They're right to be bothered: saying "I'm cold" means that a character is seriously unwell. It can be a sign that a character will be Killed Off for Real and these are their Last Words. When a new, unknown character says this it can even mean that they are a ghost. This is also something dead people are traditionally expected to tell anyone they talk to on the telephone.
This is because death... is cold.
There's sense in the trope: cold skin is a sign of shock. Coldness can also indicate blood loss or impaired blood circulation and, of course, corpses lack body-warmth. Additionally, a person suffering from a rising fever will feel cold and shiver. A mythological reason might be that Purgatory (which can sometimes include wandering the earth as a ghost) was depicted as being a cold and miserably damp place. Sleepiness or Blood from the Mouth tend to go hand in hand with this. Perversely, one emergency that often does not feature this is hypothermia: cold becomes an emergency if the victim stops being able to feel it, or is too tired to shiver. In fact, exposure victims are often found partly undressed because the lowering of their internal temperature makes them feel too warm.
A common variant, also due to the above, is "I'm tired...so tired."
Is dangerously on the verge of becoming Narm.
See Evil Is Deathly Cold for a motif. Compare Ghostly Chill; and see Incurable Cough of Death for another example of a symptom which is moderate in Real Life but presented as a sure sign of death in the world of tropes.
- A recent Pillsbury Pizza Pop ad has a young man cradling the head of a robot, whimpering his name, as the robot says that he can't feel his legs and is "so...cold". As it happens, an exploding pizza pop the robot was too slow to catch blew his body off.
- In Naruto, Sakura remarks how cold Sasuke's body feels. Apparently, that's one of the effects of the deathlike state he was put into.
- This happens in the manga version of Chrono Crusade. A character that is, Rosette Christopher collapses to the ground, near death, while a friend or her love interest and partner, Chrono runs to her side. We see the scene through her eyes, unable to hear the words of the panicking friend, while she has a dying Inner Monologue that finishes with "It's getting cold, isn't it? You can use my scarf, if you want."
- Inverted in Sailor Moon Sailor Stars where people are explicitly warm to the touch when they die. Lines that reference it are Tear Jerker material for fans. For example...
Sailor Uranus: You're warm, Michiru
- Hiroki tends to use this phrase in a slightly more life-affirming way in Junjou Romantica.
- Gunslinger Girl:
- Watch for a varation on this: it's the first real cue (aside from two large bleeding bulletholes) that Flanca really might not make it. Instead of bleeding out quietly like a sane human being, though, her blood loss leads her to decide to reeact Thelma & Louise.
- Played straight with Hilshire and Roberta Guellfi, a prosecutor he's guarding from Padania assassins. She thinks she's dying and starts talking of how her death will inspire others. Because she reminds Hilshire of a previous Love Interest he failed to save, Hilshire rallies her with a Rousing Speech and she survives.
- In Fate/stay night [Unlimited Blade Works], Illya said this when she's dying.
- A scene in The Crow which was never adapted into the film: This trope invoked because of shock, bloodloss, and death when Eric removes one of his first targets at the shins. Quite possibly the most unpleasant scene of the lot.
- Justified in the second Silver Surfer series, when Frankie Raye, a fire elemental, is fatally injured. Her flame then starts to dwindle before dying out.
- This Emergency! fic has one of the somewhat incorrect hypothermic person variety after Gage is dragged through the snow tied to a horse. He survives,though
- A couple of subversion occurs in the Gensokyo 20XX series Eirin, who notes, in her diary before her suicide, that she feels colder than the winter and we also have this with the case of Reimu, who isn't dying, notes that she feels so cold, remarking that she doesn't like that feeling.
- In My Huntsman Academia, Izuku dives into the ocean in the middle of winter to save someone he just knocked unconscious. When he's finally fished out by his friends, he doesn't feel all that cold even though he's shivering from head to toe. Then he realizes that he's suffering from hypothermia as his Aura drains itself to keep him warm and returns the sensation of cold to him.
