What is a cold injury?

Any injury that occurs due to cold weather is known as a cold injury. With extreme & adventure sports becoming more and more popular, it is becoming important that one should be knowledgeable about such conditions.

A professional mountaineer must always be aware about cold injuries because he or she lives and works in such conditions many times during the course of their career.                                      

A cold injury is often described as either localised, generalised, or miscellaneous in nature. You are more likely to contract a cold injury if you have any exposed extremities. Often, the most affected parts are those which are constantly exposed such as fingers, toes, nose, ear lobes, etc. 

If we keep these areas properly wrapped with woollen clothes, we may be able to reduce the degree of the injury to a certain extent. Severe cases may lead to necessary amputation, or even death. 

They should be diagnosed as soon as possible to decrease the effect of cold injury. 

The degree of the cold injury depends upon the temperature of the atmosphere, and how much time the body parts may have been exposed to the cold atmosphere. 

 

Localised cold injuries

Photo by Yoss Cinematic

 

A localised cold injury is when one’s skin and body tissues freeze in a very cold environment. A localised injury often means that one particular area of the body has been affected as compared to the entire body as a whole. 

With localised injuries, it is much easier to pinpoint where the affliction is, hence making it easier to deal with immediately. 

Localised cold injuries may be further classified into two parts:

 

  1. Injuries that occur in areas where the temperature above 0 degrees celsius 
  2. Injuries that occur in areas where the temperature is below 0 degree celsius.

 

Injuries that occur above zero degrees celsius

Photo by Gantas Vaičiulėnas

Injuries that occur above the freezing point of zero degrees celsius, are more commonly known as non freezing cold injuries.

These injuries often occur at temperatures that lie between the range of 0 to 15 degrees Celsius. 

They occur after the body or its extremities have been exposed to both cold, and moisture for a certain period of time. 

There are three types of injuries that come under this category, namely:

 

  1. Chilblains
  2. Trench foot or Immersion foot
  3. Frostnip

Chilblains

Photo by EVG Photos

The word chilblain is a portmanteau, coming from “chill” and “blain”. The word chill means cold, and blain, or blains in plural, means an inflammation or a sore. Chilblains are also known as pernio or perniosis. 

In chilblains, the temperature of the surface of the skin goes down because of the cold atmosphere, and the small blood vessels of the skin are painfully inflamed. 

 

Symptoms:

 

  1. Pale red colour of skin
  2. Swollen hands or feet
  3. Itching
  4. Blisters

 

Chilblains are not serious, but they can be repeated seasonally because of constant exposure of body parts in cold  atmospheres.

 

Prevention:

 

  1. Keep your body warm and hydrated  
  2. In cold atmospheres, always wear warm, and woollen clothing in several layers.
  3. Avoid smoking and drinking alcohol.
  4. If sweat is found in gloves, clothes, or socks, then remove them as soon as possible.
  5. Practice good hygiene.
  6. Don’t wear any dirty clothes.
  7. Cover maximum parts of your body.
  8. Keep your body and its extremities dry, and clean.

 

Diagnosis:

 

Chilblains are not that serious, but if we leave them untreated, then they may progress to an infection which may lead to severe damage in the body’s tissues. It is best to diagnose and treat chilblains as soon as possible.

People who are already suffering from diabetes, or poor circulatory problems may take a little longer to heal. However, if any of the blisters or swellings last more than the initial stages, then it is always better to consult a physician.

 

Treatment:

 

  1. Drink plenty of water and keep your body well hydrated.
  2. Soak your feet in warm water; it works as a catalyst to heal your wounds 
  3. Apply petroleum jelly on the affected area
  4. Keep your hands and feet dry, and warm.
  5. Warm your hands without rubbing, massaging them together, or without applying any direct heat
  6. Clean the infected area with an antiseptic, and tie loose bandages on the blisters to prevent further infection
  7. Protect your skin from further exposure.
  8. Nifedipine may be helpful (Always consult a physician before taking any medicines)

              

 

Trench foot 

Photo by Pixabay

 

Trench foot is also a non freezing injury. Trench foot mostly occurs when your gloves and shoes are full of moisture, and the outer atmosphere is very cold. 

