Environmental
Injuries
•High Altitude Sickness
•Frostbite
High Altitude Sickness
Resulting from hypoxia
Will show up within the first few days at altitude
3 types:
• AMS: Acute Mountain Sickness
• HACE: High Altitude Cerebral Edema
• HAPE: High Altitude Pulmonary Edema
High Altitude Sickness
• AMS: Acute Mountain Sickness
– Most common
– Causes: insufficient hydration, respiration, genetics
– Minor brain swelling due to hypoxic stress
• HAPE: High Altitude Pulmonary Edema
– Increased fluid in alveoli
• HACE: High Altitude Cerebral Edema
– Advanced brain swelling
– 10% as frequent as HAPE
High Altitude Sickness
• Acclimatization
Faster respiration alone cannot compensate for lower
O2 levels at higher altitudes.
Body must reset blood chemistry, resulting in
increased respiration rate and kidney function, which
produces more EPO to increase O2 uptake rate.
Some people acclimatize quickly, and can ascend
rapidly; others acclimatize slowly
AMS: Acute Mountain Sickness
S&S – What you see
• Headache
• Dizzy or lightheaded
• Nausea
HAPE = AMS + dry cough, respiratory distress, mild
chest pain,
Severe Case = cyanosis / sputum / rapid pulse
HACE = AMS + loss of muscle coordination + altered
mental state
AMS: Acute Mountain Sickness
Assessment
• ABCs – listen to breathing sounds
• LOR
• Vital Signs
• OPQRST – When did they get to altitude?
• SAMPLE – History of altitude sickness?
AMS: Acute Mountain Sickness
Treatment
• Descend
• O2 if severe S&S, or decreased LOR
• Position of comfort
• Avoid exercise or exertion
• Nonprescription drug for headache
• Hydrate
• Do not leave alone
High Altitude Sickness: Prevention
 Gradual ascent
 Never ascend with symptoms of AMS
 Avoid overexertion
 Consider prophylactics:
 Acetazikamide (Diamox)
 Dexamethasone
 Combination of above
 Ginko biloba
Frostbite
• Frostnip
• Superficial Frostbite
• Deep Frostbite
Rate and Severity depend on ~ wind chill,
alcohol a/o drugs, altitude, getting wet or
being damp, length of exposure
Frostbite – what is happening?
• The blood vessels constrict as a natural
reaction to prevent body heat loss and
hypothermia.
• With a loss of warming blood flow the fluids
in the body tissues and cellular spaces
crystallizes
• This freezing can damage the blood vessels
causing blood clotting and lack of oxygen
to the affected area and deeper tissues.
Frostbite – Alcohol & Nicotine?
• Vasodilators (eg alcohol) causes blood
vessels to stay open taking heat away from
inner core. Your body therefore cools down
faster, promoting hypothermia, and
speeding up the onset of frostbite.
• Vasoconstrictors (eg nicotine) constrict the
extremity blood vessels even more than the
body is already doing to maintain core
temperature, thereby speeding up the
onset of frostbite.
Frostnip
(1st degree frostbite)
S&S – What you see
• Most often seen on cheeks, earlobes, fingers,
toes
• Numbed skin that has turned white in color.
• Freezing of top layers of skin tissue, usually
reversible
• As it heals, appearance is similar to that of
sunburn (a 1st degree burn).
Frostnip
(cont’d)
Treatment
• Rewarm by gently blowing warm air/placing
against warm body part.
• Don’t rub - can damage tissue.
• Watch for S&S of hypothermia
Superficial Frostbite
S&S – What you see
• The skin will be white or blue and will feel
hard and frozen ; but tissue underneath is still
soft
• Blisters usually appear within 24 hours after
rewarming.
Superficial Frostbite
(cont’d)
Treatment
• For resort environments, rewarming should be done
under medical supervision
• Rapid rewarming by immersion in warm (102° to
108°F) water. Need to monitor temp carefully
– Continue for 20-30 minutes or color goes to deep red or blue
– Give hot drinks and keep patient warm
• Rewarming hurts! Suggest ibuprofen
• Do not allow to rethaw
Deep Frostbite
S&S – What you see
• Affected parts will have no feeling and blisters may be
present.
• The skin is white, blotchy and/or blue. The tissue
underneath is hard and cold to the touch.
Think - Frozen Chicken
Deep Frostbite
(cont’d)
Treatment
Delay rewarming until it can be done once & done well.
Refreezing ALWAYS causes gangrene.
• If injury is extensive & thawing is difficult, try to
keep the area frozen.
• For resort environments, rewarming should be done
under medical supervision
• If injury is small area, field rewarming can be started
– Rapidly rewarm in warm water (102° to 108°F)
– Completely immerse the frozen tissue
– Thaw completely
Deep Frostbite
(cont’d)
Treatment: post thaw care
• Prevent refreezing
• Protect the thawed tissue from trauma
• Air dry the extremity carefully; don't rub
• Elevate to reduce swelling
• Use gauze between fingers/ toes to keep areas dry as
swelling occurs.
• Do not constrict the extremity
Frostbite Summary ….DO’s
• Have injury rewarmed under medical supervision
• Stay warm after thawing.
• Rest the injury (avoid walking on frostbitten feet, etc.).
• Leave blisters intact & use sterile covering to prevent
rupturing.
• Keep affected part clean to reduce risk of infection.
• Elevate the area above the heart
Frostbite Summary ….DON’Ts
• Don't allow thawed injury refreeze as this can cause
serious/permanent injury. Best to delay warming
• Don't use dry heat (sunlamp, heating pad, etc.) to
thaw the injured area.
• Don't rub the area with snow.
• Avoid alcohol, nicotine, other drugs that may affect
blood flow.