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- [00:00]
Weatherbug Announcer
This is an iHeart podcast. Guaranteed Human no one knows what the future holds, but you deserve a weather app that can help. Weatherbug is easy to use and provides forecasts for your every need, from storm warnings to pollen levels right at your fingertips. Get the fastest local Alerts and comprehensive 10 day forecasts wherever you are. Its hyperlocal, real time customizable alerts make sure the weather never takes you by surprise so you can plan every day with confidence. Download the free Weatherbug app from the App Store today and start getting accurate weather forecasts. Forecasts 24. 7
- [00:35]
Ryan Reynolds
Ryan Reynolds here from Mint Mobile with a message for everyone Paying Big Wireless Way too much. Please, for the love of everything good in this world, stop with Mint. You can get premium wireless for just $15 a month. Of course, if you enjoy overpaying. No judgments. But that's weird. Okay, one judgment anyway. Give it a try@mintmobile.com Switch upfront payment
- [00:57]
Dr. Kendall Crowns
of $45 for three month plan equivalent to $15 per month required intro rate first three months only, then full price plan options available, taxes and fees extra@mintmobile.com magnesium supplements.
- [01:07]
Solaray Magnesium / AMU Announcer
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- [02:06]
Coldwater Creek Announcer
You see it instantly. It's Coldwater Creek, the mark of exceptional workmanship and signature touches inspired by a Mountain west heritage. Distinctive styles created from quality fabrics, silhouettes perfected with just the right drape feel good fits offering ease of movement and thoughtful details to elevate your look. For a wardrobe you can count on season after season, visit coldwatercreek.com shop the new spring collection at 20% off $75 or more with code iheart20.
- [02:35]
Dr. Kendall Crowns
Today's episode includes information about the death of individuals. If this sort of thing upsets you, this is not the episode for you. May I suggest you watch a movie? Maybe something like White Christmas. Welcome to Mayhem in the Morning with your host. Dr. Kendall crowns. Today's episode. The weather outside is frightful. Last week, winter storm Fern swept across the Midwest, south, and northeast. It affected 34 states and 220 million people, including where I live in North Texas. These winter storms bring freezing temperatures, high winds, sleet, ice and snow. And with that, burst pipes, icy roads, and power outages. People are trapped in their homes without power or heat. And, of course, the homeless, if they can't find shelter, have to find a way to survive. Every year, wherever I've worked, we will get a number of people dying from exposure to the cold, also known as hypothermia. And of course, there were more cases of hypothermia when I worked up north, but there's still a few every year here in Texas, particularly during these types of winter storms. Because Texas is just not as well prepared for Arctic temperatures, I thought on today's episode I would discuss a few of the cases I've had and my experiences when Snowzilla comes to town. So let's get started. A normal body temperature in people is 98°F, or 37°C. Hypothermia occurs when the body temperature goes below this. And this is because the loss of heat from the body exceeds the heat production by the body. The most common cause of hypothermia is, of course, exposure to low environmental temperatures. But there are other causes, including hypothyroidism, hypoglycemia, strokes, sepsis, and a number of other things. But these cases are for another show, and today we're only going to focus on cases caused by cold weather. The cases of hypothermia that come into a medical examiner's office range from, of course, the unsheltered homeless people, elderly people in homes without power, the demented or mentally ill that wander away from their care facility in the dead of winter, alcoholics that pass out on a snowy night and go to sleep outside or fall and sustain injuries in which they can't get themselves out of the cold environment. Hypothermia occurs, of course, on land, which is also known as dry hypothermia, and in water, which is known as wet or immersion Hypothermia. In my career, the majority of the hypothermia cases I have dealt with have been on land, with a few coming from the frigid water. People dying of immersion hypothermia generally die quickly or suffer from acute hypothermia because of the intense cold stress caused by falling into the freezing water. One of the cases I had of immersion hypothermia was an individual trying to fix the gears on a bascule bridge during winter. If you don't know what this type of bridge is, it's one that lifts up and lets river traffic through. He and a co worker were working on the stuck mechanism, and at some point both of them slipped and were caught by their harnesses. Other co workers called for help. As time passed, one of the workers became frustrated, dangling high above the river and slipped out of his safety harness and fell into the river. He thought he could just fall into the river and swim to the shore and be okay, but he didn't account for the fact that the water was near freezing and he was in insulated gear when he hit the water. He was seen struggling for a brief period of time and then slowly stopped moving, slipping under the water, all while his CO worker watched