Cold Weather Injuries Frostbite & Hypothermia - PowerPoint Presentation

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Cold Weather InjuriesFrostbite & Hypothermia

Clark Safety

&

Loss Control

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Cold Weather InjuriesFrostbite & HypothermiaHistorical PerspectiveCold Weather

Cold Weather Injuries

Hypothermia

Cold Stress ColdAlcohol Metal Objects & Liquid FuelsAir Temperature / ElevationCold Injuries Carbon Monoxide PoisoningChilblainImmersion foot / Trench footFrost-nipFrostbiteHypothermiaClothingC-O-L-DFirst Aid for Cold Injuries

Cold Exposures

Winter Weather Safety

Safety Procedures

Local Cold

Inj

Radiation Heat Loss

Conductive Heat Loss

Frostbite

Superficial Frostbite

Deep Frostbite

Treatment of Frostbite

Stages of Hypothermia

Mild Hypothermia

Moderate Hypothermia

Severe Hypothermia

Immersion Hypothermia

Possible Death from Hypothermia

Treatment of Hypothermia

Prevention

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Cold Weather !!!!

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Historical PerspectiveFrench invasion of Russia in 1812. Baron de Larrey, chief surgeon, noted mental and physical hardships by Soldiers exposed to the cold.Freeze-thaw-refreeze phenomenon.

George Washington; 10% of his troops perished in the winter of 1777-78

due to cold

. 16th Annual AMAA Sports Medicine Symposium

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Cold Weather !!!!Cold injuries result from our inability to properly protect ourselves from the environment. Factors of; temperature, length of exposure, wind-chill, humidity & wetness, play roles in these processes.

The majority of cold injuries encountered today affect the homeless, wilderness activities & sports.

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Cold Weather InjuriesCold weather can lower body temperature, resulting in impaired performance & cold injuries.

When body heat loss exceeds the body's ability to produce & retain heat, body temperature decreases.

When body temperature

falls below 95°F , hypothermia, follows . (a life-threatening condition)

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HypothermiaTo reduce heat loss;

The body decreases blood flow to the arms, legs, and skin.

(Although this protects the internal organs, the decreased blood flow increases susceptibility of hands, feet, ears, etc. to non-freezing

(trench foot) & freezing (frostbite) cold injuries.)

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Problems with Cold Environments

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Cold Stress Cold weather is often accompanied by wind, rain, snow, and ice, which can worsen the effects of cold. For any given air temperature, the potential for body-heat loss,

is increased by wind and moisture.

When protection is inadequate, the body has defense mechanisms to help maintain the correct temperature.

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ColdThe body protects vital internal organs (brain, heart) by reducing skin blood flow & increasing shivering.

Heat production is increased by shivering & increased physical activity.

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ColdHowever; Physical activity can cause sweating, which may increase the risk of cold injury if clothes become wet.

Also, inactivity for long periods increases the risk of cold injury. (This is a particular concern where movement is restricted.)

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ColdBecause cold-weather clothing is heavy and cumbersome, it increases the energy required for physical activity. The increased effort can result in overheating and sweating, & can contribute to increased fatigue.

Heavy work & sweating leads to dehydration, which increases susceptibility to cold injury.

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ColdIn addition; poorly conditioned people are more susceptible to cold injury. They tire more quickly & are unable to stay active to keep warm.

Lean people are more susceptible to cold injury because they lack body fat, which is good insulation against cold.

Illness, poor nutrition, & injury limit ones ability to protect against cold injury.

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Alcohol Alcohol increases susceptibility to cold injury by increasing heat loss & reducing shivering.

Alcohol increases urine output, which may lead to dehydration.

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Alcohol Alcohol also blunts the senses & impairs judgment, so the individual may not feel the signs & symptoms of developing cold injury.

In addition, any source of nicotine, such as smoking or chewing tobacco, can increase susceptibility to cold injury.

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Metal Objects & Liquid Fuels Metal objects & liquid fuels left in the cold can pose a serious hazard.

