PowerPoint Presentation by: Megan Burk

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The purpose of this statement is to provide recommendations on preventing, recognizing, and treating cold injuries which can be better done after u nderstanding the concept of the body’s thermoregulation
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By following guidelines and recommendations, lives can be saved in the athletic setting simply by preventing cold illnesses that should not happen in the first place

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3 Categories = decrease in core temperature referred to as hypothermia
Freezing injuries of the extremities
Nonfreezing injuries of the extremities
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The specific cold illnesses that will be discussed include the three conditions of hypothermia, the three stages of frostbite, chilblain/pernio, and immersion/trench foot.

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Wind chill is how the temperature actually feels relative to the actual temperature and wind speed.

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The body constantly works to maintain a homeostatic balance.
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When the body becomes too cold, its reaction is an increase in metabolic heat production, called thermogenesis through either nonshivering or shivering.
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The body will also react by peripheral vasoconstriction at the skin mostly at the extremities so there is a decrease in heat loss because of the decrease in blood flow.

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Core temperature = 98.6°F to 95°F
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Signs and Symptoms: Vigorous shivering, increased blood pressure, fine motor skill impairment, sluggishness, and slight memory loss may be present.
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Treatment: Remove any wet clothing and try to warm the athlete with insulation to the trunk. Also, move the athlete to a warmer setting and provide warm liquids.

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Core temperature = 94°F to 90°
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Signs and Symptoms: Shivering may subside, skin with be very cold upon touch, waning vital signs, and impaired mental function may be present.
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Treatment: Determine if CPR should be used and activate the emergency medical system.
Rewarm the athlete by removing wet clothing, insulating their trunk, and carefully moving the athlete to a warmer environment. Even warm the athlete during transport.

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Core temperature = Below 90°F
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Signs and Symptoms: Shivering may completely stop, hard time breathing, abnormal heart rhythms, cardiac arrest, and could even be comatose
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Treatment: Like during moderate hypothermia:
Determine if CPR should be used and activate the emergency medical system. Rewarm the athlete by removing wet clothing, insulating their trunk, and carefully moving the athlete to a warmer environment. Even continue to warm the athlete during transport.

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Frostnip is a precursor to frostbite. It is the mildest form of cold illness and can even be caused by contact with cold objects such as metal. Only the outermost skin is frozen.
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Signs and Symptoms: Most likely the extremities will be affected. There will be redness and stiffness
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Treatment: Encourage the athlete to keep their extremities covered and insulated. Get the athlete out of the cold conditions so frostbite does not develop.

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Mild frostbite is freezing of the skin and of the near subcutaneous tissues. First is extracellular water freezing, then comes cell freezing.
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Signs and Symptoms: Redness, stiffness, tingling, burning most likely of the extremities
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Treatment: Rule out hypothermia by getting the core temperature. Rewarm the skin slowly and protect the area. Do not rub the tissue too hard and do not allow the skin to refreeze or there could be nerve damage. The athlete should consult a physician.

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Severe or deep frostbite is when tissues below the skin and the adjacent tissues are frozen such as a muscle, tendon, and bone.
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Signs and Symptoms: Redness, gray appearing skin, hard tissue, vesicles, numbness, and memory decline
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Treatment: Rule out hypothermia by getting the core temperature. Rewarm by immersing the tissue in a water bath that is 98°F to 104°F for 15 to 30 minutes. The tissues should be protected as well and the athlete should consult/ be transported to a physician.

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Chilblain/pernio is an excessive inflammatory response to coldness. The severity is related to the time spent and the temperature of the environment.
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Signs and Symptoms: Exposure to cold/wet conditions for more than an hour with temperatures less than 50°F. Red bumps, redness, tenderness, itching, and pain may be present along with inflammatory signs while rewarming.
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Treatment: Remove wet clothing, dry and elevate the area, and cover it with loose blankets. If there are blisters, do not disturb them. Keep monitoring the athlete for the return of circulation and feeling.

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Immersion/ trench foot usually happens when the feet are exposed to cold, wet conditions from usually 12 hours to 4 days. It affects soft tissues like nerves and blood vessels.
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Signs and Symptoms: Burning, tingling,, itching, loss of feeling, blotchy skin, swelling, pain, and blisters may be present.
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Treatment: Clean and dry the feet with warm packs or warm water of 102°F for 5 minutes.
Replace wet socks with clean, dry socks and do not allow athletes to wear wet shoes.

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Females
Black race
Old age
Cardiovascular Disease
Improper hydration levels
Fatigue
Equipment worn that does not keep the athlete insulated
Sick athletes
Physically unfit athletes
Those with a low body and muscle mass
Nicotine, Alcohol, or drug intake

However, this statement provides recommendations that, if followed properly, can and will decrease the risks for developing cold illnesses.

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Have the athletes perform a pre-participation exam accessing any previous cold injuries and risk factors
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Do extra monitoring on athletes that show risk factors
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Have trained personnel on site at events

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Encourage athletes to maintain hydrated and eat healthy
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Develop guidelines for events, practices, and risk management procedures
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Clothing should keep the athletes as insulated as possible and extremities should be covered. There should be 3 layers
(internal, middle, and external). Also, immediately remove any wet clothing

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Supplies such as water/sports drinks, heat packs, blankets, a rectal thermometer, telephone, and a warming treatment tub should be included
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Inform medical personnel before events
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Allow athletes the opportunity to rewarm by going inside, being near heaters, and/or adding clothing

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Maintain dry clothing
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Stay out of cold, wet, and windy conditions
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Do not wear wet socks or shoes
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Educate athletes and coaches about cold illnesses

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Extra, preventative precautions should be taken because…
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Childrenhave less fatty tissue to insulate them and a small body mass compared to their surface area exposed
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Athletes older than 50may struggle tolerating and reacting to the cold
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Athletes with spinal-cord issuesmay have trouble perceiving feelings of cold temperature