Category Archives: FIrst Aid and Safety Lifeskills

It is cold out there…

winter safetyI wrote about hypothermia a few years ago hoping that people would heed all my good advice and never  have to worry about treating frostbite.   However on occasion,   someone will insist on walking the dog without wearing gloves and end up with a bit of a case of frostbite.  Since we are gearing up for actual temperatures of -24 hear in Iowa Sunday and Monday, I thought this would be a prudent time to talk about frostbite here on the blog.

Risk Factors

Some people are more at risk than others for frostbite.  Obviously little babies and elders are at greater risk.  Those with peripheral diabetic neuropathies or cardiovascular diseases which impair circulation should also take extra caution.   Being on beta blockers increases your risk of frostbite, also.   Also any agent ,  prescription or otherwise,  which thins your blood makes you more susceptible to frostbite, especially alcohol.   Dehydration and poor nutrition may also predispose one to frostbite.   The presence of  precipitation  and high winds, along with the cold  can also increase your risk. Going outside without gloves on when it is a windy -6, will also do the trick.

Source: National Weather Service

Source: National Weather Service

Frostbite causes injury during both the freezing and thawing process.  Freezing temperatures decreases blood flow and causes ice crystals to form in the interstitial fluid. These crystals may rub together and cause tissue damage or leech fluid from the cells causing dehydration.   As the skin thaws,  the inflammation process is triggered which results in vasoconstriction and more blood clots which may further reduce circulation to the affected area.

Symptoms of Frostbite Include:
1. Pain or prickly sensations.
2. Numbness
3. Pale-looking skin that feels cold, and possibly hard,  to the touch.
4. Skin may appear swollen.  Steve’s finger almost swelled out of his wedding ring even though he had a fairly mild case. .

Three Categories of Frostbite

Superficial frostbite or frostnip – This is a mild case of frostbite, so mild in fact that it is not considered true frostbite.   Skin may go white, be painful and feel cold to the touch but it is still pliable and springs back after having been touched.

Partial thickness frostbite is more serious. Generally speaking the skin feels harder and  may retain an indentation after it has been touched. In this case the injured party is likely to feel more pain and a prickling sensation verging on numbness. You might also want to assess this person for symptoms of hypothermia and treated for mild-moderate hypothermia.

Full thickness frostbite occurs when the skin is frozen solid. Touching the skin is not likely to leave an ident.   It will feel “wooden” to the person assessing the damage and numb to the injured person. Unless you are in a wilderness situation, do NOT try to handle this on your own. The injured party is almost positively going to be suffering from hypothermia at this point, as well.

Caring for Frostbite
Treat frostnip and partial thickness frostbite by submerging the skin in 40-42 degree C water or if water isn’t available skin-to-skin contact. Do not rub the skin or place the frozen skin near a heater. Both of these measures can cause further damage. You also want to be sure not to do something that will further damage already damaged skin like applying cayenne or some other rubefacient like mustard, on the skin to thaw it out.

If you want to warm someone up and increase circulation do that by giving them a warming infusion, to drink.  Sage and yarrow are nice for this  or even tea made from pine needles if that is all you can find.

The skin is properly thawed when the  color returns to the skin. The injured party will experience some pain as this happens. In more severe cases the skin may take on a red, mottled look which is referred to as flushing.   This is not by itself, a cause for concern.

Frostbite Blebs

Frostbite Blebs

Partial thickness frostbite sufferers  sometimes form blisters known as “blebs”. It is good to try to keep these from rupturing if you are dealing with this at home although they do lance them in the ER.

Once the skin is thawed, you should approach frostnip like a superficial burn although  I still like to avoid rubbing the area much, especially if there are blebs present.  Chamomile, lavender, or  meadowsweet  infusions used as tepid herbal soaks are nice.    Aloe has been indicated as being helpful, as well but I would add aloe juice to a soak rather than applying it directly.  I still maintain that the best burn treatment in the world though is my granny’s method of grating a raw potato and using it as a poultice.   Most of the time I first apply a potato poultice and follow that with the tepid herbal soaks.

Withing a few days the redness mellows and you can  move on to healing topical preparations, if necessary because of wounds left behind when the blebs rupture,  I will stick with oils and compresses because I don’t like to use ointments on open wounds.  I make a  myrrh/calendula/gotu kola compress at night and wrap it to the area with tender tape. In the morning, I apply  a comfrey/ St. John’s wort oil topically. Comfrey as a cell proliferant.  St John’s Wort because of its  anti-bacterial and anti-inflammatory properties and its affinity for nervous tissue.  Balm of Gilead is an often mentioned traditional preparation for frostbite, but I grow both comfrey and SJW, so that is what I use.

