1 cold weather injuries placer county mountain rescue mountain rescue association
TRANSCRIPT
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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• Changes in Behavior (withdrawn, attitude)• Changes in Activity Level (lethargy)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’