- From Shark Tale we have this exchange:
Frankie: [dying] Lenny, is that you?Lenny: I'm here, Frankie.Frankie: Come closer.Lenny: What is it, Frankie?Frankie: I'm so cold.Lenny: That's because we're cold-blooded.Frankie: [Frankie slaps Lenny] Moron. [dies]
- Fly in Help! I'm a Fish! says a variation of this after sustaining a bad injury due to a crab.
Fly: I-is it getting cold?Chuck: Uh......Maybe.
- Said by The Mole before he dies in South Park: Bigger, Longer & Uncut.
- In Pirates of the Caribbean: The Curse of the Black Pearl, after the title curse is broken, rendering Barbossa and his men mortals again, Jack Sparrow shoots Barbossa, who says, "I feel... cold." and promptly falls over dead. Bonus points on this one, because this is the very first thing Barbossa felt since he turned immortal and he actually sounds happy to be able to feel something.
- RoboCop 2. The child criminal Hob has been badly shot up by the Cain cyborg. When Robocop finds him, Hob says that he feels cold. Robocop (who's sympathetic toward Hob, given that he knows what dying feels like) tells him that he's going into shock.
- Lampshaded when, in Lethal Weapon 3, annoying sidekick Leo struggles with the Big Bad for a gun, and is shot in the shoulder for his efforts. He thinks he's dying because he feels numb and cold all over... which is only natural, since he was lying on the ice of a hockey rink.
- An especially creepy example occurs in Event Horizon, when Dr. Weir first encounters an apparition of his dead wife. Makes sense when we realize she killed herself by cutting her wrists.
- Spoofed in Loaded Weapon 1 where Destiny utters this line at the end of the movie, Colt then removes a bag of ice that was on her for no good reason.
- Also spoofed in Spy Hard, where the love interest says this after Agent Steele absentmindedly parked her gurney under an automated ice cube machine.
- In the live-action Casper movie, Kat tells the title character that he feels cold. Also, it's later revealed that Casper's death was caused from being out in the cold too long.
- In the movie Conan the Barbarian (1982) the last words said by Valeria as she died in Conan's arms were: "I'm cold, so cold, keep me warm." This may have been an effect of the venom from the snake with which Thulsa Doom shot her.
- Parodied in Tropic Thunder - Tugg Speedman, in an Ironic Echo, says that he can't feel his legs; Lazarus has to point out that he's fine, it's just that his legs are knee deep in a pool of cold, muddy water.
- An interesting version happens in The Return of the Living Dead. After two of the main characters are exposed to Trioxin, they start feeling crappy and complain about the cold. Near the climax they feel better as zombies.
- Subverted in Titanic (1997) where Rose says "I'm so cold," and later "I can't feel my body." It's already a foregone conclusion that she survives, as she is the narrator for the whole movie, plus she's drenched and floating on a bit of wreckage in the icy North Atlantic, she's not just mystically drifting closer to mortality.
- In X-Men Origins: Wolverine, some of Kayla's parting words was this.
- Red Dawn. When Action Girl Toni is fatally wounded by Hind gunships she asks Jed to leave her a hand grenade to kill herself with, saying "I don't want to be cold". She doesn't use it though; just leaves the grenade under her body to kill the first Dirty Communist that tries to move her.
- Tobias in Dark Floors spent most of the movie being "cold", as well as coming back as a zombie to save Sarah.
Tobias: I'm not cold anymore, Sarah
- Poltergeist III had a sequence where Lara Flynn Boyle comes back from the other side and exclaims how cold she is, so her family tries to warm her up in the shower. Except, of course, that it wasn't really her. It was her mirror-double and she was faking for attention.
- Point Break (1991): Played straight and discussed: Roach complains of being cold after being shot.
- Frantic. The last words of Michelle, the Paris street waif who has been helping the protagonist search for his kidnapped wife, fatally wounded in the film's climax.
