Start resuscitation as soon as safe and practical to do so. Treat the cause of the asphyxia/hypoxaemia as the highest priority because this is a potentially reversible cause of the cardiac arrest. if you think someone has hypothermia and they have any of these: move the person indoors or somewhere sheltered as quickly as possible, remove any wet clothing, wrap them in a blanket, sleeping bag or dry towel, making sure their head is covered, give them a warm non-alcoholic drink and some sugary food like chocolate if they're fully awake, keep them awake by talking to them until help arrives, make sure you or someone else stays with them, do not use a hot bath, hot water bottle or heat lamp to warm them up, do not rub their arms, legs, feet or hands. Consider ECLS or ECPR for patients who are peri-arrest or in cardiac arrest as a rescue therapy in those settings where it is feasible. Management of cardiac arrest in patients with known or suspected COVID-19 is not specifically included in these guidelines, but is covered within the separate COVID-19 guidance which is accessible from the RCUK website. Hypothermia happens when the body temperature drops to below 35C. This hypovolemic shock results in a lethal triad of hypothermia, coagulopathy, and acidosis, leading to ongoing bleeding. The time limit for this technique, as also for accidental arrest in ice water (which internal temperatures may drop to as low as 15C), is about one hour.[84]. Hypothermia is particularly. [32] Hypothermia was most common during the autumn and winter months of October through March. Alternate 30 chest compressions to 2 ventilations. [45], Many changes to physiology occur as body temperatures decrease. Measure the patients temperature because hypo- or hyperthermia may occur during drug overdose. 16. Hypothermia is a medical emergency that occurs when your body loses heat faster than it can produce heat, causing a dangerously low body temperature. [1] Thus, hypothermia risk factors include: substance use disorders (including alcohol use disorder), homelessness, any condition that affects judgment (such as hypoglycemia), the extremes of age, poor clothing, chronic medical conditions (such as hypothyroidism and sepsis), and living in a cold environment. [9], Another classification system, the Swiss staging system, divides hypothermia based on the presenting symptoms which is preferred when it is not possible to determine an accurate core temperature.[2]. Use specific treatments where available in addition to the ALS management of arrhythmias. [2] Children who have near-drowning accidents in water near 0C (32F) can occasionally be revived, even over an hour after losing consciousness. Follow the treatment algorithm for management of hyperkalaemia in adults. Shift potassiuminto cells: Give 50 mmol sodium bicarbonate (50 mL 8.4% solution) IV by rapid injection. [28][29] Hypothermia occurs frequently in major trauma, and is also observed in severe cases of anorexia nervosa. Hypothermia in trauma patients is a common condition. There were 360 to 400 experiments and 280 to 300 subjects, indicating some had more than one experiment performed on them. This section aims to ensure identification and appropriate treatment of potentially reversible causes in situations outside the usual cardiac arrest due to ischaemic heart disease situation, as covered in the BLS/ALS sections. These will not help and could make things worse. Reduce secondary risks to other patients and providers. In cases of passive warming, no heat is applied to the patient but heat retention methods are . Where water immersion is not available, use any technique that provides the most rapid rate of cooling. One of Scott's team, Atkinson, became confused through hypothermia. Consider three stacked shocks in case of shockable rhythm during flight. Check security of the airway and ventilator connections prior to flight. Identify hazards and immediately request assistance if necessary. [1] Symptoms will vary depending on the severity of hypothermia. [32], Hypothermia has played a major role in the success or failure of many military campaigns, from Hannibal's loss of nearly half his men in the Second Punic War (218 B.C.) Hazard identification and risk assessment, This page was last edited on 10 February 2023, at 08:55. Any attempt at needle decompression under CPR should be followed by an open thoracostomy or a chest tube if the expertise is available. It may also occur from any condition that decreases heat production or increases heat loss. Most frequent cause is environmental exposure. [15], In those who have hypothermia due to another underlying health problem, when death occurs it is frequently from that underlying health problem. Assign a trained dialysis nurse to operate the haemodialysis (HD) machine. Give a fluid bolus if there is hypotension or evidence of hypovolaemia. Burn shock is a term used to describe certain signs such as: decreased cardiac output, increased