35:24.719
<v Speaker 2>really going to focus on our bodies. How do we

0:35:24.800 --> 0:35:27.960
<v Speaker 2>typically deal with temperature stressors? What are we doing inside

0:35:27.960 --> 0:35:31.440
<v Speaker 2>of our body to generate heat when we're exposed to cold,

0:35:32.040 --> 0:35:34.840
<v Speaker 2>so that then we can understand what happens once those

0:35:34.960 --> 0:35:39.080
<v Speaker 2>start to fail us. And then next week we're going

0:35:39.120 --> 0:35:42.000
<v Speaker 2>to talk about kind of building off of that story

0:35:42.000 --> 0:35:44.960
<v Speaker 2>that you told Aarin and what we know about what

0:35:45.160 --> 0:35:49.000
<v Speaker 2>cold does to our bodies once it kicks in, and

0:35:49.080 --> 0:35:51.680
<v Speaker 2>the ways that people have thought to maybe use this

0:35:51.920 --> 0:35:54.840
<v Speaker 2>to their advantage to treat various conditions.

0:35:55.640 --> 0:35:57.880
<v Speaker 1>Harness one of nature's elements.

0:35:57.920 --> 0:36:03.360
<v Speaker 2>Ooh good, that's a good one. Okay, So two big

0:36:03.400 --> 0:36:07.440
<v Speaker 2>body compartments to think about when we think about temperature management.

0:36:08.040 --> 0:36:11.120
<v Speaker 2>We have our core body, which is our brain and

0:36:11.160 --> 0:36:14.040
<v Speaker 2>our internal organs, and then we have all the rest

0:36:14.080 --> 0:36:16.440
<v Speaker 2>of it, or our peripheral body that's our skin, our

0:36:16.480 --> 0:36:20.880
<v Speaker 2>subcutaneous tissue, our fat, our limbs. It's not the important stuff,

0:36:21.040 --> 0:36:24.120
<v Speaker 2>right when you think about your body existing.

0:36:24.920 --> 0:36:27.439
<v Speaker 1>Yeah, I mean, you can lose a pinky, but if

0:36:27.520 --> 0:36:30.920
<v Speaker 1>your heart freezes, you're done the devastation.

0:36:31.160 --> 0:36:33.719
<v Speaker 2>Yeah, exactly, and so and our body knows this, and

0:36:33.760 --> 0:36:38.920
<v Speaker 2>our hypothalamis knows this, and so because our hypothalamis knows this,

0:36:39.239 --> 0:36:44.600
<v Speaker 2>our body regulates our temperature by regulating heat loss and

0:36:45.160 --> 0:36:48.520
<v Speaker 2>essentially kind of sacrificing the things that are less important

0:36:48.960 --> 0:36:54.919
<v Speaker 2>as well as finding ways to keep heat in the

0:36:54.920 --> 0:36:58.880
<v Speaker 2>core of our bodies. Okay, to keep our internal organs warm.

0:36:59.400 --> 0:37:01.440
<v Speaker 2>So one of the the first things that our body

0:37:01.520 --> 0:37:05.560
<v Speaker 2>does in order to keep our core warm is vaso

0:37:05.760 --> 0:37:11.160
<v Speaker 2>constriction of peripheral veins and arteries in our skin. And

0:37:11.200 --> 0:37:14.200
<v Speaker 2>what that does is it keeps our blood, which is

0:37:14.280 --> 0:37:16.680
<v Speaker 2>warm in our deeper circulation.

0:37:17.960 --> 0:37:18.719
<v Speaker 1>This is going to.

0:37:18.719 --> 0:37:21.879
<v Speaker 2>Reduce the amount of heat loss from all of our

0:37:21.920 --> 0:37:25.279
<v Speaker 2>surface area of our skin, right. It's also going to

0:37:25.320 --> 0:37:29.320
<v Speaker 2>reduce the temperature of our skin and our extremities, which

0:37:29.760 --> 0:37:31.319
<v Speaker 2>can lead to frostbite.

0:37:31.800 --> 0:37:32.200
<v Speaker 1>Yes.

0:37:32.239 --> 0:37:35.719
<v Speaker 2>Ah, So I quick detour before we talk about hypothermia

0:37:35.760 --> 0:37:39.880
<v Speaker 2>itself to talk about frostbite, which you can kind of

0:37:39.920 --> 0:37:45.640
<v Speaker 2>think of as like extreme localized hypothermia. So frostbite is

0:37:45.640 --> 0:37:50.279
<v Speaker 2>when you get tissue injury that's due really to freezing itself,

0:37:50.360 --> 0:37:52.279
<v Speaker 2>and so frostbite you do tend to have to be

0:37:52.520 --> 0:37:56.680
<v Speaker 2>in pretty cold conditions rather than the more mild conditions

0:37:56.680 --> 0:38:00.160
<v Speaker 2>where you could still get hypothermia but without frostbite.

0:38:00.320 --> 0:38:05.440
<v Speaker 1>Like water versus snow, I mean, yes and no.

