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Chapter 20
Cold-Related Emergencies
Cold-Related Emergencies
• When surrounded by air or water cooler
than body temperature, body loses
heat.
• Normal body temperature is 98.6°F.
• If heat escapes faster than the body
produces it, the body temperature falls,
and cold injuries result.
How Cold Affects the Body (1 of 2)
• The body has two internal mechanisms to
maintain body temperature.
• Vasoconstriction
• Tightening of blood vessels
• Can cause discomfort, numbness, loss of
dexterity, cold injuries
• Shivering
• Stops when core temperature falls
between 86 and 90°F
How Cold Affects the Body (2 of 2)
• Physical activity produces heat.
• Heat loss increases if clothes become wet
with perspiration.
• Susceptibility can be minimized by:
• Proper hydration and nutrition
• Avoiding alcohol, caffeine, and nicotine
• Limiting periods of inactivity
Heat Loss from the Body (1 of 2)
• Four mechanisms of heat loss:
• Conduction
• Direct contact with colder object
• Convection
• Loss of heat by air blowing over skin
• Evaporation
• Conversion of liquid on skin to vapor
Heat Loss from the Body (2 of 2)
• Four mechanisms of
heat loss (cont’d):
• Radiation
• Heat given off
to cooler air
• Accounts for
the greatest
heat loss
Susceptibility to Cold Injury
• Physically unfit
• Dehydration
• Very lean people
• Elderly people
• Alcohol, caffeine
• Nicotine
• Inadequate nutrition, illness, injury
• Experienced a previous cold injury
Effects of Altitude
• Air temperature drops 3.6°F
every 1,000 feet.
• Winds are more severe.
• More susceptible to frostbite
above 8,000 feet
Effects of Water
• Water can conduct heat away from
the body much faster than air of the
same temperature.
• Wet clothing accelerates heat loss.
Effects of Wind
• Wind increases heat loss from skin
exposed to cold air.
• Windchill is the combined effect of
the ambient temperature and wind
speed.
Effects of Metal and Liquid
Fuels
• Can conduct heat away from
skin rapidly
• Contact can cause almost
instantaneous freezing
Minimizing Effects of Cold on
the Body (1 of 2)
•Layering
• Undergarment
removes
perspiration
• Wicking
properties
© Simon Price/Alamy Images
Minimizing Effects of Cold on the
Body (2 of 2)
• Middle layer insulates.
• Should be effective when wet.
• Synthetics are better than natural fibers.
• Wool
• Outer layer protects against wind.
• Waterproof
• Wind resistant
• “Breathable”
• Hat
Nonfreezing Cold Injuries
• Can occur when conditions
are cold and wet and hands
and feet cannot be kept warm
and dry
Chilblain
• Is painful
• Causes little or no
permanent damage
• Can develop in 3 to 6 hours
Recognizing Chilblain
• Swollen skin
• Skin is tender, hot to the
touch, and possibly itchy.
• Blisters
• Aching, prickly sensation,
numbness
Care for Chilblain
• Get victim out of cold.
Trench Foot
• Develops when skin on the feet is exposed to
moisture and cold for 12 hours or longer.
• Caused by:
• Wearing wet boots and shoes
• Prolonged immersion of the feet in cold
water
• Rubberized or tight-fitting boots increase risk.
Recognizing Trench Foot and
Immersion Foot
• Itching, numbness, tingling pain
• Swollen feet and pale skin cold to touch
• Red or bluish blotches on the skin
• Sometimes open weeping or bleeding
Care for Trench Foot
• Dry the skin.
• Rewarm foot gradually.
• Care for open weeping areas.
• Use mild soap and water.
• Apply a breathable dressing.
Freezing Cold Injuries
• Occur when air temperature is below freezing
• Frostnip
• Freezing is limited to skin surface.
• Frostbite
• Freezing extends into the flesh.
Frostnip
• Frostnip is
caused when
water on the skin
surface freezes.
Courtesy of Neil Malcom Winkelmann
Recognizing Frostnip
• Red and sometimes swollen
skin
• Painful
• Repeated frostnip can dry the
skin.
Care for Frostnip
• Gently warm affected area.
• Do not rub the affected area.
