When hypothermic symptoms begin, the most important treatment step is recognition. Re-warming, through use of additional layers of clothing, removal and replacement of wet clothing, or use of blankets is critical. Rest and reduction of surface area for heat loss can slow the process. Shelter from the cold, the wind, and wetness is likewise important (33).

What should be avoided is paradoxical behavior as can be seen in hypothermia where the individual removes rather than adds clothing. Also to be avoided is rubbing of the area or use of snow to deal with frostbite. Local rubbing destroys damaged skin tissue (34).

When more severe hypothermia occurs, external rewarming through the use of forced air heating blankets, radiant heat, or hot packs may be needed. In the most extreme cases, active core rewarming with heated humidified oxygen and heated intravenous fluids may be necessary. Treatment of severe hypothermia may also include appropriate treatment of impaired organ systems, including full cardiopulmonary resuscitation (37).

Despite the effects that cold can have, there are numerous cases of individuals recovering from severe hypothermia. This is particularly present in cold water drowning. There is an old saying in emergency medicine: "The person isn't dead until he is warm and dead." Thus, aggressive and continued therapy of hypothermia is warranted (37).

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