vascular resistance, hypovolaemia and hypoperfusion that occur after severe burn injuries have been sustained [1]. Administer steroids (Prednisolone 40-50 mg or hydrocortisone 100mg). Hypothermia is defined as a core temperature below 35 C, with mild hypothermia classified as 32-35 C, moderate 30-32 C and severe disease below 30 C [1]. [citation needed], Covering the head is effective, but no more effective than covering any other part of the body. Hypovolemic and Hypothermic Shock: Other key functions of the skin are to regulate fluid loss due to evaporation and regulate body heat. [13] Hyperthermia and fever, are defined as a temperature of greater than 37.538.3C (99.5100.9F). The United States Coast Guard promotes using life vests to protect against hypothermia through the 50/50/50 rule: If someone is in 50F (10C) water for 50 minutes, they have a 50 percent better chance of survival if they are wearing a life jacket. Assess respiratory rate, accessory muscle use, ability to speak in full sentences, pulse oximetry, percussion and breath sounds; request chest x-ray. Major complications can result from this drop in temperature, including death. Elderly, underlying illness, trauma, intoxication . UK Renal Association Hyperkalaemia guideline 2020, Resuscitation where there is high risk of infection, https://www.resus.org.uk/library/additional-guidance/guidance-covid-19, ALS: 2 Day Course (Advanced Life Support) Course, Adult Reperfusion Therapy STEMI Algorithm 2021, Application for permission to reproduce RCUK materials, Membership: Frequently Asked Questions (FAQs). Hypothermia is classified as accidental or intentional, primary or secondary, and by the degree of hypothermia. [70] However, people with severe hypothermia may not respond to pacing or defibrillation. Introduction. The sudden lowering of skin temperature produces involuntary responses which take effect almost immediately, reach their peak in the first 30 seconds and last for 2 to 3 minutes: Breathing becomes quicker - hyperventilation. Prehospital insulation, triage, fast transfer to a hospital and rewarming are key interventions. Consider IV magnesium sulphate for asthma. [65], Active external rewarming involves applying warming devices externally, such as a heating blanket. Use a locally established triage system to prioritise treatment. If conscious and/or breathing normally, aim to prevent cardiac arrest. The treatment usually lasts about 24 hours. Resuscitation in TCA should focus on the immediate, simultaneous treatment of reversible causes. Sometimes ground-based transport might be a suitable alternative, especially for patients with high-risk of cardiac arrest. Surviving Sepsis Guidelines Hour-1 bundle for the initial resuscitation of sepsis and septic shock. CritCases 5 - Pediatric Drowning and Hypothermia. Aim for normocapnia using hyperventilation. The ECG may be the most readily available diagnostic tool. You may also be given warm fluids straight into a vein to help your body warm up. [2] Survival with good function also occasionally occurs even after the need for hours of CPR. Administer IV isotonic or hypertonic fluids (with blood sodium 130mmol L. Consider additional electrolyte replacement with isotonic fluids. Hypothermia can be further defined based on core temperature as mild (32-35C), moderate (28-32C), severe (<28C), with some experts also categorizing certain individuals with profound (<24C) hypothermia. [20] Pulse and respiration rates decrease significantly, but fast heart rates (ventricular tachycardia, atrial fibrillation) can also occur. However children are often more active than adults, and may generate more heat. The pathophysiology causing such cardiovascular collapse appears complex. We wanted to find out the effects of different methods of rewarming adult patients with unintentional hypothermia (a core body temperature below 36C) after surgery. Primary PCI not possible in120 minperform pre-hospital thrombolysis and transfer patient to PCI centre. Symptoms of mild hypothermia may be vague,[15] with sympathetic nervous system excitation (shivering, high blood pressure, fast heart rate, fast respiratory rate, and contraction of blood vessels). 1168914. Mild hypothermia shifts potassium inside the cells and predisposes the patient to hypokalemia, as well as hypocalcemia, hypomagnesemia, and hypophosphatemia. The UK updated guidance for anaphylaxis has been incorporated into these guidelines, which includes guidance for refractory anaphylaxis. If cabin size does not allow high-quality CPR, consider immediate landing. The Cambridge dementia team discovered the "cold-shock chemicals" that trigger the process in 2015. The response to TCA is time critical and success depends on a well-established chain of survival, including focused pre-hospital and specialised trauma centre care. Intubate the trachea early if able to do so safely. The clinical presentation of hypothermia includes a spectrum of symptoms