Cold-Related Injuries

Introduction

Cold injuries are the result of exposure to cold during physical activity. Many athletes put themselves at risk related to cold by participating in fitness pursuits and physical activity year-round in cold, wet or windy conditions, or a combination of these conditions. Injuried. Exposure to cold can be uncomfortable, it can affect performance and can be life-threatening. [1] Cold injuries and illnesses commonly affect military members traditional winter sports athletes and outdoor sports athletes such as those involved in running, cycling, mountain climbing, and swimming Etc. [2][3] The seasons of traditional team sports such as football, baseball, softball, soccer, lacrosse, and track extend into late fall or early winter, or begin in early spring, when weather conditions may increase vulnerability to cold injury sex. [4]

The NATA position statement states that the occurrence of these injuries is dependent on low air or water temperatures (or both) and the effect or surface on the body’s ability to process normothermic core temperatures due to localized exposure of the extremities to cold air or wind. [5]

Alpine Environments

Cold conditions are common in alpine environments. Additionally, open areas like mountain peaks mean that windy conditions are also common in these environments and can significantly contribute to low temperatures (also known as the “wind chill factor”). [6] this The combined effect of these conditions is heat loss, which places additional demands on the body. For example, a drop of as little as 1°C in core body temperature can cause muscle tremors, which in turn lead to low blood sugar levels (hypoglycemia), reducing exercise performance. [4]

Types

Cold injuries fall into three categories:

1. Decreased core temperature (Hypothermia)
2. Freezing tissue injury of extremities
3. Limbs without frostbite[4]

Hypothermia

Human Body Temperature Scale

Hypothermia is a significant drop in body temperature [below 95°F (35°C)] because the body loses more heat than it produces. As a result, the body cannot maintain normal core body temperature. This can happen quickly, over a few hours, or gradually over days or weeks. Conditions that can cause hypothermia are low temperatures, insufficient humidity in clothing and equipment, poor nutrition, duration of the event, and exposed/exposed skin.

The Wind Chill Temperature Index (WCT) indicates how cold a person feels when exposed to a combination of cold air and wind. The index is a very useful and necessary tool for monitoring the conditions individuals will be exposed to at events held in cooler weather through a formula, but Several diagrams and applications are available for quick reference. Significantly increased body cooling due to the Wind Chill Equivalent Index (WCEI), which indicates how wind speed interacts with ambient temperature. The cooling effect is better if the body and clothes are wet from sweat, rain, snow or soaking Noticeable due to evaporation of moisture from wet clothing close to the skin. [4] [6]

The signs and symptoms of hypothermia vary from person to person, depending on previous cold weather injury (CWI), ethnicity, geological origin, ambient temperature, medications, clothing, fatigue, hydration, age, activity level, and other factors. Hypothermia is usually classified as mild, moderate, or severe Depends on the measured core temperature. Initially, the athlete may feel cold, begin to shiver, and be unable to perform motor functions, resulting in impaired motor and mental performance. Recognizing these symptoms early is key to preventing more severe hypothermia. if early symptoms Hypothermia is not recognized or treated Core body temperature will continue to drop. [4] [7]

Freezing Injuries of the Extremities

During prolonged exposure to cold conditions, the body signals blood vessels in the hands and feet to constrict to keep blood flowing to vital organs. This helps the body prevent further drops in internal temperature by reducing the blood’s exposure to outside cold. this happens The toes and fingers become increasingly cold, eventually causing injury to the associated tissues. Damage to frostbitten tissue occurs due to changes in intracellular electrolyte concentrations that cause water crystallization within the tissue. Freeze tissue temperature for cells Must be below 28°F (−2°C). The severity of frostbite is directly related to the duration of exposure and is divided into three grades based on the depth of injured tissue. [4]

Frostnip

The frost phase is the period before frostbite and occurs when the surface skin temperature falls below 50°F (10°C). The skin becomes cold and red, and the individual feels stinging. It usually occurs on the nose, ears, cheeks, fingers, and toes and causes no long-term damage. [1]

