Hypothermia/Fostbite

Hypothermia

Hypothermia is the lowering of body's core temperature such that brain and muscle function is impaired. Although this can be seen with any outdoor winter activity, cycling is not immune to this. The emphasis should be on prevention.1

Symptoms2:

• • Mild: Shivering, confusion, apathy, sometimes slurred speech.

  • Moderate: Uncontrolled shivering (clattering of ones teeth) and worsening slurred speech.

  • Severe: Shivering stops, individual displays muscle rigidity, patient may become unconscious (coma) with a decrease in pulse and blood pressure.

Management:

• • Get out of the cold and wind: On the open road, cyclist have little tools to combat hypothermia. Caught in a sudden snow storm while cycling, my buddy and I retreated to the porch of a nearby antique dealer to keep out of the wind. The dealer, seeing us shivering on the porch, invited us in for a hot cup of tea. When warmed up, we took a short cut home when the flurries stopped. Don't be afraid to knock on the door and ask for help.

  • Bundle the individual: Remove any wet clothing. Check with cyclist partners for extra clothing they may be carrying or layers they can do without.

  • Food and drink: Simple carbohydrates help warm the body. Fluids are more important then drink.

  • Call 911 for severe signs of hypothermia. Handle the individually gently so as not to overload the heart. Rescue breathing for 5 to 15 minutes may be necessary until help arrives. Additional measures for backcountry hikers are given in the references3,4.

Prevention:

• • Wear clothing that retains body heat. Carry a water proof jacket if there's a chance of rain.

  • Layer clothing, taking off layers before/if sweating occurs, and adding them back on as one gets chilly. This is especially true for long climb that we may do on trips to the French or Italian alps where on may be climbing for an hour or more. Three important layers are recommended. The first layer (undergarment) removes perspiration from the skin, the middle layers insulate, and the outer layer protects against the wind. Physically active individuals may sweat even in the cold. Therefore, the best choice of material is an outer layer that is waterproof, wind resistant, and "breathable".5

• Drink lots of water.

• Eat lots, especially carbs.

• Maintain a pace that prevents overexertion.

  • In a group, watch others for signs of hypothermia and treat early.

Fostnip and Frostbite

Frostnip: Usually affects the face, ears, or fingertips. While the skin may feel numb, pale as shown below or sometimes reddish in color, and sometimes itch. Usually there is no blistering or darkening of the extremity. Frostnip does not usually lead to permanent tissue damage but can be very uncomfortalbe.

Frostbite: Deep frostbite, in which the skin and underlying tissue freezes. Permanent damage is possible, depending on how long and how deeply the tissue is frozen. Skin may look white, at first but with progression turns grayish-yellow, or even black with severe frostbite. The skin may feel hard, waxy, and numb. Blistering is also common.

Treatment of Frostnip: If water is not available, warm the tissue with body heat. For example, warm your hands by tucking them into your armpits and warm your nose, ears, or face by covering them with dry hands

Treatment of Frostbite6:

• • Get out of the cold and get out of wet clothing as soon as possible and remove all constrictive jewelry and clothing.

• • Then immerse the affected area in warm, but not hot, water.   May take up to 20-30 minutes and you may have to keep adding hot water. The area will become very painful (to be expected). Handle delicately as the skin is very brittle.

• Do not thaw the frostbitten tissue if there is a chance that it will refreeze.

• Wrap individual around individual fingers or toes if affected and then wrap extremity,7  keep extremity warm and seek medical attention.

Do not:

• • Do not thaw the frostbitten tissue if there is a chance that it will refreeze before you get medical attention, as this increases the likelihood of permanent damage.

  • Do not rub or massage frostbitten skin or disturb blisters. The tissue is extremely delicate and rubbing or messaging can lead to further damage.

  • Do not use direct dry heat, like heating pads or a campfire to thaw frostbitten tissue. One can't feel frozen area and one is likely to get to close and burn the area.

References:

• 1. What is Hypothermia   from WebMD

1. Hypothermia   from the Mayo Clinic

   1. First Aid and Wilderness Medicine, Duff J. and Gormly P., 10th ed., Cicerone Press, 2007. ISBN: 13: 978-1-85284-500-1

   2. Backcountry First Aid, Tilton B., Falcon Press, 5th ed., 2007.  ISBN: 978-0-7627-4357-5

   3. First Aid, CPR, and AED, American College of Emergency Physicians, Jones & Barnet, 2012. ISBN: 978-1-4496-3505-3

   4. HypothermiaFrost Bite Update   An in depth look at frost bite from Nabil Ebraheim, M.D., Professor and Chairman, Department of Orthopedic Surgery, University of Toledo Medical Center.

   5. Frostbie (frostnip) from MedicineNet

   6. Frostbite Treatment and Prevention   From WebMD

   7. How to Treat Frostbite   From Wikihow