This cold temperature cools down the temperature of hand and feet rapidly, especially in the presence of moisture, or sweat. 

In trench foot the colour of feet may change to red(from being numb) or may change to blue(from lack of adequate circulation).

Again, like chilblains, trench foot isn’t a serious injury as per se, but if left untreated, it may progress into gangrene, and may require amputation of the affected area if the condition is bad enough.

 

Symptoms:

 

  1. Change of colour in feet
  2. Itching
  3. Swelling

 

If one stays in contact with cold, wet, weather for prolonged periods of time, then it may lead to hypothermia, gangrene, other localised infections like cellulitis, ulcers, etc.

 

Prevention:

 

When you go on a trek, or engage in any mountaineous activity, keep checking your shoes personally after one or two hours.

If there is any sweat, or moisture, change your socks/shoes immediately. If it is not possible to carry another pair of shoes, make sure you place your feet in the open air for some time until they are dried out. 

 

Diagnosis:

 

If someone is suffering from trench foot, then the diagnosis is not very complicated. The affected area often turns red or blue,with swelling and blisters seen at times. 

 

 Treatment:

 

  1. One of the simplest ways to prevent trench foot is to make sure that your feet are clean, dry, and warm.
  2. Change your gloves, and socks twice or thrice a day if possible.
  3. Wear hygienic socks and shoes.
  4. If moisture is seen inside socks or shoes, remove them as soon as possible.
  5. Inspect your feet after one hour intervals.
  6. Clean your feet regularly with warm water. If warm water is not available, and the temperature is too cold, then one may use antiseptic liquids like Dettol and wet tissues to keep the area clean.
  7. If there is a fungal infection, or there is any fluid oozing out, then wrap the wounds loosely with cotton bandages. 

   

 

Frostnip

Photo by Pixabay

Frostnip is a mild, preliminary form of frostbite. It is often reversible, however, if not treated on time, it progresses into its more dangerous form – frostbite.

It is known to merely cause some redness, and numbness in the skin, and does not leave lasting damage. 

It also only occurs on the surface of one’s skin, and doesn’t form any ice crystals in the deeper layers under the skin. 

 

Symptoms:

 

  1. Burning 
  2. Itching
  3. Tingling sensation
  4. Feeling of numbness

 

Treatment:

Simple re-warming of the affected area is sufficient for treating frostnip.

 

Injuries that occur below zero degree celsius

Photo by Brady Knoll

These kind of injuries are known as freezing cold injuries because the body’s tissues tend to freeze up at sub zero temperatures. These injuries are often more serious than non freezing cold injuries.                                            

Frostbite

Photo by Rodolfo Clix

Frostbite is a serious hazard faced by many hikers, and mountaineers. This is because the temperature in mountains often falls to sub zero levels, especially at night. 

However, it is not necessary that frostbite will only occur due to exposure to cold temperatures. It can just as easily occur with exposure of the skin to metals, ice, or very cold liquids when one is already at an area of high altitude.

Metalbite, a form of frostbite that occurs when one comes into contact with metal at sub zero temperatures, is very common in mountaineers due to the metal equipment they use for their expeditions.

The skin instantly sticks to the freezing metal on exposure, and will peel away with the metal if one tries to separate the metal from the skin. 

 

Symptoms:

 

First Degree:

 

  1. Numbness
  2. White/Bluish colour of the skin
  3. Swelling
  4. Blisters
  5. Fluids ooze. 

 

There is often no necrosis of the skin in the 1st degree of injury.

 

Second Degree:

 

  1. Blisters
  2. Surface of the skin hardens – may begin to dry up, change colour, and start peeling.

 

It is often at this stage, that ever present numbness may begin to develop. There may also be partial necrosis of the skin. 

 

Third Degree: 

 

  1. The layer below the skin starts to freeze.
  2. Blood blisters
  3. The skin may be discoloured – blue to grey.
  4. Persistent pain
  5. Long term ulcers
  6. Damaged growth plates??
  7. Subcutaneous tissue necrosis begins to occur. 

 

Fourth Degree:

 

  1. The injury starts to involve muscles, tendons, and bones.
  2. The skin may appear colourless.
  3. The skin may progress to a blackened state.
  4. The extent of permanent damage is greater, and may involve both gangrene, and possible amputation.