0:38:05.680 --> 0:38:08.399
<v Speaker 2>Snow is like, if you're in a snowy environment, it's

0:38:08.480 --> 0:38:10.640
<v Speaker 2>very likely that the air temperature and the wind chill

0:38:10.719 --> 0:38:13.759
<v Speaker 2>and the snow itself is below freezing. So in some

0:38:13.800 --> 0:38:16.720
<v Speaker 2>cases you might be even more likely to get frost

0:38:16.760 --> 0:38:21.560
<v Speaker 2>bite in those scenarios. In water, you could still get

0:38:21.920 --> 0:38:27.000
<v Speaker 2>like freezing if the water was cold enough, But it's

0:38:27.200 --> 0:38:30.400
<v Speaker 2>very easy to get totally hypothermic in the water because

0:38:30.440 --> 0:38:33.000
<v Speaker 2>you lose heat so much more rapidly in water because

0:38:33.000 --> 0:38:35.840
<v Speaker 2>it's a really good conductor of heat just deals right

0:38:35.840 --> 0:38:36.560
<v Speaker 2>away from us.

0:38:36.920 --> 0:38:40.319
<v Speaker 1>So like snow, you would get frost bite first and

0:38:40.360 --> 0:38:42.040
<v Speaker 1>then hypothermia.

0:38:41.360 --> 0:38:43.759
<v Speaker 2>Potentially, yeah, potentially, whereas.

0:38:43.640 --> 0:38:46.080
<v Speaker 1>Water you're gonna get hypothermia first.

0:38:46.160 --> 0:38:46.319
<v Speaker 2>Yeah.

0:38:46.360 --> 0:38:47.839
<v Speaker 1>Yeah, Yeah, that's a good way to think about it.

0:38:48.280 --> 0:38:48.680
<v Speaker 1>Love it.

0:38:49.320 --> 0:38:51.759
<v Speaker 2>I was confused and thought you meant the opposite, but

0:38:51.840 --> 0:38:57.400
<v Speaker 2>that totally makes your sense there, So yes, and the

0:38:57.440 --> 0:39:02.120
<v Speaker 2>degree of damage really varies. Right, you have degrees of frostbite.

0:39:02.160 --> 0:39:04.880
<v Speaker 2>The first degree you might just have kind of redness

0:39:04.880 --> 0:39:08.240
<v Speaker 2>of the area. It might progress to kind of a white,

0:39:08.239 --> 0:39:12.400
<v Speaker 2>almost waxy skin or blister formation. And then of course

0:39:12.440 --> 0:39:16.000
<v Speaker 2>the most severe, which is considered grade four, is black

0:39:16.120 --> 0:39:20.040
<v Speaker 2>or necrotic tissue, where your entire tissue just dies.

0:39:20.880 --> 0:39:22.239
<v Speaker 1>Yeah, and all of this is.

0:39:22.200 --> 0:39:26.200
<v Speaker 2>Going to depend on how long you're exposed and to

0:39:26.280 --> 0:39:30.400
<v Speaker 2>what degree of temperature you're exposed to, right, And the

0:39:30.520 --> 0:39:35.040
<v Speaker 2>damage that you get is due to this vaso constriction itself. Right,

0:39:35.680 --> 0:39:38.480
<v Speaker 2>It's also due to the effects of that cold on

0:39:38.560 --> 0:39:40.840
<v Speaker 2>our blood because our blood. You mentioned this in the

0:39:41.200 --> 0:39:43.799
<v Speaker 2>like what people thought happened to your blood way back,

0:39:43.800 --> 0:39:47.719
<v Speaker 2>when they're not wrong. Our blood actually becomes thicker and

0:39:47.800 --> 0:39:51.319
<v Speaker 2>kind of sludgy when it gets that cold. And then

0:39:51.360 --> 0:39:53.400
<v Speaker 2>you can also get blood clots in some of your

0:39:53.400 --> 0:39:57.000
<v Speaker 2>small vessels, which might lead to more damage due to

0:39:57.040 --> 0:40:00.440
<v Speaker 2>lack of blood flow there. And because of the actually

0:40:00.560 --> 0:40:05.080
<v Speaker 2>freezing itself, the extracellular water freezes and that ice crystal

0:40:05.120 --> 0:40:09.760
<v Speaker 2>formation can cause direct tissue damage. Right, So it's very multifactorial.

0:40:11.000 --> 0:40:16.360
<v Speaker 2>And in terms of treatment for frostbite, the treatment is

0:40:16.400 --> 0:40:19.560
<v Speaker 2>to rewarm that area to try and increase blood flow

0:40:19.600 --> 0:40:24.640
<v Speaker 2>to that area, But as likely happened during Napoleon's army,

0:40:24.719 --> 0:40:28.759
<v Speaker 2>if there is a risk that things will refreeze, you

0:40:28.840 --> 0:40:33.520
<v Speaker 2>cannot start to rewarm because freezing and then warming and

0:40:33.520 --> 0:40:37.439
<v Speaker 2>then refreezing actually causes significantly more damage.

0:40:37.760 --> 0:40:40.799
<v Speaker 1>So is there a point, like, because you talked about

0:40:40.840 --> 0:40:44.480
<v Speaker 1>the stages where there's red and then there's white, and

0:40:44.520 --> 0:40:49.719
<v Speaker 1>then there's black tissue, Yeah, like necrotic, I guess is

0:40:49.719 --> 0:40:51.960
<v Speaker 1>there a point at which the point of no return?

0:40:52.000 --> 0:40:56.400
<v Speaker 1>I'm guessing is when there's necrotic tissue, there is there nerve.

