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Cold Injuries - Donald Pelto, DPM


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

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Cold Injuries - Donald Pelto, DPM

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