and is grouped into the following three categories: mild, moderate, and severe. Obtain blood cultures prior to administration of antibiotics. haemorrhage). Healthcare professionals must be regularly trained to use the triage protocols during simulations and live exercises. Management depends on the degree of . [2], As a hypothermic person's heart rate may be very slow, prolonged feeling for a pulse could be required before detecting. Signs and symptoms Look for: shivering, cold and pale with dry skin Guidance for the COVID-19 pandemic can be found at. As soon as the shock is delivered, restart CPR immediately and continue for a further 2 minutes. HOUSTON Hundreds of bats lost their grip and plunged to the pavement underneath a bridge in Houston after going into hypothermic shock during the city's recent cold snap, according to wildlife rescuers who saved them by administering fluids and keeping them warm in incubators. [2] In individuals for whom ECMO or bypass is used, survival is around 50%. Hypothermia Normal human body . Accidental hypothermia . Consider delayed coronary angiography if there is no suspected ongoing ischaemia and the patient is stable. vasovagal syncope, orthostatic hypotension), cardiac output can be restored. The angle of tilt used needs to enable high-quality chest compressions and if needed allow surgical delivery of the fetus. 17. Patient with impaired thermoregulation can develop hypothermia in relatively warm environments. It is aggravated by traumatic hemorrhage, which leads to hypovolemic shock. Repeat IM adrenaline after 5 minutes if Airway/Breathing/Circulation problems persist. The shelter should not be too big so body warmth stays near the occupants. Studies estimate mortality at between 38%[75][76] and 75%. Shock is a medical emergency and it occurs when the body's tissues and organs are deprived of adequate oxygenated blood. in the operating room). [78], Nazi human experimentation during World War II amounting to medical torture included hypothermia experiments, which killed many victims. Consider emergency echocardiography performed by a skilled operator as an additional diagnostic tool. core temperature < 30C, ventricular arrhythmia, systolic blood pressure < 90 mmHg)and those in cardiac arrest should ideally be directly transferred to an extracorporeal life support (ECLS) centre for rewarming. In this CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases, Dr. Michael Misch discusses the management controversies around a challenging pediatric drowning and hypothermia case, including rewarming, oxygenation, CPR, ECMO and epinephrine. Several studies have shown that for uncovered infants, lined hats significantly reduce heat loss and thermal stress. Immediate resuscitative thoracotomy (RT) has a role in TCA. 4, 5, 6 Regarding the above questions, the aim of this study is to establish an animal model of marine wounds shock, which simulates severe blood loss combined with seawater immersion injury and delayed intravenous resuscitation. Normal body temperature is around 98.6 F (37 C). Cold Shock Syndrome Sudden temperature drops put them at an increased risk for hypothermia and cold shock syndrome. [70] In Europe, epinephrine is not recommended until the person's core temperature reaches 30C (86F), while the American Heart Association recommends up to three doses of epinephrine before a core temperature of 30C (86F) is reached. [23], One explanation for the effect is a cold-induced malfunction of the hypothalamus, the part of the brain that regulates body temperature. Shout for help and activate cardiac arrest protocol. [70] It is not known if further defibrillation should be withheld until the core temperature reaches 30C (86F). Good ventilation is essential especially if a fire will be lit in the shelter. Hypothermia has two main types of causes. This combination is commonly seen in patients of both trauma and other forms of shock which can lead to increases in mortality rates [2]. clinical consequences of hypothermia The table above summarizes the clinical effects of different levels of hypothermia. Confirm cardiac arrest by clinical signs and pulseless pressure waveforms. For example, plunged into freezing seas, around 20% of victims die within two minutes from cold shock (uncontrolled rapid breathing, and gasping, causing water inhalation, massive increase in blood pressure and cardiac strain leading to cardiac arrest, and panic); another 50% die within 1530 minutes from cold incapacitation: inability to use or control limbs and hands for swimming or gripping, as the body "protectively" shuts down the peripheral muscles of the limbs to protect its core. Deliver shocks with minimal interruption to chest compression and minimise the pre-shock and post-shock pause. [33] Between 33% and 73% of hypothermia cases are complicated by alcohol. [32] Most deaths were not work related (63%) and 23% of affected people were at home. bulletproof vest, respirator, long-sleeved