0:40:57.400 --> 0:41:00.800
<v Speaker 1>Can you regain nerve sensation when it's when the tissue

0:41:00.800 --> 0:41:04.440
<v Speaker 1>becomes like whitened or it depends? It totally depends.

0:41:04.680 --> 0:41:07.239
<v Speaker 2>Yeah, so you can obviously, like if it progresses all

0:41:07.239 --> 0:41:09.680
<v Speaker 2>the way to the tissue completely dying, that's when you

0:41:09.760 --> 0:41:12.600
<v Speaker 2>might lose limbs, or lose fingers or lose the tips

0:41:12.640 --> 0:41:15.919
<v Speaker 2>of noses, right where even after rewarming, that tissue will

0:41:15.920 --> 0:41:19.000
<v Speaker 2>not come back to life. Prior to that though, even

0:41:19.120 --> 0:41:21.960
<v Speaker 2>if the tissue itself can be saved, there can absolutely

0:41:22.000 --> 0:41:25.239
<v Speaker 2>be permanent nerve damage and things like that. It just

0:41:25.400 --> 0:41:33.520
<v Speaker 2>it totally depends on the specific scenario. So that's frostpine done. Well,

0:41:33.600 --> 0:41:37.200
<v Speaker 2>let's keep talking about cold, Okay. All we've said so

0:41:37.280 --> 0:41:41.520
<v Speaker 2>far is that we start with vasoconstriction in our peripheral

0:41:42.080 --> 0:41:46.240
<v Speaker 2>tissues and in our blood vessels. Sometimes that's not enough

0:41:46.480 --> 0:41:50.200
<v Speaker 2>to maintain heat. So the next thing that our body

0:41:50.239 --> 0:41:53.920
<v Speaker 2>does is to increase the production of heat inside of

0:41:53.920 --> 0:41:56.520
<v Speaker 2>our bodies. Yeah, and there's two main ways that we

0:41:56.600 --> 0:42:01.239
<v Speaker 2>do that. One is shivering, so our skeletal muscle activity

0:42:01.680 --> 0:42:04.960
<v Speaker 2>involuntarily starts to shiver and you have these repeated contractions

0:42:05.280 --> 0:42:09.480
<v Speaker 2>and that increases metabolism, and so that increases heat production.

0:42:11.440 --> 0:42:14.920
<v Speaker 2>But the downside of that is that it utilizes a

0:42:14.960 --> 0:42:18.799
<v Speaker 2>lot of energy, right, Yeah, it's costly, it's costly. It's

0:42:18.840 --> 0:42:21.280
<v Speaker 2>a very costly thing to do, but it can generate

0:42:21.280 --> 0:42:22.640
<v Speaker 2>a lot of heat, so that can help to keep

0:42:22.640 --> 0:42:26.359
<v Speaker 2>our bodies warm in some scenarios. There's another mechanism that

0:42:26.400 --> 0:42:29.200
<v Speaker 2>we use, which is brown fat, brown outapost tissue. You

0:42:29.320 --> 0:42:32.719
<v Speaker 2>mentioned this, and brown fat is so fascinating to me

0:42:33.040 --> 0:42:38.520
<v Speaker 2>because it generates only heat. So metabolism in all of

0:42:38.560 --> 0:42:40.879
<v Speaker 2>the other tissues of our body just generates heat as

0:42:40.880 --> 0:42:44.360
<v Speaker 2>like a byproduct. It doesn't it doesn't mean to, but

0:42:44.400 --> 0:42:48.840
<v Speaker 2>it happens too. But brown fat doesn't generate any energy.

0:42:48.920 --> 0:42:50.520
<v Speaker 2>It only generates heat.

0:42:50.800 --> 0:42:53.120
<v Speaker 1>It's like, that's the point. That's the point, and it

0:42:53.200 --> 0:42:53.840
<v Speaker 1>is the point.

0:42:53.960 --> 0:42:56.920
<v Speaker 2>And newborns have quite a lot of it, they do,

0:42:57.000 --> 0:43:00.719
<v Speaker 2>and as adults we have significantly less m hm. And

0:43:00.840 --> 0:43:03.200
<v Speaker 2>so you have it, but just a little bit, so

0:43:03.239 --> 0:43:06.880
<v Speaker 2>we can't use it all that much. Yeah, but sometimes

0:43:07.239 --> 0:43:10.920
<v Speaker 2>we might be exposed to cold that continues, and our

0:43:10.960 --> 0:43:13.800
<v Speaker 2>shivering and our brown fat and all of this increase

0:43:13.840 --> 0:43:17.960
<v Speaker 2>in metabolism simply can't keep up. So what happens to

0:43:18.040 --> 0:43:21.919
<v Speaker 2>the body if we cannot keep up? The first thing

0:43:22.160 --> 0:43:25.359
<v Speaker 2>is that we see what's called a cold diarysis, which

0:43:25.400 --> 0:43:28.120
<v Speaker 2>basically means that because all of our blood has been

0:43:28.160 --> 0:43:32.920
<v Speaker 2>shunted into our core, it's flowing very quickly through our organs,

0:43:33.000 --> 0:43:37.319
<v Speaker 2>including our kidneys, and so our kidneys are furiously filtering

0:43:37.840 --> 0:43:40.319
<v Speaker 2>all of this blood and we start to see an

0:43:40.400 --> 0:43:41.680
<v Speaker 2>increase in urine production.

