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Cold Weather Cold Weather InjuriesInjuries

Placer County Mountain RescueMountain Rescue Association

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ColdCold

WeatherWeather

InjuriesInjuries

DehydrationDehydration

Frost NipFrost Nip

Frost biteFrost bite

HypothermiaHypothermia

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Your Response to the Cold

Cold Challenge(negative factors)

• Temperature • Wet (rain, sweat, water) • Wind (blowing, moving, e.g. biking)

Total = Cold Challenge

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Your Response to the Cold

Heat Production(positive factors)

• Exercise, shivering Limited by: • Fitness • Fuel stores (glycogen) • Fluid status (efficient exercise) • Food intake (kindling, sticks, logs)

Total = Heat Production

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Your Response to the ColdHeat Retention

(positive factors) • Size/shape (short/stocky vs.

tall/lean) • Insulation (layering/type) • Fat (as insulation) • Shell/core - shell as a barrier

Total = Heat Retention

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Your Response to the Cold

When Heat ProductionHeat Production + Heat RetentionHeat Retention

> Cold Challenge

POSITIVE EXPERIENCEPOSITIVE EXPERIENCE

When Heat ProductionHeat Production + Heat RetentionHeat Retention

< Cold Challenge

COLD INJURIESCOLD INJURIES

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GeneralPotential Problem Indicators

• Changes in Behavior (withdrawn, attitude)• Changes in Activity Level (lethargy)

• Changes in the Weather (precipitation, clouds)• Changes in Time (day to night)

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GeneralPrevention

• Alert all participants to the potential for cold injury

• Inspect all participants for proper clothing.• Provide warm up areas/hot beverages• Inspect personnel for cold injuries• Rotate outdoor assignments• Employ buddy system – check each other • Modify/curtail non-essential outdoor activities

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Dehydration

Dehydration exists when your body does not have as much water and fluids as it should.

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DehydrationSymptoms

• Dry or sticky mouth

• Low or no urine output; concentrated urine appears dark yellow

• Not producing tears

• Sunken eyes

• Lethargic or comatose (with severe dehydration)

• vomiting, diarrhea, or the feeling that you "can't keep anything down", could be causing the dehydration.

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Dehydration Prevention

• Drink before you get thirsty

• Leaders should establish a program of regularly scheduled enforced drinking

• Inactive persons in comfortable climates need a minimum of 2 quarts of water a day

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• Hydrate !!! Warmed liquids• Sip the water, don’t gulp• Reduce salt ingestion• Do not eat snow• Rest• Observe closely• Get Medical attention

DehydrationTreatment

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FROSTNIP & FROSTBITE

• First Degree Frostbite = Frost Nip First Degree Frostbite = Frost Nip

• Second Degree Frostbite = Superficial FrostbiteSecond Degree Frostbite = Superficial Frostbite

• Third/Fourth Degree = Deep FrostbiteThird/Fourth Degree = Deep Frostbite

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Cold Weather Injuries FROSTNIP & FROSTBITE

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Frostnip1st degree Frostbite = Frostnip

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Frostbite

2nd degree Frostbite = Superficial Frostbite

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Frostbite3rd degree Frostbite = Deep Frostbite

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Frostbite4th degree Frostbite = Deep Frostbite

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Frost NipFrost Nip is cooling of the skin tissues, usually of the

fingers, toes, ears, cheeks, and chin.

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Frost NipSymptoms

• The skin will become reddened, yellow or gray• Possibly swelling. • Numbness and tingling are present • Skin remains soft and resilient• Not always painful. • Usually no further damage after re-warming. • The first sign of impending frostbite.

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Frost NipPrevention

• Wear protective clothing• Limit the duration of exposure to cold• Replace fluids• Eat proper diet to generate metabolic heat• Keep feet and other extremities dry

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Frost NipTreatment

• Prevent Further Exposure • Remove Wet, Constrictive Clothing • Avoid rubbing or massaging• Do Not Expose To Extreme Heat

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FrostbiteFrostbite is the destruction of body tissues due to

freezing (at 0°C or 32°F).

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FrostbiteSymptoms

• The skin will become white or blue.

• Tissue becomes hard and frozen

• Tissue is damaged. Cells rupture.

• Blistering occurs later.