Skin contact with fuel or metal at below freezing temperatures can result in nearly instantaneous freezing injury.

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Air Temperature / ElevationAir temperature decreases about 3.6°F with every 1000 ft increase in elevation.

Due to the lower temperatures, higher winds, & lack of oxygen.

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Cold Injuries When operating in cold environments you are at risk for cold injuries that may reduce your ability to function.

These include:

chilblain, trench foot, frost-nip, frostbite, & hypothermia.

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Carbon Monoxide PoisoningCarbon Monoxide (CO) poisoning is the leading cause of accidental poisoning deaths in America.CDC estimates annually:500 deaths from CO15,000 Emergency Room visits

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Carbon Monoxide PoisoningCarbon Monoxide is:Formed when organic compounds burnColorlessOdorlessTasteless

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Carbon Monoxide PoisoningSourcesMotor vehicle exhaustSmoke from fires

Gas hot water heaters

Kerosene space heaters

Charcoal grillsPropane heaters & stovesCigarette smokeGas or diesel generatorsGas powered tools (chain saw, weed eater, etc.)Indoor tractor pullsBoat engine exhaustSpray paint, solvents, degreasers, & paint removers

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Carbon Monoxide PoisoningSigns and SymptomsHeadacheDizziness

Nausea/ vomiting

Flu like symptoms

FatigueDyspneaChest painAbdominal painAltered mental statusAgitationHallucinationsVisual changesSyncopeSeizuresMemory problemsCherry red skinPale to cyanotic skin

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Carbon Monoxide PoisoningTreatmentScene safetyRemove patient from the environmentMonitor level of consciousness

Maintain airway (be prepared to suction if patient begins to vomit)

High flow oxygen

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Chilblain Chilblain; is a nonfreezing cold injury which, although painful, causes little or no permanent impairment.

It appears as

tender, red, swollen skin

that is hot to the touch & may itch. This can worsen to an aching, prickly ("pins and needles") sensation & then numbness. (It may develop in only a few hours in skin exposed to cold.)

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Chilblain

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Immersion foot / Trench foot Immersion foot / Trench foot;

Develops when feet are exposed to moisture & cold for prolonged periods (12 hours or longer).

The combination of cold & moisture softens skin, causing tissue loss &, often, infection. Untreated, trench foot can eventually require amputation. Often, the first sign of trench foot is itching, numbness, or tingling pain. Later the feet may appear swollen, & the skin faintly red, blue, or black.

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Immersion foot / Trench foot

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Immersion foot / Trench foot

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Immersion foot / Trench foot

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Frost-nip Frost-nip involves freezing of water on the skin surface. The skin will become reddened & possibly swollen. Although painful, there is usually no further damage after re-warming.

Repeated frost-nip can dry the skin, causing it to crack & be sensitive. Frost-nip should be taken seriously since it may be the first sign of impending frostbite.

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Frost-nip

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Frostbite Frostbite involves freezing of deeper layers of tissue. Ice crystal formation & lack of blood flow cause tissue damage. Skin freezes at about 28°F.

The skin becomes numb & turns a grey or waxy-white color, is cold to the touch, & may feel stiff.

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Frostbite

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Frostbite

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Frostbite

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Frostbite

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Frostbite

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Frostbite

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Frostbite

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Frostbite

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Hypothermia Hypothermia:

Is a life-threatening condition

in which body temperature falls below 95°F . (Generally, body temperature will not fall until after many hours of exposure to cold air or exposure to cold water. )

Body temperature can fall even when air temperatures are above freezing, if conditions are windy, clothing is wet, or inactiveness.

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HypothermiaThe first signs of developing hypothermia include; confusion, bizarre behavior, & withdrawal from group interaction.

Victims of hypothermia may be unconscious, with nearly undetectable breathing & pulse.

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HydrationMonitor hydration status by noting urine color & frequency of urination.

Dark yellow urine

& infrequent urination indicate that fluid consumption should be increased.

