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effects of extreme cold temperatures
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Effects of Cold
Characteristics of cold region Low humidity in Ladakh region High Humidity in Sikkim, Kashmir &
Arunanchal Pradesh Temp may go below -20 degree C to -40
degree C Less vegetation Wind Chill factor (at -1 degree C with
wind velocity at 50 Kmph effective temp becomes minus 10 degree C
Summer – Avalanches (Glaciers) Sun (UV Radiation) - Snow blindness
WIND-CHILL FACTOR
The felt air temperature on exposed skin due to wind
The combination of ambient low temperature and wind movement is termed the 'wind-chill' factor
The power of the climate to cause cold injuries is directly proportionate to the 'wind-chill' factor rather than its temperature alone
WIND-CHILL FACTOR
At altitude of < 2000 mtrs
Summer Slush Cold Winds But less severe because of
Protection by coniferous forests Temp low up to -10 degree C Rivers take shape here/originate Chillblains
BODY CORE - Heart- Heart - Brain- Brain - Lungs - Lungs - Liver- Liver - Kidneys- KidneysEXTREMITIES - Legs & feet- Legs & feet - Arms & hands- Arms & hands
Normal Normal core core body body
temperatemperature:ture:
98.6°F98.6°F
Adverse effects of Cold
Generalized – Hypothermia Localized
NON-FREEZING - Chillblain - Trench foot
FREEZING - Frostnip - Frostbite Others
Solar Keratitis (Snow blindness) Sunburns Rhinitis
HYPOTHERMIA
Elderly & ill Accidental In patrols/ treks, night duty Drug Addicts & Alcoholic (loss of heat & poor
decision making) Acute illness (disruption of thermoregulation) Premature neonate Diseases Hypothyroidism, Pitutary insuff,
addisons disease, Hypoglycemia, MI, Cirrhosis, Pancreatitis etc.
Outcome Acuteness and duration of exposure
HYPOTHERMIA
CORE BODY TEMP 35oC OR 95oF
MILD : 32 - 35 0C MODERATE : 32 - 28 0C SEVERE : 280C
CLINICAL FEATURES
Effects32 to 350C – Mental processes are slowed, Shivering
becomes violent, Paradoxical undressingless than320C – Ability to shiver lost, Deep tendon reflexes lost 280C – Coma supervenes, severe bradycardia 180C – EEG flat
CVS Effect Initially CO, HR & BP Then HR (Sinus bradycardia) (2-3 beats per min) ECG – Osborne wave (J wave) 280C - 300C – Susceptibility to refractory VF & Asystole
MILD HYPOTHERMIA
Shivering is intense & uncontrolled (sympathetic stimulation)
Rise in BP (peripheral V/C & increased CO)
Still alert & able to help himself Feels pain & discomfort Movements less coordinated Lethargy & later mild confusion Reversible
MODERATE HYPOTHERMIA
Shivering slows or stops Shivering is replaced by marked muscular
rigidity, and stiff distal movements Mental confusion & apathy Glassy stare slurred speech Blood pressure not detectable with arm
sphygmomanometer Breathing shallow and irregular Cardiac rhythm irregularities appear with
tachycardia, supra-ventricular arrhythmias, ventricular extra-systoles and T wave inversion in ECG
SEVERE HYPOTHERMIA
Deep coma and rigidity develop ECG may show classic J wave or Osborne
wave notching at end of QRS complex Pulmonary edema can occur Ventricular fibrillation resistant to cardio-
version May appear dead (in metabolic icebox) Lethal temperature can be highly
variable, and survival has been recorded at deep body temperature as low as 20`C
TREATMENT
PASSIVE EXTERNAL REWARMING Prevent heat loss (check rectal temp) Remove wet clothing Dry blankets Protection from wind Mattress – Ground sheet, blankets, poly sheets
Maint of airway, Oxygenation
Principle:Quick warming of the core without causing Simultaneous V/D of the periphery
TREATMENT
ACTIVE EXTERNAL REWARMING Apply warm packs at axillae, groin and
neck ‘Insulatory wrap’ (4 inches) Give warm sweetened tea, coffee or milk DON’T WARM EXTREMITIES (Arms by the
side) ‘AFTER DROP’ DON’T massage the limbs No physical activity No alcohol & tobacco
INTERNAL/CORE REWARMING 5 % IV Dextrose warmed upto 37- 41 degree