in horror. The co worker was subsequently rescued, by the way. A little later on, when this individual came into the medical examiner's office for autopsy, the first thing I had to do was remove all his gear, and once I got it off his body, I decided to weigh it, and it weighed over 120 pounds due to all the water that had seeped into the clothing. With that and the fact that he was in freezing cold water, he didn't have a chance. He died from drowning. But I also contributed hypothermia to the cause of death. Cold water conducts heat 20 to 25 times faster than dry air, so you will die quicker in cold water than you would on land. Factors that can affect your survival time can be dependent on your nutritional status, type of clothing you're wearing, and of course, the temperature of the water. If you fell into 32 degrees Fahrenheit water or 0 degrees Celsius, which is almost freezing, you will probably lose consciousness in less than 15 minutes, with a survival time range of 15 to 45 minutes. Those who die at the shorter time interval, it is often because of the production of irregular heartbeats or arrhythmias caused by the body's sudden vasoconstriction of the blood vessels and reflex stimulation of the heart due to hitting that sudden Cold water, which is a little different than dry hypothermia, where the cold temperatures slowly cool you down. Clinically, hypothermia starts when the body Temperature drops below 95 degrees Fahrenheit, or 35 degrees Celsius. From 95 to 90 degrees Fahrenheit, or 35 to 32 degrees Celsius, you start shivering, which is the body's involuntary contraction of muscles to help produce heat. You get impaired judgment, slight loss of coordination, and internally, the heart rate goes up. In an attempt to increase pumping of warm blood throughout the body, the vessels vasoconstrict to shunt blood away from the skin and towards the core, reducing heat loss. Alcohol can affect this part of the process by causing the vessels not to constrict, but to dilate, which makes alcoholics lose heat faster. There is increased mucus production during this time, which causes a very runny nose. This is because the nose works to warm and humidify cold, dry air before it reaches the lungs. This, along with the condensation formed inside nasal passages, causes the nasal glands to produce excess mucus to protect the lining. At the moderate level of hypothermia, the body temperature is between 90 and 92 degrees Fahrenheit, or 32 and 28 degrees Celsius. this point, the brain's temperature regulation begins to fail. Shivering ceases because the body has run out of energy reserves and muscles are too cold to contract. The body shunts blood only to the core, abandoning the extremities, and this causes the kidneys to filter more fluid, resulting in excess urination. There is confusion, hallucinations, and delirium, along with slurred speech. And you also have paradoxical undressing, which I will explain later. Your heart rate slows, your blood pressure drops, and your heart begins to beat irregularly, and breathing slows. At the severe level, the body temperature is between 82 and 75 degrees Fahrenheit, or 28 and 24 degrees Celsius. You're unconscious at this point, but with a pulse, you're essentially in a coma. No reflexes, fixed, dilated pupils. The heart's electrical signals are disrupted, causing slow, irregular heartbeats. The heart is no longer pumping blood enough to meet the body's demands. The lungs fill with fluid, and breathing becomes slow, labored with gasping breaths. At less than 75 degrees Fahrenheit, or 24 degrees Celsius, you appear dead, pulseless, with no breathing. At this point, you can be saved, but it's unlikely. And after this, you, of course, die.
- [10:36]
Weatherbug Announcer
No one knows what the future holds, but you deserve a weather app that can help. Weatherbug is easy to use and provides forecasts for your every need, from storm warnings to pollen levels right at your fingertips. Get the fastest local Alerts and comprehensive 10 day forecasts wherever you are. Its hyperlocal, real time customizable alerts. Make sure the weather never takes you by surprise so you can plan every day with confidence. Download the free Weatherbug app from the App Store today and start getting accurate weather forecasts. 24. Seven
- [11:06]
Solaray Magnesium / AMU Announcer
magnesium supplements. You've mastered that. Now take it to the next level. Upgrade to Solar Ray Magnesium Glycinate from the number one magnesium brand in health food stores. With a 50 year old legacy of quality and trust, Solaray triple tests every raw ingredient for identity, purity and potency. The result? Expertly chelated magnesium for powerful muscle, bone and relaxation support that fits your daily stack. Shop Solaray Magnesium Glycinate on Amazon or solaray.com these statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.
- [11:37]
Ryan Reynolds
Ryan Reynolds here from Mint Mobile with a message for everyone Paying Big Wireless Way too much. Please, for the love of everything good in this world, stop with Mint. You can get premium wireless for just $15 a month, of course, if you enjoy overpaying. No judgments, but that's weird. Okay, one judgment anyway. Give it a try@mintmobile.com Switch upfront payment
- [11:59]
Dr. Kendall Crowns
of $45 for three month plan equivalent to $15 per month required intro rate first three months only, then full price plan options available, taxes and fees extra.