Frostbite
• Two ways of
damage:
• Tissue freezing
• Obstruction of blood
supply to the tissue
• Affects feet, hands,
ears, and nose
Recognizing Frostbite (1 of 2)
• White, waxy, or grayish yellow skin
• Part feels cold and numb
• Tingling, stinging, aching
• Stiff or crusty skin
• Underlying tissue is soft
Recognizing Frostbite (2 of 2)
Indications of deep
frostbite:
•Part feels cold, hard, and
solid and cannot be
depressed.
• Blisters
• Pale, waxy skin
• Painfully cold part
suddenly stops hurting
Classifications of Frostbite
• First-degree
• Warm, swollen,
and tender
• Second-degree
• Blisters form.
• Enlarges over
several days.
• Third-degree
• Small blisters with
reddish-blue or
purplish fluid
• Red or blue skin
• Might not blanch
• Fourth-degree
• No blisters or
swelling.
• Part remains
numb, cold, and
purple.
Care for Frostbite (1 of 2)
• Get victim to warm area.
• Remove wet clothing and constricting items.
• Seek medical care.
• If affected part is partially thawed:
• Place part in warm water.
• Maintain water temperature.
• 20 to 40 minutes
• Give pain medication.
• Apply warm cloths to ear or facial injuries.
Care for Frostbite (2 of 2)
• After thawing:
• Treat the victim as a stretcher case.
• Protect area from contact with clothing and
bedding.
• Place dry gauze between toes and fingers.
• Slightly elevate the affected part.
• Apply aloe vera gel.
• Provide pain medication.
Hypothermia
• A life-threatening condition in which the
body’s core temperature falls below 95°F
• Body loses more heat than it produces.
• Heartbeat/breathing may be undetected
• Begin CPR immediately.
• Consider whenever victim’s behavior and
history and the weather conditions indicate
abnormal heat loss
Types of Exposure
• Acute
• Usually in
water
• 6 hours or less
• Subacute
• 6 to 24 hours
• Land or water
• Chronic
• Occurs on land
• Exceeds 24
hours
Hypothermia Symptoms
• Change in mental status
• Disorientation
• Apathy
• Changes in personality
• Shivering
• Cool abdomen
• Low core body temperature
Types of Hypothermia
• Mild to severe based on core body
temperature
• In severe cases, shivering stops.
• Do not start CPR if:
• Core body temperature is below 60°F.
• Chest is frozen.
• Submerged in water for more than 60 minutes.
• A lethal injury exists.
• Transport will be delayed.
• Rescuers are endangered.
Recognizing Mild Hypothermia
• Vigorous, uncontrolled shivering
• Decreased mental skills
• Slurred speech
• Difficulty using fingers or hands
• Staggers while walking
• Cool or cold skin on abdomen, chest, or back
• Core body temperature above 90°F
Care for Mild Hypothermia
• Get victim out of cold.
• Handle gently.
• Prevent heat loss.
• Cover the victim with a vapor barrier.
• Keep the victim horizontal.
• Call 9-1-1.
• Allow the victim to shiver.
• Give warm, sugary drinks.
Recognizing Severe
Hypothermia
• No shivering
• Ice cold and blue skin
• Stiff and rigid muscles
• Altered mental status
• Slow breathing and pulse
• Might appear dead.
• Core body temperature is below 90°F.
Care for Severe Hypothermia
• Get victim out of the cold.
• Handle gently.
• Prevent heat loss.
• Cover with vapor barrier.
• Keep victim horizontal.
• Call 9-1-1.
• When remote, warm by available heat.
Adding Heat
• Problems with rewarming:
• Warm water immersion requires a lot of
warm water and a bathtub.
• Body-to-body contact in insulated sleeping
bag is not better than shivering.
• No evidence that chemical heating pads
are capable of rewarming a hypothermic
victim.
Dehydration (1 of 2)
• Occurs because of unperceived fluid loss
combined with inadequate fluid intake.
• Cold weather: fluid lost through breath
• Drink even if not thirsty
• Inactive: drink two quarts of water daily
• Color and volume of urine indicate
hydration.
Dehydration (2 of 2)
• Unmelted snow and ice should not be
consumed for water.
• Irritates the mouth.
