Translations:AY Honors/Winter Camping/Answer Key/57/en

Frostbite

Frostbite occurs when ice crystals form in the skin or deeper tissues after exposure to a temperature of 32°F (0°C) or lower. Depending upon the temperature, altitude, and wind speed, the exposure time necessary to produce frostbite varies from a few minutes to several hours.

The areas most commonly affected are the face and extremities. The symptoms of frostbite are progressive. Victims generally incur this injury without being acutely aware of it. Initially, the affected skin reddens and there is an uncomfortable coldness. With continued heat loss, there is a numbness of the affected area due to reduced circulation. As ice crystals form, the frozen extremity appears white, yellow-white, or mottled blue-white, and is cold, hard, and insensitive to touch or pressure. Frostbite is classified as superficial or deep, depending on the extent of tissue involvement.

Superficial Frostbite

In superficial frostbite the surface of the skin will feel hard or rubbery, but the underlying tissue will be soft, allowing it to move over bony ridges. On the exposed skin on the neck and face it is common to first notice patches that are white or waxy in appearance. This is evidence that only the skin and the region just below it are involved. Very little information is available in wilderness first aid training on the appearance of mid and dark toned skin that has been exposed to mild or superficial frostbite. General treatment for superficial frostbite is as follows:

1. Take the victim indoors, or at a minimum, increase their shelter from the elements.
2. Superficial frostbite around the head can typically be reversed quickly by sheltering from the elements with a scarf, hat, or even a gloved hand.
3. Rewarm hands by placing them under the armpits, against the abdomen, or between the legs.
4. Rewarm feet by placing them in the armpit or against the abdomen of the buddy.
5. Gradually rewarm the affected area by warm water immersion, skin-to-skin contact, or hot water bottles.
6. Place hot water bottles into a dry sock/glove to avoid overheating skin.
7. Never rub a frostbite area.

Deep Frostbite

In deep frostbite, the freezing reaches into the deep tissue layers. There are ice crystals in the entire thickness of the extremity. The skin will not move over bony ridges and will feel hard and solid. The objectives of treatment are to protect the frozen areas from further injury, to rapidly thaw the affected area, and to be prepared to respond to circulatory or respiratory difficulties.

1. Carefully assess and treat any other injuries first. Constantly monitor the victim’s pulse and breathing since respiratory and heart problems can develop rapidly. Be prepared to administer CPR if necessary.
2. Do not attempt to thaw the frostbitten area if there is a possibility of refreezing. It is better to leave the part frozen until the victim arrives at a medical treatment facility equipped for long-term care. Refreezing of a thawed extremity causes severe and disabling damage.
3. Treat all victims with injuries to the feet or legs as litter patients. When this is not possible, the victim may walk on the frozen limb, since it has been proven that walking will not lessen the chances of successful treatment as long as the limb has not thawed out.
4. When adequate protection from further cold exposure is available, prepare the victim for rewarming by removing all constricting clothing such as gloves, boots, and socks. Boots and clothing frozen on the body should be thawed by warm-water immersion before removal.
5. Rapidly rewarm frozen areas by immersion in water at 100°F to 105°F (38°C to 41°C). Keep the water warm by adding fresh hot water, but do not pour the water directly on the injured area. Ensure that the frozen area is completely surrounded by water; do not let it rest on the side or bottom of the tub.
6. After rewarming has been completed, pat the area dry with a soft towel. Later it will swell, sting, and burn. Blisters may develop. These should be protected from breaking. Avoid pressure, rubbing, or constriction of the injured area. Keep the skin dry with sterile dressings and place cotton between the toes and fingers to prevent their sticking together.
7. Protect the tissue from additional injury and keep it as clean as possible (use sterile dressings and linen).
8. Try to improve the general morale and comfort of the victim by giving hot, stimulating fluids such as tea or coffee. Do not allow the victim to smoke or use alcoholic beverages while being treated.
9. Transfer to a medical treatment facility as soon as possible. During transportation, slightly elevate the frostbitten area and keep the victim and the injured area warm. Do not allow the injured area to be exposed to the cold.