- [12:06]
Coldwater Creek Announcer
See full terms@mintmobile.com you see it instantly. It's Coldwater Creek, the mark of exceptional workmanship and signature touches inspired by a mo Mountain west heritage. Distinctive styles created from quality fabrics, silhouettes perfected with just the right drape feel Good fits offering ease of movement and thoughtful details to elevate your look. For a wardrobe you can count on season after season, visit coldwatercreek.com shop the new spring collection at 20% off $75 or more with code iheart20.
- [12:36]
Dr. Kendall Crowns
There was one case I had of an elderly woman whose electricity and gas were shut off due to non payment of bills. During the coldest few days of the year, the temperature in the house had plummeted and her house was poorly insulated. She had areas of the house where there were gaps letting in cold air. She attempted to plug these with plastic grocery sacks and also she had been putting plastic grocery sacks in between the walls to act as insulation because the house had no real insulation. No one had seen her for over a week and eventually a well being check was performed by police. When police entered her home, her attempt at insulating with grocery sacks had failed. The inside of the house was freezing. The house was also in disarray, but not like a hoarder home. There was instead a nightstand tipped over, books and clothes piled on a couch and strewn about the house. They found her body naked and burrowed underneath her couch with multiple items of clothing laying on top of her. There was initial concern of foul play because of how she was found, but what had happened was she was exhibiting the findings that occur in hypothermia cases. And these are paradoxical undressing, hide and die behavior, which is also known as terminal burrowing. Paradoxical undressing and hide and die behavior are not present in every case of hypothermia, but occur in fairly large percentages. Paradoxical undressing occurs when the individual is suffering from extreme confusion and disorientation coupled with the muscles of the blood vessels becoming exhausted, which causes the vasoconstriction to fail, resulting in widespread vasodilation. This causes a surge of warm blood from the core to be circulated everywhere, resulting in a hot flash. The confused brain thinks the person is burning up and solves this problem by removing all the clothing, making the individual naked. And this is often associated with the hide and die syndrome or terminal burrowing. With this behavior, people have been found burrowed into cabinets, pantries, under shelves with pull down furniture, books and clothes on top of them. The reason for this behavior is a primal response by the brainstem that causes the individual to seek small confined spaces for protection, similar to hibernating animals. When this decedent was brought into the medical examiner's office, she showed the typical autopsy findings of hypothermia and nothing else. So her cause of death was hypothermia. Again, but before we go into the autopsy findings, I want to discuss another complication of hypothermia, and that is the frozen body. And my example of this was a case of a young man in his 20s. He was found dead by railroad workers in an open topped railroad car at the Union Pacific railroad yard in Chicago. It was early February in 2004 and the temperature had been as low as 6 degrees Fahrenheit with associated snow, ice and freezing fog. When the decedent was found in the railroad car, he was dressed for winter thermal beanie, insulated jacket, two Shirts and thick pants, as well as boots. He also had with him a red mountain bike. It was believed he might have been trying to get somewhere by jumping on the train and then getting off later to go biking. He had no identification, so who knows where he had come from? They tried fingerprinting him, but no prints matched anything where he came from. Who knows who he was? Who knows? I don't think he was actually ever identified. And in a few days, that case will be nearly 22 years old. the scene, there was no signs of foul play. Law enforcement felt it looked like he had just laid down and went to sleep after getting on the train. On the day I performed his autopsy, I got the body out of the cooler, and when I opened the body bag to evaluate him, I found he was frozen hard. The thing about it is, the average adult body is made up of about 60% water. And when a body is left in freezing conditions, it will freeze as solid as a rock. You can't even cut into their skin with a scalpel blade because it is so hard. So what do we do in this situation? Well, it's like taking a frozen turkey out. You let them thaw. This can be done at room temperature, which takes a long period of time. But in Chicago, what we did was we put them under warming lights or heat lights, or as the autopsy techs like to call them, fry lights. You don't want to warm the body too fast because it can create artifacts. So you place the body under these lights and every day you go check to see if they thought enough to be autopsied. You would do this by poking them in the abdomen with your finger. I know, real scientific, right? And when you poke the abdomen, if it feels like poking, play doh. They were warm enough to autopsy, and that's what I did with this case. Once he was thawed out enough, we did the autopsy. And cutting into these thawed bodies is always difficult. The skin and muscle can still be somewhat frozen and less pliable, which makes it more difficult to separate. The organs can still be stiff and frozen and hard to cut through. And the blood and other bodily fluids are semi solid to ice crystals. Everything is cold and it makes your hands hurt. I typically have warm water running to combat this, but not too hot. One time I had the water too hot and cooked all the organs that I had out in a