0:43:43.120 --> 0:43:46.480
<v Speaker 1>I feel like I came across that somewhere, and I

0:43:46.520 --> 0:43:50.440
<v Speaker 1>don't know where if it was like, yeah, I read

0:43:51.040 --> 0:43:53.480
<v Speaker 1>the Shackleton's Expedition.

0:43:53.000 --> 0:43:55.160
<v Speaker 2>Book for this one of my husband's favorite books.

0:43:55.760 --> 0:43:58.720
<v Speaker 1>It's great. I mean it's like it's unbelievable. And the pictures,

0:43:58.760 --> 0:44:01.799
<v Speaker 1>the fact that there are pictures is wild, yeah to me.

0:44:02.320 --> 0:44:04.600
<v Speaker 1>But anyway, I don't remember if that's where somebody was

0:44:04.640 --> 0:44:06.680
<v Speaker 1>talking about peeing a lot, or if it was because

0:44:06.680 --> 0:44:08.680
<v Speaker 1>they're like freezing at night and no one wanted to

0:44:08.719 --> 0:44:11.319
<v Speaker 1>go outside until it was like who didn't want to

0:44:11.320 --> 0:44:12.800
<v Speaker 1>play the one or who didn't want to play the

0:44:12.840 --> 0:44:14.600
<v Speaker 1>game where it was like the last person who fills

0:44:14.640 --> 0:44:16.920
<v Speaker 1>the pot has to empty it, so you just hold it.

0:44:16.960 --> 0:44:21.719
<v Speaker 2>Anyway, Well, yes, you do start to have a cold

0:44:21.760 --> 0:44:23.440
<v Speaker 2>diuresis this is not a good sign.

0:44:24.239 --> 0:44:25.600
<v Speaker 1>It means that things are not going well.

0:44:26.280 --> 0:44:28.279
<v Speaker 2>And on top of that, not only is it just

0:44:28.280 --> 0:44:29.680
<v Speaker 2>not a good sign, but what it means is that

0:44:29.719 --> 0:44:33.320
<v Speaker 2>you can end up getting dehydrated right because you're losing

0:44:33.320 --> 0:44:35.759
<v Speaker 2>all of this fluid through your urine. You could end

0:44:35.800 --> 0:44:38.680
<v Speaker 2>up with acid base disturbances, you can end up with

0:44:38.760 --> 0:44:44.560
<v Speaker 2>electrolyte issues, and eventually our body really cannot keep up

0:44:44.600 --> 0:44:47.840
<v Speaker 2>with all of this loss, and our core body temperature

0:44:47.920 --> 0:44:53.320
<v Speaker 2>will start to decrease. And as our core body temperature decreases,

0:44:54.680 --> 0:44:59.920
<v Speaker 2>our energy expenditure also starts to decrease, and pretty dramatically actually,

0:45:00.440 --> 0:45:05.000
<v Speaker 2>h I think for every one degree celsius decrease in

0:45:05.040 --> 0:45:08.920
<v Speaker 2>core body temperature, our energy expenditure decreases by like thirteen percent.

0:45:09.840 --> 0:45:12.759
<v Speaker 2>So there's no more shivering a lot of times. A

0:45:12.760 --> 0:45:15.279
<v Speaker 2>lot of times shivering will stop. Yeah, because things are

0:45:15.320 --> 0:45:17.560
<v Speaker 2>just sort of slowing down, and all of our cellular

0:45:17.600 --> 0:45:21.960
<v Speaker 2>functions start to slow down, and this eventually results in

0:45:22.040 --> 0:45:24.960
<v Speaker 2>our central nervous system slowing down so much that we

0:45:25.040 --> 0:45:29.840
<v Speaker 2>lose consciousness. Usually that doesn't happen until our central like

0:45:29.880 --> 0:45:33.080
<v Speaker 2>our core body temperature drops to around thirty degrees celsius.

0:45:33.560 --> 0:45:35.560
<v Speaker 2>Should have looked up what that is in fahrenheit, but

0:45:35.600 --> 0:45:40.000
<v Speaker 2>I didn't. It's cold, Yeah, it's cold. But what is

0:45:40.080 --> 0:45:43.040
<v Speaker 2>usually lethal is not the effects on our central nervous system,

0:45:43.040 --> 0:45:46.640
<v Speaker 2>but actually the effects on our heart. Because first you

0:45:46.640 --> 0:45:50.600
<v Speaker 2>can get those acid base like and electrolyte disturbances from

0:45:50.680 --> 0:45:54.320
<v Speaker 2>all of this diarysis that can affect the contractility of

0:45:54.360 --> 0:45:57.719
<v Speaker 2>your heart and it can lead to arrhythmias. Okay, And

0:45:58.160 --> 0:46:01.719
<v Speaker 2>as our heart beat is slowing down and all of

0:46:01.719 --> 0:46:04.760
<v Speaker 2>this metabolism is slowing down in our heart, the time

0:46:04.840 --> 0:46:09.160
<v Speaker 2>between beats can prolong, so we get what's called breta cardia.

