2. Characteristics of cold region
Low humidity in Ladakh region
High Humidity in Sikkim, Kashmir & Arunanchal
Pradesh
Temp may go below -20 degree C to -40 degree
C
Less vegetation
Wind Chill factor (at -1 degree C with wind
velocity at 50 Kmph effective temp becomes
minus 10 degree C
Summer – Avalanches (Glaciers)
Sun (UV Radiation) - Snow blindness
3. WIND-CHILL FACTOR
The felt air temperature on exposed skin due
to wind
The combination of ambient low temperature
and wind movement is termed the 'wind-chill'
factor
The power of the climate to cause cold injuries
is directly proportionate to the 'wind-chill' factor
rather than its temperature alone
5. At altitude of < 2000 mtrs
Summer Slush
Cold Winds But less severe because of
Protection by coniferous forests
Temp low up to -10 degree C
Rivers take shape here/originate
Chillblains
6. BODY CORE
- Heart
- Brain
- Lungs
- Liver
- Kidneys
EXTREMITIES
- Legs & feet
- Arms & hands
Normal
core
body
temperat
ure:
98.6°F
8. HYPOTHERMIA
Elderly & ill
Accidental
In patrols/ treks, night duty
Drug Addicts & Alcoholic (loss of heat & poor
decision making)
Acute illness (disruption of thermoregulation)
Premature neonate
Diseases Hypothyroidism, Pitutary insuff, addisons
disease, Hypoglycemia, MI, Cirrhosis, Pancreatitis etc.
Outcome
Acuteness and duration of exposure
9. HYPOTHERMIA
CORE BODY TEMP 35oC OR 95oF
MILD : 32 - 35 0C
MODERATE : 32 - 28 0C
SEVERE : 280C
10. CLINICAL FEATURES
Effects
32 to 350C – Mental processes are slowed, Shivering
becomes violent, Paradoxical
undressing
less than320C – Ability to shiver lost, Deep tendon
reflexes lost
280C – Coma supervenes, severe bradycardia
180C – EEG flat
CVS Effect
Initially CO, HR & BP
Then HR (Sinus bradycardia) (2-3 beats per min)
ECG – Osborne wave (J wave)
00
11. MILD HYPOTHERMIA
Shivering is intense & uncontrolled
(sympathetic stimulation)
Rise in BP (peripheral V/C & increased CO)
Still alert & able to help himself
Feels pain & discomfort
Movements less coordinated
Lethargy & later mild confusion
Reversible
12. MODERATE HYPOTHERMIA
Shivering slows or stops
Shivering is replaced by marked muscular rigidity,
and stiff distal movements
Mental confusion & apathy
Glassy stare slurred speech
Blood pressure not detectable with arm
sphygmomanometer
Breathing shallow and irregular
Cardiac rhythm irregularities appear with
tachycardia, supra-ventricular arrhythmias,
ventricular extra-systoles and T wave inversion in
ECG
13. SEVERE HYPOTHERMIA
Deep coma and rigidity develop
ECG may show classic J wave or Osborne
wave notching at end of QRS complex
Pulmonary edema can occur
Ventricular fibrillation resistant to cardio-version
May appear dead (in metabolic icebox)
Lethal temperature can be highly variable, and
survival has been recorded at deep body
temperature as low as 20`C
14. TREATMENT
Principle:
Quick warming of the core without causing Simultaneous
V/D of the periphery
PASSIVE EXTERNAL REWARMING
Prevent heat loss (check rectal temp)
Remove wet clothing
Dry blankets
Protection from wind
Mattress – Ground sheet, blankets, poly
sheets
Maint of airway, Oxygenation
15. TREATMENT
ACTIVE EXTERNAL REWARMING
Apply warm packs at axillae, groin and neck
‘Insulatory wrap’ (4 inches)
Give warm sweetened tea, coffee or milk
DON’T WARM EXTREMITIES (Arms by the
side) ‘AFTER DROP’
DON’T massage the limbs
No physical activity
No alcohol & tobacco
16. INTERNAL/CORE REWARMING
5 % IV Dextrose warmed upto 37- 41 degree C
500ml to 1 ltr in half to one hr
Oxygen inhalation by face mask
Catheterise, monitor urine output
Monitoring rectal temp (thermometer inserted at
least 15 cm into rectum)
CPR if no carotid pulse
Peritoneal / hemo-dialysis fluid at 37 – 41 degree
C
17. Declare DEAD only after re-warming
to 36 degree C of core
temp
DICTUM : “A patient of hypothermia, in
finality, is
never “Cold and Dead” but is
“WARM AND DEAD”
19. COMMONLY AFFECTED AREAS
Fingers
Toes
Ear lobes
Nose
Cheeks
Chin
Soles, heel
Dorsal surface of
foot
Male genitalia
Buttocks
20. CHILLBLAINS
- Nonfreezing cold injury
- Cold, wet conditions (high humidity)
- Repeated, prolonged exposure of bare skin
- Can develop in only a few hours
- Ears, nose, cheeks, fingers, and toes
21. CHILLBLAINS
SYMPTOMS:
Initially pale and colorless
worsens to achy, prickly sensation then
numbness
red, swollen, hot, itchy, tender skin upon
rewarming
Blistering in severe cases
22. TRENCH FOOT
Potentially crippling,
nonfreezing injury
Prolonged exposure of
skin to moisture (12 or
more hours, days)
High risk during wet
weather, in wet areas,
or sweat accumulated
in boots or gloves
24. TRENCH FOOT
SYMPTOMS:
Initially appears wet, soggy, white, shriveled
Sensations of pins and needles, tingling,
numbness and then pain
Skin discoloration - red, bluish, or black
Becomes cold, swollen and waxy appearance
May develop blisters, open weeping or bleeding
25. FROSTNIP
Mildest form of a freezing cold injury
Generally reversible, no tissue injury or
permanent damage
Skin turns white, top layer of skin feels hard but
deeper tissue still feels normal (soft)
May feel tingling or numbness
26. FROSTBITE
Exposure to below freezing
temperatures
Can occur in above freezing
temperatures due to wind
chill factors and wetness
Contact with extremely cold
objects (especially metal)
Contact with cooled or
compressed gases, at normal
temperatures (e.g., liquid
nitrogen)
40. DO’S & DON’T’S
DO’S
- Remove tight shoes, socks etc.
- Warm the injured parts (Not by direct heat)
- Cover the body with blankets
- Provide hot drinks and rest
- Cover blisters with dry dressing
- Treat as a stretcher patients
DON’T’S
- Don’t massage or rub the parts
- Don’t smoke or drink