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HydrationAvoid alcohol & tobacco because of their adverse effects in the cold.

Keep hands, feet, & skin dry. Change socks whenever they become wet or sweaty.

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ClothingKeep clothing clean; Dirty clothing packs down, loses insulation value, & prevents evaporation of sweat.

Wear clothes in layers;

Layered clothing allows to adjust to changes in temperature or physical workload.

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ClothingWear clothes that allow air flow (ventilation) for evaporation of sweat. (If sweat does not evaporate, it will accumulate. Wet clothing loses its insulation value, increasing the risk of cold injury.)

The standard light-duty leather glove, worn with woolen inserts, provides inactive persons with about 30 minutes of protection from frostbite when air temperature is 0°F.

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C-O-L-DWHEN USING COLD-WEATHER CLOTHING REMEMBER “C-O-L-D” C - keep it-------Clean

O - avoid---------

Overheating

L - wear it-------Loose in layers D - keep it-------Dry

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First Aid for Cold Injuries For Chilblain & Trench foot, (Remove wet or constrictive clothing. ) Gently wash, dry, & elevate the injured part.

Cover the injured area with layers of loose warm clothing & allow to re-warm.

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First Aid for Cold InjuriesPain & blisters may develop. Do not; pop blisters, apply lotions or creams, do not massage, do not expose to extreme heat, do not allow victim to walk on injury.

Seek medical attention.

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FrostbiteFor Frostbite;Prevent further cold exposure & remove wet, constrictive clothing. Gradually re-warm the injury by direct skin-to-skin contact between injured area & non-injured skin of victim or a buddy.

Evacuate for medical treatment;

Victims with foot injuries should not walk,

but should be evacuated by litter. Do not thaw frostbite injuries if there is a possibility of refreezing during evacuation.

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HypothermiaFor Hypothermia; Prevent further cold exposure & remove wet clothing.

Start CPR if required.

Re-warm by covering with blankets, sleeping bags, & with body-to-body contact. Handle gently during treatment & evacuation. (rough handling can cause dangerous irregular heartbeats in hypothermic victims.)

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Cold ExposuresLocal Cold Injuries;Occurs when a portion of the skin is exposed to cold temperatures & freezes.

Exposed areas of the body are most prone to local cold injuries.

Fingers

ToesEarsNoseChin

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Cold ExposureLocal Cold Injuries: Risk Factors;Any trauma in cold weatherExtremes of age

Tight footwear

Use of alcohol during exposure to cold

Wet clothingHigh altitudesLoss of bloodArteriosclerosis

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Cold ExposuresLocal Cold Injuries Classification;Late or deep (frost bite)Freezing of the body part to include skin & underlying tissue

Skin appears white & waxy

Area will be firm to hard (frozen feeling)

Loss of sensationSwelling & fluid filled blisters may be presentSkin may become blotchy or mottled as warming occurs

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Winter Weather SafetyWeather Definitions;BlizzardWinds over 35 mph with blowing snow & reduced visibility to nearly zero

Blowing snow advisory

Wind driven snow that significantly reduces visibility & causes drifting. May be from falling snow, or snow that is already on the ground

Snow advisory3 to 6 inches of snow is to fall within a 12 hour periodSnow flurriesLight snow fall with little or no accumulation

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Winter Weather SafetyWeather Definitions;Snow showersSnow falling at various intensities for brief periods of time. Some accumulation is possible.

Snow squalls

Brief intense snow showers accompanied by strong, gusty winds. Accumulation may be significant. Usually occur around the Great Lakes.

SleetRain drops that freeze into ice pellets before reaching the ground. Usually bounces when hitting a surface & does not stick to objects. It can accumulate & become hazardous.Freezing rainRain that falls onto a surface with a temperature below freezing causing it to freeze on the surface (trees, cars, roads, power lines) forming a sheet of ice.

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Winter Weather SafetyWeather Definitions;Wind Chill AdvisoryStrong winds that increase the danger of exposure to cold air

Winter Storm Watch

Indicate that severe winter weather may affect your area.