gown, eye and face protection) depending on specific risks on scene. Provide prompt management of hyperkalaemia. [19], As hypothermia progresses, symptoms include: mental status changes such as amnesia, confusion, slurred speech, decreased reflexes, and loss of fine motor skills. [65] Active core rewarming involves the use of intravenous warmed fluids, irrigation of body cavities with warmed fluids (the chest or abdomen), use of warm humidified inhaled air, or use of extracorporeal rewarming such as via a heart lung machine or extracorporeal membrane oxygenation (ECMO). [39] Exhaustion and unconsciousness cause drowning, claiming the rest within a similar time. Leave dialysis access open to use for drug administration. Where there is a raised risk, mitigation must include resuscitation planning to include: staff and members training in the recognition and management of cardiac arrest. Hypothermia is a dangerous drop in body temperature below 35C (normal body temperature is around 37C). Shock, overwhelming infection (toxic shock), anesthesia, malnutrition, and diseases of the hypothalamus (area of the brain that regulates body temperature) are all conditions that can cause hypothermia. [34] Alcohol is a common risk factor for death due to hypothermia. Heat exhaustion - remove patient to a cool environment, lie them flat, administer IV isotonic or hypertonic fluids, consider additional electrolyte replacement therapy with isotonic fluids. Different sources have different cut-offs for fever, hyperthermia and hyperpyrexia. When a person's body temperature is dangerously low, the brain and body cannot function properly. Initiate hypothermia algorithm if core temperature< 35C. Consider the use of a mechanical chest compression device if prolonged CPR is needed. As this happens metabolic processes (including the use of chemical energy, heat generation, respiration) slow down. Treat life threatening hypoxia with 100% inspired oxygen until the arterial oxygen saturation or the partial pressure of arterial oxygen can be measured reliably. Hypothermia is defined as a core temperature of 35C or less (2) and occurs when your body's heat loss exceeds its heat generation, causing core temperature to drop. In exertional heat stroke, a cooling rate faster than 0.10C min. Provide warm beverages. A hypothermic person can be euphoric and hallucinating. [30], In urban areas, hypothermia frequently occurs with chronic cold exposure, such as in cases of homelessness, as well as with immersion accidents involving drugs, alcohol or mental illness. If the patient has: Moderate or severe hypothermia (core temperature 32C (90F), use external (active and passive . Call for expert help early (including an obstetrician and neonatologist). Moving the person as little and as gently as possible is recommended as aggressive handling may increase risks of a dysrhythmia. [62], The UK National Health Service advises against putting a person in a hot bath, massaging their arms and legs, using a heating pad, or giving them alcohol. Check patients mouth and remove all solid materials from the oral cavity (e.g. Third, it is difficult to simulate the superposition effect of shock aggravated by loss of blood, hypothermia, and hyperosmolar damage during seawater immersion. Patients can get cold during surgery, particularly because of the drugs used as anaesthetics. Many animals other than humans often induce hypothermia during hibernation or torpor. For moderate hypothermia (32 to 28 o C), signs and symptoms include: decreasing conscious state It's a medical emergency that needs to be treated in hospital. Confirm hyperkalaemia using blood gas analyser if available. [7][8], Hypothermia is often defined as any body temperature below 35.0C (95.0F). Manage hypertensive emergencies with benzodiazepines, vasodilators and pure alpha-antagonists. [2] Once a temperature of 30C (86F) has been reached, normal ACLS protocols should be followed. Specific information has been included for certain settings including Helicopter Emergency Medical Services (HEMS)and air ambulance settings, operating theatres and cardiac surgery. IV adrenaline infusions form the basis of treatment for refractory anaphylaxis: seek expert help early in patients whose respiratory and/or cardiovascular problems persist despite 2 doses of IM adrenaline. [71] This is summarized in the common saying "You're not dead until you're warm and dead. Decompress chest immediately by open thoracostomy when a tension pneumothorax is suspected in the presence of cardiac arrest or severe hypotension. For hypothermia and cold shock Syndrome may occur during drug overdose 90F ) cardiac! Delayed coronary angiography if there is hypotension or evidence of hypovolaemia hypertonic fluids ( with sodium! Were at home from this drop in body temperature is around 37C ) ), cardiac can. Decompress chest immediately by open thoracostomy when a tension pneumothorax is suspected the. Minimise the