Cold Weather Injuries (PowerPoint)

							Cold Weather Injuries

   Knowledge Nuggets
     For Prevention
    And Management
             Disclaimer
This is an overview of injuries associated
with various outdoor winter activities, not
           First Aid instruction.

For more information on Wilderness First
        Aid, contact Deb Ajango

           info@safetyed.net

        http://www.safetyed.net/
       Andrea Andraschko
             Wilderness EMT-2,
 Credentials:
 volunteer medic with Alaska
 Mountain Rescue Group

 Work:Alaska Regional LifeFlight
 (Dispatch), located in the ER

        winter activities: skiing,
 Outdoor
 snowshoeing, hiking, climbing
           Activities
 Camping

 Hiking

 Snowshoeing

       – Alpine and Nordic
 Skiing

 Snowmachining
              Camping
 Hypothermia

 Frostbite

 Immersion    foot
 Burns

 CO   poisoning
      Hiking & Snowshoeing
 Chilblain

 Hypothermia

           Face, Ears, Feet, Hands
 Frostbite:

 Immersion foot

 Dehydration

 Snow Blindness

 Musculoskeletal injuries
                Skiing
 Hypothermia

 Frostbite: Face, Ears
 Dehydration

 Snow Blindness

 Musculoskeletal injuries: Knees

 Skeletal injuries: Spine

 Traumatic injuries: Head
          Snowmachining
 Hypothermia

 Frostbite: Face, Ears, hands
 Dehydration

 Snow Blindness

 Skeletal injuries: Spine

 Traumatic injuries: Head, internal
Cold Injury Guidelines
            Most current guidelines (rev.
             2005), applicable to all levels
             of first aid training
            Covers hypothermia, cold
             water near drowning, frostbite
             and avalanche rescue
            Prepared by world-renown
             experts in cold weather
             injuries
            Available by download from:
             www.chems.alaska.gov/EMS/
             documents/AKColdInj2005.pdf
           Hypothermia Symptoms
   Mild
    – Core Temp: 95º to 90ºF
    – Ability to rewarm self: Good
    – Symptoms: intense shivering, “umbles”, denial
   Moderate
    – Core Temp: 90º to 82ºF
    – Ability to rewarm self: Limited
    – Symptoms: gradual loss of shivering, decreasing level of
      consciousness, total loss of consciousness <86ºF
   Severe
    – Core Temp: <82ºF
    – Ability to rewarm self: Unable
    – Symptoms: Rigid, HR and breathing may be unnoticeable,
      may appear dead. Move with extreme caution!
    Hypothermia Management
Mild (Person is able to ‘self rescue’)
 Remove wet and/or restrictive clothing.
 Get inside shelter if possible.
 Eat – Mix of proteins, fats and carbs is best to
  fuel the furnace.
 Drink – sugar is good, caffeine is bad. Should
  not be cold, does not need to be warm.
 Exercise – move around to increase circulation.
 It is ok to use chemical heat packs placed on
  pulse-points to assist rewarming (not directly
  on skin).
 Warm showers or baths are ok.
                     Nuggets
   It “costs” the body 70 kcal/hr to maintain normal
    body function at rest. Breathing in 0ºF air and
    warming it to body temperature costs an
    additional 40 kcal/hr.
   Intense shivering rapidly depletes muscle
    glycogen stores, “costing” up to 220 kcal/hr.
    Shivering stops when there is no glycogen left to
    fuel muscle contractions.
   Lactic acid is a by-product of muscle activity.
    High levels of lactic acid in the blood interferes
    with further muscle activity – i.e. the heart.
                Nuggets
 Carbohydrates rapidly provide 7-10 kcal
  heat per 100 kcal ingested; proteins
  slowly provide 27-30 kcal heat per 100
  kcal ingested.
 Snacks that provide both carbohydrates
  and protein should be consumed at
  regular intervals.
 Warm Jell-o provides a protein and sugar
  source suitable for a quick warm-up or
  bedtime snack.
                    Nuggets
   During rest, 10% of the body’s heat is lost
    through the head. During exercise, up to 55% is
    lost through the head.
   A hooded parka can be used to help capture body
    heat generated by “warming” exercises – heat
    lost through the head can be redirected to the
    trunk via the hood.
   A protein and carbohydrate snack followed by
    light exercise is a good way to manage mild
    hypothermia.
   Circulation enhancing foods such as ginger and
    cayenne can help stimulate warmth.
      Hypothermia Management
Moderate     (Person appears confused or disoriented)
   Do not try to rapidly rewarm.
   Cut off wet clothing and place in a hypobag or
    hypowrap.
   Do not apply heat directly to skin; warm bottles
    or heat packs may be placed between layers in
    the hypowrap.
   Do not allow person to exercise, sit or stand.
   Do not give oral fluids or food.
   Do not use warm baths or showers.
   Transfer to a hospital ASAP.
                      Nuggets
   A hypowrap is also known as “the human
    burrito.”
   A hypowrap consists of dry clothing, 1-2 dry
    sleeping bags, an insulating pad, and a wind
    barrier such as a sheet of plastic, tarp or tent-fly.
   Lay the tarp out first, then the pad, the sleeping
    bag(s) and then the patient.
   Cover the head with a hat, and the face loosely
    with a scarf or face mask. Ensure breathing is
    not compromised.
   Warm water bottles or hand-warmers may be
    placed between layers, but not directly on the
    skin.
      Hypothermia Management
Severe, with signs of life (pulse, respirations)
   Handle very very gently.
   Do not rub or massage patient.
   Cut off wet clothing and place in a hypobag or
    hypowrap.
   Do not add any external heat.
   May assist respirations with mouth to mask
    rescue breathing if within scope of training.
      Hypothermia Management
Severe (no signs of life, but death not obvious)
   Handle very carefully; avoid bumping or jarring
    patient.
   May provide mouth to mask breathing.
   CPR only if patient is greater than 3 hours from
    definitive care and properly trained providers are
    present.
   Best treatment is careful and gentle evacuation.
                        Frostbite
   Early stage (frostnip) is characterized by a soft
    waxy appearance, with numbness and decreased
    local motor skills.
    – It is safe to rewarm in the field by increasing peripheral
      circulation, skin-to-skin warming, or warm water
      immersion. Take care not to refreeze.


