The hypothermic matchstick girl

hipotermic

Surely as a young man they read you the story of "La Cerillera", by Hans Christian Andersen. A poor girl, selling matches for a living, dies on New Year's Eve because of the winter cold without anyone repairing her. This story shows a harsh lesson for the little ones on values such as solidarity and empathy for others.

Why do I write about this story on my blog, if it doesn't have any a priori relationship with the health issue? Because I think with him we can learn in an original way about hypothermia and its pathophysiology.

The tale begins with a cold, dark winter night in a snow-covered city. A little girl (I suppose about 8 to 12 years old) walks the streets of the city on New Year's Eve trying to sell a handful of matches to be able to eat. At first, the body temperature of the cerillera would be normal, at about 37oC thanks to its organic thermoregulation mechanisms. In a cold environment where there is loss of body heat, thermogenesis would be activated, comprising measures such as:the cerillera

  • Increased cellular metabolism.
  • Use of proteins, glycides and lipids.
  • Stimulation of the sympathetic nervous system.
  • Thyroid hormone secretion
  • Piloerection
  • Tremor
  • Skin vasoconstriction

All of them aimed at counteracting this loss of heat caused by:

  • Radiation 65%: generated by the temperature difference between the street environment and the girl's body.
  • Evaporation 20%: The piglet's breathing, panting and sweating as she tried to run after people to sell her matches and somewhat wet clothes also contributed to the girl's temperature dropping further.
  • Driving 7.5%: When the girl lost her shoes when she escapes from the horse-drawn carriage that nearly ran her over and went barefoot through the snow, she was losing a lot of heat through her feet by contact between them and the ground.
  • Convection 7'5%: the freezing wind and the humidity of the snow generated a decrease in the thermal sensation of the cerillera, making it even cooler.

cerilleraAt first, the ceillera would be able to counteract the losses thanks to the above mechanisms and react satisfactorily to thermal aggression. When his body reached 35oC, he would start shaking, chills and his hands and feet would begin to pale and cool due to skin vasoconstriction (from the more distal areas to keep more heat in the central part and thus ensure the operation of its target organs). Later they would also acquire a bluish tone (acrocyanosis) because of the lack of tissue oxygen in both limbs.
To meet new metabolic demands, the cerillera heart will increase your beats per minute (FC >105ppm) as well as the pressure in your arterial vessels (TA >130/90ppm). Unfortunately, these measures are not very effective in the long term and in a short time, both their heart rate and blood pressure, will fall to FC figures<75ppm y="" ta=""></75ppm><85/55mmHg.></85/55mmHg.>
The breathing rate will increase satisfactorily, remaining in tachypnea figures >15rpm, at least as long as the small one has a temperature above 32oC.
The cold would stimulate his desire to micute (urinate), and the motility of his intestines would be slightly paralyzed, so we would no longer hear airborne noises or borborismos coming from his abdomen, despite the hunger that flooded the poor.
The affectation of his central nervous system would make him look listless, (which is probably why he sat in a corner to rest and light his matches), somewhat confusing and trouble speaking (dysartria).

cerillera 2The little girl, with her temperature plummeting, would try to warm herself by lighting the few matches she had left to sell. When his body went over 32oC, the tremor disappeared, but not because the fire was taking effect, but quite the opposite. She kept lighting the matches, but with every match she spent she had a visual and even auditory hallucination: a beautiful Christmas tree, a succulent New Year's Eve dinner and her beloved granny giving her love.
His body became ever stiffer, the breath was bradyipneic to<13rpm y su TA seguía bajando. y="" su="" ta="" seguía=""></13rpm y su TA seguía bajando.> The heart was beating more and more slowly and began to have an irregular rhythm (supraventricular arrhythmias such as fibrillation and atrial flutter would appear). She was progressively losing heat until she was 28oC, at which point the creature had her grandmother's last vision, leaving with her to a better place and then fell unconscious.

From this point on, the girl was in a situation of severe hypothermia, but was still potentially reanimable. He had severe neurological impairment, his pupils were fixed, myrhedritic and barely reactive to light. His heart was dying slowly and was unable to function properly, so he could hardly get his pulse taken and was suffering from increasingly severe arrhythmias (ventricular tachycardia and ventricular fibrillation). The cerillera suffered from a very severe picture of hypotension and hypoventilation, but could still fight for his life if he had been provided with adequate life support as long as his temperature remained above 24oC.

dead cerilleraUnfortunately, no one helped the little girl, and when she finally exceeded the 24oC limit, she entered an apparent death situation. His heart went from ventricular fibrillation to asistolia, so if we had applied a monitor his ECG would be completely flat. His respiratory pattern passed to apnea. It would still keep the chest compressible and the abdomen depressible until 15oC. By the time it passed 14oC thorax and abdomen would be stiff, progressively the mouth and nose would begin to partially block by the ice, the eyes would freeze and its rectal temperature would drop to match that of the environment.

We might think that fortunately this is just a story, but reality shows us every winter that it is not. From 2006 to 2012, a total of 473 homeless people have died on the streets of our country, and from that total, 38 from hypothermia. According to Anna Carceller, director of the Institute of Mountain and Sports Medicine, she said in an interview given for the newspaper El País "at minus 30 degrees, the temperature reached in parts of the United States, a poorly prepared person freezes in one minute." Therefore it is important that we take hypothermia as one more pathology, and not simply as a state or a therapeutic technique.

I hope you found this post original. If you are interested in learning more about the assessment and care of hypothermia, I would be heartily grateful if you would tell me to prepare a new one and thus clarify any doubts that may have arisen during the reading of this. And while… Keep enjoying my blog and see you next week!

Bibliography:

  1. Lizarralde Palacios, E; Gutierrez Macías, A; Martínez Ortiz de Zárate, M. Thermoregulation disturbances. Rev. Emergencies 2000; Vol. 12; pp. 192-207
  2. Cold-environment survival, Rivera Prat, C. A. 2004 Marina Magazine. Science and technology. Retrieved 01 June 2014. Available in: http://revistamarina.cl/revistas/2004/2/rivera.pdf
  3. Soteras Martíneza, I; Subirats Bayego, E; Reistein, O. Accidental hypothermia. Clinical Medicine 2011; Vol. 137; N º. 4; pp.: 171–177

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