Medical Monday Nov 11 2019

Another week, another medical monday post. This week we are going to cover cold weather injuries. Identification, treatment, and even prevention will all be covered. Once again, if you want an input into what will be discussed on medical monday, you must go join Unchained Preppers. I have topics for a few more weeks, but once I start getting very low I’ll start asking for ideas over there. So head over and make an account. I promise medical is not the only subject you’ll learn over there.

Cold weather injuries are some of the easiest to prevent and the hardest to come back from long term. Frostbite can lead to gangrene in the extremities if not dealt with quickly enough and hypothermia can cause death. But they are relatively easy to prevent.

Frost bite is generally defined as freezing of the skin and underlying tissues. Just like burns in comes in levels of severity. The first is Frost nip. Frost nip is generally mild, does not cause permanent damage and is easily treatable. You can identify by mild redness and a numb/tingling sensation in the affected area. Anything that is exposed to outside air can become affected but generally your appendages (hands, fingers, toes, and feet) and ears and nose are some of the first to be affected by frost bite at all. This is mostly due to the fact that the blood vessels in these are some of the first to shunt, or close off, during times of extreme cold. Simply rewarm the affected areas and be sure to keep them covered to prevent it from advancing any further.

Superficial frostbite is the next severity and is when the reddened skin starts to turn white or pale. After rewarming the skin may appear mottled (spotted or blotchy) and after 12-36 hours a fluid filled blister may appear. This type is frost bite reaches deeper into the skin and affects may be permanent. Prevention is the best medicine you can get for this.

Deep frostbite reaches all the way down to the underlying tissues beneath the skin and is the most serious. Skin will turn white or bluish gray and you will experience numbness. Loosing all sensation of heat, cold, touch, and even pain. Joints or muscles may no longer work. Large blisters will form 24-48 hours after rewarming. The skin will turn black and hard later, as the tissue dies. There is little to no treatment for this. You are treating the related issues, like gangrene.

With all kinds of frostbite, prevention going to be key. Keep exposed skin to a minimum in extreme cold. Wear clothing in layers that you can adjust to the temperature and your activity. You want to be able to remove layers to prevent from sweating if you are being extremely active, like chopping wood, or walking a perimeter patrol. Sweating can lead to hypothermia. Wear an outer layer that blocks the wind. Goretex is great for an outer layer. I won’t go into specifics because it really depends on your location, the specific climate, and what you are going to be doing. If it does occur gradually rewarm the affected areas. Do not stick them in hot water or extremely close to a fire. The loss of sensation will prevent them from noticing the tissue burning until you smell it, and at that point the damage is already done. Also do not rub or massage the affected areas because that can cause damage to the surrounding tissues.

Along the same vein as Frostbite is Chilblains. Chilblains is caused when it is cold but not freezing, and wet. The affected area will be red, inflamed, itchy, and blistered. Treatment is the same as frostbite. Remove the person from the weather, warm gradually, and keep dry. Prevent is pretty much the same. Keep warm and dry. Liner gloves play a big role here. Just like liner socks for hiking the idea is to wick away moisture and prevent skin to fabric friction.

Hypothermia is lowering of the core body temperature. It isn’t just relegated to cold climates either. Spending all day in the lake on a summer day can cause it. Normal body temperature is roughly 98.6 degrees F. Hypothermia is defined as anything less than 95 degrees F.

Shivering is the first symptom you will notice. Shivering is a natural response to lowering core temperature. This does not mean that they are into hypothermia so far that you need to worry about them, just that you should keep an eye on this person to make sure it doesn’t progress any further. Like how you sweat when it’s hot out. It is just your body trying to maintain normal the medical term for this is homeostasis.

You need to be concerned once the patient progresses further down the rabbit hole. Slurred speech or mumbling, slow and shallow breathing, weak pulse, clumsiness or lack of coordination, drowsiness or very low energy, confusion or memory loss, loss of consciousness, and in infants bright red, cold skin.

Most people with true hypothermia don’t know that they are experiencing it. The gradual onset is a big part. Another is the confusion and memory loss prevent self awareness. This is why it is important to stay in groups. Everyone can watch each other for these signs and symptoms.

Treatment is fairly simple. Remove the patient from the environment and slowly warm them. Remove all wet clothing and either leave them naked, or replace with dry clothing if you have it. This is why during cold weather field exercises people are told to keep at least one pair of dry clean socks in their bag, to wear at night. You do not want to dump them into a steaming hot bath or shower because it can cause the body to go into shock. If they are conscious have them ingest lukewarm fluids. Get them close to a heat source, but closely monitor them to make sure they don’t burn themselves. give them blankets or a sleeping bag to cover up with. Something we were taught when I was in scouting was “skin to skin wins”. Simply put, get down to your skivvies and get under a blanket with them. Let your body heat gradually warm them.

As with anything else in life, prevention is the best course of action. Layering is your friend. Stay away from cotton in the colder months. Especially if you leave near water (including the frozen kinds). Utilize natural and synthetic fibers to wick away moisture from your skin. I am a huge advocate of wool. Specifically Merino wool, but about any kind would do the job. Wool has amazing heat retention properties and when wet still maintains around 80% of it warming properties. Military surplus (especially foreign) is a great place to get ahold of wool clothing. I used to use a German military wool sweater, Czech military wool pants, a wool ski cap, poly-pro long john top and bottoms, and lined waterproof boots in Eastern Washington during the winter when my Scout Troop would go camping and it more than did the job even down to negative temperatures. Military Goretex jackets are great outer layers because they are waterproof and block the wind, but still allow moisture to exit. I am even more so a fan of wool now that I live in Eastern NC. If it came down to having to do patrols during the winter, that ability to stay warm while wet is invaluable. And remember, it’s not about being toasty and cozy, it’s about staying warm enough to not die. “Pack light, freeze at night” has been a part of the military vernacular far longer than goretex has been around. Find equipment that works for you in your environment. But part of that requires training. Get training.

Don’t be left out in the cold, bleeding like a stuck pig.

Published by MechMedic

MechMedic is the owner of Stuck Pig Medical and medical instructor for Brushbeater Training and Consulting. After 5 years in the beloved Corps, Mech joined the National Guard where he became a medic. Lifelong survivalist, and overall outdoorsman. When not being a family man, he enjoys good bourbon and good cigars.

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