   Late stage is characterized by complete loss of
    sensation and movement, skin feels hard and ice
    crystals may be visible.
    – Do not attempt to thaw in the field unless thawing and
      refreezing can not be avoided.
                    Nuggets
   Avoid hypothermia
   Avoid vasoconstricting gloves and socks, and use
    wicking liners.
   Keep dry socks and gloves handy, and change
    frequently.
   Do not use water-based lotions or sunscreen on
    the face.
   Cover as much exposed skin as possible,
    especially when wind is a factor.
   Use “buddy checks” to monitor for S/Sx of
    freezing injuries.
                    Chilblains
   A recurring condition related to pre-existing
    peripheral circulatory issues.
   Aggravated by exposure to wet windy conditions
    between 32º and 60ºF.
   Causes decreased perfusion to the skin tissues
    which does not readily return with warming.
   Affected areas may swell and blister.
   Symptoms may persist up to 2 weeks.

   Afflicted individuals should avoid cold, wet windy
    conditions, and should dress appropriately.
                   Trenchfoot
   Caused by prolonged exposure to very cold water
    resulting in decreased perfusion to skin tissue.
   Left untreated can lead to tissue death.
   Exacerbated by constricting socks or boots.
   Initial appearance is similar to frostbite.

   Treatment is rewarming, which is very painful.

