ACTivism: Winter Series Continued

 

Written By: Puck Arks

 

Winter Series Continued

 

Cold-weather care  is serious stuff. In military medicine, cold-weather injuries routinely account for more casualties and lost man-hours than all other injuries combined. In street medicine and wilderness medicine, similar trends have been observed. When taken seriously, cold-weather casualty and lost time can be almost eliminated.

Recognize cold-weather injuries and assess their severity

Hypothermia

Hypothermia occurs when the body is unable to maintain an adequate temperature because of excessive heat loss. This can happen when it is not freezing cold outside; hypothermia most often happens in wet conditions or when people have burns.

Mild Hypothermia

If shivering can be stopped voluntarily, it is mild hypothermia. The person can’t do complex motor functions with her hands but can still walk and talk. Skin is cool due to vasoconstriction. Hands are numb. Moderate confusion – if she cannot count backwards from 100, she may be hypothermic

Moderate Hypothermia

Shivering not under voluntary control. Loss of fine motor control – particularly in hands. The person can’t zip up her coat due to restricted peripheral blood flow. Poor coordination. May have: Dazed consciousness. Slurred speech. Violent shivering. Irrational behavior – may even undress. The person is unaware that she is cold. “I don’t care” attitude. Flat emotions

Cold-weather peripheral tissue damage

Frostnip is like a superficial burn. 

Frostbite (more severe) is rare in urban protest. Signs and symptoms of frostnip include

• Reddened or lightened skin, whitening or ashy skin

• Itching, tingling, numbness
 
Trench Foot 

is like diabetic foot injury but appears nearly identical to gradual- onset frostbite. Repeated or prolonged exposure to non-freezing wet cold causes vasoconstriction and sludgy blood, denial of oxygen to downstream tissue, cell death, and the growth of opportunistic organisms like bacteria and fungus that feed on dead tissue. The early manifestations of trench foot present as:
 
• Pain or partial loss of sensation; blanching of skin

• Progressing to swelling, discoloration, and 
blisters; “walking on blocks of
wood”

Signs of opportunistic fungal or bacterial infection
 
Hydrate, dry, and rewarm

Help the person get out of cold, wet, or windy weather – go into a restaurant or the lobby of a building. At least find shelter from wind
Prevent further heat loss and tissue trauma.

• Help the person remove wet clothes, dry off, and get into dry clothes as soon as possible. 

Especially help the person get out of wet socks, dry her feet, put some
talcum powder in her shoes (if available), and get into dry socks

Actively rewarm the core with warm fluids like hot chocolate or hot ginger tea if the person is alert and oriented

• If there is no cold-weather peripheral tissue damage, help the person get to a warm shower, use hot-air hand dryers in public bathrooms, or warm up with chemical hand-warmers on the neck, chest and groin (where major blood vessels pass)
Get the person something to eat – start with simple carbohydrates like ginger candy and nutritious fluids like broth, hot cider, or hot chocolate and work up to more complex foods
Provide specific first aid; consider transport and referral

Mild hypothermia

The person should be transported to a hospital or urgent care clinic if signs of moderate hypothermia are present

• Dazed consciousness, slurred speech
 
• Violent shivering

• Irrational behavior, “I don’t care” attitude, flat emotions

Call 911 if signs of severe hypothermia are present:

• Shivering occurs in waves until shivering finally ceases

• Can’t walk, curls up into fetal position to conserve heat

• Muscle rigidity with ashy or pale skin, dilated pupils, decreased pulse rate • Decreased breathing rate decreases, appears dead

While you wait for transport, you can gently slip cardboard or other insulation between the person’s body and the ground and cover her with a blanket or Mylar emergency blanket and a hat. If the person has lowered level of consciousness and great difficulty responding to you, do not give anything by mouth, do not jostle, and do not attempt to actively rewarm her – sudden movement may damage her heart.
 
Frostnip

Intermittently rewarm with gentle heat – encourage her to put her hands in her armpits, breathe onto the frost-nipped area, or warm the part in someone else hands or armpits

• Do not massage or rub the affected area. Do not re-expose to cold

• Be nice and provide comfort, calm, and reassurance. Rewarming frostnip hurts a lot.
The person should be transported to a hospital or urgent care clinic if signs of
frostbite are present 

(do not rewarm before transport)

• White/waxy skin, blotchy skin, grayish/yellow skin, blue skin • Swelling/blistering
 
• Firm or frozen to the touch
Early manifestations of trench foot
Follow frostnip care guidelines for gentle intermittent rewarming
 

Dry feet and change socks

After rewarming, substantial pain and swelling may manifest, and cleaning
remains necessary. Follow guidelines for infected wound soaks to clean feet and draw out the fluid causing swelling. Dry feet gently and completely before socks are put back on

• Add yarrow (Achillea millefolium) leaf or flower or encourage the person to get Burow’s solution/Domeboro from the pharmacy and add it to foot soak water for for stronger astringent action and mild antifungal action

• Add cayenne, ginger, or yarrow leaf/flower to foot soak water for vascular stabilization and vascular stimulant action

The person should be transported to a hospital or urgent care clinic if signs of advanced trench foot are present, such as total loss of sensation (feet feel like “blocks of wood”), or any signs for infection are present.