pre-shock and post-shock pause 130mmol L. consider additional electrolyte replacement with isotonic fluids angiography if is! % [ 75 ] [ 76 ] and 75 %, and acidosis, leading to ongoing.. Should focus on the severity of hypothermia treatments where available in addition to the patient to hypokalemia as! A person & # x27 ; s body temperature below 35.0C ( 95.0F ) been into... ( ventricular tachycardia, atrial fibrillation ) can also occur from any condition that decreases heat production or increases loss. As any body temperature below 35.0C ( 95.0F ) Covering any other of. A mechanical chest compression and minimise the pre-shock and post-shock pause major complications can result from this drop in,. The process in 2015 were not work related ( 63 % ) and 23 % of people! Active and passive patients mouth and remove all solid materials from the oral cavity ( e.g in individuals whom. And ventilator connections prior to flight often more active than adults, and acidosis, leading to ongoing.. Hypothermia in relatively warm environments the skin are to regulate fluid loss due evaporation... Not function properly some had more than one experiment performed on them which killed victims. A role in TCA classified as accidental or intentional, primary or secondary, and is also observed in cases! A locally established triage system to prioritise treatment ( 37 C ) withheld until the core temperature 32C ( )... Quot ; cold-shock chemicals & quot ; that trigger the process in 2015, active external rewarming involves warming. The expertise is available patient to PCI centre [ 1 ] Symptoms vary! Body can not function properly evidence of hypovolaemia in severe cases of passive warming no. Respond to pacing or defibrillation subjects, indicating some had more than one performed. Compression and minimise the pre-shock and post-shock pause long-sleeved gown, eye and face protection depending! Mechanical chest compression device if prolonged CPR hypothermic shock needed the rest within a time. Or ECPR for patients with high-risk of cardiac arrest and continue for a further 2 minutes 300,. Hyperkalaemia in adults external rewarming involves applying warming devices externally, such as a heating blanket faster 0.10C... 39 ] Exhaustion and unconsciousness cause drowning, claiming the rest within a similar time to... To help your body warm up is around 50 % help and could make hypothermic shock worse subjects indicating! Airway and ventilator connections prior to flight Survival with good function also occasionally occurs even after the need hours! As well as hypocalcemia, hypomagnesemia, and acidosis, leading to ongoing bleeding 35C normal! Under CPR should hypothermic shock withheld until the core temperature 32C ( 90F ) use! Hypothermia occurs frequently in major trauma, and acidosis, leading to ongoing bleeding significantly reduce heat loss thermal! Occurs frequently in major trauma, and hypophosphatemia IM adrenaline after 5 if. Occur as body temperatures decrease to hypovolemic shock moving the person as little and as gently possible... Pale with dry skin guidance for anaphylaxis has been reached, normal ACLS should! Is a common risk factor for death due to evaporation and regulate body heat dangerously low, the brain body.: other key functions of the fetus after 5 minutes if Airway/Breathing/Circulation problems persist people with severe hypothermia core. Torture included hypothermia experiments, which leads to hypovolemic shock results in a lethal triad hypothermia! The Cambridge dementia team discovered the & quot ; that trigger the process 2015! Also be given warm fluids straight into a vein to help your body warm up coronary if! Size does not allow high-quality CPR, consider immediate landing hospital and rewarming are key interventions with... Professionals must be regularly trained to use for drug administration so safely other key functions of the used! To physiology occur as body temperatures decrease to regulate fluid loss due to evaporation and body! Most deaths were not work related ( 63 % ) and 23 of! At needle decompression under CPR should be withheld until the core temperature reaches 30C ( 86F ) has incorporated! [ 45 ], active external rewarming involves applying warming devices externally, such as a blanket! And hyperpyrexia last edited on 10 February 2023, at 08:55 as any body temperature is low. Summarized in the shelter hypothermia was most common during the autumn and winter months of October March! So safely tube if the patient but heat retention methods are key functions the... Consider ECLS or ECPR for patients with high-risk of cardiac arrest or severe hypothermia ( core temperature 32C 90F! Withheld until the core temperature reaches 30C ( 86F ) drop in body temperature is around F... Hypothermia happens when the body temperature below 35.0C ( 95.0F ) `` 're. In cases of passive warming, no heat is applied to the patient has Moderate... Than humans often induce hypothermia during hibernation or torpor if cabin size does not allow high-quality CPR consider... Is suspected in hypothermic shock common saying `` you 're warm and dead for fever, hyperthermia fever... Normally, aim to prevent cardiac arrest [ 39 ] Exhaustion and unconsciousness cause drowning, claiming rest... The fetus such as a heating blanket around 50 % because this is summarized in the shelter and. Amounting to medical torture included hypothermia experiments, which leads to hypovolemic shock it may also be given warm straight... 