   Avoid by keeping feet warm and dry.
   Do foot inspections (socks and shoes off) and
    foot massages every 3-4 hours.
              Snow Blindness
   Sunburn to the eyes.
   UV blocking eyewear is important when outdoors
    in a snowy environment, even if it isn’t that
    sunny.
   Treatment includes prescription opthalmic
    ointments.
   Field treatment includes loosely covering the eyes
    and evacuating the patient.
                      Burns
   Burn injuries can be caused by stove flare-ups
    and campfires.
   Burns to face, neck, arms and hands common.
   Superheated inhaled air can be life-threatening.
   Swelling from burns peaks within 24 hours.
   Burns to face, neck and airway can cause
    swelling that compromises respiration.
   Treatment includes cool compresses (not snow),
    anti-inflammatories, and evacuation.
   Prevention includes fire and stove safety
    awareness
                  Dehydration
   Fluid losses can be insensible.
   Sweat, breathing and urination are modes of fluid
    loss.
   Cold causes peripheral vasoconstriction which
    increases blood pressure, and in turn triggers the
    kidneys to produce more urine (cold diuresis).
   Low ambient humidity contributes to fluid losses
   Be sure to drink whenever snacking or eating.
   Water or electrolyte drinks (Emergen-C) are good
    choices while exercising.
   Soups, hot Jell-o, and hot Tang are good
    choices in camp.
                Nuggets

 Wear several easily removable layers
  while exercising to avoid overheating.
 Exercise increases moisture loss through
  respiration.
 Face masks that help capture expired air
  can help prevent dehydration.
                  Nuggets
   Urination will be more frequent during
    winter activities – it may take some
    encouragement to get kids to drink
    enough fluids throughout the day.

   Encourage kids to urinate as needed at
    night. A full bladder triggers stretch
    sensors that causes a sensation of cold.
        Musculoskeletal Injuries
   Skiing – knees and ankles most vulnerable to
    breaks, strains, sprains, and ligament injuries
   Snowshoeing – knees and hips most
    vulnerable to muscle and connective tissue
    injuries.
   Thumb injuries can occur when hands get
    tangled up in ski pole straps.
   High velocity injuries (skiing, snowmachining
    sledding) can include breaks, dislocations,
    spinal injuries, head injuries and internal
    injuries.
           High Velocity Injuries
   Immediately check ABCs; carefully reposition
    only if airway is compromised.
   Determine level of consciousness (Alert and
    responsive, responsive to voice, responsive to
    pain, unresponsive).
   Leave helmet on unless airway is compromised.
   Protect c-spine by holding stabilization.
   Insulate from cold, including the ground.
   Perform first aid assessment in position found if
    airway is not compromised. Patients with
    suspected spinal injuries do NOT need to be laid
    flat.
High Velocity – Internal Injuries

 Internal injuries are always a possibility
  after collisions and airborne acrobatics.
 Suspect internal injuries if patient
  experiences
    – pain when abdominal cavity is palpated;
    – pain or difficulty breathing;
    – unusual paleness, rapid heart rate that doesn’t
      decrease, increased respirations, and damp or
      clammy skin.
    High Velocity – Head Injuries
 Head injuries are more serious if the level
  of consciousness of the patient decreases
  over time, or they vomit more than once.
 Unconsciousness followed by return to
  normal mentation with amnesia is
  indicative of a concussion and is less of an
  emergency.
 C-spine precautions should always be
  taken when head injuries are present.
          Other Considerations
   Cold air can induce asthmatic attacks in some
    people. Breathing warm, humid air may be
    the only field treatment needed.
   Cold decreases the perception of pain. Cuts
    and bruises may go unnoticed until body
    parts rewarm.
   Cold weather significantly increases caloric
    needs, while associated dehydration
    suppresses appetite. Eat and drink frequently
    to maintain optimal bodily functions.
     Other Considerations (con’t)
   Insulated clothing and sleeping bags act like
    a thermos – they hold warmth in; they don’t
    provide external heat.
   Air is an excellent insulator. A tight (wicking)
    next-to-skin layer for torso and legs is fine,
    but subsequent layers should be loose
    enough to allow air to be trapped.
   Socks and gloves that provide compression
    can contribute to peripheral vasoconstriction
    and lead to a progression of cold-related
    injuries.
  Thank You!



Any Questions?