Speaker 1: The cold was so intense. One constantly found men who,
Speaker 1: overcome by the cold, had been forced to drop out
Speaker 1: and had fallen to the ground, too weak or too
Speaker 1: numb to stand. Ought one to help them along, which
Speaker 1: practically meant carrying them. They begged one to let them alone.
Speaker 1: There were bivouacs all along the road, ought one to
Speaker 1: take them to a campfire. Once these poor wretches fell asleep,
Speaker 1: they were dead. If they resisted the craving for sleep,
Speaker 1: another passerby would help them along a little farther, thus
Speaker 1: prolonging their agony for a short while, but not saving them.
Speaker 1: For in this condition, the drowsiness engendered by cold is
Speaker 1: irresistibly strong. Sleep comes inevitably, and to sleep is to die.
Speaker 1: I tried in vain to save a number of these unfortunates.
Speaker 1: The only words they uttered were to beg me for
Speaker 1: the love of God, to go away and let them sleep.
Speaker 1: To hear them, would have thought sleep was their salvation. Unhappily,
Speaker 1: it was a poor wretch's last wish. But at least
Speaker 1: he ceased to suffer without pain or agony. Gratitude and
Speaker 1: even a smile was imprinted on his discolored lips. What
Speaker 1: I have related about the effects of extreme cold and
Speaker 1: of this kind of death by freezing is based on
Speaker 1: what I saw happen to thousands of individuals. The road
Speaker 1: was covered with their corpses.
Speaker 2: What Aaron is that from?
Speaker 1: That is from Napoleon's close advisor Armand de Callancourt about
Speaker 1: the retreat from Moscow. And I'll talk a little bit
Speaker 1: more about it, but it is it is horrific. Yeah,
Speaker 1: the words can't adequately describe. Yeah. Hi, I'm Aaron Welsh.
Speaker 2: And I'm Erin on Updyke.
Speaker 1: And this is this podcast will kill You.
Speaker 2: Today's very uplifting episode. It's going to be about hypothermia.
Speaker 1: It is about hypothermia. And it's one of two parts
Speaker 1: because as we kind of were talking about hypothermia and
Speaker 1: the effects of cold, and we thought, well, it's it's
Speaker 1: unfair to paint cold in just one light. It's this
Speaker 1: bad thing and hypothermia. So this is a two parter.
Speaker 1: Part one is cold is bad and part two is
Speaker 1: cold can be Good? Right?
Speaker 2: Are those our titles? Because I love it. Part one
Speaker 2: hypothermia cold is bad. Part two Cold is not always bad?
Speaker 1: Yeah, Yeah, there's nuance even to cold. How about that?
Speaker 1: I am excited. There's I feel like this is a
Speaker 1: topic that we have not really I mean, I guess
Speaker 1: we've done fever, but it's like so related to infection,
Speaker 1: whereas this is just like what happens when your body
Speaker 1: is stretched beyond its physiological lembits. I know.
Speaker 2: And it's interesting because especially like, well at least you
Speaker 2: live somewhere where you probably are people are seeing hypothermia
Speaker 2: more than like where I live. I'm like, how come
Speaker 2: we didn't choose heat stress as our first temperature because.
Speaker 1: It is July. We're recording this quite early. It is July.
Speaker 1: Like the heat. The heat is so strong. I am
Speaker 1: in a long sleeve wool sweater with skiers on it.
Speaker 1: You've got some deer also wool. Are they elk?
Speaker 2: Not sure they're sweaty? You're sweat they are.
Speaker 1: They're sweaty. Yeah, we are sweaty sweaters. But it also
Speaker 1: was reading about hypothermia now and about the cold was
Speaker 1: kind of like, oh, yeah, there is another temperature besides
Speaker 1: besides heat ninety one degrees. Yeah.
Speaker 2: Yeah, Well we'll get into all of it, but first,
Speaker 2: it's quarantine time.
Speaker 1: What are we drinking this week? The uncommon cold? I
Speaker 1: mean hypothermia is I'm sure you'll have stats later. It's not.
Speaker 2: Yeah, I don't many stats honestly, but it's not that.
Speaker 2: It just very much depends on where you live.
Speaker 1: But right right, yeah, it's not that's more uncommon than
Speaker 1: the common cold. Yeah, okay, definitely, And we thought, in
Speaker 1: light of the fact that cold can be bad and good,
Speaker 1: we're going to do a cold blended drink, but that
Speaker 1: also has heated elements into it. Spicy. Yeah, so it's
Speaker 1: like have an arrow margarita.
Speaker 2: Yeah, blended blended, which is not my favorite kind of margarita.
Speaker 2: So if you don't want that, don't do that.
Speaker 1: Yeah, you do whatever you want.
Speaker 2: Listen. We'll post the full recipe on our website, this podcast,
Speaker 2: amplay dot com, and all of our social media channels.
Speaker 2: To make sure you're following us there, please.
Speaker 1: Do please do. On our website This podcast will Kill
Speaker 1: You dot com, you can find all sorts of things.
Speaker 1: You can find transcripts. You can find sources for each
Speaker 1: and every one of our episodes. Links to bookshop dot org,
Speaker 1: affiliate account, links to our Goodreads list, links to music
Speaker 1: by Bloodmobile, links to a contact us form, links to
Speaker 1: a submit your first hand account form, Patreon merch things.
Speaker 1: Check it out.
Speaker 2: This podcast will kill you dot com rate, review, and
Speaker 2: subscribe on your favorite podcast, which might be iHeart podcasts.
Speaker 2: Did you know we're there? We're also on Apple of
Speaker 2: the podcast. We're also on the Spotify and now on YouTube.
Speaker 1: You I can't bring myself to say that, but yes
Speaker 1: we are.
Speaker 2: I can't not say it that way. Go to the.
Speaker 1: Exactly right YouTube channel and you can subscribe so you
Speaker 1: never miss an episode.
Speaker 2: Okay, moving on, Erin, tell me about the history of hypothermia.
Speaker 2: What I mean, listen, I'm assuming we've always frozen.
Speaker 1: Yeah, that's true, but we'll get into a little bit
Speaker 1: more of that good right after this break. Humans have
Speaker 1: existed thrived, even on the farthest reaches of the Earth,
Speaker 1: for tens of thousands of years.
Speaker 2: True.
Speaker 1: The earliest evidence of humans in the European Arctic, for example,
Speaker 1: dates back forty thousand years.
Speaker 2: Wow. Yeah, that's a long time.
Speaker 1: There were It is a long time. There were mammoth
Speaker 1: tusks with human made cuts, sliced wolf bones, stone artifacts,
Speaker 1: and other animal bones with like clear human you know,
Speaker 1: manipulation or whatever found above the Arctic Circle.
Speaker 2: Pretty cool.
Speaker 1: That means that, like only a few thousand years after
Speaker 1: humans reached Europe, they just kept right on heading north.
Speaker 2: Okay, why just looking for something new? I guess by amos.
