Combat Life Saver Lesson 23 IDENTIFY AND TREAT COLD INJURIES Compiled and edited by, 2LT John C. Miller, PA-C.

Combat Life SaverCombat Life Saver

Lesson 23Lesson 23IDENTIFY AND TREAT COLDIDENTIFY AND TREAT COLD

INJURIESINJURIES

Compiled and edited by,2LT John C. Miller, PA-C

Lesson 23Lesson 23IDENTIFY AND TREAT COLDIDENTIFY AND TREAT COLD

INJURIESINJURIES

INTRODUCTIONINTRODUCTION

Cold injuries have always been a threat to military Cold injuries have always been a threat to military forces operating in cold climates. In addition to forces operating in cold climates. In addition to frostbite (which occurs in freezing weather), there are frostbite (which occurs in freezing weather), there are several cold injuries such as trench foot, chilblain, several cold injuries such as trench foot, chilblain, and hypothermia which can occur even when the and hypothermia which can occur even when the temperature is above freezing.temperature is above freezing.

IDENTIFY AND TREAT IDENTIFY AND TREAT COLD INJURIESCOLD INJURIES

TASKTASK

Identify the proper procedures for treating a cold Identify the proper procedures for treating a cold injury casualty.injury casualty.

CONDITIONCONDITION

Given written items pertaining to the identification and Given written items pertaining to the identification and treatment of cold injuries.treatment of cold injuries.

STANDARDSTANDARD

Score 70 or more points on the 100-point written Score 70 or more points on the 100-point written examination.examination.

IDENTIFY SIGNS AND SYMPTOMS OFIDENTIFY SIGNS AND SYMPTOMS OFCHILBLAINCHILBLAIN

Skin exposed to cool temperatures (50 degrees F or Skin exposed to cool temperatures (50 degrees F or lower).lower).

Acutely red, swollen, hot, tender, and/or itching skin.Acutely red, swollen, hot, tender, and/or itching skin. Open sores or bleeding lesions from continued Open sores or bleeding lesions from continued

exposure.exposure.

TREAT A CASUALTY WITHTREAT A CASUALTY WITH CHILBLAIN CHILBLAIN

Apply local warming (put bare hands over the Apply local warming (put bare hands over the affected area on the face, put affected hands inside affected area on the face, put affected hands inside the uniform under the armpits, etc.).the uniform under the armpits, etc.).

Do not rub or massage the affected area.Do not rub or massage the affected area. Apply a field dressing to lesions (sores).Apply a field dressing to lesions (sores). Have the casualty examined by medical personnel Have the casualty examined by medical personnel

when the opportunity presents itself.when the opportunity presents itself.

IDENTIFY SIGNS AND SYMPTOMS OFIDENTIFY SIGNS AND SYMPTOMS OFIMMERSION SYNDROMEIMMERSION SYNDROME

Hand or foot in water for an extended time.Hand or foot in water for an extended time. Affected hand or foot may have blisters, swelling, Affected hand or foot may have blisters, swelling,

redness, and bleeding.redness, and bleeding. First phaseFirst phase: Hand or foot is cold and without pain.: Hand or foot is cold and without pain. Second phaseSecond phase: Affected limb feels burning hot and : Affected limb feels burning hot and

has shooting pains.has shooting pains. Third phaseThird phase: Pale skin, bluish coloring around the : Pale skin, bluish coloring around the

nailbeds and lips, weak pulse.nailbeds and lips, weak pulse.

TREAT A CASUALTY WITH TREAT A CASUALTY WITH IMMERSION SYNDROMEIMMERSION SYNDROME

Dry the affected part immediately.Dry the affected part immediately. Remove wet clothing and replace with dry, warm Remove wet clothing and replace with dry, warm

clothing.clothing. Rewarm the affected area gradually in warm air.Rewarm the affected area gradually in warm air.

• Do not rub or massage the affected hand or foot.Do not rub or massage the affected hand or foot.

Elevate the affected part to reduce swelling.Elevate the affected part to reduce swelling. Protect the casualty from additional injury.Protect the casualty from additional injury. Evacuate casualty to a medical treatment facility as Evacuate casualty to a medical treatment facility as

soon as practical.soon as practical.

IDENTIFY SIGNS AND SYMPTOMS OFIDENTIFY SIGNS AND SYMPTOMS OFFROSTBITEFROSTBITE

Flesh has been exposed to freezing temperatures Flesh has been exposed to freezing temperatures (below 32 degrees F).(below 32 degrees F).

Usually occurs on the feet, toes, nose, ears, chin, Usually occurs on the feet, toes, nose, ears, chin, cheeks, forehead, fingers, hands, and wrists.cheeks, forehead, fingers, hands, and wrists.

Superficial FrostbiteSuperficial Frostbite A reddish (in light-skinned individuals) or grayish (in A reddish (in light-skinned individuals) or grayish (in

dark-skinned individuals) area on exposed skin.dark-skinned individuals) area on exposed skin. A sudden blanching (whitening) of the affected area.A sudden blanching (whitening) of the affected area. A tingling sensation, followed by numbness.A tingling sensation, followed by numbness.