Hypothermia

Hypothermia is caused by continued exposure to low or rapidly falling temperatures, cold moisture, snow, or ice. Those exposed to low temperatures for extended periods may suffer ill effects, even if they are well protected by clothing, because cold affects the body systems slowly, almost without notice. As the body cools, there are several stages of progressive discomfort and disability. he first symptom is shivering, which is an attempt to generate heat by repeated contractions of surface muscles. This is followed by a feeling of listlessness, indifference, and drowsiness. Unconsciousness can follow quickly. Shock becomes evident as the victim’s eyes assume a glassy stare, respiration becomes slow and shallow, and the pulse is weak or absent. As the body temperature drops even lower, peripheral circulation decreases and the extremities become susceptible to freezing. Finally, death results as the core temperature of the body approaches 80°F (27°C). The steps for treatment of hypothermia are as follows:

1. Carefully observe respiratory effort and heart beat; CPR may be required while the warming process is underway.
2. Rewarm the victim as soon as possible. It may be necessary to treat other injuries before the victim can be moved to a warmer place. Severe bleeding must be controlled and fractures splinted over clothing before the victim is moved.
3. Replace wet or frozen clothing and remove anything that constricts the victim’s arms, legs, or fingers, interfering with circulation.
4. If the victim is inside a warm place and is conscious, the most effective method of warming is immersion in a tub of warm (100° to 105°F or 38° to 41°C) water. The water should be warm to the elbow - never hot. Observe closely for signs of respiratory failure and cardiac arrest (rewarming shock). Rewarming shock can be minimized by warming the body trunk before the limbs to prevent vasodilation in the extremities with subsequent shock due to blood volume shifts.
5. If a tub is not available, apply external heat to both sides of the victim. Natural body heat (skin to skin) from two rescuers is the best method. This is called “buddy warming.” If this is not practical, use hot water bottles or an electric rewarming blanket. Do not place the blanket or bottles next to bare skin, however, and be careful to monitor the temperature of the artificial heat source, since the victim is very susceptible to burn injury. Because the victim is unable to generate adequate body heat, placement under a blanket or in a sleeping bag is not sufficient treatment.
6. If the victim is conscious, give warm liquids to drink. Never give alcoholic beverages or allow the victim to smoke.
7. Dry the victim thoroughly if water is used for rewarming.
8. As soon as possible, transfer the victim to a definitive care facility. Be alert for the signs of respiratory and cardiac arrest during transfer, and keep the victim warm.

Snow Blindness

Exposure to reflected sunlight from snow, ice, or water, even on grey overcast days, can result in sunburn of the tissues comprising the surface of the eye, as well as the retina, producing snow blindness.

Symptoms

Symptoms may not be apparent until up to 12 hours after exposure. The eyes initially feel irritated and dry; then, as time passes, eyes feel as though they are full of sand. Blinking and moving the eyes may be extremely painful. The eyelids are usually red, swollen, and difficult to open.

Remedial Action

A mild case will heal spontaneously in a few days, but you can obtain some relief by applying cold compresses and a lightproof bandage. An ophthalmic ointment can be applied hourly to relieve pain and lessen the inflammatory reaction.

WARNING

Do not rub your eyes.

Dehydration

Dehydration is the depletion of water from the body. It can be prevented by drinking plenty of water, especially during periods of physical exertion. One to five percent dehydration will make you lose your appetite, become sleepy and nauseated, and begin to vomit. As dehydration goes up to 10 percent, dizziness results. You will have headaches, difficulty in breathing, tingling of the legs and arms caused by poor circulation, indistinct speech, and, finally, an inability to walk. Still, 10 percent dehydration generally causes no permanent ill effects. When dehydration exceeds 10 percent, you will become delirious, spastic, almost deaf, and barely able to see. The skin shrivels and becomes numb. At temperatures above 90°F, dehydration over 15 percent is generally fatal. At 85° and less, the body can stand up to 25 percent dehydration. Dehydration is quickly cured by water—in fact, only water can cure it. When you are dehydrated, you don’t have to worry about how much water you drink or how quickly you drink it, or if the water is warm or cool. Cold water, though, will upset the stomach.