0:46:09.200 --> 0:46:12.640
<v Speaker 2>Your heart beat is slowing down, and then the time

0:46:12.680 --> 0:46:15.319
<v Speaker 2>that it takes for the electric signals to actually be

0:46:15.440 --> 0:46:19.719
<v Speaker 2>conducted through the heart also gets affected, so you end

0:46:19.800 --> 0:46:22.120
<v Speaker 2>up with a rhythmias. There's a bunch of different types

0:46:22.160 --> 0:46:26.960
<v Speaker 2>that you can get, but most often it's ventricular fibrillation,

0:46:27.080 --> 0:46:31.480
<v Speaker 2>which is your heart just kind of quivering instead of contracting,

0:46:31.920 --> 0:46:35.560
<v Speaker 2>and then eventually it stops completely. And that is how

0:46:35.600 --> 0:46:37.680
<v Speaker 2>death usually happens with hypothermia.

0:46:39.280 --> 0:46:43.360
<v Speaker 1>It's so it's I this makes me really look forward

0:46:43.360 --> 0:46:46.160
<v Speaker 1>to next week because I'm trying to figure out is

0:46:46.239 --> 0:46:51.440
<v Speaker 1>this Are there are clear costs costs, yes, and so

0:46:51.480 --> 0:46:53.560
<v Speaker 1>there must be enough of a benefit or is there

0:46:53.640 --> 0:46:55.560
<v Speaker 1>enough of benefit? But that's a question I guess.

0:46:55.360 --> 0:46:56.040
<v Speaker 2>For next week.

0:46:56.080 --> 0:47:00.960
<v Speaker 1>Next week, Yes, okay, I feel like I have some questions.

0:47:01.280 --> 0:47:04.239
<v Speaker 1>So what about are you going to talk about like

0:47:04.280 --> 0:47:08.400
<v Speaker 1>rewarming and how okay? Okay, so yeah, so you know,

0:47:08.760 --> 0:47:11.840
<v Speaker 1>I guess the rate at which hypothermia occurs is dependent

0:47:11.920 --> 0:47:15.560
<v Speaker 1>upon the individual, upon the environmental conditions, on clothing, upon

0:47:16.120 --> 0:47:23.040
<v Speaker 1>too much to even go into, right, So are their thresholds?

0:47:23.160 --> 0:47:27.240
<v Speaker 1>Are there established thresholds for like the risk or something?

0:47:27.800 --> 0:47:29.560
<v Speaker 2>No I knew you were going to ask, and no,

0:47:29.760 --> 0:47:32.120
<v Speaker 2>it's it's what's really I think it's one of the

0:47:32.160 --> 0:47:35.440
<v Speaker 2>things that's very interesting about hypothermia. Right, there's not like

0:47:35.520 --> 0:47:38.520
<v Speaker 2>a textbook that's like, below this temperature you are at

0:47:38.600 --> 0:47:41.120
<v Speaker 2>risk of hypothermia because it depends, like you said, on

0:47:41.200 --> 0:47:45.040
<v Speaker 2>so many different things. We do know that extremes of

0:47:45.120 --> 0:47:49.360
<v Speaker 2>age are more susceptible to hypothermia. So newborn babies and

0:47:49.800 --> 0:47:52.840
<v Speaker 2>small babies and infants in general have a much greater

0:47:52.960 --> 0:47:55.799
<v Speaker 2>surface area to volume ratio, So even though they have

0:47:55.960 --> 0:47:58.960
<v Speaker 2>that great brown fat and everything, they just lose a

0:47:59.000 --> 0:48:02.360
<v Speaker 2>lot more heat, and so they're at higher risk of

0:48:02.400 --> 0:48:07.000
<v Speaker 2>core temperature drops and hypothermia people who are elderly, So

0:48:07.120 --> 0:48:10.359
<v Speaker 2>as you get older, you have less efficient, we think,

0:48:10.520 --> 0:48:14.960
<v Speaker 2>thermoregulatory mechanisms. We also often see changes in like body

0:48:15.040 --> 0:48:18.680
<v Speaker 2>mass composition during aging, and so that makes it so

0:48:18.719 --> 0:48:21.120
<v Speaker 2>that you're less able to regulate your temperature. If you

0:48:21.120 --> 0:48:24.120
<v Speaker 2>think about like your grandparents are cold all the time, right,

0:48:24.560 --> 0:48:26.640
<v Speaker 2>they're just not as able to maintain their heat.

0:48:27.600 --> 0:48:28.760
<v Speaker 1>You mentioned being.

0:48:28.600 --> 0:48:33.719
<v Speaker 2>Unhoused, right, not having access to the behavioral mechanisms that

0:48:33.760 --> 0:48:37.120
<v Speaker 2>we as humans rely on to maintain our temperature, like

0:48:37.160 --> 0:48:41.120
<v Speaker 2>adequate clothing and shelter, fires or other forms of heat

0:48:41.120 --> 0:48:44.680
<v Speaker 2>to keep us warm. And then also substance use like

0:48:44.719 --> 0:48:49.520
<v Speaker 2>alcohol and other central nervous system medications like opioids or

0:48:49.560 --> 0:48:52.600
<v Speaker 2>any any kind of thing that's affecting your central nervous

0:48:52.600 --> 0:48:55.839
<v Speaker 2>system and depressing your central nervous system function is going

0:48:55.880 --> 0:49:01.080
<v Speaker 2>to put you at higher risk of hypothermia hugely. So, Yeah,

0:49:01.080 --> 0:49:03.160
<v Speaker 2>but there's not like you can certainly see we see

0:49:03.239 --> 0:49:06.160
<v Speaker 2>hypothermia here in San Diego, even in the winter, and

0:49:06.239 --> 0:49:10.400
<v Speaker 2>it doesn't get very cold here, right, Yeah, In terms

0:49:10.400 --> 0:49:13.600
<v Speaker 2>of how we treat it, it really depends on how

0:49:13.800 --> 0:49:17.200
<v Speaker 2>severe it is, and then like the specifics of the

0:49:17.239 --> 0:49:21.720
<v Speaker 2>person and the scenario themselves. But across the board, it's rewarming, rights,

0:49:21.880 --> 0:49:25.279
<v Speaker 2>it is rewarming that person's body back to a normal temperature.