Mild/superficial frostbite

frostbite

This occurs when the temperature of the skin drops below 28°F (-2°C) and the superficial tissue freezes. Initially the skin appears reddened, then turns white or pale. Individuals may experience tingling and swelling at the injured site. Fluid-filled blisters can be seen after 12 to 36 hours Rewarming[8][9]

Deep/severe frostbite

This occurs when the deeper layers of the skin are affected. The skin may appear white or blue-gray, and the individual may experience numbness. Large blisters develop after 24-48 hours of rewarming. The injured area turns black and hardens as the tissue dies. Seek medical attention when frostbite occurs Signs and symptoms of superficial or deep frostbite. [1]

Hypothermia and frostbite occur at rates of 3% to 5% of all injuries, respectively, in mountaineers and 20% of all injuries in Nordic skiers. The reported frequency of cold injuries in military personnel ranges from 0.2 to 366 per 1000 exposures. [8][10]

Non-freezing Injuries of the Extremities

Chilblain

Chilblain

Chilblain is a type of non-freezing cold injury, also known as frostbite, an injury associated with prolonged exposure (1-5 hours) to a cold, humid environment. The severity of frostbite is related to time and temperature. The warmer the water (usually between 32°F [0°C] and 60°F [16°C]) the longer the exposure time required to develop frostbite. [11] Exposure time is often measured in hours or even days rather than the minutes or hours associated with frostbite. This is an exaggerated or abnormal inflammatory response to cold exposure. extend Skin vasoconstriction leads to hypoxemia and inflammation of vessel walls; dermal edema may also occur. It may occur with or without tissue freezing. The hands and feet are the most commonly affected areas, but chilblains have also been reported on the thighs. Condition This can happen during times including alpine sports, mountaineering, hiking, endurance sports and team sports in which footwear and clothing remain wet for extended periods of time due to contact with water or perspiration. [12][13][14]

Immersion (Trench) Foot

Immersion Foot

Foot soaking usually occurs with prolonged (12 hours to 4 days) exposure to cold, humid conditions, usually in temperatures ranging from 32°F to 65°F (0°C–18°C). It usually primarily affects soft tissues, including nerves and blood vessels, because The inflammatory response results in high levels of extracellular fluid. The most common mechanism for developing trench foot is continued wearing of wet socks or shoes (or both). [13][15]

Signs and Symptoms

Conditions Signs and Symptoms Hyperthermia Mild core temperature 98.6°F to 95°F (37°C -35°C) Amnesia Drowsiness Severe tremors Fine motor control Impaired cold extremities Cold polyuria Usually conscious Blood temperature within normal range Moderate core temperature 94°F to 90°F (34°C -32°C) respiratory and pulse suppression arrhythmias cyanosis cessation of tremors 90°F (32°C) stiff bradycardia severe depression hypotension pulmonary edema spontaneous ventricular fibrillation or cardiac arrest usually coma frostbite mild/superficial dry waxy skin erythema edema transient stinging or burning skin white or blue Gray patches Affected skin cold and hard to the touch Limited movement in affected area Deeper skin is hard and cold Skin may be waxy and immobile poor blood circulation Regional progressive tissue necrosis Nerve apraxia within 36 to 72 hours Hemorrhagic blisters Peripheral muscles Nerves and joints May be damaged Chilblains/Chilblains Red or cyanotic lesions Swollen lesions Increased temperature Tenderness Itching Numbness Burning or stinging Skin necrosis Skin peeling soak (trenches) burning tingling or itching in feet loss of sensation cyanosis or blotchy skin swelling painful/sensitive blisters skin fissures or maceration

[16][17]

Risk Factors

When there is insufficient food intake or insufficient oxygen (such as at high altitudes), blood flow is impeded and the risk of frostbite increases. It falls into two categories:

• Non-environmental factors: Athletes are often vulnerable to cold weather before heading outside. Risk factors that increase susceptibility to cold weather injury include nutrition and hydration age medicines body size and composition fitness level and clothing. certain medical conditions can Leaves athletes vulnerable to cold injuries, including exercise-induced bronchospasm (EIB), Raynaud’s syndrome, and cardiovascular disease. [4][16]
• Environment: Environmental conditions such as low temperatures and weather conditions can place additional stress on the body. Before training or competing outdoors, check various environmental conditions such as air temperature, humidity, rain, snow and wind to determine if it is safe for the athlete. [16]

