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Cold Injuries - Donald Pelto, DPM
 

Cold Injuries - Donald Pelto, DPM

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Lecture given to EMTs on cold injures. Focus on foot problmes.

Lecture given to EMTs on cold injures. Focus on foot problmes.
www.drpelto.com

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    Cold Injuries - Donald Pelto, DPM Cold Injuries - Donald Pelto, DPM Presentation Transcript

    • Cold Injuries Donald Pelto, DPM Central Massachusetts Podiatry Worceter, MA
    • How We Lose Heat
      • Radiation – loss of heat to the environment due to temperature gradient
      • Conduction – through direct contact between objects
        • Water conducts heat away 25 times faster than air ( Stay dry = stay alive!)
        • Steel conducts heat away faster than water
    • How We Lose Heat – 2
      • Convection – contact with something that is in motion
        • Wind Chill – the air is moving around and causes greater heat loss
      • Evaporation – heat loss from converting water from a liquid to a gas
        • Perspiration can be due to sweating and breathing
    • Hypothermia – decrease in the core body temperature to a level at which normal muscular and cerebral functions are impaired.
      • Heat + Heat – Cold = Hypothermia
      • Retention Production Challenge
      Insulation Body Fat Surface to Volume Ratio Exercise Shivering Temperature Wetness Wind
    • How to regulate core temperature
      • Vasodilation / Vasoconstriction
      • Sweating / Shivering
      • Increasing / Decreasing Activity
      • Behavioral Responses – removing or applying layers of clothing
    • Core Periphery
    • Conditions leading to hypothermia
      • Cold Temperature
      • Improper clothing and equipment
      • Wetness
      • Fatigue, exhaustion
      • Dehydration
      • Poor food intake
      • Alcohol intake – causes vasodilation and heat loss
    • Signs and symptoms of hypothermia
      • Watch for “Umbles”
        • Stumbles
        • Mumbles
        • Fumbles
        • Grumbles
      • They show change in motor coordination and levels of consciousness
    • Levels of hypothermia
      • Mild – core temperature 98.6 – 96 degrees F
        • Shivering
        • Unable to perform complex motor functions
        • Vasoconstriction to periphery
      • Moderate - core temperature 95 – 93 degrees F
        • Dazed consciousness
        • Loss of fine motor coordination – zipping coat
        • Slurred speech
        • Violent shivering
        • Irrational behavior – taking off clothing
        • “ I don’t care attitude”
      • Severe - core temperature 92 – 86 degrees F
        • Shivering occurs in waves – less to conserve energy
        • Fall to ground, can’t walk, fetal position
        • Muscle rigidity – lactic acid and CO2 buildup
        • Skin is pale
        • Pupils dilate
        • Pulse decreases
    • How to assess hypothermia
      • Shivering can be stopped voluntarily = mild hypothermia
      • If can’t be stopped = moderate
      • If you can’t get a radial pulse at the wrist
      • Curled in fetal position
      • Can’t count backward from 100 by 9’s
    • Treatment
      • Reduce Heat Loss
        • More layers
        • Dry clothing
        • Increase Physical Activity
        • Shelter
      • Add Fuel and Food
        • Carbs, Proteins, Fats
        • Hot liquids, Sugars
      • Avoid
        • Alcohol – vasodilator, causes peripheral heat loss
        • Caffeine – a diuretic causes water loss and dehydration
        • Tobacco – a vasoconstrictor, increase risk of frostbite
      • Add heat
        • Fire
        • Body to body contact
    • Hypothermia Wrap
    • Cold Injuries
      • Frostnip
      • Frostbite
      • Trench Foot
      • Eye Injuries
    • Frostnip
      • Freezing of tip layers of skin tissue
      • Reversible
      • Top layer hard and rubbery but deeper tissue is still soft
      • Numbness
      • Seen on cheeks, earlobes, fingers, toes
      • Treatment – warm slowly, do not rub the area
    • Frost Bite
      • Skin is white and “wooden” feel
      • Includes all skin layers
      • Numb or no feeling
      • Can freeze muscle or bone
      • Treatment – rewarm by immersion is water bath, don’t use dry heat, avoid from refreezing
    • Frost Bite
    • Trench Foot – Immersion Foot
      • Prolonged exposure of the feet to cool, wet conditions.
      • Wet feet lose heat 25x faster than dry
      • Treatment – Gentle rewarming, do not walk on foot
    • Eye Injuries
      • Freezing of Cornea
        • Forcing eyes open during strong winds without goggles
        • Treatment – rapid warming
      • Eyelashes freezing together
      • Snowblindness
        • Sunburn of the eyes, occurs 8-12 hours after
        • Treatment – wear sunglasses or goggles
    • The End
    • Burns
    • Maggot Therapy
    • Trauma                             <>                <>
    • Ulcer
    •  
    •