Speaker 1: But I feel like if you have spent a winter
Speaker 1: in or close to the Arctic, it might be like
Speaker 1: which you have it's cut I have. Yeah, it's a
Speaker 1: natural question to ask. Even if you absolutely love the
Speaker 1: winter and you long for the days to get shorter
Speaker 1: so that you can break out your favorite pomp pom
Speaker 1: wool hat and cozy sweaters, or even if you get
Speaker 1: to see the southern or northern lights in the winter
Speaker 1: and you love to snowshoe or ski, you have to
Speaker 1: admit that the polar regions are not an easy place
Speaker 1: to live, and they don't let you forget it. Grabbing
Speaker 1: the wrong jacket before you step outside, losing a glove,
Speaker 1: a window that's lost its insulating ability. These things don't
Speaker 1: go unnoticed, at least not for very long. Whether immediately
Speaker 1: or eventually, the cold makes itself known. It insinuates itself
Speaker 1: into the nooks and crannies of your jacket, of your body,
Speaker 1: the tips of noses, toes, fingers, and it settles into
Speaker 1: your bones until you feel like you'll never be warm again.
Speaker 2: That is the exact way that I would describe living
Speaker 2: in Illinois.
Speaker 1: Will I ever be warm against any like?
Speaker 2: So many memories of that feeling of like your bones
Speaker 2: being so cold, which I know they're not really, but
Speaker 2: your bones being so cold that you don't it is
Speaker 2: impossible to remember warmth.
Speaker 1: Yeah, right now, it's impossible for me to remember cold,
Speaker 1: even though I'm talking about it. I'm so so witty.
Speaker 1: I'll have to try to remember this moment come February exactly. Yeah.
Speaker 1: But I think that many of us lower latitude dwellers
Speaker 1: have kind of a sense of awe, at least I
Speaker 1: do for those living in the Antarctic and Arctic regions
Speaker 1: of the world, because even with the warmest of jackets
Speaker 1: and the most insulated of shelters, polar life exists on
Speaker 1: a knife edge, where even the tiniest thing can tip
Speaker 1: the scales, turning a minor mistake or a minor accident
Speaker 1: into a fatal outcome. I cruised the Wikipedia page for
Speaker 1: hypothermia related deaths, which is quite morbid, I know, and
Speaker 1: the one thing that really stuck out to me was
Speaker 1: just how easily it can happen. I went through and
Speaker 1: I like read different people's stories and it was just
Speaker 1: like and then on one wrong step, yeah, and that
Speaker 1: was it. That was it. And how powerless you are
Speaker 1: when the cold really sets in. And yet many species
Speaker 1: call these polar regions their home, not just humans. Why
Speaker 1: would an animal live in a place that is so brutal,
Speaker 1: so unforgiving, although not all the time, as we'll see,
Speaker 1: there are all sorts of reasons. Maybe it's more available, habitat,
Speaker 1: less competition for resources, escape from predators, escape from parasites,
Speaker 1: a combination, or something else entirely, But for this episode,
Speaker 1: the why isn't as interesting to me as the how,
Speaker 1: Like how can species live at the ends of the earth,
Speaker 1: not just like eking out a meager existence, but flourishing
Speaker 1: despite the deadly cold. Humans have innovated incredible clothing, shelter, transportation,
Speaker 1: and tools to help protect from freezing temperatures, and animals
Speaker 1: have evolved a vast array of strategies anatomical, physiological behavioral
Speaker 1: to resist hypothermia and other harmful consequences of cold, like frostbite.
Speaker 1: Would you like to learn about some of these thrilled?
Speaker 1: Thrilled to learn about these one way is just to
Speaker 1: avoid it. Just migrate the heck out of it. Birds.
Speaker 1: Birds love this, they're big fans of the migration.
Speaker 2: Yeah.
Speaker 1: And some bats and you know, other things, but way
Speaker 1: big for birds. Yeah. And then there's torpor, which includes
Speaker 1: hibernation and dormancy. Basically, an animal just turns down the
Speaker 1: dials on body temperature, activity and metabolism to get through
Speaker 1: the winter. Bears, ground squirrels, bats, some frogs. And then
Speaker 1: there's cold resistance, so like you keep operating mostly as
Speaker 1: normal during the cold months, but you just bump up
Speaker 1: your your own systems, your defense against Yeah, and that
Speaker 1: would be something like arctic foxes, polar bears and so on.
Speaker 1: And these strategies they're not mutually exclusive. You can have
Speaker 1: a little bit of this and a little bit of that.
Speaker 1: And there's also a great variation within some of these,
Speaker 1: So like hibernating black bears only drop their body temperature
Speaker 1: by a few degrees celsius, while some mammals, small mammals
Speaker 1: drop temperatures twenty to thirty degrees celcish body temperatures. What
Speaker 1: oh it gets it gets better. Wood frogs, Oh, do
Speaker 1: you know about wood? Yes, I know about wood. Frogs.
Speaker 1: Who does it? But no, lots of people don't. I
Speaker 1: had I had to refresh my memory because the stats
Speaker 1: are I was like, this can't be. I was like,
Speaker 1: I need to fact check this right multiple places.
Speaker 2: I love this real.
Speaker 1: They're the Hall of Famers for dormancy. They survive freezing
Speaker 1: temperatures below minus twenty celsius for months on end, like
Speaker 1: seven months, seven merely freezing, Yeah, nearly freezing solid. Fifty
Speaker 1: to sixty five percent of their body water is frozen. Wow,
Speaker 1: just frozen. Yeah. These are frogs that live above the
Speaker 1: Arctic circle. What what Like? I just can't get over it.
Speaker 1: And then you've got the fish that avoid freezing in
Speaker 1: Antarctic waters by using anti freeze proteins that let them
Speaker 1: keep swimming around. Other animals like polar bears, ptarmigan wolves
Speaker 1: and hares make simple burrows in the snow to help
Speaker 1: with insulation.
Speaker 2: Question, which is, yeah, what's a ptarmagan?
Speaker 1: It's a bird? Okay, thank you. Yeah, they're really cute. Yes,
Speaker 1: or sometimes they'll employ bagel formation, which is not the
Speaker 1: technical term, but I love those. Okay. It's like where
Speaker 1: you make yourself into a tiny ball, like a little
Speaker 1: ball to trap heat like the doggies do you Yeah, okay, exactly,
Speaker 1: you just tuck your little nose and you're in bagel formation.
Speaker 1: Bagel formation. And then other animals that live in colonies,
Speaker 1: like walruses and penguins, they'll huddle together for warmth, especially
Speaker 1: baby emperor penguins.
Speaker 2: Yes, they're very cute.
Speaker 1: They're very cute. Thick fur and blubber help to reduce
Speaker 1: heat loss, as do changes in the circulatory system or
Speaker 1: even the type of hemoglobin that an animal has, So
Speaker 1: like pretty cool, yeah, because of and then there's like
Speaker 1: circulatory changes, so because there are these specialized changes in
Speaker 1: blood flow in pawpads of Arctic wolves and foxes that
Speaker 1: allows them to stand on the ground that has a
Speaker 1: temperature of minus fifty celsius but their feet don't freeze
Speaker 1: or become damaged. What I don't know. And then nasal cavities.