Winter Storm WarningIndicate that severe winter weather is imminent & you should take immediate precautions.Winter Weather AdvisoryWinter weather conditions are expected to cause significant inconveniences & may be hazardous. If caution is exercised, these situations should not become life threatening. The greatest hazard is to motorists.

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Safety ProceduresWhat to do:Call 9-911Move to warm area

Remove wet clothing

Drink warm sweet fluids

Do not rub the affected areaWrap in soft cloth

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“The patient is not deadunlessthey are warm & dead”

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Cold ExposuresWays the body losses heat

Radiation is the most significant mechanism of heat loss.

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Cold ExposuresAffect of wind on temperature

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Cold ExposuresAffect of water temperature on core temperature

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Local Cold InjuryCo-morbid factors;Tend to occur on extremities; ears, nose, faceFrostbite;Localized condition in which specific body tissues freeze

Water lies in & around the cells. When water freezes, it forms ice swells, damaging the cells.

In severe cases this can lead to gangrene.

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Local Cold InjurySuperficial frostbite;Affects the dermis & shallow subcutaneous layersDeep frostbite;Affects the dermal & sub-dermal layers of tissue

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Local Cold InjurySigns & symptoms ;Local injury with clear demarcationEarly or superficial injury

Blanching evident

Loss of feeling & sensation to the area

Skin remains softIf re-warmed, tingling sensationLate or deep injuryWhite, waxy skinFirm to frozen feeling on palpationSwelling may be presentBlisters may be presentIf thawed, skin may appear flushed with areas of purple and blanching, or mottled and cyanotic

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Radiation Heat LossRadiation is heat loss to the surrounding environment & can be significant, depending on the amount of blood flow to the skin. It accounts for 60% of body heat loss at rest. A large amount of heat loss comes from the head.

Radiant heat loss is reduced by wearing adequate clothing --

especially a hat

!

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Conductive Heat LossConductive heat loss is heat transfer by direct contact with an object.

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Heat loss from evaporation (i.e. respiration & perspiration) is affected by the relative humidity & ambient temperature of the environment. The body loses heat 25 times faster if the skin is wet. Evaporative loss is reduced by staying dry, using a vapor barrier & using mouth / nose moisture traps.

Convection heat loss is determined by air movement over the skin (i.e. wind-chill) & is reduced by a windproof layer.

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FrostbiteFrostbite occurs when the skin actually freezes & loses water.Freezing of deep layers of skin

Pale, waxy-white skin color

Skin becomes hard & numb

Usually affects:Fingers / handsToes / feetEars / nose

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FrostbiteThree stages of frostbite:Frost nip;

Individual experiences a “pins and needles” sensation & skin is unusually white and soft.

Superficial;

Characterized by waxy feeling, frozen, numb, & possible blistering skin.Deep;The most serious type of frostbite affects the blood vessels, muscles, nerves, tendons, & even bone -leading to possible permanent damage, blood clots, and death of body tissues.

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FrostbiteFrostbite occurs when the deep layers of the skin & other body tissues freeze (tissue temperature <28°F-30°F). Ice crystals form, destroying tissues & causing permanent damage. In severe cases, amputation of the frostbitten area may be required.

Toes / feet

Fingers / hand

EarsFrostbite typically affects; These parts are farthest from the body core, receive less blood flow, & are thinner so they cool faster.NoseCheeksChin

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FrostbiteExposure to below freezing temperaturesCan occur in above freezing temperatures due to wind chill factors & wetnessContact with extremely cold

objects (especially metal)

Contact with cooled or

compressed gases, at normal temperatures (e.g., liquid nitrogen)Causesair temp.+wind+wetness

cold condition

=

Direct skin exposure to freezing metal, extreme cold, or high winds can cause frostbite in minutes

.

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FrostbiteFrostbite can be classified into two main divisions:

Superficial

(mild)

Deep (severe)The extent of frostbite depends on the extremeness conditions & duration of exposure.