IDENTIFY SIGNS AND SYMPTOMS OFIDENTIFY SIGNS AND SYMPTOMS OFFROSTBITEFROSTBITE

Deep FrostbiteDeep Frostbite Total lack of feeling in the affected (frozen) tissue.Total lack of feeling in the affected (frozen) tissue. Pale, yellowish, waxy-looking skin.Pale, yellowish, waxy-looking skin. Solid flesh (feels wooden to the touch).Solid flesh (feels wooden to the touch). Red-violet discoloration, blisters, and sloughing of Red-violet discoloration, blisters, and sloughing of

affected skin may occur (usually 1 to 5 days after the affected skin may occur (usually 1 to 5 days after the initial injury).initial injury).

TREAT A CASUALTY WITH TREAT A CASUALTY WITH FROSTBITEFROSTBITE

Move the casualty to a sheltered area.Move the casualty to a sheltered area. Loosen constricting clothing.Loosen constricting clothing. Remove jewelry on the affected limb, if applicable. (A Remove jewelry on the affected limb, if applicable. (A

ring on a swollen finger could interfere with blood ring on a swollen finger could interfere with blood circulation.).circulation.).


Gradually warm the casualty.Gradually warm the casualty.• Use the same warming procedures as with chilblain.Use the same warming procedures as with chilblain.• If the feet are frostbitten, remove the casualty's boots and If the feet are frostbitten, remove the casualty's boots and

socks and put his feet against the exposed abdomen of socks and put his feet against the exposed abdomen of another soldier. Cover both soldiers to keep them warm.another soldier. Cover both soldiers to keep them warm.

• Do not expose the frostbitten area to extreme heat which Do not expose the frostbitten area to extreme heat which could result in burns.could result in burns.

• Do not rub, massage, or soak the frostbitten area.Do not rub, massage, or soak the frostbitten area.

Give the casualty something warm to drink.Give the casualty something warm to drink.• Do not give alcoholic beverages or tobacco products to the Do not give alcoholic beverages or tobacco products to the

casualty. Alcohol and tobacco can promote heat loss.casualty. Alcohol and tobacco can promote heat loss.


Protect the frostbitten area from cold and additional Protect the frostbitten area from cold and additional injury.injury.

Evacuate the casualty to a medical treatment facility Evacuate the casualty to a medical treatment facility as soon as possible. If the casualty's frozen feet as soon as possible. If the casualty's frozen feet must be exposed to freezing temperature during must be exposed to freezing temperature during evacuation, do not thaw his feet prior to evacuation.evacuation, do not thaw his feet prior to evacuation.

QuestionQuestion: : • Suppose a soldier has a foot with deep frostbite and will Suppose a soldier has a foot with deep frostbite and will

have to walk to a nearby medical treatment facility. Should have to walk to a nearby medical treatment facility. Should you warm his foot before sending him to the facility?you warm his foot before sending him to the facility?

ResponseResponse: : • No.No.

IDENTIFY SIGNS AND SYMPTOMS OFIDENTIFY SIGNS AND SYMPTOMS OFGENERALIZED HYPOTHERMIAGENERALIZED HYPOTHERMIA

Generalized hypothermia occurs when the whole Generalized hypothermia occurs when the whole body (rather than just a body part) is cooled to an body (rather than just a body part) is cooled to an unusually low temperature. It is a medical emergency unusually low temperature. It is a medical emergency which can result in death if not treated promptly. which can result in death if not treated promptly. Generalized hypothermia is often called simply Generalized hypothermia is often called simply "hypothermia.""hypothermia."


Moderate HypothermiaModerate Hypothermia Apathetic, lethargic behavior.Apathetic, lethargic behavior. Pale, cold skin.Pale, cold skin. Acetone (sweet, fruity) breath odor.Acetone (sweet, fruity) breath odor. Shivering, which soon stops.Shivering, which soon stops.


Severe HypothermiaSevere Hypothermia Skin ice cold.Skin ice cold. Slow, shallow respirations.Slow, shallow respirations. Faint, irregular pulse or lack of detectable pulse.Faint, irregular pulse or lack of detectable pulse. Glassy eyes.Glassy eyes. Mental confusion.Mental confusion. Unconsciousness.Unconsciousness.

TREAT A CASUALTY WITH TREAT A CASUALTY WITH GENERALIZED HYPOTHERMIAGENERALIZED HYPOTHERMIA

Moderate HypothermiaModerate Hypothermia Move the casualty out of the wind to a shelteredMove the casualty out of the wind to a sheltered environment.environment. Replace wet clothing with dry clothing or sleeping Replace wet clothing with dry clothing or sleeping

bags.bags. Cover the casualty with blankets or other insulating Cover the casualty with blankets or other insulating

material.material.


Give the casualty warm, nutritious fluids to drink.Give the casualty warm, nutritious fluids to drink.• Do not give alcoholic beverages or tobacco products to the Do not give alcoholic beverages or tobacco products to the

casualty.casualty.