Speaker 1: I didn't realize that, like the shape of a nasal
Speaker 1: cavity could be so important, but it is.
Speaker 2: I feel like I remember learning this at some point.
Speaker 1: Tell me about it, Aaron, Okay, okay, So reindeer have
Speaker 1: nasal cavities that warm the air before it enters the
Speaker 1: body and it sort of like warms it and then
Speaker 1: there's like water condensation, right, But then instead of losing
Speaker 1: that heat and water to the environment, they also somehow
Speaker 1: cool the air before it leaves, and so you're basically
Speaker 1: conserving heat and water because of the way that they're
Speaker 1: nasal cavities. Oh that's fascinating. Yeah. Babies of Arctic animals
Speaker 1: are born well equipped with extra warm fur or feathers
Speaker 1: or brown adipose tissue that keeps them super warm, and
Speaker 1: mom will also often provision them with super fatty milk.
Speaker 1: One of my go to fun facts to share at
Speaker 1: a cocktail party is that some whale milk is so fatty,
Speaker 1: like thirty to sixty percent fat, that it has the
Speaker 1: consistency of toothpastete. That's one of my favorite things too. Yeah,
Speaker 1: just I love it.
Speaker 2: Baby whales lap it up toothpaste in the ocean.
Speaker 1: I mean, I think it also must help with like
Speaker 1: not just just diluting into the environment. Yeah, so they
Speaker 1: can kind of like yeah, get it. Yeah, But for comparison,
Speaker 1: human breast milk is like four percent fat compared to
Speaker 1: thirty to sixty for some whales.
Speaker 2: Like imagine the lipped cream you could make oh my, I.
Speaker 1: Mean it's already whipped, right, it's like solid, Like, what
Speaker 1: do you do, It's like butter, It's just butter. Yeah,
Speaker 1: it's actually just butter. Okay, So one last fun fact
Speaker 1: before I get to humans. One of the major challenges
Speaker 1: with living in polar regions is food availability. It's not
Speaker 1: always reliable, and in those times of scarcity, you're not
Speaker 1: only expending energy trying to find food, you're also using
Speaker 1: more energy staying warm. And some Arctic species deal with
Speaker 1: this by cashing food. So like one arctic fox hoard
Speaker 1: had one hundred and thirty six seabirds and then yeah.
Speaker 2: It was just like little He's like, listen, they're frozen.
Speaker 2: They're going to keep don't worry about it. Yeah, I
Speaker 2: feel through the wind chest freezer.
Speaker 1: This is my cost code. Yeah. And an ermine was
Speaker 1: found to have hidden over one hundred and fifty lemmings
Speaker 1: as white.
Speaker 2: You know, I still like, I know that a lemming
Speaker 2: is an animal, but I have no idea what they
Speaker 2: look like. I cannot picture a lemming.
Speaker 1: Little rodenty things. I only do you.
Speaker 2: Remember that game the lemmings going over a cliff?
Speaker 1: You don't remember this game? No, there was it was
Speaker 1: on what hard on what device?
Speaker 2: Computer computer? It was a computer game where there's I
Speaker 2: think they were they were called lemmings, but they were
Speaker 2: like little people looking things and they just were going.
Speaker 1: Over a cliff. If you, oh, no, I'm going to
Speaker 1: need to look this up. I feel great. I feel wow. Yeah.
Speaker 1: Is it like Ski Free era? You remember that game
Speaker 1: with the Yes?
Speaker 2: Okay, I don't know if it was same era. I
Speaker 2: have no idea.
Speaker 1: Okay, sorry, we'll have to We'll have to find it.
Speaker 2: That's what I think of when I think of vings,
Speaker 2: and that's why I can't like picture that there's an
Speaker 2: animal called letting.
Speaker 1: Just pictured tiny humans just okay, I don't think they
Speaker 1: look like miniature humans with little like gnome hats on. No,
Speaker 1: I don't believe that they have constructed nome hats irl okay, okay.
Speaker 1: So another besides casing food and lemmings uh not with
Speaker 1: no mats, another approach is storing extreme amounts of fat,
Speaker 1: so seal pups undergo something called catastrophic molting, which sounds
Speaker 1: a lot scarier than it actually is. They just lose
Speaker 1: all their fur at once, and then they have to
Speaker 1: wait a while to grow back a new layer, and
Speaker 1: so during that time they can't go in the water
Speaker 1: for food because they'll get hypothermia, so they don't eat. Oh,
Speaker 1: they can go fifty two days without food or water.
Speaker 2: Wow, and that Wow, it's a really long time.
Speaker 1: It's a really long time. And so my point with
Speaker 1: all of this, besides being able to share with everyone
Speaker 1: the whale milk toothpaste fun fact, so that you have
Speaker 1: something to share at like, you know, the next round
Speaker 1: table ice breaker type thing.
Speaker 2: And the wood frogs icebreaker, but wood.
Speaker 1: Frogs, my god, icebreaker would also have been a good quarantine.
Speaker 2: Wow.
Speaker 1: Anyway, Yeah, that animals have evolved. My whole point is
Speaker 1: that animals have evolved an incredible array of ways to
Speaker 1: deal with the cold, and unfortunately humans lag behind in
Speaker 1: this respect. And so under the right set of circumstances,
Speaker 1: our body struggles to warm itself, our temperature drops and
Speaker 1: we slip into hypothermia, which is something that we've been
Speaker 1: doing for as long as we've been human. So even
Speaker 1: though I just spent a good deal of time in
Speaker 1: the polar regions with polar animals, you can get hypothermia
Speaker 1: anywhere on Earth. Some of the earliest references to hypothermia
Speaker 1: come from ancient Greece, which is certainly not arctic. Hippocrates,
Speaker 1: of course, noted the benefits of cold, but also the
Speaker 1: dangers quote cold is bad for the bones, teeth, nerves, brain,
Speaker 1: and the spinal cord. In four point fifty BCE, the
Speaker 1: Greek historian Herodotus wrote about soldiers dying in a sea expedition.
Speaker 1: Quote some were seized by these sea monsters and so perished,
Speaker 1: while others were dashed against the rocks, and some of
Speaker 1: them did not know how to swim, and perished for
Speaker 1: that cause, others again by reason of cold end quote seamusters.
Speaker 1: War has always been a bad spot for hypothermia. In fact,
Speaker 1: most historical records of hypothermia come from various wars throughout history.
Speaker 1: In two eighteen BCE, Hannibal's army of twelve thousand cavalry,
Speaker 1: ninety thousand infantry, and forty elephants was cut down to
Speaker 1: nineteen thousand men and some uncertain number of elephants during
Speaker 1: their march over the Alps, with many of them dying
Speaker 1: of cold. During the American Revolutionary War, countless soldiers suffered
Speaker 1: frostbite and hypothermia, especially during the winter of seventeen seventy
Speaker 1: seven seventeen seventy eight, when nearly a fifth of the
Speaker 1: eleven thousand men who retreated into Valley Forge did not
Speaker 1: have shoes or boots at all. Oh, I just imagine
Speaker 1: that in the winter. No, I can't imagine that. And
Speaker 1: then there's Napoleon's army, this retreat from Moscow in eighteen twelve.