• Wastes body heat
• Lowers body temperature
• Be sure snow and ice are disinfected
before consumption.

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Chapter 20 Cold-Related Emergencies

  • 2. Cold-Related Emergencies • When surrounded by air or water cooler than body temperature, body loses heat. • Normal body temperature is 98.6°F. • If heat escapes faster than the body produces it, the body temperature falls, and cold injuries result.
  • 3. How Cold Affects the Body (1 of 2) • The body has two internal mechanisms to maintain body temperature. • Vasoconstriction • Tightening of blood vessels • Can cause discomfort, numbness, loss of dexterity, cold injuries • Shivering • Stops when core temperature falls between 86 and 90°F
  • 4. How Cold Affects the Body (2 of 2) • Physical activity produces heat. • Heat loss increases if clothes become wet with perspiration. • Susceptibility can be minimized by: • Proper hydration and nutrition • Avoiding alcohol, caffeine, and nicotine • Limiting periods of inactivity
  • 5. Heat Loss from the Body (1 of 2) • Four mechanisms of heat loss: • Conduction • Direct contact with colder object • Convection • Loss of heat by air blowing over skin • Evaporation • Conversion of liquid on skin to vapor
  • 6. Heat Loss from the Body (2 of 2) • Four mechanisms of heat loss (cont’d): • Radiation • Heat given off to cooler air • Accounts for the greatest heat loss
  • 7. Susceptibility to Cold Injury • Physically unfit • Dehydration • Very lean people • Elderly people • Alcohol, caffeine • Nicotine • Inadequate nutrition, illness, injury • Experienced a previous cold injury
  • 8. Effects of Altitude • Air temperature drops 3.6°F every 1,000 feet. • Winds are more severe. • More susceptible to frostbite above 8,000 feet
  • 9. Effects of Water • Water can conduct heat away from the body much faster than air of the same temperature. • Wet clothing accelerates heat loss.
  • 10. Effects of Wind • Wind increases heat loss from skin exposed to cold air. • Windchill is the combined effect of the ambient temperature and wind speed.
  • 11. Effects of Metal and Liquid Fuels • Can conduct heat away from skin rapidly • Contact can cause almost instantaneous freezing
  • 12. Minimizing Effects of Cold on the Body (1 of 2) •Layering • Undergarment removes perspiration • Wicking properties © Simon Price/Alamy Images
  • 13. Minimizing Effects of Cold on the Body (2 of 2) • Middle layer insulates. • Should be effective when wet. • Synthetics are better than natural fibers. • Wool • Outer layer protects against wind. • Waterproof • Wind resistant • “Breathable” • Hat
  • 14. Nonfreezing Cold Injuries • Can occur when conditions are cold and wet and hands and feet cannot be kept warm and dry
  • 15. Chilblain • Is painful • Causes little or no permanent damage • Can develop in 3 to 6 hours
  • 16. Recognizing Chilblain • Swollen skin • Skin is tender, hot to the touch, and possibly itchy. • Blisters • Aching, prickly sensation, numbness
  • 17. Care for Chilblain • Get victim out of cold.
  • 18. Trench Foot • Develops when skin on the feet is exposed to moisture and cold for 12 hours or longer. • Caused by: • Wearing wet boots and shoes • Prolonged immersion of the feet in cold water • Rubberized or tight-fitting boots increase risk.
  • 19. Recognizing Trench Foot and Immersion Foot • Itching, numbness, tingling pain • Swollen feet and pale skin cold to touch • Red or bluish blotches on the skin • Sometimes open weeping or bleeding
  • 20. Care for Trench Foot • Dry the skin. • Rewarm foot gradually. • Care for open weeping areas. • Use mild soap and water. • Apply a breathable dressing.
  • 21. Freezing Cold Injuries • Occur when air temperature is below freezing • Frostnip • Freezing is limited to skin surface. • Frostbite • Freezing extends into the flesh.
  • 22. Frostnip • Frostnip is caused when water on the skin surface freezes. Courtesy of Neil Malcom Winkelmann
  • 23. Recognizing Frostnip • Red and sometimes swollen skin • Painful • Repeated frostnip can dry the skin.
  • 24. Care for Frostnip • Gently warm affected area. • Do not rub the affected area.
