Articles by Dr. Whitney
 

Cold Injuries
Articles by Dr. Whitney >> Newsletters

Thousands of Americans suffer cold injuries each year. The CDC estimates over 1000 annual deaths, most common in the elderly because of their underlying chronic diseases, medication effects, a reduced ability to sense cold and generate heat, and social isolation. 

As we enter the coldest months of the year, remember to be smart and be prepared. Heart attacks are most common in extreme cold and after a high-pressure air mass has passed. These events often coincide as will occur this weekend. If you have known heart disease, or are at risk, minimize the time you spend outdoors. Also, avoid shoveling snow, especially in the morning when heart attacks are most common. Research has shown that exertion after only 10 minutes of shoveling snow is equivalent to a maximal stress test.

The two most common cold injuries are hypothermia and frostbite.

Hypothermia

Hypothermia is when our core body temperature drops below 95°F. Although most common in cold weather, it can occur in warm climates due to prolonged exposure to cool water.

Prevention of hypothermia

• Dress appropriately by wearing layers, hats, gloves, and avoid cotton material.
• Drink plenty of fluids, but avoid alcohol.
• Avoid tobacco
• Prepare emergency cold weather kits for your home and car.
• Mild hypothermia (90-95°F)
• Shivering occurs which is our body's attempt to generate heat.
• Difficulty speaking, difficulty walking, impaired judgment, and confusion begin. A person can appear intoxicated.
• Fast heart rate and rapid breathing
• Increased urination
• Treatment is mostly commonsense. Move them to a warm environment, remove wet clothing, wrap them in blankets, and give warm fluids.
• Moderate hypothermia (82-90°F)
• Shivering stops and confusion worsens. Victims may even try to undress. Moderate hypothermia is a medical emergency. Seek medical care immediately! Be very gentle when handling them because exertion and rough handling can trigger heart arrhythmias.

Frostbite

Frostbite is direct freezing of the skin. It occurs with or without hypothermia and is most common in the hands, feet, nose, and ears. Blood vessels are damaged, cells die, and nerves are injured.

Classification of frostbite is similar to burns:

• First degree- There is a white appearance, numbness, and skin swelling.
• Second degree- Blisters develop
• Third degree- Much deeper injury occurs and a black scab (eschar) may last for several weeks.
• Fourth degree- Involves muscle and bone. The extremity is usually lost.
• Cold weather is obviously a risk factor for frostbite. Other risk factors include:
• Smoking and exposure to vibration, which constricts blood vessels. Keep this in mind when operating outdoor machinery in the cold.
• Medical conditions that reduced blood flow to the extremity such as diabetes and peripheral vascular disease.
• Alcohol and mental illness which affect our ability to respond to cold stress appropriately.
• Use of socks and gloves that don't allow sweat to be wicked away from the skin.
• Previous frostbite
• Treatment
• DO NOT RUB THE AREA! Rubbing increases tissue damage.
• Do not rewarm the area if there is a chance of refreezing. Refreezing also increases tissue damage.
• Avoid walking on frostbitten feet.
• Warm with body heat or warm water.
• Avoid fires since frostbitten tissue has minimal sensation and burns can occur.Frostbite causes permanent damage such as excessive sweating, cold extremities, numbness of the affected area, discoloration, nail changes, and increased susceptibility to future frostbite.

Be Prepared!

To reduce your risk of sustaining hypothermia or frostbite, prepare emergency kits to keep in your cars and at home. Prepackaged kits are available.

• Car Kit
• blankets
• hats, gloves, scarves
• jumper cables
• bag of sand or cat litter
• collapsible shovel
• tire sealant
• tow rope
• flashlight
• flares/matches
• water bottle
• Home Kit
• paper, kindling, and wood for a fireplace
• matches
• kerosene heater
• blankets, supply of water, and food
• For a more complete list of supplies and recommendations, visit this CDC Website

Last changed: Jun 14 2009 at 11:36 PM