- In Vertical Limit, Tom MacLaren basically says this. Justified in that he's severely wounded and dying of hypothermia halfway up K2. He's really in trouble when he stops feeling cold.
- Parodied in The Mask. The Mask, dressed like a cowboy, is shot in the chest and falls into the shooter's arms, overly dramatically telling him he's "so cold" while coughing, and saying his last wishes before dying dramatically. He then receives an Oscar for his performance, while the shooter starts weeping.
- The "I'm tired" variant serves as Annie's dying words in Imitation Of Life (1959).
- Said verbatim by Emu O'Hara in the film adaptation of Crying Freeman. Completely justified, as she has taken a few bullets and suffers from a large blood loss.
- Played straight as an arrow in Mulholland Falls with the death of Elleroy.
- Parodied in Ghosthunters On Icy Trails: Hugo says that he is cold with much pathos, shortly before he's frozen solid by the ice ghost. He is also close to dying permanently, but that's not related to the cold.
- Sonne in Victoria (2015) utters these lines during his last moments.
- Inverted in Welcome to Dongmakgol when a gutshot Yeo-il says "It's hot" right before she dies.
- Pat Garrett and Billy the Kid: In Spanish! Billy rescues a Mexican husband and wife from Chisum's goons, but it's too late for the husband, who says "Siento mucho frio", then says "Como te sientes tu, Billy?" ("How do you feel?") right before he dies.
- Subverted in Dragon Bones: Ward says that he will never be warm again, after killing someone else.
- In Catch-22, the rear gunner, Snowden, who Yossarian tries and fails to save mutters this repeatedly as Yossarian tries to patch up his leg. Yossarian thinks this is because they're high in the sky in the tail of a plane with holes shot it in it. It's also because the gunner has been nearly shot in half - though is still alive - and Yossarian doesn't realize he's had his gut torn open by shrapnel which got underneath his flak jacket.
Snowden: "I'm cold . . . I'm so cold . . ."Yossarian: "Don't worry. Don't worry, you're gonna be fine."Snowden: "I'M COLD!"Yossarian: [panicky] "IT'S VERY WARM ON THIS PLANE!"
- While he never says the trope, the Marquis de Carabas from Neverwhere describes death as "very dark, and very cold".
- Animorphs has this in a rather chilling portion with this exchange:
So cold. Just... Can you just get me a blanket or... I'm scared. Does that... Does that make you happy, Andalite?Jake: No. No, it doesn't make me happy.
- Although he never records himself saying these exact words, Frodo spends a lot of the time after he has been stabbed with the Morgul knife shivering and describing how cold he feels.
- Wuthering Heights.
'I heard distinctly the gusty wind, and the driving of the snow; I heard, also, the fir bough repeat its teasing sound, and ascribed it to the right cause: but it annoyed me so much, that I resolved to silence it, if possible; and, I thought, I rose and endeavoured to unhasp the casement....'I must stop it, nevertheless!' I muttered, knocking my knuckles through the glass, and stretching an arm out to seize the importunate branch; instead of which, my fingers closed on the fingers of a little, ice-cold hand! The intense horror of nightmare came over me: I tried to draw back my arm, but the hand clung to it, and a most melancholy voice sobbed, 'Let me in - let me in!' 'Who are you?' I asked, struggling, meanwhile, to disengage myself. 'Catherine Linton,' it replied, shiveringly....'I'm come home: I'd lost my way on the moor!'
- From Fool Moon:
Harry (after Murphy nonfatally shoots him): I'm so cold.Murphy (angry): We're all cold, moron....it must be below forty, already, and we're wet besides.
- In The Secrets of the Immortal Nicholas Flamel, Prometheus does a variation of this with: "I'm tired now, so tired. It will be good to rest." He then proceeds to die in the arms of his daughter. Bonus points because the aforementioned daughter had just revived him, but he made her let him die.
- Last words of a Drachelander (German-descended) knight in the first book of the World of Tiers series, after he was swarmed by enemies and the protagonist arrived just too late to save him: "'siz kalt."