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Superficial FrostbiteIncludes all layers of the skinInitially redness in light skin, grayish in dark skin

Burning, tingling, itching, or cold sensations in the affected areas, followed by numbness

Skin turns white, waxy; some resistance when pressed (feels firm or “wooden” but underlying tissue is soft); cold to the touch

May have blistering

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Deep FrostbiteInvolves skin, muscle, tendons, nerves, blood vessels; may include boneWhite or yellowish waxy skin that turns purplish blue as it thaws

Underlying tissue hard, no resistance when pressed, may appear blackened and dead

Blood-filled blisters & swelling may develop

May develop blood clots

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Deep FrostbiteSignificant pain as affected areas re-warm; dull continuous ache becomes throbbing sensation in 2-3 days & may last weeks to months .Frostbitten skin is highly susceptible to infection, & gangrene (death & decay of body tissues) may develop.Time will reveal the final amount of tissue damage.

Many people with frostbite may also be experiencing hypothermia.

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Treatment of FrostbiteMove the person to a warm dry area. (Don’t leave the person alone.)Remove any wet or tight clothing that may cut off blood flow to the affected area.

Treat for hypothermia, if victim is also experiencing hypothermia. (Saving their lives is more important than preserving a finger or foot.)

Perform CPR if necessary.

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Treatment of FrostbiteDo not rub the affected area, (rubbing may cause damage to the skin and tissue.)Gently place the affected area in a warm (105°F) water, bath, & monitor the water temperature to slowly warm the tissue. (Don’t pour warm water directly on the affected area because it will warm the tissue too fast causing tissue damage. Warming takes about 25-40 minutes.)

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Treatment of FrostbiteAfter the affected area has been warmed, it may become puffy & blister. The affected area may have a burning feeling or numbness. When normal feeling, movement, & skin color have returned, the affected area should be dried & wrapped to keep it warm.

Seek medical attention as soon as possible.

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Treatment of FrostbiteNOTE: If there is a chance the affected area may get cold again, do not re-warm the skin.

If the skin is warmed & then becomes cold again, it will cause severe tissue damage.

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Stages of Hypothermia

Approximate

Core Body TemperatureMild hypothermia95°F - 98°F

Moderate hypothermia

90°F - 95°F

Severe hypothermia

<90°F

Hypothermia progresses through three indistinct but sequential stages as core body temperature continues to decline:

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HypothermiaHowever, it can occur at warmer temperatures as high as 65°F, or more, if a person becomes chilled from prolonged exposures to wetness (rain, snow, submersion in cold water, or sweat) & accompanying winds.

Generally, in cold dry environments, hypothermia occurs over

a period of hours. In cold water, core temperature can drop to dangerous levels in a matter of minutes.

Most cases of hypothermia occur in air temperatures from 30°F to 40°F.

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Mild Hypothermiashivering, mild to severesensation of cold, then pain in extremitiespale, waxy, cold skin

numbness of hands

unable to perform complex tasks (fumbling with items in the hand)

able to walk and talkSigns/SymptomsirritabilityPhysical

Mental

If shivering can be stopped voluntarily



mild hypothermia

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Moderate HypothermiaIntense shivering becomes persistent and violentSluggish; labored movementsStumbling

Loss of fine motor coordination in hands (fumbling)

Signs/Symptoms

Confused, may appear alertIrrational behavior – “Paradoxical Undressing” (person starts to undress, unaware they are cold)Apathetic/flattened affect – "I don't care” attitude" Withdrawn behaviorSlurred speech, difficulty speakingSluggish thinkingSigns of depression

Physical

Mental

Watch for the “-numbles”

stumbles

mumbles

fumbles

grumbles

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Severe HypothermiaShivering stopsExposed skin blue or puffyMuscle coordination very poor, muscle rigidity

Stupor

Can’t walk; falls to ground & curls up into fetal position to conserve heat

Decreased pulse & respiration rateIrregular heart rhythmSigns/SymptomsPhysical

Incoherent, irrational behavior

May be able to maintain posture & appearance of awareness

Semi-conscious, drowsy

Loss of awareness of others

Amnesia, memory lapses

Mental

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Immersion HypothermiaWater Temperature in

Degrees F

(Degrees C)

Exhaustion or Unconsciousness

Expected Time of Survival

32.5 (0.3)

Under 15 min.