 

Prevention:

 

  1. Cover your body and head with adequate clothing and caps.
  2. Avoid constrictive footwear
  3. Remain active (but not exhausted)
  4. Repeated exposure to cold liquids makes one more likely to suffer frostbite.
  5. Always wear clothing in layers – it makes it easier to manage with changes in temperature.
  6. Do not touch any metals with your bare hands. Always wear gloves if you are handling metallic equipment.

 

Diagnosis:

 

The patient has a pale disposition and is feeling numb. Some blisters or swelling may be present. Lack of coordination is an indication that the patient needs immediate medical help. 

 

Treatment:

 

  1. If an individual is seen with the symptoms of frostbite, then he or she must move to a warmer area, so that their fingers and toes do not freeze again.  
  2. Keep taking warm fluids regularly.
  3. Rehydrate your body.
  4. Provide proper nutrition to your body, so it can heal its wounds as soon as possible.
  5. Don’t expose any naked parts to the cold environment.
  6. It is not recommended to rub, or apply snow to any of the afflicted parts.
  7. There are times when surgery may become necessary ( see 3rd degree or worse)
  8. The victim should be kept in an oxygen chamber.
  9. Amputation should be delayed for a few months, so as to determine the extent of the injury, and to see if it is necessary to amputate or not. 
  10. In case of metalbite, a tetanus injection is necessary to prevent any further infection.

 

Emergency measures:

 

  1. Remove any jewellery or metallic material that could constrict the body parts.
  2. Re-warm the affected area slowly until it turns soft.
  3. Try to prevent re-freezing of the affected area
  4. Give the patient warm fluids to rehydrate his/her body.
  5. In case of metalbite – try to warm up the metal by pouring warm water over it. Do NOT try to force the metal apart otherwise – it will peel the skin along with it. 

 

Non-localised Cold Injuries

Photo by Maël Balland

A non localised cold injury is said to have occurred when the body’s core temperature has dropped as a whole. 

 

Normally, the body temperature of humans is approximately 37 degrees Celsius. Hypothermia –  a state where one’s body tends to lose heat faster than it gains heat, occurs at 35 degrees Celsius and below. 

Hypothermia

Photo by Kristin Vogt

Hypothermia is very common at high altitudes, and cold temperatures. This often occurs due to clothes being wet, or sweat cooling down one’s body even further.

If the temperature of the body has not increased, and it continues to be exposed to the cold atmosphere, then the body may go into a comatose state.

“Windchill” is a factor that determines how cold one may feel in a cold atmosphere when there is wind blowing around. To put simply, it means that your body gets colder when there’s a windchill factor involved. 

A low windchill factor often means that one is at a greater risk of contracting hypothermia or frostbite. 

Symptoms of Hypothermia:

 

Mild Symptoms: 

 

  1. Shivering
  2. High Blood Pressure
  3. High pulse rate
  4. High rate of respiration
  5. Contraction of blood vessels

 

All of the above are generally physiological responses to preserve body heat.

 

An increased rate of urine production due to the cold, and general mental confusion may also be present. 

 

Moderate Symptoms:

 

  1. Violent shivering
  2. Slow movements
  3. Lack of coordination in muscles/limbs
  4. Confused state of mind – even if the patient seems alert and lucid.
  5. The patient’s skin becomes pale – it may even start showing signs of blue discolouration. 

 

Severe Symptoms:

 

  1. As the temperature of the body keeps decreasing, the patient’s heart rate, respiratory rate and blood pressure may start to decrease.
  2. The patient may be sluggish in nature.
  3. The patient may face difficulties in speaking properly.
  4. The patient may not be able to walk properly – stumbling is common.
  5. Amnesia may be present as well.

 

Prevention:

 

  1. Try to wear as many layers as possible when in cold weather. Layers can help one coordinate with fluctuations in temperature more efficiently as compared to wearing a single heavy jacket. 
  2. Make use of woollen clothes or down jackets.
  3. Keep your body well hydrated.
  4. Take warm fluids regularly and ensure proper nutrition.
  5. Make sure you are wearing dry clothes at all time – if your clothes get wet, try to change out of them as soon as possible. 
  6. Try to wear looser clothing instead of clothing that constricts your body’s movements. Let your skin breathe properly.