Speaker 1: So he this is like where this is infamous, and
Speaker 1: we've talked about this in several other times of the podcast.
Speaker 1: Napoleon and his army started out in June with nearly
Speaker 1: half a million soldiers. By the time they had gotten
Speaker 1: to Moscow in late fall, numbers had dwindled pretty substantially
Speaker 1: by at least one hundred thousand. But when they arrived,
Speaker 1: they found a burned out, abandoned city, no opportunity to restock,
Speaker 1: to refuel, no food, nothing. The Russian forces had adopted
Speaker 1: this like scorched earth tactic, and that would prove to
Speaker 1: be Napoleon's downfall. So he waited around a bit just
Speaker 1: trying to figure out what do I do here? Do
Speaker 1: we stay?
Speaker 2: Do we go?
Speaker 1: And then was like, you know what, we should just
Speaker 1: get back to France. So a retreat to France. That
Speaker 1: was the move. The army started back in October, still
Speaker 1: dressed in their summer uniforms, and they pushed through the
Speaker 1: snow and ice and frozen rivers in November through December
Speaker 1: and even into January. Count Philippe Paul de Segur, a
Speaker 1: brigadier an aid to Napoleon, wrote, quote, Russian winter in
Speaker 1: this new guy's attacked them on all sides. It cut
Speaker 1: through their thin uniforms and worn shoes. Their wet clothing
Speaker 1: froze on them, and this icy shroud molded them their
Speaker 1: bodies and stiffen their limbs. The sharp wind made them
Speaker 1: gasp for breath and froze the moisture from their mouths
Speaker 1: and nostrils into icicles on their beards end. Quote. By
Speaker 1: the time they got back to France, all that remained
Speaker 1: of Napoleon's five hundred thousand troops was ten thousand. Oh
Speaker 1: my gosh. Yeah, some died in battle, others from their
Speaker 1: injuries or infections. If you remember back to our Typhus episode,
Speaker 1: that was a major, major killer, but many succumbed to
Speaker 1: the cold. A frost bitten and constantly water logged foot
Speaker 1: turned gangrenous with the infections spreading to the rest of
Speaker 1: the body. A raid on a liquor store allegedly killed
Speaker 1: eight hundred soldiers who imbibed a bit too much and
Speaker 1: fell asleep in the snow. At the time, it was
Speaker 1: thought that alcohol was warming and helped stave off the
Speaker 1: negative effects of the cold, although I'm not sure they
Speaker 1: were drinking it as medicine. And by the way, it
Speaker 1: is not warming. It is not what you should use
Speaker 1: to treat someone suffering from hypodermy.
Speaker 2: Alcohol actually can can There's actually thought that not just
Speaker 2: the risk of you know, drowsiness or falling asleep or
Speaker 2: you know, making decisions about what clothes you might wear
Speaker 2: that are impaired because of the effects of alcohol, there's
Speaker 2: actually thought that the alcohol, the effects of alcohol itself
Speaker 2: also contribute to hypothermia.
Speaker 1: Yeah, so more heat loss exactly, yeah, yeah, yeah yeah.
Speaker 1: And then there was also just poor nutrition and grueling
Speaker 1: conditions that took many others just after they drifted off
Speaker 1: to sleep. One of Napoleon's surgeons wrote quote, the first
Speaker 1: hours of sleep offered deceptive delight, precursor to the grave
Speaker 1: that yawned for them. Far from finding safety in the
Speaker 1: sweets of sleep, they were seized and benumbed by cold,
Speaker 1: and never saw daylight. More along the road, in the
Speaker 1: neighboring ditches of fields were perceived human carcasses, heaped up
Speaker 1: and lying at random in fives, then fifteens, and twenties
Speaker 1: of as had perished during the night end quote. No
Speaker 1: one was spared, not even the surgeons, who wrote how
Speaker 1: their brains had become so dulled by the cold that
Speaker 1: they could barely recognize one another. So many dyed or
Speaker 1: suffered permanent injuries from the cold on this retreat, not
Speaker 1: just because of poor quality clothing and shoes or insufficient food,
Speaker 1: but also because no one really knew how to treat
Speaker 1: hypothermia or frostbite. Those words didn't even exist yet, a
Speaker 1: practical thermometer that could be used clinically was still decades away. Instead,
Speaker 1: the effects of cold were kind of grouped together under
Speaker 1: the term asphyxia, partial asphyxia usually referring to frostbite, and
Speaker 1: general asphyxia referring to hypothermia. Interesting, these were diagnosed from
Speaker 1: like subjective observation, so it was thought that like basically
Speaker 1: there was congealing in your body, fluids were congealing and
Speaker 1: blood in start at the at the extremity, right at
Speaker 1: your flick fingertips and nose, and then yeah, and then
Speaker 1: as it grew your whole if you're so, that was
Speaker 1: like frostbite, so you're like, okay, there's no it's all congealed.
Speaker 1: And then then hypothermia it was like your whole body.
Speaker 1: It's not that far off. Yeah, yeah, I say, yeah
Speaker 1: and so. But because of this, treatment usually took the
Speaker 1: form of slowly rewarming to get everything to re liquefy,
Speaker 1: and you were supposed to start in reverse. So you
Speaker 1: start with snow, rubbing snow on your you know, frostbitten fingers,
Speaker 1: and then yeah, and then cold water and then cool water,
Speaker 1: then tepid water. You get the really okay, interesting go
Speaker 1: slow yeah. Earlier physicians had learned their lesson the hard
Speaker 1: way not to use extreme heat, and revival efforts were
Speaker 1: occasionally successful during Napoleon's retreat, but they often weren't even
Speaker 1: attempted if someone looked dead, and it wasn't widely known
Speaker 1: at the time how many of the signs of hypothermia,
Speaker 1: signs that mimicked death could be reversed. One of the surgeons,
Speaker 1: later learning of this, wrote quote how many resurrections might
Speaker 1: have been made on the retreat from Moscow, probably lots,
Speaker 1: and as later, medical advancements in the late nineteenth but
Speaker 1: especially the first half of the twentieth century revealed hypothermia
Speaker 1: did not always carry with it a death sentence, and
Speaker 1: doctors could more readily measure temperature thresholds beyond which recovery
Speaker 1: was unlikely. And as the term hypothermia came into more
Speaker 1: usage in the first decades of the twentieth century and
Speaker 1: it became a distinct clinical entity, focused interest in prevention
Speaker 1: and treatment of the condition increased, especially during World War Two.
Speaker 1: So I don't know when exactly I tried to find
Speaker 1: when exactly the phrase you're not dead until you're warm
Speaker 1: and dead you originated. Yeah, but it was likely in
Speaker 1: the last few decades of the twentieth century, showing the
Speaker 1: huge amount of progress made understanding hypothermia and reversing it.