0:49:26.320 --> 0:49:29.399
<v Speaker 2>But whether that means just insulating them against any more

0:49:29.400 --> 0:49:33.920
<v Speaker 2>heat loss, like if they're just mildly hypothermic, or if

0:49:33.920 --> 0:49:38.359
<v Speaker 2>you need to actively rewarm somebody, and that might mean externally,

0:49:38.440 --> 0:49:41.080
<v Speaker 2>like putting them in warm water or using we have

0:49:41.200 --> 0:49:44.799
<v Speaker 2>in the hospital these things called bear huggers. Yeh, I'm

0:49:44.800 --> 0:49:47.680
<v Speaker 2>pretty sure that's a brand name, Okay, But it's like

0:49:47.719 --> 0:49:51.800
<v Speaker 2>these forced air it's like these blanket, paper, blankeant things

0:49:51.800 --> 0:49:53.720
<v Speaker 2>that you put over someone. We use them in surgery

0:49:53.760 --> 0:49:56.719
<v Speaker 2>a lot too, but also in hypothermia, and they just

0:49:56.840 --> 0:49:59.920
<v Speaker 2>force hot air, so then you're like insulated with this

0:50:00.080 --> 0:50:02.600
<v Speaker 2>blanket of hot air that's moving over you. They're quite cute,

0:50:03.760 --> 0:50:06.000
<v Speaker 2>uh huh. And then heated blankets. These are all like

0:50:06.120 --> 0:50:09.400
<v Speaker 2>external ways that you could warm a person's body if

0:50:09.440 --> 0:50:15.719
<v Speaker 2>they're mildly hypothermic. Okay, and then there's internal rewarming, which

0:50:15.800 --> 0:50:20.000
<v Speaker 2>is of course much more invasive, and there's obsceeded on

0:50:20.360 --> 0:50:24.440
<v Speaker 2>er I'm sure you have many times. There's a lot

0:50:24.480 --> 0:50:26.040
<v Speaker 2>of different ways that you can do it. You can

0:50:26.080 --> 0:50:28.640
<v Speaker 2>do it with just like heated ivy fluids, so like

0:50:28.760 --> 0:50:30.960
<v Speaker 2>just in you know, a peripheral line. You can do

0:50:31.000 --> 0:50:35.360
<v Speaker 2>it via body like U body cavity levage, so like

0:50:35.440 --> 0:50:38.600
<v Speaker 2>any of your body cavities. You can flush warm fluid

0:50:38.640 --> 0:50:41.719
<v Speaker 2>through those body cavities and then drain it out, I know.

0:50:42.200 --> 0:50:44.720
<v Speaker 2>And then you also could use essentially like an ECMO

0:50:44.880 --> 0:50:50.360
<v Speaker 2>machine that's extra extra corporeal rewarming machine that just takes

0:50:50.400 --> 0:50:53.000
<v Speaker 2>your blood from your body, runs it through a machine,

0:50:53.000 --> 0:50:56.239
<v Speaker 2>warms it up and oxygenates it, and then returns it

0:50:56.280 --> 0:50:57.120
<v Speaker 2>back to your.

0:50:56.960 --> 0:51:07.080
<v Speaker 1>Body pretty darn cordn incredible. Yeah, and that's that is it? Arin. Okay,

0:51:07.120 --> 0:51:10.080
<v Speaker 1>So I have a question about something that you I

0:51:10.120 --> 0:51:12.799
<v Speaker 1>don't know, I don't think you mentioned it, but like

0:51:12.960 --> 0:51:20.440
<v Speaker 1>the your your ability to make decisions kind of gets

0:51:20.440 --> 0:51:23.080
<v Speaker 1>all funky too. So that's one of the things. There's

0:51:23.120 --> 0:51:26.200
<v Speaker 1>this what is it called where you disrobe, like you

0:51:26.239 --> 0:51:27.400
<v Speaker 1>start to take off your clothes.