Wrap the casualty from head to toe and evacuate to Wrap the casualty from head to toe and evacuate to a medical treatment facility in a recumbent (lying a medical treatment facility in a recumbent (lying down) position.down) position.


Severe HypothermiaSevere Hypothermia Cut away wet clothing and replace with dry clothing.Cut away wet clothing and replace with dry clothing. Ensure that the casualty's airway remains open and Ensure that the casualty's airway remains open and

the casualty continues to breathe.the casualty continues to breathe.• Perform mouth-to-mouth resuscitation if the casualty's Perform mouth-to-mouth resuscitation if the casualty's

breathing rate drops below five respirations per minute.breathing rate drops below five respirations per minute.• Use J-tube if needed and the casualty is unconscious.Use J-tube if needed and the casualty is unconscious.


Apply an additional heat source since the casualty's Apply an additional heat source since the casualty's body cannot generate sufficient body heat to warm body cannot generate sufficient body heat to warm itself.itself.• Have another soldier remove his outer clothing and get into Have another soldier remove his outer clothing and get into

the same sleeping bag as the casualty, then covering both the same sleeping bag as the casualty, then covering both soldiers. The second soldier's body heat will warm the soldiers. The second soldier's body heat will warm the casualty's body.casualty's body.

Evacuate the casualty to a medical treatment facility Evacuate the casualty to a medical treatment facility as soon as possible.as soon as possible.• Evacuate the casualty even if you cannot detect Evacuate the casualty even if you cannot detect

respiration or a heartbeat.respiration or a heartbeat.• Be gentle when moving the casualty.Be gentle when moving the casualty.

IDENTIFY SIGNS AND SYMPTOMS OF IDENTIFY SIGNS AND SYMPTOMS OF SNOW BLINDNESSSNOW BLINDNESS

Snow blindness is a temporary loss of sight caused Snow blindness is a temporary loss of sight caused by ultraviolet rays from the sun reflecting off snow or by ultraviolet rays from the sun reflecting off snow or ice. Snow blindness can usually be prevented by ice. Snow blindness can usually be prevented by wearing regular or improvised sunglasses which cut wearing regular or improvised sunglasses which cut down on the amount of ultraviolet rays which reach down on the amount of ultraviolet rays which reach the eyes.the eyes.


QuestionQuestion: : • Suppose a soldier working in an ice-covered terrain says Suppose a soldier working in an ice-covered terrain says

that he will not wear his sunglasses because it is cloudy? that he will not wear his sunglasses because it is cloudy? Should the soldier still wear his sunglasses?Should the soldier still wear his sunglasses?

ResponseResponse: : • Yes. Snow blindness often occurs in cloudy or hazy Yes. Snow blindness often occurs in cloudy or hazy

weather. Clouds and haze do not stop the invisible ultraviolet weather. Clouds and haze do not stop the invisible ultraviolet radiation.radiation.


Scratchy feeling in the eyes as though dirt or sand Scratchy feeling in the eyes as though dirt or sand were present in the eyes, sometimes more severe were present in the eyes, sometimes more severe pain.pain.

Decreased vision.Decreased vision. Tears.Tears. Difficulty in opening eyelids.Difficulty in opening eyelids. Headache.Headache. Pain.Pain.

TREAT A CASUALTY WITH TREAT A CASUALTY WITH SNOW BLINDNESSSNOW BLINDNESS

Cover the casualty's eyes with a dark cloth.Cover the casualty's eyes with a dark cloth. Reassure the casualty that the condition is temporary Reassure the casualty that the condition is temporary

and he will regain his sight.and he will regain his sight. Evacuate him to a medical treatment facility as soon Evacuate him to a medical treatment facility as soon

as practical.as practical.

COLDCOLDINJURIESINJURIES

QuestionQuestion: : • Of the cold injuries discussed, which is a medical Of the cold injuries discussed, which is a medical

emergency requiring immediate treatment?emergency requiring immediate treatment?

ResponseResponse: : • Hypothermia.Hypothermia.

IDENTIFY AND TREAT IDENTIFY AND TREAT COLD INJURIESCOLD INJURIES

CLOSINGCLOSING

Cold can be a deadly enemy. Soldiers can protect Cold can be a deadly enemy. Soldiers can protect themselves from this enemy by taking preventive themselves from this enemy by taking preventive measures. The buddy-system should be used since it measures. The buddy-system should be used since it may be easier to detect the early signs and may be easier to detect the early signs and symptoms of cold injury on another person than on symptoms of cold injury on another person than on yourself. If a soldier does become a cold injury yourself. If a soldier does become a cold injury casualty, you must be ready to recognize the problem casualty, you must be ready to recognize the problem and provide proper treatment. This lesson is tested in and provide proper treatment. This lesson is tested in the written multiple-choice examination.the written multiple-choice examination.

QuestionsQuestions

Combat Life Saver Lesson 23 IDENTIFY AND TREAT COLD INJURIES Compiled and edited by, 2LT John C. Miller, PA-C.

Documents

b superficial frostbite

b pale

b condition

b open sores

b solid flesh

b standard score

symptoms of chilblain

symptoms of frostbite