Speaker 1: And so before I turn it over to you, Aaron,
Speaker 1: to tell us what exactly is happening when our body
Speaker 1: temperature dropped to dangerous levels and what we do about it,
Speaker 1: I want to end with one of the most amazing
Speaker 1: hypothermia revival stories that shows just how far we've come. Oh,
Speaker 1: I love it. Like Napoleon's surgeon's minds would have been
Speaker 1: absolutely blown by learning of this story. Okay. In nineteen
Speaker 1: ninety nine, a twenty nine year old Swedish woman named
Speaker 1: Anna moved to a small town in northern Norway in
Speaker 1: the Arctic Circle to complete her medical residency or above
Speaker 1: the Arctic Circle, and part of the reason that she
Speaker 1: chose this location was because she was an avid and
Speaker 1: very experienced backcountry skier. In May, she and a couple
Speaker 1: friends who also had medical training, went out skiing for
Speaker 1: the day. At six twenty pm, Anna or Anna maybe
Speaker 1: lost her balance and fell headfirst into a waterfall gully,
Speaker 1: where she became wedged in the ice and water. Her
Speaker 1: friends couldn't get her out. They tried to pull her out,
Speaker 1: and they couldn't get to her, and so they called
Speaker 1: for help, and unfortunately help was slow to arrive. The
Speaker 1: only rescue helicopter available was on its way to transport
Speaker 1: a sick child, which was in the other direction from Anna.
Speaker 1: At seven pm, she stopped moving those forty minutes in
Speaker 1: the ice. At seven point forty a ground rescue team
Speaker 1: arrived and extracted her from the ice. She was clinically dead.
Speaker 1: The helicopter arrived around eight pm and she was loaded
Speaker 1: onto it for transport to Tromso Hospital, which is about
Speaker 1: an hour's flight away, and with the adage you're not
Speaker 1: dead until you're warm and dead in mind, resuscitation efforts
Speaker 1: were started in transit and continued along with rewarming at
Speaker 1: the hospital. When she got there, doctors found that she
Speaker 1: was not breathing, She had no pulse, her pupils were
Speaker 1: widely dilated and unresponsive to light. Her EEG was flatline.
Speaker 1: Nurses and doctors continued their chest compressions in ventilation as
Speaker 1: they prepped to put her on a heart lung machine.
Speaker 1: At nine fifty two pm, so this is three and
Speaker 1: a half hours after she went into the ice, her temperature,
Speaker 1: her body temperature was measured at thirteen point seven degrees
Speaker 1: celsius or fifty six point six degrees fahrenheit. Wow. At
Speaker 1: that point, yeah, she'd been three hours without a heartbeat.
Speaker 1: But then at I guess I kind of spoiled it
Speaker 1: at the beginning by saying revival story, but I mean,
Speaker 1: you know where this is going. But then at ten
Speaker 1: fifteen pm something on the monitor a heart beat, then another,
Speaker 1: then a steady rhythm. She woke up ten days later
Speaker 1: and spent another couple of weeks in the intensive carry unit,
Speaker 1: and initially she showed signs of paralysis below the neck
Speaker 1: and struggled with various organ dysfunctions, but over time she
Speaker 1: made an almost complete recovery. After five months she was
Speaker 1: like basically back to normal, back to skiing. It's an
Speaker 1: amazing story that shows what both the human body and
Speaker 1: modern medicine are capable of. And that being said, every
Speaker 1: year many people, especially those who are unhoused or struggle
Speaker 1: to keep their homes warm in the winter who can't
Speaker 1: afford to do so, die of hypothermia. And most of
Speaker 1: these deaths are they represent a failure not of modern
Speaker 1: medicine but of our society in providing a safety net
Speaker 1: to prevent death in this way, because like stories like
Speaker 1: Annas show us, it is possible, and it can sometimes
Speaker 1: be reversed. But in a lot of these cases it
Speaker 1: should never have happened in the first place. Yeah, but
Speaker 1: now Erin, I'll turn it over to you to tell
Speaker 1: me more about how we deal with hypothermia today. I
Speaker 1: would love to.
Speaker 2: You mentioned at the top erin the last time that
Speaker 2: we talked about human body temperature was in relation to fevers,
Speaker 2: and we learned in that episode, and maybe everyone forgotten.
Speaker 2: That's fine, I'm gonna tell you again. But we learned
Speaker 2: that a fever is what happens when our temperature set
Speaker 2: point gets moved. Right. Our brain, specifically our hypothalamus controls
Speaker 2: our temperature set point, and so a fever is what
Speaker 2: happens when our hypothalamis is like, we need to get hotter, right,
Speaker 2: But most of the time, outside of a fever, we
Speaker 2: as humans seek to exist at about thirty seven degrees
Speaker 2: celsius ninety six or so fahrenheit, right, And that is
Speaker 2: that particular temperature is what our body is constantly maintaining.
Speaker 2: And because we are endotherms like all mammals, we maintain
Speaker 2: this temperature by physiologic mechanisms within our own body.
Speaker 1: Right.
Speaker 2: We don't rely on the sun or our environment to
Speaker 2: warm us or cool us, right I. And all of this, like,
Speaker 2: all of these processes are basically coordinated in our brain
Speaker 2: by our hypothalmis because this is controlling our temperature set point.
Speaker 2: So hypothermia is like the easiest way to look at
Speaker 2: it is just that this is what happens when we
Speaker 2: can no longer do that, when all of the mechanisms
Speaker 2: that we have to keep our bodies warm and at
Speaker 2: the right temperature fail us. And that happens mostly when
Speaker 2: the environment is either just way too cold or it's
Speaker 2: just a little cold but for way too long for
Speaker 2: us to generate enough heat via our metabolism and all
Speaker 2: the things going on inside of our bodies, okay, and
Speaker 2: the external trappings that we use of course as humans,
Speaker 2: so we can pretty well maintain our body at a
Speaker 2: constant temperature without our bodies having to work very hard
Speaker 2: to do it, even if we were totally naked. If
Speaker 2: we exist between like twenty five and thirty celsius, which
Speaker 2: is like seventy seven to eighty six fahrenheit, that's our
Speaker 2: like thermoneutral zone. Once you get above this or below this,
Speaker 2: our bodies are going to have to work harder to
Speaker 2: maintain our temperature. Now, that's seventy seven fahrenheit twenty five celsius.
Speaker 2: That's not cold, no, it's quite warm, it's quite warm.
Speaker 2: But below around that temperature means that our body is
Speaker 2: having to do something to generate heat. Right if you were,
Speaker 2: if you were totally naked like, but we're off if
Speaker 2: you were totally naked those onto So that's that's behavioral adaptations.
Speaker 2: So what I want to talk about is less about
Speaker 2: the behavioral adaptations because those are obviously important, But I'm
Speaker 2: really going to focus on our bodies. How do we
Speaker 2: typically deal with temperature stressors? What are we doing inside
Speaker 2: of our body to generate heat when we're exposed to cold,
Speaker 2: so that then we can understand what happens once those
Speaker 2: start to fail us. And then next week we're going
Speaker 2: to talk about kind of building off of that story
Speaker 2: that you told Aarin and what we know about what
Speaker 2: cold does to our bodies once it kicks in, and
Speaker 2: the ways that people have thought to maybe use this
Speaker 2: to their advantage to treat various conditions.
Speaker 1: Harness one of nature's elements.