C 500ml to 1 ltr in half to one hr Oxygen inhalation by face mask Catheterise, monitor urine output Monitoring rectal temp (thermometer
inserted at least 15 cm into rectum) CPR if no carotid pulse Peritoneal / hemo-dialysis fluid at 37 – 41
degree C
Declare DEAD only after re-warming to 36 degree C of core temp
DICTUM : “A patient of hypothermia, in finality, is
never “Cold and Dead” but is “WARM AND DEAD”
Local Cold Injuries
COMMONLY AFFECTED AREAS
FingersFingers ToesToes Ear lobesEar lobes NoseNose CheeksCheeks Chin Chin Soles, heelSoles, heel Dorsal surface of Dorsal surface of
foot foot Male genitaliaMale genitalia ButtocksButtocks
CHILLBLAINS
- Nonfreezing cold injury - Cold, wet conditions (high humidity) - Repeated, prolonged exposure of bare skin - Can develop in only a few hours - Ears, nose, cheeks, fingers, and toes
CHILLBLAINS
SYMPTOMS: Initially pale and colorless worsens to achy, prickly sensation
then numbness red, swollen, hot, itchy, tender skin
upon rewarming Blistering in severe cases
TRENCH FOOT
Potentially crippling, nonfreezing injury
Prolonged exposure of skin to moisture (12 or more hours, days)
High risk during wet weather, in wet areas, or sweat accumulated in boots or gloves
TRENCH FOOT
TRENCH FOOT
SYMPTOMS: Initially appears wet, soggy, white,
shriveled Sensations of pins and needles, tingling,
numbness and then pain Skin discoloration - red, bluish, or black Becomes cold, swollen and waxy
appearance May develop blisters, open weeping or
bleeding
FROSTNIP
Mildest form of a freezing cold injury Generally reversible, no tissue injury or
permanent damage
Skin turns white, top layer of skin feels hard but deeper tissue still feels normal (soft)
May feel tingling or numbness
FROSTBITE Exposure to below
freezing temperatures
Can occur in above freezing temperatures due to wind chill factors and wetness
Contact with extremely cold objects (especially metal)
Contact with cooled or compressed gases, at normal temperatures (e.g., liquid nitrogen)
CLINICAL CLASSIFICATIONFIRST DEGREE - Erythema - Edema - Itching - No blisters/necrosis - Recovers
completely
CLINICAL CLASSIFICATION
SECOND DEGREE - Vesicles with clear
or milky fluid - Edema
CLINICAL CLASSIFICATION
THIRD DEGREE - Skin Necrosis - Blue grey
discolouration - Presence of blood
filled blisters
CLINICAL CLASSIFICATION
FOURTH DEGREE - Minimal oedema - Initially mottled, deep
red/cyanotic - Full thickness damage
affecting muscles, tendons & bones
- Later stages mummified
- Auto amputation
Frostbite Face
TREATMENT & PREVENTION
TREATMENT
PRE-HOSPITAL - Prevent further cold injury - Prevent mechanical trauma - Avoid rubbing - Restore general body warmth - Analgesics - Tetanus toxoid
TREATMENT
• Re-warming- 37 – 410 c for about 30 mins/ till flushed- Danger of burn injury- Avoid freeze-thaw-freeze cycle- Analgesics/sedatives
• Sterile loose dressings• Prophylactic antibiotics
TREATMENT
SURGERY- Excision- Escharotomy, - Skin graft- Amputation- Reconstruction procedures
TREATMENT
DRUG THERAPY - Vasodilators (ketanserin, buflomedil) - Pentoxifylline - Platelet aggregation inhibitiors (Aspirin) - Heparin - Hyperbaric oxygen
PRIMARY PREVENTION
Health promotion - Hygiene - Nutrition - Exercise - Avoid Smoking
Specific protection - Shelter - Clothing, boots & socks - Foot hygiene - Avoid Venous congestion - Aloe Vera
SECONDARY PREVENTION Early Diagnosis First Aid Prompt treatment
PREVENTION …contd Buddy system Cold adaptation Rapid evacuation Limit tissue injury Avoid re-exposure
DO’S & DON’T’S
DO’S - Remove tight shoes, socks etc. - Warm the injured parts (Not by direct heat) - Cover the body with blankets - Provide hot drinks and rest - Cover blisters with dry dressing - Treat as a stretcher patients
DON’T’S - Don’t massage or rub the parts - Don’t smoke or drink
DISCUSSION
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