Under 15 to 45 min.

32.5 to 40 (0.3 to 4.5)

15 to 30 min.

30 to 90 min.

40 to 50 (4.5 to 10)

30 to 60 min.

to 3 hrs.

50 to 60 (10 to 15.5)

to 2 hrs.

to 6 hrs.

60 to 70 (15.5 to 21)

2 to 7 hrs.

2 to 40 hrs.

70 to 80 (2 to 26.5)

2 to 12 hrs.

3 hrs. to indefinite

Over 80 (Over 26.5)

Indefinite

Indefinite

Water transfers heat away from the human body

25 times faster than air,

so even moderate water temperatures can be dangerous in a relatively short time.

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Possible Death from HypothermiaErratic, shallow breathingMay not be able to feel pulse

Pupils dilated & fixed

Cold, blue skin

Unresponsive to any stimuliPulmonary edema, cardiac & respiratory failureDeath possible below 78°FPhysical Brain activity seriously slowedUnconscious, appears comatose or dead

Mental

Core body temperature below 82°F - 78°F

Worker may appear dead & show all the accepted clinical signs of death, but many of these people have made complete recoveries when re-warmed.

“No one is dead until

warm

and dead”

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Treatment of HypothermiaTreatment depends on the severity of the hypothermia.

Remove wet clothes from victim and replace with dry clothes and/or wrap in warm blankets; cover the head.

Move to a warm environment.

Do not exercise to warm up. Do not re-warm person in a warm bath or by massaging or rubbing.Drink a warm (not hot) sugary drink Avoid drinks with caffeine (coffee, tea, or hot chocolate) or alcohol.Transport victim to an emergency medical facility for evaluation.Mild HypothermiaHandle the victim gently and minimize his or her exertion.

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Treatment of HypothermiaCall for emergency help.Follow the procedures on the preceding slide. In addition:Cover all extremities completely, place very warm objects, such as hot packs or water bottles on the victim's head, neck, chest & groin. Arms & legs should be warmed last.

Moderate Hypothermia

Handle the victim gently. Rough handling can cause heartbeat irregularities & death.

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Treatment of HypothermiaCall for emergency help. Give CPR if necessary.Follow the procedures for treating mild hypothermia.

Do not apply external heat (hot water bath, heat lamp, electric blanket, electric heater, etc.) to re-warm.

Transport the victim to an emergency medical facility as soon as possible.

Severe HypothermiaHandle the victim very gently. Transport to hospital for treatment as soon as possible.

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PreventionAdequate food & fluid intake. Staying dry & avoiding fatigue. Proper Clothing & shelter.

Other considerations include;

Trip planning Weather awareness Proper equipment Avoiding alcohol Avoiding reflex vasoconstriction---cover all skin Use of chemical warmers Check toes and fingers intermittently Buddy system for recognizing facial frost-nip.

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The Right Winter Clothing ??

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A Thought - To Ponder !Life is like a roll of toilet paper.The closer it gets to the end, the faster it goes.

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Test1. Define two types of cold emergencies.2. Identify 3 factors affecting cold emergencies.

3. Name two ways the body looses heat.

4. List at least four signs and symptoms of generalized hypothermia.

5. Outline the treatment for generalized hypothermia (including hypothermic arrest).6. Describe the difference between superficial local cold injuries and deep local cold injuries.7. Outline the treatment for local cold injuries.8. Identify 5 signs and symptoms of carbon monoxide poisoning.9. Identify 4 sources of carbon monoxide poisoning.10. Name three ways to stay safe on the road during winter weather.11. Identify at least 5 items that should be in an emergency road kit.

12. What is a winter weather advisory?