Speaker 2: Ooh good, that's a good one. Okay, So two big
Speaker 2: body compartments to think about when we think about temperature management.
Speaker 2: We have our core body, which is our brain and
Speaker 2: our internal organs, and then we have all the rest
Speaker 2: of it, or our peripheral body that's our skin, our
Speaker 2: subcutaneous tissue, our fat, our limbs. It's not the important stuff,
Speaker 2: right when you think about your body existing.
Speaker 1: Yeah, I mean, you can lose a pinky, but if
Speaker 1: your heart freezes, you're done the devastation.
Speaker 2: Yeah, exactly, and so and our body knows this, and
Speaker 2: our hypothalamis knows this, and so because our hypothalamis knows this,
Speaker 2: our body regulates our temperature by regulating heat loss and
Speaker 2: essentially kind of sacrificing the things that are less important
Speaker 2: as well as finding ways to keep heat in the
Speaker 2: core of our bodies. Okay, to keep our internal organs warm.
Speaker 2: So one of the the first things that our body
Speaker 2: does in order to keep our core warm is vaso
Speaker 2: constriction of peripheral veins and arteries in our skin. And
Speaker 2: what that does is it keeps our blood, which is
Speaker 2: warm in our deeper circulation.
Speaker 1: This is going to.
Speaker 2: Reduce the amount of heat loss from all of our
Speaker 2: surface area of our skin, right. It's also going to
Speaker 2: reduce the temperature of our skin and our extremities, which
Speaker 2: can lead to frostbite.
Speaker 1: Yes.
Speaker 2: Ah, So I quick detour before we talk about hypothermia
Speaker 2: itself to talk about frostbite, which you can kind of
Speaker 2: think of as like extreme localized hypothermia. So frostbite is
Speaker 2: when you get tissue injury that's due really to freezing itself,
Speaker 2: and so frostbite you do tend to have to be
Speaker 2: in pretty cold conditions rather than the more mild conditions
Speaker 2: where you could still get hypothermia but without frostbite.
Speaker 1: Like water versus snow, I mean, yes and no.
Speaker 2: Snow is like, if you're in a snowy environment, it's
Speaker 2: very likely that the air temperature and the wind chill
Speaker 2: and the snow itself is below freezing. So in some
Speaker 2: cases you might be even more likely to get frost
Speaker 2: bite in those scenarios. In water, you could still get
Speaker 2: like freezing if the water was cold enough, But it's
Speaker 2: very easy to get totally hypothermic in the water because
Speaker 2: you lose heat so much more rapidly in water because
Speaker 2: it's a really good conductor of heat just deals right
Speaker 2: away from us.
Speaker 1: So like snow, you would get frost bite first and
Speaker 1: then hypothermia.
Speaker 2: Potentially, yeah, potentially, whereas.
Speaker 1: Water you're gonna get hypothermia first.
Speaker 2: Yeah.
Speaker 1: Yeah, Yeah, that's a good way to think about it.
Speaker 1: Love it.
Speaker 2: I was confused and thought you meant the opposite, but
Speaker 2: that totally makes your sense there, So yes, and the
Speaker 2: degree of damage really varies. Right, you have degrees of frostbite.
Speaker 2: The first degree you might just have kind of redness
Speaker 2: of the area. It might progress to kind of a white,
Speaker 2: almost waxy skin or blister formation. And then of course
Speaker 2: the most severe, which is considered grade four, is black
Speaker 2: or necrotic tissue, where your entire tissue just dies.
Speaker 1: Yeah, and all of this is.
Speaker 2: Going to depend on how long you're exposed and to
Speaker 2: what degree of temperature you're exposed to, right, And the
Speaker 2: damage that you get is due to this vaso constriction itself. Right,
Speaker 2: It's also due to the effects of that cold on
Speaker 2: our blood because our blood. You mentioned this in the
Speaker 2: like what people thought happened to your blood way back,
Speaker 2: when they're not wrong. Our blood actually becomes thicker and
Speaker 2: kind of sludgy when it gets that cold. And then
Speaker 2: you can also get blood clots in some of your
Speaker 2: small vessels, which might lead to more damage due to
Speaker 2: lack of blood flow there. And because of the actually
Speaker 2: freezing itself, the extracellular water freezes and that ice crystal
Speaker 2: formation can cause direct tissue damage. Right, So it's very multifactorial.
Speaker 2: And in terms of treatment for frostbite, the treatment is
Speaker 2: to rewarm that area to try and increase blood flow
Speaker 2: to that area, But as likely happened during Napoleon's army,
Speaker 2: if there is a risk that things will refreeze, you
Speaker 2: cannot start to rewarm because freezing and then warming and
Speaker 2: then refreezing actually causes significantly more damage.
Speaker 1: So is there a point, like, because you talked about
Speaker 1: the stages where there's red and then there's white, and
Speaker 1: then there's black tissue, Yeah, like necrotic, I guess is
Speaker 1: there a point at which the point of no return?
Speaker 1: I'm guessing is when there's necrotic tissue, there is there nerve.
Speaker 1: Can you regain nerve sensation when it's when the tissue
Speaker 1: becomes like whitened or it depends? It totally depends.
Speaker 2: Yeah, so you can obviously, like if it progresses all
Speaker 2: the way to the tissue completely dying, that's when you
Speaker 2: might lose limbs, or lose fingers or lose the tips
Speaker 2: of noses, right where even after rewarming, that tissue will
Speaker 2: not come back to life. Prior to that though, even
Speaker 2: if the tissue itself can be saved, there can absolutely
Speaker 2: be permanent nerve damage and things like that. It just
Speaker 2: it totally depends on the specific scenario. So that's frostpine done. Well,
Speaker 2: let's keep talking about cold, Okay. All we've said so
Speaker 2: far is that we start with vasoconstriction in our peripheral
Speaker 2: tissues and in our blood vessels. Sometimes that's not enough
Speaker 2: to maintain heat. So the next thing that our body
Speaker 2: does is to increase the production of heat inside of
Speaker 2: our bodies. Yeah, and there's two main ways that we
Speaker 2: do that. One is shivering, so our skeletal muscle activity
Speaker 2: involuntarily starts to shiver and you have these repeated contractions
Speaker 2: and that increases metabolism, and so that increases heat production.
Speaker 2: But the downside of that is that it utilizes a
Speaker 2: lot of energy, right, Yeah, it's costly, it's costly. It's
Speaker 2: a very costly thing to do, but it can generate
Speaker 2: a lot of heat, so that can help to keep
Speaker 2: our bodies warm in some scenarios. There's another mechanism that
Speaker 2: we use, which is brown fat, brown outapost tissue. You
Speaker 2: mentioned this, and brown fat is so fascinating to me
Speaker 2: because it generates only heat. So metabolism in all of
Speaker 2: the other tissues of our body just generates heat as
Speaker 2: like a byproduct. It doesn't it doesn't mean to, but
Speaker 2: it happens too. But brown fat doesn't generate any energy.
Speaker 2: It only generates heat.
Speaker 1: It's like, that's the point. That's the point, and it
Speaker 1: is the point.
