is followed by a feeling of listlessness, indifference, and drowsiness. Unconsciousness can follow quickly. Shock becomes evident as the casualty's eyes assume a glassy stare, respiration becomes slow and shallow, and the pulse is weak or absent. As body temperature drops even lower, peripheral circulation decreases, and the extremities become susceptible to freezing. Finally, death results as the core temperature of the body approaches 80°F.
To treat hypothermia, take the following steps:
1. Carefully observe respiratory effort and heartbeat; you may have to give CPR during the warming process.
2. Rewarm the casualty as soon as possible. Severe bleeding must be controlled and fractures splinted over clothing before the casualty is moved.
3. Replace wet or frozen clothing and remove anything that constricts the casualty's arms, legs, or fingers, interfering with blood circulation.
4. If the casualty is inside a warm place and is conscious, the most effective method of warming is immersion in a tub of warm water (100°F to 105°F or 38°C to 41°C). The water should be warm to the elbow and never hot. Observe closely for signs of respiratory failure and cardiac arrest (rewarming shock).
5. If a tub is not available, apply external heat to both sides of the casualty. Natural body heat (skin to skin) from two rescuers is the best method. This is called "buddy warming."If this is not practical, use hot water bottles or an electric rewarming blanket, but do not place them next to bare skin. Be careful to monitor the temperature of the artificial heat source; the casualty is very susceptible to burn injury. Because casualties are unable to generate adequate body heat, placing them under a blanket or in a sleeping bag is not sufficient treatment.
6. If the casualty is conscious, give warm liquids to drink. Never give alcoholic beverages, or allow the casualty to smoke.
7. Dry the casualty thoroughly if water is used for rewarming.
8. As soon as possible, transfer the casualty to a definitive care facility. Be alert for the signs of respiratory and cardiac arrest during transfer, and keep the casualty warm.
CHILBLAINS. - Chilblains are a mild cold injury caused by prolonged and repeated exposure to air temperatures from just above freezing (32°F or 0°C) to as high as 60°F or 16°C. Chilblains are characterized by redness, swelling, tingling, and pain of the skin area. Injuries of this nature require no specific treatment except warming of the affected part, keeping it dry, and preventing further exposure.
IMMERSION FOOT.- Immersion foot, which also may occur in the hands, results from prolonged exposure to wet cold at temperatures ranging from just above freezing to 50°F or 10°C. It is usually in connection with limited motion of the extremities and water-soaked protective clothing.
Signs and symptoms of immersion foot are tingling and numbness of the affected areas; swelling of the legs, feet, or hands; bluish discoloration of the skin; and painful blisters. Gangrene may occur.
To treat immersion foot, follow these steps:
1. Get the casualty off his/her feet as soon as possible.
2. Remove wet shoes, socks, and gloves to improve circulation.
3. Expose the affected area to warm dry air.
4. Keep the casualty warm.
5. Do not rupture blisters or apply salves and ointments.
6. If the skin is not broken or loose, the injured part may be left exposed; however, if you must transport the casualty, cover the injured area with loosely wrapped fluff bandages of sterile gauze.
7. If the skin is broken, place a sterile sheet under the extremity and gently wrap it to protect the sensitive tissue from pressure and additional injury.
8. Transport the casualty as soon as possible to a medical facility as a litter patient.
FROSTBITE. - Frostbite occurs when ice crystals form in the skin or deeper tissues after exposure to a cold temperature, high altitude, and high-wind speed. The exposure time necessary to produce frostbite varies from a few minutes to several hours. The areas commonly affected are the face and extremities.
The symptoms of frostbite are progressive. Casualties generally incur this injury without being acutely aware of it.Initially, the affected skin reddens and there is an uncomfortable coldness. With continued heat loss, there is a numbness of the affected 13-22