• Can result in permanent injury

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Cold Weather Injuries FROSTBITE

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Cold Weather Injuries FROSTBITE

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Cold Weather Injuries FROSTBITE

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Cold Weather Injuries FROSTBITECIRCUMFERENTIAL

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Cold Weather Injuries FROSTBITE

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Cold Weather Injuries FROSTBITE

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Cold Weather Injuries FROSTBITE

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Cold Weather Injuries FROSTBITE

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Cold Weather Injuries FROSTBITE

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Cold Weather Injuries FROSTBITE

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FrostbitePrevention

• Consider the mechanisms of heat loss• Don’t touch metal with bare fingers. • Don’t touch fuel with bare skin. • Don’t wear tight shoes, constricting clothes• Check your toes, fingers and face every evening

for trouble spots. • Toss hot water bottles (tomorrows drinking

water) in your sleeping bag at night.

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FrostbitePrevention

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FrostbiteTreatment

• Protect from further injury

• Re-warm the injured part AND When NOT to re-warm

• Obtain Medical care

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FrostbiteTreatment

PROTECT FROM FURTHER INJURY

• Cover any frozen part.

• Get the victim indoors.

• Remove jewelry, watches, and any constrictive clothing.

• Do not break any blisters that form.

• Do not rewarm a frostbite injury over an open flame

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FrostbiteTreatment

REWARM THE INJURED PART

• Rewarm Gradually - Direct Skin-To-Skin Contact

• Do not use radiant or dry heat

• Mild frostbite can be rewarmed by placing the frozen part in warm water

• If warm water is inaccessible, gently wrap the affected area in a warm blanket or sheet.

• After warmth has returned to the area, cover the area with a cloth, then with a blanket or sleeping bag.

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FrostbiteTreatment

REWARM THE INJURED PART

• Offer something warm to drink.

• Once circulation has been reestablished, the area may become itchy, red and painful.

• Stop warming at this point. Swelling is likely to develop after thawing and further warming will only make the swelling worse.

• After the frostbitten body part has been rewarmed, flex or exercise it if possible.

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FrostbiteTreatment

DO NOT REWARM THE INJURED PART,

• IF the frostbite injury could refreeze during evacuation.

• IF frostbitten part must be used during evacuation.

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HypothermiaCooling the body core temperature to 95o or below

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HypothermiaSymptoms

Impending Hypothermia 96.8o

Mild Hypothermia 95.0o - 93.2o

Moderate Hypothermia 91.4o – 87.8o

Severe Hypothermia > 87.8o

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HypothermiaSymptoms

Impending Hypothermia• Core temperature 96.8o degrees. • The person will increase activity to warm up.• The skin may become pale, numb and waxy.• Muscles become tense. • Shivering may begin but can be overcome by activity.• Fatigue and signs of weakness begin to show.

• Controlled Shivering.

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HypothermiaSymptoms

Mild Hypothermia• Core temperature 95.0o to 93.2o. • Uncontrolled, intense shivering. • Unable to solve problems .• Mild depression, confusion• Loss of fine motor skills.• Cool, pale skin• Coldness is creating some pain and discomfort.

• The ‘umbles’ – Stumble, mumble, fumble

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HypothermiaSymptoms

Moderate Hypothermia• Core temperature 91.4o to 87.8o. • Uncontrollable shivering. • Muscles begin to stiffen.• Mental confusion and apathy sets in. • Speech becomes slow, vague and slurred • Breathing becomes slower and shallow. • Drowsiness and strange behavior may occur.

• Shivering stops. Lethargic

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HypothermiaSymptoms

Severe Hypothermia• Core temperature below 87.8o. • Skin is cold, may be bluish-gray in color.• Eyes may be dilated. • Muscle rigidity.• Gradual loss of consciousness. • No apparent breathing• Unconscious• May appear dead.

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HypothermiaPrevention

W Wet? Get dry C Clean Clothing

A Attired properly O Avoid Overheating

R Rain gear L Loose Layers

M Munch food D Dry Clothing

T Thermo-regulate

H H20 – Stay Hydrated

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HypothermiaTreatment

Impending Hypothermia: • Seek or build a shelter. • Start a fire or stove to provide warmth. • Provide a hot drink.• Halt further heat loss with extra clothes, etc.