  • 25. Frostbite • Two ways of damage: • Tissue freezing • Obstruction of blood supply to the tissue • Affects feet, hands, ears, and nose
  • 26. Recognizing Frostbite (1 of 2) • White, waxy, or grayish yellow skin • Part feels cold and numb • Tingling, stinging, aching • Stiff or crusty skin • Underlying tissue is soft
  • 27. Recognizing Frostbite (2 of 2) Indications of deep frostbite: •Part feels cold, hard, and solid and cannot be depressed. • Blisters • Pale, waxy skin • Painfully cold part suddenly stops hurting
  • 28. Classifications of Frostbite • First-degree • Warm, swollen, and tender • Second-degree • Blisters form. • Enlarges over several days. • Third-degree • Small blisters with reddish-blue or purplish fluid • Red or blue skin • Might not blanch • Fourth-degree • No blisters or swelling. • Part remains numb, cold, and purple.
  • 29. Care for Frostbite (1 of 2) • Get victim to warm area. • Remove wet clothing and constricting items. • Seek medical care. • If affected part is partially thawed: • Place part in warm water. • Maintain water temperature. • 20 to 40 minutes • Give pain medication. • Apply warm cloths to ear or facial injuries.
  • 30. Care for Frostbite (2 of 2) • After thawing: • Treat the victim as a stretcher case. • Protect area from contact with clothing and bedding. • Place dry gauze between toes and fingers. • Slightly elevate the affected part. • Apply aloe vera gel. • Provide pain medication.
  • 31. Hypothermia • A life-threatening condition in which the body’s core temperature falls below 95°F • Body loses more heat than it produces. • Heartbeat/breathing may be undetected • Begin CPR immediately. • Consider whenever victim’s behavior and history and the weather conditions indicate abnormal heat loss
  • 32. Types of Exposure • Acute • Usually in water • 6 hours or less • Subacute • 6 to 24 hours • Land or water • Chronic • Occurs on land • Exceeds 24 hours
  • 33. Hypothermia Symptoms • Change in mental status • Disorientation • Apathy • Changes in personality • Shivering • Cool abdomen • Low core body temperature
  • 34. Types of Hypothermia • Mild to severe based on core body temperature • In severe cases, shivering stops. • Do not start CPR if: • Core body temperature is below 60°F. • Chest is frozen. • Submerged in water for more than 60 minutes. • A lethal injury exists. • Transport will be delayed. • Rescuers are endangered.
  • 35. Recognizing Mild Hypothermia • Vigorous, uncontrolled shivering • Decreased mental skills • Slurred speech • Difficulty using fingers or hands • Staggers while walking • Cool or cold skin on abdomen, chest, or back • Core body temperature above 90°F
  • 36. Care for Mild Hypothermia • Get victim out of cold. • Handle gently. • Prevent heat loss. • Cover the victim with a vapor barrier. • Keep the victim horizontal. • Call 9-1-1. • Allow the victim to shiver. • Give warm, sugary drinks.
  • 37. Recognizing Severe Hypothermia • No shivering • Ice cold and blue skin • Stiff and rigid muscles • Altered mental status • Slow breathing and pulse • Might appear dead. • Core body temperature is below 90°F.
  • 38. Care for Severe Hypothermia • Get victim out of the cold. • Handle gently. • Prevent heat loss. • Cover with vapor barrier. • Keep victim horizontal. • Call 9-1-1. • When remote, warm by available heat.
  • 39. Adding Heat • Problems with rewarming: • Warm water immersion requires a lot of warm water and a bathtub. • Body-to-body contact in insulated sleeping bag is not better than shivering. • No evidence that chemical heating pads are capable of rewarming a hypothermic victim.
  • 40. Dehydration (1 of 2) • Occurs because of unperceived fluid loss combined with inadequate fluid intake. • Cold weather: fluid lost through breath • Drink even if not thirsty • Inactive: drink two quarts of water daily • Color and volume of urine indicate hydration.
  • 41. Dehydration (2 of 2) • Unmelted snow and ice should not be consumed for water. • Irritates the mouth. • Wastes body heat • Lowers body temperature • Be sure snow and ice are disinfected before consumption.