0:51:27.440 --> 0:51:30.239
<v Speaker 2>Yeah, paradoxical dysrobing, I think, or something they call it

0:51:30.360 --> 0:51:32.200
<v Speaker 2>what it is. Yeah, yeah, I mean I don't We

0:51:32.239 --> 0:51:34.319
<v Speaker 2>don't really have a great understanding of why and how

0:51:34.320 --> 0:51:36.160
<v Speaker 2>that happens, but it is something that you can see,

0:51:36.440 --> 0:51:39.760
<v Speaker 2>and we think that it's just due to Even though

0:51:39.840 --> 0:51:43.359
<v Speaker 2>you might not lose consciousness until your body gets quite cold,

0:51:43.400 --> 0:51:46.160
<v Speaker 2>like a core temperature of around thirty, the effects on

0:51:46.320 --> 0:51:49.920
<v Speaker 2>your brain and your central nervous system can be pretty substantial,

0:51:50.000 --> 0:51:54.719
<v Speaker 2>even at relatively mild hypothermia, which means that yeah, people

0:51:54.800 --> 0:51:57.520
<v Speaker 2>might not be like and we don't really know, like

0:51:57.880 --> 0:52:02.359
<v Speaker 2>no one's thankfully today doing human experiments to figure out

0:52:02.400 --> 0:52:05.360
<v Speaker 2>like what are you thinking about when your body is

0:52:05.400 --> 0:52:07.680
<v Speaker 2>getting to be that cold? And so we don't have

0:52:07.760 --> 0:52:10.399
<v Speaker 2>great data on like why do these types of things

0:52:10.440 --> 0:52:13.040
<v Speaker 2>but it can certainly complicate. I read a couple of

0:52:13.080 --> 0:52:17.120
<v Speaker 2>like forensic examiner type papers where they were, like, hypothermia

0:52:17.200 --> 0:52:19.719
<v Speaker 2>deaths if you're like investigating them as like a forensic

0:52:19.840 --> 0:52:24.480
<v Speaker 2>medical person, can be really complicated because sometimes it is

0:52:24.680 --> 0:52:26.640
<v Speaker 2>just hypothermia, but it can look like there's a lot

0:52:26.680 --> 0:52:29.320
<v Speaker 2>of foul play involved, or it can look like really

0:52:29.360 --> 0:52:32.919
<v Speaker 2>complicated scenarios and then it's ultimately determined that it's all

0:52:33.000 --> 0:52:38.920
<v Speaker 2>just due to hypothermia. But so it is. It's really fascinating. Yeah, okay, okay,

0:52:39.480 --> 0:52:43.600
<v Speaker 2>And what I think is also so fascinating about hypothermia

0:52:44.600 --> 0:52:47.319
<v Speaker 2>are the kinds of stories, like you told Aaron, of

0:52:47.960 --> 0:52:53.520
<v Speaker 2>people actually being able to recover. Yeah, especially when you

0:52:53.640 --> 0:52:58.960
<v Speaker 2>contrast it to heat stress, right, like hyperthermia, the way

0:52:59.000 --> 0:53:03.480
<v Speaker 2>that extreme heat induces damage to our proteins, to our

0:53:03.520 --> 0:53:07.759
<v Speaker 2>cell structures itself, that has a pretty poor prognosis if

0:53:07.800 --> 0:53:10.600
<v Speaker 2>your body temperature gets way too hot.

0:53:11.080 --> 0:53:13.759
<v Speaker 1>Yeah, you're looking at like a degree of a few

0:53:13.840 --> 0:53:16.680
<v Speaker 1>degrees versus like tens of degrees that people have come

0:53:16.760 --> 0:53:17.800
<v Speaker 1>back from exactly.

0:53:18.960 --> 0:53:25.440
<v Speaker 2>And it's in part because hypothermia overall is reducing our

0:53:25.520 --> 0:53:30.680
<v Speaker 2>cellular functioning and our energy demands, which means that we

0:53:30.920 --> 0:53:36.200
<v Speaker 2>need less oxygen and our cells can therefore survive in

0:53:36.400 --> 0:53:42.440
<v Speaker 2>absence of oxygen, and that is why people have thought

0:53:42.520 --> 0:53:48.040
<v Speaker 2>to use this in medicine as a therapeutic device. And

0:53:48.160 --> 0:53:50.640
<v Speaker 2>that is what we're going to talk about next week.

0:53:51.400 --> 0:53:56.960
<v Speaker 1>Loved that Cliffhanger transition. Loved it. Thank You's great, Thank

0:53:56.960 --> 0:54:01.040
<v Speaker 1>you so much. It was great. I'm really looking forward

0:54:01.080 --> 0:54:03.239
<v Speaker 1>to that because I want to know. I feel like

0:54:03.280 --> 0:54:06.040
<v Speaker 1>I have made some assumptions about therapeutic hypothermia, so I'm

0:54:06.080 --> 0:54:08.280
<v Speaker 1>ready to have those corrected. I can't wait. I'm excited

0:54:08.320 --> 0:54:08.759
<v Speaker 1>if it need be.

0:54:09.600 --> 0:54:10.840
<v Speaker 2>Yeah, maybe they're all correct.

0:54:10.880 --> 0:54:15.520
<v Speaker 1>I don't know who. I don't know much, but I'll

0:54:15.520 --> 0:54:18.080
<v Speaker 1>know more next week. And if you want to know

0:54:18.360 --> 0:54:19.680
<v Speaker 1>more this week.

0:54:19.480 --> 0:54:22.200
<v Speaker 2>Right now, so many sources, Okay.

0:54:22.640 --> 0:54:26.440
<v Speaker 1>Let me pull mine up. So for both of these episodes,

0:54:26.560 --> 0:54:28.239
<v Speaker 1>I read a book that gave me a lot of

0:54:28.239 --> 0:54:33.040
<v Speaker 1>different ideas called Out Cold by Phil Jakol. It's a

0:54:33.120 --> 0:54:36.360
<v Speaker 1>chilling descent into the macabre, controversial, life saving history of

0:54:36.400 --> 0:54:40.160
<v Speaker 1>hypothermia book from twenty twenty one. And then if you

0:54:40.239 --> 0:54:43.560
<v Speaker 1>want to read more, I absolutely loved this review paper

0:54:43.680 --> 0:54:47.320
<v Speaker 1>about it's called Adaptations to Polar Life in Mammals and Birds.

