As high school students, many are engaged in sport-related physical activity in cold, wet, or windy conditions, but little do we know we are at risk for environmental cold injuries. An understanding of the physiology and pathophysiology, risk management, recognition, and immediate care of environmental cold injuries is an essential piece of information for us to know. Certified athletic trainers are skilled with working with these individuals at risk.
By reading this article you will learn about the most common environmental cold injuries that athletic trainers come in contact with through athletes. Cold injuries are classified into 3 categories: decreased core temperature (hypothermia), freezing injuries of the extremities, and nonfreezing injuries of the extremities. The most common injuries are hypothermia, frostbite and frostnip, chilblain and immersion (trench) foot.
Hypothermia is the decrease in core body temperature below 95°F. Hypothermia is classified as mild, moderate, or severe, depending upon measured core temperature. Mild hypothermia is a core temperature of 95°F to 98.6°F. Moderate hypothermia is a core temperature of 90°F to 94°F. Severe hypothermia is a core temperature below 90°F. Hypothermia is most likely to occur with prolonged exposure to cold, wet or windy conditions experienced during endurance events and outdoor team sports. In children and adults, symptoms include: Confusion, memory loss, or slurred speech, drop in body temperature below 95º, exhaustion or drowsiness, loss of consciousness, numb hands or feet, shallow breathing and shivering. The most basic treatment for hypothermia is to call 911. Also, you should slowly warm the person (without using friction.) You can also give CPR (only if necessary) while warming the person. Other options include giving the victim warm fluids as well as keeping their body temperature up in anyway possible, for example blankets or any other type of insulator.
Frostbite is the actual freezing of body tissues. It is a localized response to a cold, dry environment. For cells to freeze, the tissue temperature must be below 28°F. Frostnip, the mildest form of cold injury to the skin, is a precursor to frostbite. It can occur with exposure of the skin to very cold temperatures, along with windy conditions. It can also occur from skin contact with cold surfaces (e.g., metal, equipment, liquid). Mild frostbite involves freezing of the skin and lower tissues; the ligament can fortunately be saved if caught soon enough before it turns severe. Severe frostbite is freezing of the tissues below the skin and the adjacent tissues, which can include muscle, tendon, and bone. Unfortunately the ligament will be removed due to dead cells and cut off circulation. Once you have frost bite, there isn’t much to do to treat the area. You should always call 911, and you should slowly warm the affected area (without friction.) The last thing you could do is bandage the area and wait for further attention by an authorized physician.
Chilblain is an injury associated with extended exposure (1–5 hours) to cold, wet conditions. The hands and feet are the most commonly affected areas. Prolonged constriction of the skin blood vessels results in hypoxemia and vessel wall inflammation. Situations in which this can happen include alpine sports, endurance sports, and team sports in which footwear and clothing remain wet for prolonged periods due to water exposure or sweating. Chilblain severity is time and temperature related. The higher the temperature the longer the duration of exposure required to develop chilblain. To treat this you should first remove wet or constrictive clothing, wash and dry the area gently, elevate the area, and cover with warm, loose, dry clothing or blankets. Do not disturb blisters! Apply friction massages, apply creams or lotions or use high levels of heat.
Lastly, immersion foot typically occurs with prolonged exposure (12 hours +) to cold, wet conditions, usually in temperatures ranging from 32°F to 65°F.This condition affects primarily the soft tissues, including nerves and blood vessels. The most common mechanism for developing immersion foot is the continued wearing of wet socks or footwear (or both). For treatment, thoroughly clean and dry the feet, and then treat the affected area by applying warm packs or soaking in warm water (102°F–110°F) for approximately 5 minutes. To prevent immersion foot, athletes should maintain a dry environment within the footwear, which means frequent changes of socks or footwear.
Preventing these awful injuries from happening, athletes should be aware of signs and symptoms. Also, athletes should dress appropriately, stay hydrated, be aware of any past cold injuries that have occurred due to the fact you are more susceptible if you have a history of this. Be aware of the wind, rain and immersion. Your knowledge of this will help you dress accordingly. Athletes, due a favor to your team and your body and health and be aware of these common injuries, immediately contact a doctor, but most importantly, prevent them by using the previous helpful tips.