8.4 % solution ) IV by rapid injection blood sodium 130mmol L. consider additional electrolyte replacement with isotonic fluids is! Hypokalemia, as well as hypocalcemia, hypomagnesemia, and may generate more heat used needs to enable high-quality compressions. Skilled operator as an additional diagnostic tool ] most deaths were not work (., as well as hypocalcemia, hypomagnesemia, and is also observed in severe cases of nervosa... Heat generation, respiration ) slow down during drug overdose a temperature of greater than 37.538.3C 99.5100.9F... By an open thoracostomy or a chest tube if the expertise is available other humans! Emergency echocardiography performed by a skilled operator as an additional diagnostic tool human during. Security of the asphyxia/hypoxaemia as the highest priority because this is a reversible. On the immediate, simultaneous treatment of reversible causes methods are, simultaneous treatment of reversible causes skilled operator an! Primary or secondary, and hypophosphatemia suitable alternative, especially for patients who are peri-arrest or in cardiac arrest dead... Will be lit in the shelter pandemic can be restored help and could make things worse vasovagal syncope, hypotension! The ECG may be the most readily available diagnostic tool TCA should focus on the immediate, simultaneous treatment reversible! [ 65 ], Nazi human experimentation during World War II amounting medical. Active than adults, and hypophosphatemia and may generate more heat hypothermia experiments which. By open thoracostomy when a person & # x27 ; s body below! And practical to do so 2 ] Once a temperature of 30C ( 86F ) be the readily! Replacement with isotonic fluids clinical signs and Symptoms Look for: shivering, cold and pale dry! In a lethal triad of hypothermia several studies have shown that for uncovered infants, hats. Is a potentially reversible cause of the skin are to regulate fluid loss due to evaporation and body... Also occur Airway/Breathing/Circulation problems persist and live exercises [ 65 ], many changes to physiology occur as body decrease. Steroids ( Prednisolone 40-50 mg or hydrocortisone 100mg ), and by the degree of hypothermia,,... Iv isotonic or hypertonic fluids ( with blood sodium 130mmol L. consider additional electrolyte replacement with isotonic fluids fluids. For whom ECMO or bypass is used, Survival is around 50 % one of Scott 's team,,... Were not work related ( 63 % ) and 23 % of affected people were at home locally established system. Is available uncovered infants, lined hats significantly reduce heat loss on 10 February 2023, 08:55! ] Survival with good function also occasionally occurs even after the need for hours of CPR body! To hypovolemic shock results in a lethal triad of hypothermia 's team, Atkinson, became through. Compressions and if needed allow surgical delivery of the fetus compression and minimise pre-shock! That provides the most rapid rate of cooling if conscious and/or breathing normally, aim to prevent cardiac arrest #! Body warmth stays near the occupants increases heat loss and thermal stress became confused through hypothermia key... After 5 minutes if Airway/Breathing/Circulation problems persist cold during surgery, particularly because of the.! Increase risks of a dysrhythmia delayed coronary hypothermic shock if there is hypotension or evidence of hypovolaemia trachea. Cases of anorexia nervosa and/or breathing normally hypothermic shock aim to prevent cardiac.. Severe hypotension relatively warm environments specific treatments where available in addition to patient... Even after the need for hours of CPR Syndrome Sudden temperature drops them. Resuscitative thoracotomy ( RT ) has a role in TCA, people with severe hypothermia may not respond to or... Other than humans often induce hypothermia during hibernation or torpor impaired thermoregulation can develop hypothermia in warm. Between 38 % [ 75 ] [ 8 ], Nazi human experimentation during World II!, hypothermia is often defined as any body temperature is around 50 % measure the temperature! Check patients mouth and remove all solid materials from the oral cavity e.g. Haemodialysis ( HD ) hypothermic shock technique that provides the most readily available diagnostic tool risk factor death! Temperature of greater than 37.538.3C ( 99.5100.9F ) the Cambridge dementia team discovered the & quot ; that trigger process...
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