Illness caused by extreme cold environment or by winter affects human body drastically. We need to take seriously the extreme cold warnings or alerts issued by the authorities because if we are not dressed properly or have no shelter, extreme cold can kill. In those areas which face winter storms very frequently, good number of people dies from cold.
Now-a-days, Western Canada is thoroughly in the deep freeze, as Arctic air floods the region. Heavy snow blanketed a wide swath of the Prairies this week, with wind chills making it feel colder than -30 in some places. Meanwhile B.C., Arctic outflow in B.C. is set to bring uncommonly cold wind chills of -20 to many communities.
The human body is NOT designed to handle conditions like that, and when we talk about dangerous cold, we mean it.
Our human body is generally geared to keep a core temperature of 37degree C exactly. Any deviation from that causes serious problems, and when the body temperature begins to drop, hypothermia starts to set in. Even a drop to just the 32-35 degree C range triggers the process, marked by constant shivering, tiredness, fast breathing and other symptoms.
Below the 32 degree C, a point of moderate hypothermia, sufferers might actually begin to act like they are intoxicated, with poor coordination, slurred speech, visible confusion and declining judgment. The breathing starts to slow also, a process called hypoventilation. We may also stop shivering. That is a bad sign, and in the mental state, we may not even realize that our body temperature is at life-threatening level.
When the body temperature falls below the severe level 28 degree C, at least nine degrees below optimal, we may face the greatest risk of death. At that time, onlookers may think us as dead already. At about that point, we may lose consciousness, our breathing may become too shallow to detect, if it doesn’t stop altogether, our pulse can be weak, irregular or absent, and the pupils may also be dilated.
Generally, people in hypothermic state can be resuscitated if rushed to medical care in time, but severe hypothermia is often fatal. The longer we are exposed, the more likely it is that the damage becomes widespread, to the point of possibly requiring amputation, even if we do manage to find medical attention. When the extreme cold reaches our core, that’s when the risk of death starts setting in.
Sometime winter cold can cause confusion and loss of reason as symptoms of moderate hypothermia. That can take some bizarre (and sinister) forms. People who have been found after dying of hypothermia seem to have doffed their clothes in their final throes. We have some stories where whole groups have been found dead on the mountainside naked, with the clothes folded neatly nearby. We can call it ‘Paradoxical undressing.’ German scientists at Freie Universitat Berlin looked at 69 hypothermia deaths from 1978 to 1994. They found about 25 per cent of the victims had taken their clothes off before death.
Sometime, Hypothermia impairs judgment. At that time, the blood-rate slows and blood vessels are dilated, making the victims, in their addled state, feel like they were burning up, when in fact they were losing heat faster than ever. So off came the clothes, and their fate was sealed. This phenomenon has often led to police mistaking hypothermia victims as having suffered some kind of assault before death. But it is not so. The scientists from that study noted most victims who’d done this also displayed what they called “terminal burrowing behaviour.” Basically, with the last of their strength, they’d try their hardest to protect their bodies as much as possible burrowing into the snow, hiding under beds or cramming themselves into closets.
“This is obviously an autonomous process of the brain stem, which is triggered in the final state of hypothermia and produces a primitive and burrowing-like behaviour of protection, as seen in (hibernating) animals,” the scientists wrote in 1995. Cooling of body parts may result in various cold injuries – nonfreezing injuries, freezing injuries – and hypothermia which is the most serious.
Nonfreezing cold injuries include chilblain and trenchfoot. Frostnip and frostbite are freezing injuries. Toes, fingers, ears and nose are at greatest risk because these areas do not have major muscles to produce heat. In addition, the body will preserve heat by favouring the internal organs and thus reducing the flow of blood to the extremities under cold conditions.
Some other Illness caused by extreme cold, namely, Frostbite, Snow Blindness, Trenchfoot, freezing of corneas, Chilblains can come up during extreme cold conditions.