Management

Hypothermia (Mild)

Hypothermia wrap

• Identify signs and symptoms of hypothermia, including severe shaking, increased blood pressure, rectal temperature < 98.6°F (37°C) but > 95°F (35°C), impaired fine motor skills, lethargy, apathy, and apathy degree of amnesia.
• A rectal temperature obtained with a thermometer (digital or mercury) that reads below 94°F (34°C) is the preferred method of assessing core temperature in individuals suspected of hypothermia.
• Remove wet clothing first; isolate athlete with warm, dry clothing or blankets (including head covering); move athlete to a warm, wind-protected, rain-sheltered environment.
• When rewarming, warm only the trunk and other heat transfer areas, including the axillary chest wall and groin. Rewarming extremities produces after-descent, which is caused by dilation of the peripheral blood vessels in the arms and legs when warm, which normally deliver high levels of cold blood Acidity and metabolic by-products from the periphery to the core. This blood cools the core, causing the core temperature to drop and potentially causing cardiac arrhythmia and even death.
• Offer warm non-alcoholic fluids and a meal containing 6% to 8% carbohydrates to help maintain shivering and maintain metabolic heat production. [18][19]

Hypothermia (Moderate/Severe)

• Identify signs and symptoms of moderate and severe hypothermia, including cessation of shivering Cold skin on palpation Vital signs Lower rectal temperature between 90°F (32°C) and 95°F (35°C) (moderate Hypothermia or below 90 °F (32°C) severe Hypothermia can impair mental function, slurred speech, loss of consciousness, and impairment of gross motor skills.
• If a hypothermic athlete is suspected to have signs of arrhythmia, they should be moved very gently to prevent paroxysmal ventricular fibrillation.
• Begin with an initial assessment to determine the need for cardiopulmonary resuscitation (CPR) and activation of EMS. Remove wet or damp clothing; isolate by covering head with warm dry clothing or a blanket, and remove to a warm environment with shelter from wind and rain.
• Initiate a rewarming strategy immediately and continue rewarming during transport and in the hospital. During treatment and/or transfer, continuously check vital signs and prepare for airway management. When rewarming, provide heat only to the trunk and other heat transfer areas, including Axillary chest wall and groin and more aggressive rewarming programs including inhalational rewarming heated IV fluids peritoneal lavage blood rewarming and administration of antiarrhythmic drugs.
• Immediately after treatment is complete, check for post-rewarming complications, including infection and renal failure. [1][20]

Frostbite (Superficial)

Heated water bath

• Recognize the signs and symptoms of superficial frostbite, including edema, redness, mottled gray skin appearance, stiffness and transient tingling or burning.
• Rule out hypothermia by evaluating observable signs and symptoms and measuring core body temperature.
• The choice of rewarming an athlete depends on available resources and therefore on the possibility of refreezing. Rewarming can be done at room temperature or by placing the affected tissue on another person’s warm skin. Rewarming should be done slowly, with water temperatures > Avoid temperatures between 98°F and 104°F (37°C–40°C). If rewarming is not performed, protect the affected area from additional injury and further tissue hypothermia and consult a medical professional or transport to a medical facility.
• Avoid applying lateral friction to the tissue and leave any vesicles (fluid-filled blisters) intact.
• Once rewarming has begun, the affected tissue should not be refrozen as it would cause tissue necrosis. [18][21][22]

Frostbite (Deep)