- Bill Bryson discusses the dangers of hypothermia to Appalachian Trail hikers in A Walk In The Woods, and the 'Paradoxical Undressing' phenomena (see below). He also recounts a day when he went off hiking and forget to pack his waterproofs. He gets soaked by the incessant drizzle and starts to lose track of time... it turns out that his watch had stopped.
- In the Redwall series book Lord Brocktree, Fleetscut dies with a smile on his face; "Funny. Don't feel hungry anymore. Jolly cold, wot!"
- Justified by Demnor in The Stone Prince even before he nearly dies of battle wounds; he's a Rebel Prince, and his very angry mother is the avatar of a fire god, able to withdraw Its warmth from her son.
- Inverted in The Lost Fleet: Geary feels incredibly cold after being revived from 100 years of being a Human Popsicle.
- The Bronze Horseman by Paullina Simons. Tatiana says this after Alexander rescues her from a bombed out building, but it's because she's in shock from several broken bones, not because she's near death. Shock can be life-threatening if not treated, but fortunately Alexander is there to share his bodily warmth.
- In Roger Elwood's The Wandering, Ferene describes his death as this.
- Said word for word by a ghost that Lucy and Lockwood encounter in Lockwood & Co.
Annabel: I'm cold, lost and cold. Lost and cold...and DEAD!
- Played with in Black Man. Ertekin makes a Deathbed Confession that she'd planned to murder a police colleague who'd betrayed her genetically-engineered husband to the authorities, but she lacked the ruthlessness to carry it through. "You have to be cold, so cold..."
- Subverted on Smallville. Eric says something like this when he is drained of Clark's powers, but he survived.
- Subverted in Firefly where Kaylee says something like this after being shot, but she recovers without complication. She says it not because of impending death, but because she's going in to shock from the traumatic injury.
- In the Charmed episode "All Hell Breaks Loose," when Piper is shot by a sniper and is close to death, she says, "Prue, I'm cold. I can't - I can't - I can't feel my legs. Don't go. I love you."
- Doctor Who
- Subverted in "The Age of Steel", when a downed Cyberman whose emotional inhibitor has been removed asks "why... am... I... cold?" It's revealed she has no idea what has happened, and still thinks she's on the way to her wedding. (The trope name drop is especially apt, as this is what finally convinces the Doctor that the cybermen are no longer really alive, and therefore can be destroyed.)
- Played with in "Twice Upon A Time". A British army captain is in a Mexican Standoff with a German soldier in a muddy crater in World War One. He says, "Cold, isn't it? It's about to get colder, I suppose, for one of us."
- Played with in "White Light Fever", an episode of the revived The Outer Limits (1995) series. An old, rich, selfish man who nearly died says that death feels cold. When he dies, he meets an innocent girl who died earlier as a result of his selfishness, and asks to go with her. She says he can't because they're not going to the same place; where she's going, it's warm. Then she says that she always thought it was the other way around.
- The pilot of Look Around You uses this trope in the conversation with intelligent calcium, where the aforementioned substance answers the scientist's question of "how do you feel?" with "cold". The scientist then forces the obvious conclusion by capping the test tube, suffocating the intelligent calcium inside.
- Star Trek: Voyager:
- In "Before And After", whenever Kes said this, it was an indication that she was about to shift back in time.
- In "Course: Oblivion", on board the biomimetic Voyager, B'Elanna Torres experiences getting cold when she starts to lose molecular cohesion due to exposure to warp drive radiation.
- When a Cold Case villain flashes back to his first kill (inadvertent, as he merely let the woman die rather than outright harming her), he remember a woman trapped in a well, frantically treading water and babbling, "Cold. . .so cold".
- In Warehouse 13, this is the sign of the artifact of season 3's "Insatiable" affecting someone. Other side effects include an insatiable hunger and eventual death from hypothermia.