 

Diagnosis:

 

  1. Temperature of the body is below 35 degrees Celsius.
  2. Patient starts to shiver.
  3. Patient is confused and has a lack of coordination.

 

Treatment:

 

  1. Remove any wet clothes immediately.
  2. Try to dry them and warm their body.
  3. Don’t put them into hot water or try to massage their limbs – this can cause a cardiac arrest.
  4. Give them warm fluids which do not contain any alcoholic contents.
  5. Give them high energy foods such as chocolate, if the patient is able to chew and swallow foods.

 

 

Miscellaneous cold injuries

Photo by Alex Smith

Miscellaneous cold injuries are those which cannot be particularly covered under localised, or non localised cold injuries. These injuries are not concerned with one’s body temperature or moisture, but may indirectly harm them when they are in an area of high altitude.

Examples of such injuries would be snow blindness, and sunburns. 

 

Snow blindness

Photo by Tiffany Bui

It is no secret that ultraviolet rays are stronger at areas of high altitude. Snow, on the other hand, is one of the most reflective surfaces in nature. The combination of these two factors  makes it very easy to fall prey to UV rays. 

When people are at an area of high altitude, the UV rays are so harmful that they create burns in the cornea of one’s eyes. This affliction is known as photo-keratitis. It is more commonly known as snow blindness to laymen. 

 

Symptoms:

 

  1. Burning sensation in eyes
  2. Swollen eyelids
  3. Headaches
  4. Temporary loss of vision

 

Prevention: 

 

  1. Use polarised sunglasses that completely cover your eyes
  2. Remove yourself from the area, try to rest your eyes when feeling strained.

 

Diagnosis:

 

Temporary loss of vision along with a burning sensation in the eyes means that one may have snow blindness. 

 

     

Treatment:

 

  1. Stay indoors – rest your eyes.
  2. Anaesthetic eye drops may provide temporary relief, but are not for long term use. 
  3. Cool and wet compresses help in alleviating the pain while the eyes heal.

 

The cornea usually heals on its own in about 24 to 72 hours, if not aggravated further.

Please consult a physician immediately if symptoms worsen, or do not get better with some rest.

 

Sunburns

Photo by Jenna Hamra

To understand how damaging a sunburn can be, we must first differentiate it from your run of the mill suntan. A suntan is something that occurs when your skin is exposed to the sun – on a jog, or trek. Your skin starts to tan because the melanin present in your skin starts to protect your skin against potential damage caused by ultraviolet rays. 

A sunburn, on the other hand, is a more serious affliction. It occurs when your skin and its underlying layers have already been subjected to some form of damage by exposure to ultraviolet rays.

A more visual distinction would be that a suntan merely darkens your skin, whereas a sunburn would leave your skin looking an angry shade of red, swollen, and often peeling from its outermost layers.

 

Symptoms:

 

  1. Skin turns red
  2. Patient experiences both pain, and itchiness
  3. Blisters
  4. Peeling skin
  5. Rashes

 

Depending on your skin type, you may get sunburnt in as little as 15 minutes, or as long as 2 hours or more. 

 

 Prevention:

 

  1. Try to limit being exposed to the sun from the hours of 10:00 to 16:00
  2. Always wear sunglasses that cover your eyes completely
  3. Wear clothing that not only protects/covers your skin adequately, but is also breathable. 
  4. Make sure you use a good sunscreen lotion – try to use SPF 30 at the very least, if not higher.
  5. Keep yourself adequately hydrated.

 

Treatment:

 

  1. First of all, try to prevent further damage at all costs.
  2. Observe the affected area closely for any signs of blistering. Do NOT try to burst any blisters. If you find that blisters have covered a significant portion of your skin, it is best to seek medical advice as soon as possible.
  3. Non-steroidal anti-inflammatory drugs like ibuprofen or aspirin may be able to relieve the pain and swelling from sunburns. Always consult a physician before taking any sort of medicine.
  4. Apply aloe vera gels, or other topical creams to soothe the skin, and aid in its healing – do NOT try to peel the skin further.

 

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