• Recognize the signs and symptoms of deep frostbite, including edematous mottled or gray skin, tissue that feels firm and does not rebound, blisters, and numbness.
• Hypothermia is ruled out by evaluating observable signs and symptoms and measuring core temperature.
• To rewarm the affected area, immerse it in a warm (98°F–104°F [37°C–40°C]) water bath. Water temperature should be monitored and maintained. Remove any tight clothing and flood the entire affected area. The water needs to be gently circulated, Therefore, the area should be soaked for 15 to 30 minutes. Thawing is complete when the tissue is soft and the color and feel return to normal. Rewarming can cause severe pain, so a medical professional may prescribe appropriate pain medication.
• Do not use dry heat or steam to reheat the affected tissue, also avoid rubbing massage or vigorous rubbing of the affected tissue, and keep any blisters or fluid-filled blisters intact. If the vesicles rupture, they must be treated to stop the infection.
• Tissue plasminogen activator (tPA) can be administered to enhance tissue perfusion. These drugs have been shown to limit the need for subsequent amputations due to tissue death.
• Once rewarming has begun, the affected tissue should not be refrozen as this would result in tissue necrosis. Weight bearings should also be avoided when the feet are involved. If there is a possibility of refreezing, rewarming should be delayed until often advanced medical attention get.
• If tissue necrosis and tissue loss occur, debridement and infection control measures are required. [19][21][22]

Chilblain

• Identify signs and symptoms, including small erythematous papules with edema, tenderness, itching, and pain following exposure to cold and humidity for >60 minutes at temperatures below 50°F (16°C). Inflammation, redness and swelling of the skin after rewarming Itching or burning and increased temperature. [twenty three]
• Remove wet or tight clothing, wash and dry the area, gently lift the affected area, and cover with warm loose dry clothing or a blanket.
• Do not disturb the blisters Apply rubbing massage Apply creams or lotions Use high levels of heat or place weight on the affected area.
• During treatment, keep checking the affected area to see if circulation and feeling are restored. [11][12]

Immersion Foot

• Early detection of signs and symptoms, including exposure to cold, wet conditions for 12 hours to 3 or 4 days, burning, stinging or itching, loss of sensation, cyanosis or blotching, skin swelling, pain or sensitivity, blisters and cracks in the skin or Dipping. [twenty four]
• For treatment by thoroughly cleaning and drying the feet, then treat the affected area by applying a warm pack or soaking in warm water (102°F–110°F [39°C–43°C]) for about 5 minutes . Replace wet socks with a clean, dry pair and rotate or allow shoes to dry before wearing them reuse.
• Use a risk management process that includes strategies to prevent, identify and treat cold injuries during the event. These strategies can then be used to prepare and develop risk management protocols and plans when frostbite may also occur. [1] [25]

Prevention Strategies

Many cold-related injuries can often be prevented by planning adequate preparation and using the proper equipment. These strategies are discussed below.

• Education: Preventative education for athletes is key to reducing the likelihood of cold injury or illness. Individuals should be educated about the preventive risks associated with activities in cold environments and the early recognition and treatment of cold injuries prior to the sports season. this Sports medical personnel and coaches should be aware of individuals with conditions that may put team members at greater risk (eg, predisposing medical conditions, physiological factors, mechanical factors, environmental conditions, etc.) [1]
• Hydration: Athletes are more likely to become dehydrated during cold-weather exercise because the thirst reflex and urge to drink are also reduced, even though hydration needs remain the same as when training at optimal temperatures. Hydration before or after practice is essential and should Focus more on carbohydrate-based snacks. Depending on outdoor winter activity, providing warm fluids during short breaks may help re-warm the body from the inside out. [26]
• Nutrition: Proper nutrition is equally important during cold-weather activities, as training in a cold-weather environment puts additional stress on the body. Encouraging proper nutrition is critical to maintaining peak performance during cold weather sports. Exposure to cold and shivering during activity is Fueled primarily by glycogen. This results in athletes requiring additional carbohydrates and calories. [27]
• Clothing: Wearing adequate clothing around the core of the body is one of the most important considerations for preventing cold-related injuries and should not be overlooked. Individuals should be advised to wear layers of clothing and to keep as dry as possible. Whether it’s sweat or moisture Precipitation significantly increases body heat loss. Layers can be added or removed based on temperature activity level and wind chill.
• Energy: Maintain energy levels by using meal energy snacks and carbohydrate/electrolyte sports drinks. Because negative energy balance increases susceptibility to hypothermia.
• Warm up: Warm up thoroughly and keep warm throughout practice or competition to minimize loss of muscle or body temperature. Schedule warm-ups and jump into competition almost immediately. Add clothes after the race to avoid a quick cool down. [3][5][18]