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How to Treat and Care for Hypothermia and Frostbite

Much of the United States has felt the cold snap that stretches from Texas to Massachusetts. With the official start of winter still a few days away, forecasters warned that the entire eastern two-thirds of the United States would feel the bite of the invading Arctic cold that triggered the storm. Dr. Emily Senay has important information on how to avoid over-exposure to the cold and how to treat frostbite and hypothermia.


Hypothermia and its main symptoms



Hypothermia occurs when the body temperature dips below the optimal 98.6 degrees Fahrenheit. Symptoms take effect in three stages. The first stage is mild hypothermia. It is characterized by bouts of shivering, grogginess and muddled thinking. The second stage is moderate hypothermia. Symptoms include violent shivering or shivering with sudden stops, inability to think and pay attention, slow, shallow breathing, or slow, weak pulse. The severe hypothermia has set in when shivering stops. The patient loses consciousness. There is little or no breathing.


Pulse is weak, irregular or non-existent.


Who is at risk for hypothermia?



The elderly and babies under one year old are most at risk among people with no other complaints. However, people who already have something wrong with them are also at a higher risk, as they may not be aware of how severely they are exposing themselves to the cold.


The main risk groups are:


  • People who have been involved in accidents;
  • Mentally ill patients;
  • People with heart problems;
  • Hypothyroid patients;
  • Patients on sedatives;
  • Alcoholics.


What is the treatment for hypothermia?



The first step is to contact the emergency services since extreme hypothermia requires urgent professional attention. All cold, wet clothing should be replaced with warm, dry clothing to prevent further heat loss immediately.


If breathing has stopped or there is no pulse, cardiopulmonary resuscitation (CPR) should be attempted until the emergency services arrive.


Rapid rewarming with hot water or massaging cold extremities should be avoided as, if done improperly, it could lead to serious tissue damage.


Do not give alcohol or nicotine products to someone suffering from hypothermia.


How can hypothermia be prevented?



The key rules are to wear many layers of clothing, drink plenty of fluids and hot drinks (but not alcohol) and keep well nourished. Maintaining movement to keep circulation up is also advised.


Frostbite and its symptoms



Frostbite is an injury caused by freezing of the skin or other body tissues. Although most frostbite occurs in cold weather, it can have other causes as well, including mishandling of refrigerants (dry ice, Freon), improper use of ice packs and inhalant abuse. Mechanical injury and dehydration of cells occur as ice crystals form in the tissue, and further damage to the area results from insufficient blood flow, also known a ischemia.


Frostbite requires treatment in a specialized center, frequently in a burn unit because of the similarity of some of the treatments.


Areas that have become numb should be covered in loosely fitting, warm and dry clothing and removed from the cold environment. Frostbitten limbs should be elevated, padded and splinted, and the victim should be transported to a hospital.


Care for frostbite



Rapid rewarming with water at a measured 104-108 degrees should only be done if (1) the affected part will not be subjected to cold again and (2) there is no close medical facility available. Avoid rubbing the area, as that may increase skin injury. Refrain from using heat from a campfire or tailpipe. Leave blisters intact. Avoid alcohol consumption or smoking.


Illness, alcohol or drug misuse and motor vehicle breakdowns frequently lead to civilian frostbite injury. The risk for frostbite is increased by a previous cold injury, diabetes (which may impair both ciculation and sensation), use of beta-blocker drugs, hardening of the arteries, or smoking.


When frostbite is suspected, medical care should be sought immediately. Frozen tissues are susceptible to physical injury and should not be rubbed or massaged. In addition, restrictive clothing or jewelry should be removed, and if the feet are involved, the patient should be carried and not allowed to walk


Frostbitten skin is hard, pale, cold, and has no feeling. When skin has thawed out, it becomes red and painful (early frostbite). With more severe frostbite, the skin may appear white and numb (tissue has started to freeze). Very severe frostbite may cause blister; gangrene (blackened tissue that died after blood vessels froze); or hard, frozen skin (frostbite can penetrate all the way down to blood vessels and bone).


Factors that contribute to frostbite



Extreme cold; wet clothes; high winds; and poor circulation, which can be caused by tight clothing or boots, cramped positions, fatigue, certain medication, smoking, alcohol use, or diseases that affect the blood vessels, such as diabetes.


What to do if frostbitten



Wear suitable clothing in cold temperatures and protect susceptible areas. In cold weather, wear mittens (not gloves); wind-proof, water-resistant, many-layered clothing; two pairs of socks (cotton next to skin, then wool); and a scarf and a hat that cover the ears (to avoid substantial heat loss through the scalp).


Before anticipated prolonged exposure to cold, don't drink alcohol or smoke, and get adequate food and rest. If caught in a severe snowstorm, find shelter early or increase physical activity to maintain body warmth.

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