skin is cold to touch, both where exposed and where usually warm, for example the abdomen and axilla
puffy face and hoarse voice
confusion, drowsiness and stupor, with poor judgement
increased muscle tone, with rigidity at 32 degrees C
shivering, until below 30 degrees C
weakness
hypokinesia
ataxia, occasionally tremor
tachycardia, followed by bradycardia at lower temperatures
characteristic changes on the ECG e.g. J-waves, prolonged QT and T wave inversion may be found
hypertension, with hypotension at lower temperatures
hyperventilation, followed by shallow respiration, with hypoventilation causing hypoxia at lower temperatures
Reference
Dow J, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Society clinical practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2019 update. Wilderness Environ Med. 2019 Dec;30(4 Suppl):S47-69.
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