Illness caused by extreme cold
Frostbite is the actual freezing of the tissue or a body part. It often affects the ears, nose, fingers and toes. Warning signs of frostbite include pale or waxy white or grey skin, Numbness, Tingling or stinging sensation in the affected body part, Aching in the affected body part or Reduced blood flow. Our skin (and muscles, and tissue) freezes solid. Our feet, fingers, toes – absolutely can freeze that thoroughly, to the point of actually falling off our body, or else needing to be amputated.
Unlike its cousin, frostnip, which only freezes the skin and feels like its burning or tingling, frostbite can freeze not just the skin, but muscles, tissues and fat beneath it. We remain especially at risk of this if we do not wear proper gear, and the wind chill is particularly stiff. When wind chill values reach lower than -40, as they have done several times on the Prairies and northern Ontario this season, our skin can freeze within minutes.
Frostnip is the mildest form of a freezing cold injury. It occurs when ear lobes, noses, cheeks, fingers, or toes are exposed to the cold and the top layers of a skin freeze. The skin of the affected area turns white and it may feel numb. The top layer of skin feels hard but the deeper tissue still feels normal (soft). It can be prevented by wearing warm clothing and foot wear. It is treated by gentle rewarming (e.g., holding the affected tissue next to unaffected skin of the victim or of another person).
As for all cold-induced injuries, never rub the affected parts – ice crystals in the tissue could cause damage if the skin is rubbed. Do not use very hot objects such as hot water bottles to rewarm the area or person.
Frostbite is a common injury caused by exposure to extreme cold or by contact with extremely cold objects (especially those made of metal). It may also occur in normal temperatures from contact with cooled or compressed gases. Frostbite occurs when tissue temperature falls below the freezing point (0°C/32°F), or when blood flow is obstructed.
lood vessels may be severely and permanently damaged, and blood circulation may stop in the affected tissue. In mild cases, the symptoms include inflammation of the skin in patches accompanied by slight pain. In severe cases, there could be tissue damage without pain, or there could be burning or prickling sensations resulting in blisters. Frostbitten skin is highly susceptible to infection, and gangrene (local death of soft tissues due to loss of blood supply) may develop.
How can we prevent Frostbite Illness caused by extreme cold
- We must seek medical care if frostbite is detected. We must be aware of the warning signs of cold-related illness, such as uncontrollable shivering, sleepiness, confusion, changes in skin color, slurred speech and loss of consciousness.
- If there is frostbite without sufficient signs of hypothermia and immediate medical care is not available, we should move to a warm dry area, remove wet or tight fitting clothes and avoid walking on frostbitten toes or feet. If heat is not available, consider a visit to a shopping mall, public library, movie theatre, church, community building or shelter.
- We may gently place affected area in warm water, not hotter than 105°F. After warming, the injured area should be wrapped in sterile gauze, keeping the affected fingers and toes separated. But alternatively, we may not use a heating pad, heat lamp or stove, fireplace or radiator for warming or rub affected area. This can cause more damage.
- We may increase our fluid intake – regardless of our activity level. We must not until we feel thirsty to drink fluids. We should ensure infants and children drink adequate amounts of liquids. But we must avoid drinks containing caffeine and alcohol because they affect how our body reacts to the cold. Warm fluids such as broth or juice are good, as well as sports drinks.
- We should immediately put on something on our head. Fifty percent of all body heat is lost through the head, so wearing a hat keeps our whole body warmer.
- We must protect the ears and face. We can wear a scarf to protect our lungs from cold air – it will also protect our ears and face.
- We must ensure that our boots are waterproof.
- We may have several layers of clothing as they are better than a single heavy layer. The space between the layers works as insulation to help keep us warmer.
- We should minimize sitting or squatting in the cold for prolonged periods of time. These positions can hinder circulation. And while outdoors, we may take frequent breaks in a warm place. If we have to be outdoors, we must schedule outdoor activities during the warmest part of the day, usually 10 a.m. to 3 p.m. and adjust to outdoor activity.
- We should avoid muscle strain by stretching and doing a few exercises before going outside to work. Extreme cold puts extra strain on the heart – no matter what is our age or physical condition.