Speaker 2: And newborns have quite a lot of it, they do,
Speaker 2: and as adults we have significantly less m hm. And
Speaker 2: so you have it, but just a little bit, so
Speaker 2: we can't use it all that much. Yeah, but sometimes
Speaker 2: we might be exposed to cold that continues, and our
Speaker 2: shivering and our brown fat and all of this increase
Speaker 2: in metabolism simply can't keep up. So what happens to
Speaker 2: the body if we cannot keep up? The first thing
Speaker 2: is that we see what's called a cold diarysis, which
Speaker 2: basically means that because all of our blood has been
Speaker 2: shunted into our core, it's flowing very quickly through our organs,
Speaker 2: including our kidneys, and so our kidneys are furiously filtering
Speaker 2: all of this blood and we start to see an
Speaker 2: increase in urine production.
Speaker 1: I feel like I came across that somewhere, and I
Speaker 1: don't know where if it was like, yeah, I read
Speaker 1: the Shackleton's Expedition.
Speaker 2: Book for this one of my husband's favorite books.
Speaker 1: It's great. I mean it's like it's unbelievable. And the pictures,
Speaker 1: the fact that there are pictures is wild, yeah to me.
Speaker 1: But anyway, I don't remember if that's where somebody was
Speaker 1: talking about peeing a lot, or if it was because
Speaker 1: they're like freezing at night and no one wanted to
Speaker 1: go outside until it was like who didn't want to
Speaker 1: play the one or who didn't want to play the
Speaker 1: game where it was like the last person who fills
Speaker 1: the pot has to empty it, so you just hold it.
Speaker 2: Anyway, Well, yes, you do start to have a cold
Speaker 2: diuresis this is not a good sign.
Speaker 1: It means that things are not going well.
Speaker 2: And on top of that, not only is it just
Speaker 2: not a good sign, but what it means is that
Speaker 2: you can end up getting dehydrated right because you're losing
Speaker 2: all of this fluid through your urine. You could end
Speaker 2: up with acid base disturbances, you can end up with
Speaker 2: electrolyte issues, and eventually our body really cannot keep up
Speaker 2: with all of this loss, and our core body temperature
Speaker 2: will start to decrease. And as our core body temperature decreases,
Speaker 2: our energy expenditure also starts to decrease, and pretty dramatically actually,
Speaker 2: h I think for every one degree celsius decrease in
Speaker 2: core body temperature, our energy expenditure decreases by like thirteen percent.
Speaker 2: So there's no more shivering a lot of times. A
Speaker 2: lot of times shivering will stop. Yeah, because things are
Speaker 2: just sort of slowing down, and all of our cellular
Speaker 2: functions start to slow down, and this eventually results in
Speaker 2: our central nervous system slowing down so much that we
Speaker 2: lose consciousness. Usually that doesn't happen until our central like
Speaker 2: our core body temperature drops to around thirty degrees celsius.
Speaker 2: Should have looked up what that is in fahrenheit, but
Speaker 2: I didn't. It's cold, Yeah, it's cold. But what is
Speaker 2: usually lethal is not the effects on our central nervous system,
Speaker 2: but actually the effects on our heart. Because first you
Speaker 2: can get those acid base like and electrolyte disturbances from
Speaker 2: all of this diarysis that can affect the contractility of
Speaker 2: your heart and it can lead to arrhythmias. Okay, And
Speaker 2: as our heart beat is slowing down and all of
Speaker 2: this metabolism is slowing down in our heart, the time
Speaker 2: between beats can prolong, so we get what's called breta cardia.
Speaker 2: Your heart beat is slowing down, and then the time
Speaker 2: that it takes for the electric signals to actually be
Speaker 2: conducted through the heart also gets affected, so you end
Speaker 2: up with a rhythmias. There's a bunch of different types
Speaker 2: that you can get, but most often it's ventricular fibrillation,
Speaker 2: which is your heart just kind of quivering instead of contracting,
Speaker 2: and then eventually it stops completely. And that is how
Speaker 2: death usually happens with hypothermia.
Speaker 1: It's so it's I this makes me really look forward
Speaker 1: to next week because I'm trying to figure out is
Speaker 1: this Are there are clear costs costs, yes, and so
Speaker 1: there must be enough of a benefit or is there
Speaker 1: enough of benefit? But that's a question I guess.
Speaker 2: For next week.
Speaker 1: Next week, Yes, okay, I feel like I have some questions.
Speaker 1: So what about are you going to talk about like
Speaker 1: rewarming and how okay? Okay, so yeah, so you know,
Speaker 1: I guess the rate at which hypothermia occurs is dependent
Speaker 1: upon the individual, upon the environmental conditions, on clothing, upon
Speaker 1: too much to even go into, right, So are their thresholds?
Speaker 1: Are there established thresholds for like the risk or something?
Speaker 2: No I knew you were going to ask, and no,
Speaker 2: it's it's what's really I think it's one of the
Speaker 2: things that's very interesting about hypothermia. Right, there's not like
Speaker 2: a textbook that's like, below this temperature you are at
Speaker 2: risk of hypothermia because it depends, like you said, on
Speaker 2: so many different things. We do know that extremes of
Speaker 2: age are more susceptible to hypothermia. So newborn babies and
Speaker 2: small babies and infants in general have a much greater
Speaker 2: surface area to volume ratio, So even though they have
Speaker 2: that great brown fat and everything, they just lose a
Speaker 2: lot more heat, and so they're at higher risk of
Speaker 2: core temperature drops and hypothermia people who are elderly, So
Speaker 2: as you get older, you have less efficient, we think,
Speaker 2: thermoregulatory mechanisms. We also often see changes in like body
Speaker 2: mass composition during aging, and so that makes it so
Speaker 2: that you're less able to regulate your temperature. If you
Speaker 2: think about like your grandparents are cold all the time, right,
Speaker 2: they're just not as able to maintain their heat.
Speaker 1: You mentioned being.
Speaker 2: Unhoused, right, not having access to the behavioral mechanisms that
Speaker 2: we as humans rely on to maintain our temperature, like
Speaker 2: adequate clothing and shelter, fires or other forms of heat
Speaker 2: to keep us warm. And then also substance use like
Speaker 2: alcohol and other central nervous system medications like opioids or
Speaker 2: any any kind of thing that's affecting your central nervous
Speaker 2: system and depressing your central nervous system function is going
Speaker 2: to put you at higher risk of hypothermia hugely. So, Yeah,
Speaker 2: but there's not like you can certainly see we see
Speaker 2: hypothermia here in San Diego, even in the winter, and
Speaker 2: it doesn't get very cold here, right, Yeah, In terms
Speaker 2: of how we treat it, it really depends on how
Speaker 2: severe it is, and then like the specifics of the
Speaker 2: person and the scenario themselves. But across the board, it's rewarming, rights,
Speaker 2: it is rewarming that person's body back to a normal temperature.