- Angel: Wesley in "The Thin Dead Line", after the zombie cop shoots him. He doesn't die, though.
Wesley: Is anyone else cold?
- Person of Interest. Played with in "Terra Incognita". An apparent flashback has Reese on a stakeout, during which he keeps complaining of the cold and turning up the heater. Later it's revealed this is a Fever Dream Episode, and Reese is actually dying of shock and hypothermia after being shot by the Villain of the Week.
- In an episode of The Outer Limits (1995), an ancient tycoon played by Billy Hickey has been running from death his whole life, because he has seen the other side and knows it is deathly cold. Eventually his increasingly desperate machinations lead to the death of a young woman, and corpses start coming back to life and informing the old guy's doctor that his century of cheating death has so screwed up fate that it will eventually rupture time itself. So the doctor corners the old guy and forces him to die. As he crosses over to the other side, he sees the spirit of the young woman, who informs him that they "are not going to the same place. Where I'm going it's warm. Funny, I always thought it was the other way around."
- That's So Raven: In "Soup to Nuts", Raven does this while faking an illness to avoid going to school. This is brought back up later, when Raven finds out that she missed a Senior Surprise Day trip to a water park due to her "illness".
Raven: Senior Surprise Day? And I missed it?!Cory: Yeah, because you were "so cold, so cold".Raven: You keep going, you're gonna be out cold in a second.
- "Second Birth" by Obsidian Shell starts with "So cold... am I dying?"
- In the Blue October song Into the Ocean the narrator—a boy struggling with suicide after a loss—dreams of committing suicide by drowning. While drowning he laments "I'm cold as cold as cold can be..."
- In "Wuthering Heights" by Kate Bush, the refrain includes the words "I'm so cold." The narrator is a ghost.
- An infamous The Stephanie Miller Show sketch ends with Yogi Bear's sidekick Boo Boo being killed off by Sarah Palin; this phrase is part of his death scene.
- Somewhat subverted in the radio play version of the second (or fifth) Star Wars movie, The Empire Strikes Back, when Luke (still played by Mark Hamill) nearly freezes to death in the ice planet Hoth. As Han Solo finds him delirious in the snow, Luke moans about being cold, followed by "Warmer now," which causes a deeply concerned Han to yell "No, Luke, that means you're freezing!"
- In the musical RENT Mimi complains of being cold in the finale, where she appears to be on the edge of death but subverted in that she doesn't actually die.
- Invoked, then poignantly subverted in Puccini's Opera La Bohème (the 'original' Rent). As she lies dying, Mimi is 'cold, so cold' and longs at least to warm her hands. Her friends rush out to buy her a fur muff. She is happy, and murmurs as she drifts off to sleep that she feels warm at last. These are her last words - she dies quietly, while the dramatic focus is on the other characters.
- This is a common death line in Fire Emblem.
- Baldur's Gate:
- In Baldur's Gate, this is Imoen's last words before her hit points drop to zero.
- In Baldur's Gate II, "I feel so cold" are Aerie's last words before her hit points drop to zero.
- There's also a ghost in the expansion to the second game who complains of this. He won't say anything else until you light a fire in the hearth for him.
- Shai-Gen Corporation cronies in Crackdown tend to spout this as they die. Even if they died from immolation.
- Justified in the Golden Sun series— the Fire Clan members who say it are freezing to death, having been deprived of the strength to warm themselves or escape.
- One of the enemy officer death lines in the Dynasty Warriors / Samurai Warriors crossover Warriors Orochi is 'Such a cold embrace...'
- In Pathways into Darkness, one of the dead Nazis you encounter has completely forgotten about everything except that death is cold.
- In one of the Slayers videogames, the gang barely manages to rescue Amelia, but when they do, she says "I feel...so cold..."
- In Silent Hill, Lisa Garland tells Harry Mason that she's "scared and cold" in a futile attempt to convince Harry to stay with her. When he meets up with her again, she reveals her discovery that she's been Dead All Along, and begins bleeding from every pore as Harry watches in horror.