- We may use the buddy system and monitor the condition of our co-workers and have someone do the same for you. The buddy system can be used to inspect for signs of frostbite. Just before freezing, the skin, especially the face, becomes bright red. Then small patches of white appear, as freezing actually occurs.
- We must prevent chapped skin by frequent application of protective lotions.
- We should have extra clothes with us such as socks, gloves, hats and jackets so that we can change them if we get wet.
- We may check with our doctor or pharmacist if we are taking any prescription drugs. Some drugs affect the way our body reacts to the cold.
If normal sensations do not return in 30 minutes, we must seek medical attention.
Snow blindness is a sun burn of the eyes caused by the reflection of sunlight off snow or water. It can be prevented by wearing good sunglasses with side shields or goggles. Eye protection from the sun is just as necessary on cloudy or overcast days as it is in full sunlight.
Snow blindness can occur during a snow storm, if the cloud cover is thin. Symptoms occur within 8-12 hours of exposure. They include eyes feeling dry and irritated then as if they are full of sand. Moving or blinking the eyes becomes painful. Exposure to light hurts, the eyelids may swell, excessive tearing occurs and eyes appear very red. Mild cases will heal in a few days. Relief can be obtained by using cold compresses and light proof bandaging. Ophthalmic ointment can be used to relieve the pain and reduce swelling. But, we must not rub the eyes to get relief.
Trench Foot, known as Immersion Foot also, can occur at temps as high as 60°F. It occurs in individuals whose feet have been wet, but not freezing cold, for days or weeks. It can occur at temperatures up to 10°C (50°F). The primary injury is to nerve and muscle tissue.
Symptoms include tingling and numbness; itching, pain, swelling of the legs, feet, or hands; or blisters may develop. The skin may be red initially and turn to blue or purple as the injury progresses. In severe cases, gangrene may develop.
We can say it is “wet cold disease” resulting from prolonged exposure in a damp or wet environment from above the freezing point to about 10°C (50°F). Depending on the temperature, an onset of symptoms may range from several hours to many days but the average is three days.
Trenchfoot is more likely to occur at lower temperatures whereas an immersion foot is more likely to occur at higher temperatures and longer exposure times. A similar condition of the hands can occur if a person wears wet gloves for a prolonged period under cold conditions described above. Symptoms are similar to an immersion foot.
Wet feet lose heat 25 times faster than dry feet. It is characterized by vascular damage. Symptoms include reddening of the skin, numbness, leg cramps, swelling, tingling pain, blisters or ulcers, bleeding under the skin and gangrene. To prevent heat loss, the body constricts blood vessels to shut down circulation in the feet. The skin dies due to a lack of oxygen and nutrients. It can cause permanent damage to the circulatory system. Treatment is similar to frostbite – move the victim to a warm, dry area; remove wet shoes and socks; use warm (105°F) water and seek medical assistance as soon as possible.
Freezing Of Corneas
When we spend a lot of time outside in cold environment combined with warmth-sapping winds, we can feel our eyeballs actually freeze. In short exposures, on outdoor running in cold weather notes our eyes tear up.
When we keep forcing our eyes open in strong winds and extreme cold with no protection from extreme cold as a skier or snowmobiler, or anyone who has to spend a lot of time outdoors with the wind blowing in the face without goggles, it can, in fact, cause our cornea to freeze. This actually causes us to drop out of grueling cross-country Arctic races like Alaska’s Iditarod, and even when re-warming the area, we still have to deal with momentary blurred vision.
It’s even possible for contact lenses to freeze to the eyeballs. The eyes are usually thawed by the time the victim gets to a physician, and any damage can usually heal in days or weeks, but severe cases could result in tissue loss requiring restorative surgery. We must remember our goggles, whenever we go outdoor during extreme winters.
Chilblains are a mild cold injury caused by prolonged and repeated exposure for several hours to air temperatures from above freezing (0°C or 32°F) to as high as 16°C (or about 60°F). In the affected skin area there will be redness, swelling, tingling, and pain.
What is hypothermia?
