Question: Dear Health Care Magic, the following question is for the sake of reference. I am working on a novel and have a question related to frostbite, hypothermia, and the consequences of each. I have listed a lot of information that I hope may give you an idea of the situation, and I understand that there are many uncounted variables, but even a general idea of the consequences that are likely to happen in this case would be incredibly helpful. I have included the specific questions below the information. Thank you ---Overview--- Girl leaves home on the middle of a cold, windy night in the middle of winter. Walks approximately 1.4 miles. While walking her lower legs and boots become wet from traipsing through thick snow. Eventually she lays down at her resting spot where she remains until she is discovered several hours later and brought to an emergency room. ---Victim Information--- Age: 10 Sex: Female Height: 4'3”/129.6 cm Weight: 56 lbs BMI: 15.2 Exposure: No experience with extreme temperature over long periods of time. Grew up in a cold area and plays outside in the cold on occasion. Clothing: Merrell Winter Boots: Waterproof shell, suede/faux fur upper, side zipper, winter insulation. Nine inch high shafts No Socks Down Winter Jacket with polyester shell, waist-high with hood (worn down) and slightly long at the arms, unzipped at front Cotton underwear 100% Cotton T-shirt ---Weather Information--- Air Temperature: -18.4 degrees Fahrenheit and warms to 6 degrees Fahrenheit with sunrise Wind Speeds: 5 mph sustained wind-speed with gusts up to 15 mph Precipitation: None Sunlight: 2 days past full moon Time of Departure: 12:04 a.m. Time of Arrival: 12:35 a.m. (approximately) Time of Discovery: 10:24 a.m. ---More Information--- The girl is not in great physical condition and has been sleeping inadequately the last several weeks leading up to the incident. 1. How long would hypothermia and frostbite take to set in? 2. When would loss of consciousness be experienced? 3. Would heart stop? 4. If yes to 3, would any limb damage would occur due to exposure and circulation issues? 5. A general idea of injuries and damages in similar situations would be very helpful. Thank you VERY much! XXXX

Dr. Shehu, Thank you very much for your prompt initial responses! I greatly appreciate it. I know that cold temperatures can help prolong the possibility of revival. If the girl loses consciousness roughly an hour and a half after laying down can you give a rough estimate of time when revival would no longer be possible? Gangrene can also be a problem with hypothermia and cardiac/circulatory failure. Do you think it could become a problem in this instance, and if so, how quickly is gangrene dealt with? I've observed cases where the gangrene is surgically removed. Is tissue infected with gangrene removed immediately during emergency care or dealt with separately? Thanks again and have a wonderful day, XXXX

Dr. Benard, I think I'm set! If I have any more related questions that come to mind I'll make sure to let you know within the time frame available. Much thanks, XXXX

Dear Dr. Benard, If the girl was brought into the Emergency Room in time to be resuscitated how long would she be kept before being released by the hospital? Are patients released when they have reached a sufficient core temperature and other symptoms are no longer noticeable or do they remain under supervision for a longer period of time? Also what is the standard procedure for dealing with a patient in this condition? What I've read has pointed strongly to the use of a heart lung machine in the rewarming process. Is this the “standard” way of dealing with patients with extremely low core temperatures? Thanks, XXXX