title: Comparison of heat donation through the head or torso on mild hypothermia rewarming.
abstract: OBJECTIVE
  The purpose of the study was to compare the effectiveness of head vs torso warming in rewarming mildly hypothermic, vigorously shivering subjects using a similar source of heat donation.
  
  
  METHODS
  Six subjects (1 female) were cooled on 3 occasions in 8 ºC water for 60 minutes or to a core temperature of 35 ºC. They were then dried, insulated, and rewarmed by 1) shivering only; 2) charcoal heater applied to the head; or 3) charcoal heater applied to the torso. The order of rewarming methods followed a balanced design. Esophageal temperature, skin temperature, heart rate, oxygen consumption, and heat flux were measured.
  
  
  RESULTS
  There were no significant differences in rewarming rate among the 3 conditions. Torso warming increased skin temperature and inhibited shivering heat production, thus providing similar net heat gain (268 ± 66 W) as did shivering only (355 ± 105 W). Head warming did not inhibit average shivering heat production (290 ± 72 W); it thus provided a greater net heat gain during 35 to 60 minutes of rewarming than did shivering only.
  
  
  CONCLUSIONS
  Head warming is as effective as torso warming for rewarming mildly hypothermic victims. Head warming may be the preferred method of rewarming in the field management of hypothermic patients if: 1) extreme conditions in which removal of the insulation and exposure of the torso to the cold is contraindicated; 2) excessive movement is contraindicated (eg, potential spinal injury or severe hypothermia that has a risk of ventricular fibrillation); or 3) if emergency personnel are working on the torso.
authors.affiliation: Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Bhupinder Jit K
authors.initials: BJ
authors.lastname: Sran
authors.affiliation: Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Gerren K
authors.initials: GK
authors.lastname: McDonald
authors.affiliation: Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Steinman
authors.affiliation: Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Phillip F
authors.initials: PF
authors.lastname: Gardiner
authors.affiliation: Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: giesbrec@cc.umanitoba.ca.
authors.forename: Gordon G
authors.initials: GG
authors.lastname: Giesbrecht
mesh_terms: D000328:Adult; D005260:Female; D006257:Head; D006339:Heart Rate; D006801:Humans; D007035:Hypothermia / Q000628:therapy*; D008297:Male; D010101:Oxygen Consumption; D017694:Rewarming / Q000379:methods*; D012768:Shivering / Q000502:physiology; D012881:Skin Temperature; D060726:Torso
keywords: afterdrop; effective perfused mass; prehospital treatment; shivering heat production; thermal core