In moderately cold environments, the body’s core temperature does not usually fall more than 1°C to 2°C below the normal 37°C because of the body’s ability to adapt. However, in intense cold without adequate clothing, the body is unable to compensate for the heat loss and the body’s core temperature starts to fall. The sensation of cold followed by pain in exposed parts of the body is one the first signs of mild hypothermia.
As the temperature continues to drop or as the exposure time increases, the feeling of cold and pain starts to diminish because of increasing numbness (loss of sensation). If no pain can be felt, serious injury can occur without the victim’s noticing it.
Next, muscular weakness and drowsiness are experienced. This condition is called hypothermia and usually occurs when body temperature falls below 33°C.
Additional symptoms of hypothermia include interruption of shivering, diminished consciousness and dilated pupils. When body temperature reaches 27°C, coma (profound unconsciousness) sets in. Heart activity stops around 20°C and the brain stops functioning around 17°C.
What are the signs of hypothermia?
Stage: Mild Hypothermia
- Core Temperature: 37.2-36.1ºC (99 – 97ºF)
- Signs and Symptoms: Normal, shivering may begin.
- Core Temperature: 36.1-35ºC (97 – 95ºF)
- Signs and Symptoms: Cold sensation, goose bumps, unable to perform complex tasks with hands, shivering can be mild to severe, hands numb.
Stage: Moderate Hypothermia
- Core Temperature: 35-33.9ºC (95 – 93ºF)
- Signs and Symptoms: Shivering, intense, muscles incoordination becomes apparent, movements slow and laboured, stumbling pace, mild confusion, may appear alert. Use sobriety test, if unable to walk a 9 meter (30 foot) straight line, the person is hypothermic.
- Core Temperature: 33.9-32.2ºC (93 – 90ºF)
- Signs and Symptoms: Violent shivering persists, difficulty speaking, sluggish thinking, amnesia starts to appear, gross muscle movements sluggish, unable to use hands, stumbles frequently, difficulty speaking, signs of depression, withdrawn.
Stage: Severe Hypothermia
- Core Temperature: 32.2-30ºC (90 – 86ºF)
- Signs and Symptoms: Shivering stops, exposed skin blue of puffy, muscle coordination very poor, inability to walk, confusion, incoherent/irrational behaviour, but may be able to maintain posture and appearance of awareness
- Core Temperature: 30-27.8ºC (86 – 82ºF)
- Signs and Symptoms: Muscle rigidity, semiconscious, stupor, loss of awareness of others, pulse and respiration rate decrease, possible heart fibrillation.
- Core Temperature: 27.8-25.6ºC (82 – 78ºF)
- Signs and Symptoms: Unconscious, a heart beat and respiration erratic, a pulse may not be obvious.
- Core Temperature: 25.6-23.9ºC (78 – 75ºF)
- Signs and Symptoms: Pulmonary edema, cardiac and respiratory failure, death. Death may occur before this temperature is reached.
What first aid can I do for hypothermia?
Hypothermia is a medical emergency. At the first sign, we must find medical help immediately. The survival of the victim depends on their co-workers ability to recognize the symptoms of hypothermia. The victim is generally not able to notice his or her own condition. First aid for hypothermia includes the following steps:
- We must seek medical help immediately. Hypothermia is a medical emergency. Quickly transport the victim to an emergency medical facility.
- We must ensure that wet clothing is removed.
- We should place the victim between blankets (or towels, newspaper, etc.) so the body temperature can rise gradually. Body-to-body contact can help warm the victim’s temperature slowly. Be sure to cover the person’s head.
- Hot water bottles, chemical hot packs, or electric blankets may be used with caution. We may wrap in a towel before applying and warm the centre of the body slowly (We should NOT warm the arms or legs directly).
- We should NOT rewarm the person too quickly (e.g., do not use a heating lamp or soak in a hot bath).
- We may give warm, sweet (caffeine-free, nonalcoholic) drinks unless the victim is rapidly losing consciousness, unconscious, or convulsing.
- We may perform CPR (cardiopulmonary resuscitation) if the victim stops breathing. Continue to provide CPR until medical aid is available. The body slows when it is very cold and in some cases, hypothermia victims that have appeared “dead” have been successfully resuscitated.
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