pan, making them all a kind of dull gray color. Plus it gave off an odd odor best described as hot dog vomit with a twist of iron. I only did that once in this particular case, he had, again, the typical findings associated with hypothermia and no other signs of injury or medical conditions. So his cause of death was made hypothermia, manner of death, accident. Determining the cause of death of hypothermia at autopsy can be difficult because there are no definitive findings that point only to a diagnosis of hypothermia. All of the findings can be found in other conditions, but when you get a combination of these findings along with the seen findings, and especially at body temperature, you can determine hypothermia quite easily. And there are a triad of findings that are usually found that traditionally point to a diagnosis of hypothermia. And these are Wisniewski's ulcers, frost erythema and hemorrhage in the muscles, particularly the iliopsoas muscle. Let's go through the findings of the triad as well as other findings. The one most people agree is associated with hypothermia is called Wushniewski's ulcers or spots. These spots were found by a Russian doctor by the name of S.M. wishnewski, who in 1895 described these dark brown or black gastric mucosal lesions in association with cold exposure. They have been described as ulcers, but are really more hemorrhagic areas in the gastric mucosa that vary in size from about a millimeter to 2 centimeters in diameter. And sometimes you can have a few of them to hundreds, making the mucosa surface of the stomach look like a leopard's pelt. They vary in presence in hypothermia cases. In the literature, it's said that it occurs in about 40 to 100% of cases. They're not ulcerations and they're not erosions, but they're believed to be possibly hemorrhages of the gastric glands in the lining of the stomach. But this is also not 100% certain. Wisniewski's spots can also be seen in numerous other conditions, including diabetic ketoacidosis, fatal burns, and methanol and ethylene glycol poisoning. So they aren't specific to hypothermia. The next finding is frost erythema, which was first described by a German naturalist named Wilhelm Kefferstein. Frost erythema are reddish to purple to violet or brownish areas of skin discoloration that are found located over extensive surfaces of large joints, usually like the elbows or knees. Typically, we see them most in the knees, so it can be called the red knees of hypothermia. Lividity can also be bright red or pink in coloration, but this isn't specific to hypothermia. Other conditions that you may see this in is carbon monoxide toxicity and exposure to cyanide. Also, if a body's been left in the cooler too long, they'll take this pink coloration on. So again, it's not very specific for hypothermia. The pancreas can be hemorrhagic, which was traditionally thought to be part of cold exposure. But in recent literature this has been ruled out as a diagnostic criteria because it occurs in other conditions and some believe the person may have had hemorrhagic pancreatitis and just happened to be in a cold environment. So it's difficult to say. The last part of the triad is hemorrhage or bleeding in the skeletal muscle, particularly the iliopsoas muscle, which is located in your lower back. It's postulated that these hemorrhages are associated with intense shivering associated with hypothermia. Microscopically, there can be a number of specific findings as depletion of the liver's glycogen, fatty degeneration of the renal tubular epithelium, various areas of hemorrhage, and necrosis of the pancreas, as well as hypoxic and fatty changes of the cardiac myocytes. There's also reports of postmortem biochemistry where there's been findings of alterations in the blood ketones, cortisol free fatty acids, as well as urine catecholamines. But I have never actually run those tests, so I won't comment on those further. Ultimately, there are several findings that can be found and in the setting of an individual found in a cold environment with paradoxical undressing cold body temperature, findings of Wisniewski's ulcers, red knees, as well as hemorrhages and musculature all can point to hypothermia. In closing, hypothermia is a complex cause of death determined with clinical investigative findings and a combination of autopsy and laboratory findings. All these combined can give you the final answer and I just want to say winter weather can be fun, but remember to take a break and warm up. And that brings us to the end of the episode. I hope you learned something and I hope you were entertained until the next time.
- [23:30]
Weatherbug Announcer
No one knows what the future holds, but you deserve a weather app that can help. Weatherbug is easy to use and provides forecasts for your every need. From storm warnings to pollen levels right at your fingertips. Get the fastest local Alerts and comprehensive 10 day forecasts wherever you are. Its hyperlocal, real time customizable alerts make sure the weather never takes you by surprise so you can plan every day with confidence. Download the free Weatherbug app from the App Store today and start Getting accurate weather forecasts 24. 7.
- [24:00]
Coldwater Creek Announcer
You see it instantly. It's Coldwater Creek, the mark of exceptional workmanship and signature touches inspired by a Mountain west heritage. Distinctive styles created from quality fabrics, silhouettes perfected with just the right drape. Feel good fits offering ease of movement and thoughtful details to elevate your look. For a wardrobe you can count on season after season. Visit coldwatercreek.com Shop the new spring collection at 20% off $75 or more with
- [24:28]
Solaray Magnesium / AMU Announcer
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- [25:14]
Dr. Kendall Crowns
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