0:54:47.440 --> 0:54:51.520
<v Speaker 1>I love it by Blicks from twenty sixteen. And it's

0:54:51.600 --> 0:54:54.880
<v Speaker 1>just like such a fun, fascinating, just like a paper

0:54:54.880 --> 0:54:55.399
<v Speaker 1>that talks a.

0:54:55.320 --> 0:54:56.239
<v Speaker 2>Lot fun all the ways.

0:54:56.360 --> 0:55:00.000
<v Speaker 1>I love it. Yes, then there's for more of the history,

0:55:00.080 --> 0:55:03.000
<v Speaker 1>especially the Napoleon stuff. There's a paper by Lankfort from

0:55:03.040 --> 0:55:07.240
<v Speaker 1>twenty sixteen titled Dull Brains and Frozen Feet, a historical

0:55:07.320 --> 0:55:11.000
<v Speaker 1>essay on cold And finally, I want to just put

0:55:11.040 --> 0:55:14.760
<v Speaker 1>a plug in for a short story by Jack London

0:55:14.960 --> 0:55:18.600
<v Speaker 1>called to Build a Fire and it's available. Just search it.

0:55:18.640 --> 0:55:20.880
<v Speaker 1>You can find a PDF. It's by the public domain.

0:55:21.680 --> 0:55:25.319
<v Speaker 1>And it is I mean, it's a story of hypothermia.

0:55:25.480 --> 0:55:30.800
<v Speaker 1>Is it is chilling and good and yeah, I clearly

0:55:30.800 --> 0:55:34.520
<v Speaker 1>should have thought of more better adjectives before telling people

0:55:34.560 --> 0:55:37.640
<v Speaker 1>to read it, but it is really it's it's I

0:55:37.680 --> 0:55:39.799
<v Speaker 1>think it does a really good job of kind of

0:55:39.800 --> 0:55:45.239
<v Speaker 1>taking you through how what hypothermia might feel like and

0:55:45.440 --> 0:55:49.440
<v Speaker 1>sort of the one fault like one false step, one

0:55:49.680 --> 0:55:52.279
<v Speaker 1>one miss misstep, one one bad move.

0:55:53.480 --> 0:55:57.360
<v Speaker 2>Aaron, I don't have like really fun recommendation like that, Aaron.

0:55:57.520 --> 0:56:01.279
<v Speaker 2>I have you know a page called body temperature and

0:56:01.360 --> 0:56:07.520
<v Speaker 2>it's regulation by kot and Farmery from Antesesion Intensive Care Medicine.

0:56:07.680 --> 0:56:11.640
<v Speaker 2>I've Got Hypothermia by Turk in Forensic Science, Medicine Pathology.

0:56:11.640 --> 0:56:14.640
<v Speaker 2>That one was kind of interesting. Accidental Hypothermia from the

0:56:14.640 --> 0:56:16.759
<v Speaker 2>New England Journal Medicine nineteen ninety four. We got a

0:56:16.800 --> 0:56:19.720
<v Speaker 2>few other papers. Okay, there is an update from twenty

0:56:19.760 --> 0:56:22.040
<v Speaker 2>twenty two on the accidental hypothermia one.

0:56:22.120 --> 0:56:22.520
<v Speaker 1>So listen.

0:56:22.600 --> 0:56:25.800
<v Speaker 2>You can find all of the sources from this episode

0:56:25.800 --> 0:56:27.719
<v Speaker 2>and every single one that we've ever done on our

0:56:27.760 --> 0:56:29.800
<v Speaker 2>website this podcast willkin you dot com.

0:56:29.840 --> 0:56:33.720
<v Speaker 1>You can. You can thank you to Bloodmobile for providing

0:56:33.719 --> 0:56:36.200
<v Speaker 1>the music for this episode and all of our episodes.

0:56:36.480 --> 0:56:39.960
<v Speaker 2>Thank you to Leanna and Tom and Brent and Pete

0:56:40.040 --> 0:56:44.239
<v Speaker 2>and Jessica and Mike and everyone else. I think there's

0:56:44.239 --> 0:56:46.200
<v Speaker 2>more people. I'm probably forgetting to say thank you too,

0:56:46.239 --> 0:56:47.640
<v Speaker 2>but thank you also.

0:56:47.600 --> 0:56:51.440
<v Speaker 1>Everyone at exactly right and every one of our listeners

0:56:51.480 --> 0:56:54.359
<v Speaker 1>are watchers. Anyone who participates in this podcast in some way,

0:56:54.520 --> 0:56:58.799
<v Speaker 1>we really appreciate it, and especially to our patrons, your

0:56:58.840 --> 0:57:01.160
<v Speaker 1>support means it means the world to us. It really

0:57:01.200 --> 0:57:05.399
<v Speaker 1>does so much. Thank you. Well, until next time, wash

0:57:05.400 --> 0:57:06.880
<v Speaker 1>your hands you kill the animals.

0:57:12.760 --> 0:57:12.800
<v Speaker 2>M