- MadWorld works this trope into the form of a song, aptly titled So Cold, which takes over the previously boastful boss theme halfway through the final fight.
- In Apollo Justice: Ace Attorney, Apollo actually watches someone die... and the victim says 'I'm cold... so cold' as he tells Apollo who the witness is.
- In Shannara, Shella, as she lies dying, says to Jak 'I'm cold...so cold'
- Among the many theories for why Touhoues wear such silly hats is that it prevents them from freezing to death.
- At a certain spot in Amnesia: The Dark Descent you'll hear this phrase as a disembodied whisper.
- The skeletons from later parts of They Hunger sometimes mutter, "...Cold..."
- Left 4 Dead has a music track for being close to dying while incapacitated explicitly called I Am So Cold
- In some unused dialogue in the first game would have been used in a cutscene immediately after completing the "No Mercy" campaign implies that the helicopter pilot had been infected before he picked them up, and was about to make the transformation mid-flight. The pilot then uses the "I'm cold" line.
- It was cut it from the game because the developers felt that it would be like punishing the players for completing the campaign.
- In the DLC campaign "Crash Course", it's revealed that the chopper they were in ended up crashing, anyway. They still all survived. Unscathed, too.
- Some of the midget deaths from Borderlands 2: "SO COLD! Sooo cooold..."
- Gaffgarion's final words in Final Fantasy Tactics.
- The Servants in Thief II: The Metal Age will occasionally utter the phrase "So cold...So very cold..." Considering the nature of their servitude, one can imagine why they feel like that.
- Telepath Tactics has two examples. Phoebe's death message is "I've often wondered what it would feel like to die. The cold...it trickles in like water..." Sarn Kamina's is in Lissit, but can be translated as "I am cold..." (There's some ambiguity, as the word for "cold" can also mean "afraid".) Harynx's death message also features the "I'm tired" variant.
- In Undertale, you eventually encounter a monster whose check and flavor text is "It's so cold." She's one of the most pitiful fights of the game; her attacks are listless and a few don't even enter the battle box. Unlike the other amalgamates, Snowdrake's mother seems to barely even be alive.
- Played for laughs in this Order of the Stick interlude.
- In Sluggy Freelance a man has this reaction after having to put gym shorts on a Duh-Mentor.
- Subverted elsewhere, when it turns out Jane's been playing with the thermostat to make Gwynn think she's died and risen as a zombie.
- Subverted in Terinu. When the title character is badly wounded, he starts feeling warmer as he slips into shock, since his body is losing the ability regulate temperature correctly. The comic's author is a nurse, so this counts as a case of Shown Their Work.
- A variant is spoken by one of the drowned children in Solstice Twins as seen here.
- Pea-Steve from VG Cats.
- This Dysfunctional Family Circus from the 1990s shows Jeffy holding up a teddy bear for a security guard, with his mom, Thel, in the background. One of the captions has Jeffy telling the security guard, "But don't let him bite you. He got Thel, and now all she can say is, 'sooo coold.'"
- In Avatar: The Last Airbender, this doesn't actually happen, but is the topic of a ghost story Katara tells to the Gaang. Of course, said story is set at the South Pole, and the death did occur during a week-long blizzard.
- In Harvey Birdman, Attorney at Law, the Jetsons arrive in Birdman's office, but have to walk to his desk, as there is no conveyor belt. Eventually, Astro collapses during the trek, saying "Ro rold, ro rold..."
- In The Simpsons episode "Home Sweet Homediddly-Dum-Doodily", when Bart is discovered to have head lice on class picture day (as a result of playing with a monkey Milhouse found), he comments "Nothing ever happens to Milhouse." We then see Milhouse standing there pale, wrapped in a blanket, muttering "Cold, so very, very cold."
- In a recent episode, the GPS from Homer's car says "So cold, so cold..." after Homer rips it out and throws it in a nearby fountain.