I really hope no one ever has to deal with this, but it should go without saying that you should only attempt to handle full thickness frostbite, if you have no way of getting to a hospital. Submerging the frozen body parts in water that is between 40-42 degrees Celsius is still the preferred treatment but you need to be prepared for the fact that this is going to be intensely painful for the injured party and that the skin may take on a black dead look almost immediately upon thawing.  Compounding this problem is the fact that the person is likely to have severe hypothermia, as well.     It really isn’t something to try to tackle on your own, seek immediate medical attention as soon as possible.

I hope that none of you have any need of any of this information over the next few days.  Be safe.   If you must be outside, read up on hypothermia and take appropriate precautions.  Travel with a winter safety kit and keep your cell phone charged at all times.

 

Winter Time Safety: Hypothermia

winter safetyThe technical definition of hypothermia is when the body loses heat to the environment faster than it can produce heat resulting in a drop in core body temperature.

General hypothermia which was referred to as “exposure” in the old texts. This occurs in degrees.

Mild Hypothermia

The beginning stage of hypothermia is often overlooked as it occurs before noticeable shivering occurs. This is unfortunate because hypothermia is most easily treated in the early stages. A person suffering from mild hypothermia is likely to first notice a decline in gross motor skills and may stumble or become less agile. Fine motor may begin to decline next and you might notice a person dropping items or that their reflexes may slow. Brain function may begin to decline and you might notice that a person’s speech may begin to slur or they might stutter. You might also begin to notice a person exhibiting less social behavior such as irritability or combativeness. A person’s heart rate or respiration rate may rise and the skin will pale slightly.

Moderate Hypothermia

When uncontrollable shivering begins it signifies that you are experiencing moderate hypothermia. Shivering expends a great deal of energy so you will lose heat more quickly. The symptoms listed above may increase to the point that one is unable to walk or talk. They may become delirious or begin to hallucinate. The skin becomes even more pale and cooler to the touch.

Severe Hypothermia

When shivering ceases, the musculature may become rigid. The sufferer progresses from a mental stupor to unconsciousness. It is also at this point that the heart rate and respiration begin to slow and possibly arrest. Seizures are possible and if not treated quickly the exposed person might slip into a coma. Skin will be cold to the touch and most likely cyanotic.

Obviously, exposure to the cold is the primary cause of hypothermia. Certain factors, however, may increase your susceptibility to hypothermia. I prefer to focus on prevention, so I will present the various measures one can take to avoid hypothermia when exposure to the cold is inevitable.

1. Dress appropriately. Layers and a head covering are essential. Make sure your ears are covered.

2. Maintain constant hydration – dehydration can sneak up on you in cooler weather as the dryer air and cold tend to rob your body of fluids in an entirely different manner than the summer heat.

3. Avoid stimulants such as caffeine and tobacco. They cause vasoconstriction which restricts blood flow to the periphery.

4. Avoid alcohol and other drugs which impair circulation.

5. Stay dry; remove clothing if you begin to sweat. Keep a spare pair of dry socks in your pack.

6. Keep active; move around frequently.

Diet can contribute to prevention measures as well. When spending time outdoors in cold weather follow the following dietary advice:

1. High calorie diet with adequate amounts of protein and saturated fats.

2. Increase intake of Omega-3 fatty acids and other healthy fats. Include fish oils, nuts, olive oils and coconut oil.

3. Increase intake of anti-oxidant rich vegetables.

4. Drink 6-8 glasses of water or herbal infusions daily.

Sample Menu Items

1. Hot soups made with fresh vegetables and warming herbs such as  ginger,  pepper, turmeric, garlic and cayenne.

2. Kitchari, dhal, congee or other traditional recipes for preparing legumes or grains.

3. Ginger tea with honey.

4. Dried fruits including cherries and blueberries mixed with nuts and seeds that have been lightly roasted in oil.    In Food as Medicine,  Todd Caldecott recommends roasting seeds and nuts at 300 degrees for 10-15 minutes in order to reduce antinutrient factors.   You can toss some seeds and nuts of your choice in olive oil and then sprinkle warming herbs of your choice over the oil coated nuts before baking.

Treatment

Do not attempt to treat severe hypothermia on your own. Supplemental oxygen so as to avoid hypoxia is a key treatment component at this degree of exposure. Follow the following procedure for treating mild-moderate hypothermia but immediately seek medical assistance.

Mild – Moderate Hypothermia

1. Ensure that the person is dry. If necessary change out wet clothing for drying clothing.

2. Shelter the person from wind and water either by placing them in a shelter or covering them with a windproof layer.

3. Insulate person from the ground with a tarp under extra sleeping bag or thermorest.

4. Place person in another sleeping bag on top of insulation or conversely sandwich them between two more bags. If you have them you can tuck heat packs or hot water bottles inside bags.

5. Wrap the tarp around person “like a burrito”.

6. Give warm liquids and simple foods to people suffering mild-moderate hypothermia.

Center, University of Maryland Medical. Medical Reference – Complementary Medicine. 16 11 2011 .

Tilton, Buck. Wilderness First Responder: Second Edition. Connecticut: FalconGuide, 2004.