A Cautionary Tale

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We’ve got the science on page 1. And then we have the Aussie on page 2.

Winter is coming! And we’ll still be outside, right? This post is to let you know why it’s so darned important to stay warm – but not too warm – and dry. Prepare for those winter hikes. Carry dry gloves and socks. Maybe an extra undershirt. And if you experience cold and numbness, stop and take care of the problem before you go on.

The girl shown on page 2 ( ack! language and social inappropriateness ) is a cautionary tale. You don’t want to end up like her waiting to see how many, if any, digits she would lose. And, hey, you can get frostbite from an ice bag. So take care when you are hiking in the winter.

See you on the trails!

 

foot

Frostbite is localized freezing of tissue that results in a range of signs, symptoms, and outcomes for alpinists. The areas farthest from the body core are most commonly affected. Early recognition and subsequent rewarming are essential to minimizing the extent of tissue damage. The following recommendations are based on the Wilderness Medical Society’s “Practice Guidelines for the Prevention and Treatment of Frostbite.”

PREVENTION

Clothing must protect from wind and cold. Clothing layers that get wet, either from overexertion or precipitation, should be changed out for dry layers as soon as practical. When tissue initially becomes cold and numb actively rewarm those areas before continuing.

ASSESSMENT

Frostbite is commonly classified into two categories: superficial or deep. Superficial injuries tend to heal within the first month if not allowed to refreeze, while deep injury can result in ongoing pain and potentially permanent tissue loss. Each instance of frostbite will predispose a climber to increased risk for future frostbite injury.

Superficial Frostbite (Damage limited to the outermost layers of skin)

Numbness
Blanching of skin (pale)
Skin remains pliable
Mild pain and swelling upon rewarming
No immediate blister formation, but clear-fluid blistering is possible
Deep Frostbite (Inner and outer skin layers affected, with potential underlying muscle, tendon, and bone damage)

Significant diminishment of circulation, sensation, and motion
Skin discoloration (red, purple, and/or black)
Skin is frozen and non-pliable
Intense pain and significant swelling upon rewarming is likely
No immediate blister formation, but blood-filled blisters are likely
Eschar (black, dead tissue) can develop over days/weeks following rewarming
FIELD TREATMENT

Patient should be removed from the cold environment and wet layers exchanged for dry. Hypothermia should be treated before any frostbite injury. Once hypothermia is managed, as long as there is no chance of the tissue refreezing, it should be thawed immediately, either by skin-to-skin rewarming or warm-water bath (99°–102°F, 37°– 39°C), if available.  Loose-fitting gauze, aloe vera, and ibuprofen should be used if available. Pain control may be required, especially with deep frostbite.

HOSPITAL TREATMENT
Advanced treatments now available at specialized centers offer improved chances of preserving tissue damaged by deep frostbite. Note that thrombolytic therapies (clot busting) require immediate patient evacuation—the elapsed time from thawing of frozen tissue to arrival at a burn/frostbite center must be no greater than 24 hours.

Click on page 2. You’ll see a frostbitten girl who passed out in the snow while drunk.

Caution: graphic images and some f-bombs.

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