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HypothermiaTreatment

Mild Hypothermia: • Insulate the patient keep the head and neck

covered. • Provide a warm, sweetened drink. • Provide some high energy food. • Limited exercise may help to generate some

internal heat.

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HypothermiaTreatment

Moderate Hypothermia: • Remove from the cold environment• Keep the head and neck covered. • Apply mild heat to the head, neck, chest,

armpits and groin. • Use hot water bottles.• Offer sips of warm, sweetened liquids

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HypothermiaTreatment

Moderate Hypothermia: • It is possible that you may have to continue

this treatment for some time.

• Patient should be seen by a physician.

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HypothermiaTreatment

Severe Hypothermia:

• Place patient in a pre-warmed sleeping bag.• Use one or two other people. • Skin to skin contact in the areas of the chest (ribs)

and neck is effective. • Exhale warm air near the patient's nose and mouth,

or introduce steam into the area. • Try to keep the patient awake.• Ignore pleas of "leave me alone, I'm ok". • Keep a close, continuous watch over the patient.

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HypothermiaTreatment

Severe Hypothermia:

• Apply mild heat, with the aim of stopping

temperature drop, not rewarming.

• If patient has lost consciousness be very gentle.

The heart is extremely sensitive.

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HypothermiaTreatment

Severe Hypothermia:

Always assume the patient is revivable,

do not give up.• Check for pulse at the carotid artery for two

full minutes • If you find no pulse check on the other side

of the neck for two full minutes.

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HypothermiaTreatment

Severe Hypothermia: • If there is any breathing or pulse,

no matter how faint, do not give CPR • Keep very close watch for changes in vital signs. • If no pulse is found begin CPR immediately• Rewarm the CORE before the SHELL• Medical help is imperative, hospitalization is

needed.

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HypothermiaTreatment

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Hypothermia

Severe Hypothermia

"no one is dead until warm and dead".

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ColdCold

WeatherWeather

InjuriesInjuries

Trench-foot & ChilblainTrench-foot & Chilblain

Snow Blindness & SunburnSnow Blindness & Sunburn

Carbon Monoxide PoisoningCarbon Monoxide Poisoning

Acute Mountain SicknessAcute Mountain Sickness

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Cold Weather Injuries Trenchfoot

• very serious nonfreezing cold injury • develops when skin of the feet is exposed to

moisture and cold for prolonged periods (12 hours or longer)

• cold and moisture softens skin, causing tissue loss and, often, infection.

• Untreated, can eventually require amputation.• Early signs - itching, numbness, or tingling pain.• Later – swelling of feet the feet may appear

swollen, and the skin mildly red, blue, or black.

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Trenchfoot/Chilblains Symptoms

• Skin initially pale and colorless

• Worsens to achy, prickly sensation then

numbness

• Red, swollen, hot, itchy, tender skin upon

rewarming

• Blistering in severe cases

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Trenchfoot/Chilblains Prevention

• keep dry and warm• cover exposed skin• wear uniform properly• Don’t Smoke• use the “Buddy System”

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Trenchfoot/Chilblains Treatment

• Prevent further exposure• Elevate• Wash, dry gently• Rewarm (apply body heat) • Don’t massage or rub• Dry sterile dressing• Seek medical aid

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Other Cold Injuries

Snow Blindness and Sunburn

Carbon Monoxide Poisoning

Acute Mountain Sickness

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END

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Acute Mountain Sickness

Definition: Altitude related illness results from insufficient O2 in the blood, secondary to a decreased atmospheric pressure.

• Any time of year, but we go up for the snow

• Usually > 10,000 feet.

• Poor hydration

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Signs and SymptomsMild/Moderate AMS

• Headache• Nausea• Loss of appetite• Insomnia

• Possibly vomiting• Unusual shortness of

breath on exercise• Lethargy• Fatigue or weakness at

rest

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Signs and SymptomsSevere AMS

• Severe Headache• Extreme fatigue• Unusual shortness of

breath at rest– Pale or cyanotic

• Increased Heart Rate• Increased Respirations• Wet lung sounds

• Ataxia – ‘Stumbles’• LOC Changes

– Disoriented

– Irritable

– Combative

– Unconscious

• Vomiting

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Acute Mountain Sickness Treatment

• Hydration• Light exercise• Tylenol• Observe closely• Descend at least 2000’