- Happens in an episode of Ben 10 when Ben offers another character a piece of chocolate, which ended up poisoning him due to it coincidentally being his Kryptonite Factor.
- Ren says this in an episode of The Pirates of Dark Water. Justified in that Tula was purposefully lowering his body temperature in order to kill him so they could save Ioz.
- In one episode of The Venture Bros., a group that seems oddly familiar infiltrates Dr. Venture's mansion and snoops around. At the end, they run afoul of a berserking Brock Sampson, who promptly kills the Fred, Shaggy and Scooby equivalents. As Shaggy dies, gutshot and bleeding out on the floor, he whimpers, "So cold, man...."
- A disturbing example from an obscure BBC children's cartoon called The Brollys, about a boy making friends with a man and a woman who control the weather. While most of the weather is rather pleasant, the ice and snow brings with it the terrifying Jack Frost, who not only freezes Mr. and Mrs. Brolly, but also tries to kill the little boy by making him succumb to sleeping in the cold.
- In the Danny Phantom episode Urban Jungle, Danny complains about being really, really cold, despite the warm weather. Later, this turns out to be a sign of his ice powers awakening.
- Also, Danny's ghost-sense, which is mentioned to be related to his ice powers, apparently feels like the sudden chill caused by a ghost's presence.
- Used in the Dilbert animated series, in the episode Holiday. During the Dogbert Day parade, Dilberts obnoxious co-worker, the aptly named Dick, who has spent the entire episode making Dilbert even more miserable than usual, is crushed along with his equally obnoxious SUV by Dogberts giant parade float. As he lies in the wreckage, he utters this trope. Dilbert, who is watching the parade on TV with his mother, remarks that the holidays are a magical season.
- In the Futurama episode, Anthology of Interest II, General Pacman's last words after being hit by a Space Invader's beam is "So cold...".
- Used in an episode Drawn Together where the pumpkin carriage crashes (Mulan was driving), mortally wounding some of the Disney Princesses. Princess Clara begs Sleeping Beauty to keep her eyes open, only for her to respond with "But... I'm so... tired."
- Victims of shock frequently complain of feeling cold, and cold clammy (diaphoretic) skin is a major sign of shock, along with rapid heart rate and low blood pressure. Sudden complaint of cold in a trauma patient or one with known risk of shock (from infection, heart failure, internal bleeding, etc) is a very ominous sign indeed.
- Cold itself is also a leading contributor to morbidity and mortality in shock patients, as it forms one of the three bases of the "trauma triad" or "triad of death": cold induces massive shivering as the patient attempts to maintain body heat, which generates lactic acid buildup in the bloodstream through anaerobic metabolism, which in turn impairs tissue oxygenation and promotes coagulopathy (inability to clot blood properly). Survival rates in this situation are dismal. Modern care of the shock victim frequently involves aggressive rewarming measures in addition to the usual protocols (fluid and/or blood product replacement, pressors where indicated, etc) in recognition of the risks of this outcome.
- In cases of drowning and hypothermia, severe cold serves as a protective mechanism in a euvolemic victim (i.e. one not in shock to begin with). Below a certain point (usually around 32 C), low core temperatures drastically slow metabolism, preserving organs from hypoxic damage, and occasionally allowing successful resuscitation in a victim who would otherwise be long past saving. To that end, an old aphorism of emergency medicine states that hypothermia victims "aren't dead till they're warm and dead." The same effect is also exploited in active cooling therapies for heart attack and stroke patients, in which the patient is deliberately rendered hypothermic in the ICU to protect the heart or brain from further ischemic insult. This has also been used as an effective treatment for those suffering from spinal injuries.
- In severe hypothermia cases, the victim may engage in 'paradoxical undressing' wherein they remove all their clothes. No one has experienced this and survived, but it has been suggested that at such a late stage the blood vessels close to the skin 'give up' and widen as they do when experiencing heat, causing the victim to feel too hot and strip. In this case, "I'm hot... so hot" might be more appropriate!