Speaker 2: But whether that means just insulating them against any more
Speaker 2: heat loss, like if they're just mildly hypothermic, or if
Speaker 2: you need to actively rewarm somebody, and that might mean externally,
Speaker 2: like putting them in warm water or using we have
Speaker 2: in the hospital these things called bear huggers. Yeh, I'm
Speaker 2: pretty sure that's a brand name, Okay, But it's like
Speaker 2: these forced air it's like these blanket, paper, blankeant things
Speaker 2: that you put over someone. We use them in surgery
Speaker 2: a lot too, but also in hypothermia, and they just
Speaker 2: force hot air, so then you're like insulated with this
Speaker 2: blanket of hot air that's moving over you. They're quite cute,
Speaker 2: uh huh. And then heated blankets. These are all like
Speaker 2: external ways that you could warm a person's body if
Speaker 2: they're mildly hypothermic. Okay, and then there's internal rewarming, which
Speaker 2: is of course much more invasive, and there's obsceeded on
Speaker 2: er I'm sure you have many times. There's a lot
Speaker 2: of different ways that you can do it. You can
Speaker 2: do it with just like heated ivy fluids, so like
Speaker 2: just in you know, a peripheral line. You can do
Speaker 2: it via body like U body cavity levage, so like
Speaker 2: any of your body cavities. You can flush warm fluid
Speaker 2: through those body cavities and then drain it out, I know.
Speaker 2: And then you also could use essentially like an ECMO
Speaker 2: machine that's extra extra corporeal rewarming machine that just takes
Speaker 2: your blood from your body, runs it through a machine,
Speaker 2: warms it up and oxygenates it, and then returns it
Speaker 2: back to your.
Speaker 1: Body pretty darn cordn incredible. Yeah, and that's that is it? Arin. Okay,
Speaker 1: So I have a question about something that you I
Speaker 1: don't know, I don't think you mentioned it, but like
Speaker 1: the your your ability to make decisions kind of gets
Speaker 1: all funky too. So that's one of the things. There's
Speaker 1: this what is it called where you disrobe, like you
Speaker 1: start to take off your clothes.
Speaker 2: Yeah, paradoxical dysrobing, I think, or something they call it
Speaker 2: what it is. Yeah, yeah, I mean I don't We
Speaker 2: don't really have a great understanding of why and how
Speaker 2: that happens, but it is something that you can see,
Speaker 2: and we think that it's just due to Even though
Speaker 2: you might not lose consciousness until your body gets quite cold,
Speaker 2: like a core temperature of around thirty, the effects on
Speaker 2: your brain and your central nervous system can be pretty substantial,
Speaker 2: even at relatively mild hypothermia, which means that yeah, people
Speaker 2: might not be like and we don't really know, like
Speaker 2: no one's thankfully today doing human experiments to figure out
Speaker 2: like what are you thinking about when your body is
Speaker 2: getting to be that cold? And so we don't have
Speaker 2: great data on like why do these types of things
Speaker 2: but it can certainly complicate. I read a couple of
Speaker 2: like forensic examiner type papers where they were, like, hypothermia
Speaker 2: deaths if you're like investigating them as like a forensic
Speaker 2: medical person, can be really complicated because sometimes it is
Speaker 2: just hypothermia, but it can look like there's a lot
Speaker 2: of foul play involved, or it can look like really
Speaker 2: complicated scenarios and then it's ultimately determined that it's all
Speaker 2: just due to hypothermia. But so it is. It's really fascinating. Yeah, okay, okay,
Speaker 2: And what I think is also so fascinating about hypothermia
Speaker 2: are the kinds of stories, like you told Aaron, of
Speaker 2: people actually being able to recover. Yeah, especially when you
Speaker 2: contrast it to heat stress, right, like hyperthermia, the way
Speaker 2: that extreme heat induces damage to our proteins, to our
Speaker 2: cell structures itself, that has a pretty poor prognosis if
Speaker 2: your body temperature gets way too hot.
Speaker 1: Yeah, you're looking at like a degree of a few
Speaker 1: degrees versus like tens of degrees that people have come
Speaker 1: back from exactly.
Speaker 2: And it's in part because hypothermia overall is reducing our
Speaker 2: cellular functioning and our energy demands, which means that we
Speaker 2: need less oxygen and our cells can therefore survive in
Speaker 2: absence of oxygen, and that is why people have thought
Speaker 2: to use this in medicine as a therapeutic device. And
Speaker 2: that is what we're going to talk about next week.
Speaker 1: Loved that Cliffhanger transition. Loved it. Thank You's great, Thank
Speaker 1: you so much. It was great. I'm really looking forward
Speaker 1: to that because I want to know. I feel like
Speaker 1: I have made some assumptions about therapeutic hypothermia, so I'm
Speaker 1: ready to have those corrected. I can't wait. I'm excited
Speaker 1: if it need be.
Speaker 2: Yeah, maybe they're all correct.
Speaker 1: I don't know who. I don't know much, but I'll
Speaker 1: know more next week. And if you want to know
Speaker 1: more this week.
Speaker 2: Right now, so many sources, Okay.
Speaker 1: Let me pull mine up. So for both of these episodes,
Speaker 1: I read a book that gave me a lot of
Speaker 1: different ideas called Out Cold by Phil Jakol. It's a
Speaker 1: chilling descent into the macabre, controversial, life saving history of
Speaker 1: hypothermia book from twenty twenty one. And then if you
Speaker 1: want to read more, I absolutely loved this review paper
Speaker 1: about it's called Adaptations to Polar Life in Mammals and Birds.
Speaker 1: I love it by Blicks from twenty sixteen. And it's
Speaker 1: just like such a fun, fascinating, just like a paper
Speaker 1: that talks a.
Speaker 2: Lot fun all the ways.
Speaker 1: I love it. Yes, then there's for more of the history,
Speaker 1: especially the Napoleon stuff. There's a paper by Lankfort from
Speaker 1: twenty sixteen titled Dull Brains and Frozen Feet, a historical
Speaker 1: essay on cold And finally, I want to just put
Speaker 1: a plug in for a short story by Jack London
Speaker 1: called to Build a Fire and it's available. Just search it.
Speaker 1: You can find a PDF. It's by the public domain.
Speaker 1: And it is I mean, it's a story of hypothermia.
Speaker 1: Is it is chilling and good and yeah, I clearly
Speaker 1: should have thought of more better adjectives before telling people
Speaker 1: to read it, but it is really it's it's I
Speaker 1: think it does a really good job of kind of
Speaker 1: taking you through how what hypothermia might feel like and
Speaker 1: sort of the one fault like one false step, one
Speaker 1: one miss misstep, one one bad move.
Speaker 2: Aaron, I don't have like really fun recommendation like that, Aaron.
Speaker 2: I have you know a page called body temperature and
Speaker 2: it's regulation by kot and Farmery from Antesesion Intensive Care Medicine.
Speaker 2: I've Got Hypothermia by Turk in Forensic Science, Medicine Pathology.
Speaker 2: That one was kind of interesting. Accidental Hypothermia from the
Speaker 2: New England Journal Medicine nineteen ninety four. We got a
Speaker 2: few other papers. Okay, there is an update from twenty
Speaker 2: twenty two on the accidental hypothermia one.
Speaker 1: So listen.
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Speaker 2: and every single one that we've ever done on our
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Speaker 2: M