Download Heat Exposure Injuries - Canadian Ski Patrol – Calgary Zone

ENVIRONMENTAL
INJURIES
Environmental Injuries

The Patroller is most likely to be called and treat
environmental injuries, both on and off the ski
hill:
 Altitude Sickness
 Cold Exposure Injuries
 Heat Exposure Injuries
 Electrical Shock
 Lightning Strikes
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Altitude Sickness

Altitude sickness can be categorised into three
groups:
 Mild acute mountain sickness
 High altitude pulmonary edema (HAPE)
 High altitude cerebral edema (HACE)
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Mild Acute Mountain Sickness


Can show up at elevations as low as 2,100 to 2.400 m
Signs and symptoms:
 Mild headache
 Mild insomnia
 Loss of appetite
 Shortness of breath when exercising

Treatment:
 Symptoms should disappear within 24 hours
 If not, take patient to lower altitude
 If persist, consider oxygen and further medical care
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High Altitude Pulmonary Edema

Continued shortage of oxygen increases pressure in
arteries which results in damage to the lungs with fluid
accumulation
Can become life threatening quickly

Signs and symptoms:

 Marked breathlessness on exertion and at rest
 Headache and cough

Treatment:
 Take to lower altitude ASAP
 Oxygen
 Keep the patient at rest
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High Altitude Cerebral Edema

Swelling in the brain due to cell wall damage can lead to cerebral
edema
Generally develops slowly over a few days

Signs and symptoms:
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Severe headache
Insomnia
Nausea and vomiting
Ataxia (loss of co-ordination)
Lassitude or irrational behaviour
Treatment:
 Get to low altitude ASAP
 Give oxygen and keep at rest
 Treat as Load and Go and seek medical care
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Heat & Cold Injuries
The systems of the body function less effectively
as the internal body temperature falls below its
normal temperature.
 The body may also be severely damaged if the
internal temperature rises above normal.

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Body Temperature

The temperature-regulating mechanisms of the body
continuously attempt to maintain a balance between
internal heat production (metabolism) and external heat
gains or losses

Heat injuries
 systemic - heat stroke
 localized – burns

Cold injuries
 systemic – hypothermia
 localized - frostbite
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Heat Transfer Mechanisms
Basic heat transfer mechanisms are identical
whether applied to cold or heat injuries
 Heat transfer occurs as a result of:

 Radiation
 Conduction
 Convection
 Evaporation
 Respiration
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Other Factors Affecting Body
Heat Balance

Additional factors can affect the basic heat
transfer mechanisms:
 Wind and wind chill factor
 Water
 Clothing
 Nutrition
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Cold Exposure - Hypothermia

Hypothermia is a serious cold injury which occurs when
the body loses more heat than it can produce or retain.

The nervous, cardiovascular, respiratory and digestive
systems function less efficiently as the body core
temperature falls below the normal 37°C.

Should the core temperature continue to fall, these
functions may cease and death will follow.
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Types of Hypothermia
Acute Hypothermia
 May develop over a short period of time as a
result of immersion in cold water, or over a
period of up to 12 ~ 24 hours exposure to cool or
cold weather conditions
Chronic Hypothermia
 Develops over a period of time. This is seen
most commonly in the elderly as a result of
aging processes, some diseases, some
medications, and inadequate heating in their
homes.
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Prevention of Hypothermia
Place insulating material between the patient
and the snow
 Replace clothing if necessary
 Put a layer of warm clothing on top of the patient
 Provide some shelter and warmth by huddling
 Remove the patient from the hill or trail as soon
as possible

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General Treatment of
Hypothermia
Ensure that the patient’s airway, breathing and
circulation are adequate.
 Prevent further heat loss.
 For patients in mild to severe condition, add heat
to re-warm the patient’s body.
 If the patient is fully conscious, give fuel in the
form of hot sweet drinks and sweetened foods .
 Handle the patient gently.
 If the patient in unresponsive, place the patient
in a semi-prone position, monitor and treat as
Load and Go

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Localized Cold Injuries

Non-freezing Cold Injury:
 Also known as frostnip, immersion foot or trench foot
 Skin is cold to the touch and pale, but not frozen

Superficial Frostbite:
 Skin surface is hard, but tissue underneath is soft
 Frequently occur on tip of nose, earlobes, cheeks,
toes and fingers

Deep Frostbite:
 Tissue freezes down into and beyond the
subcutaneous layers
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Signs and Symptoms of
Localized Hypothermia

Non-freezing cold injury:
 Feeling is usually still present to some extent
 Usually there will be tingling, pain and redness during the
re-warming

Superficial Frostbite:
 Skin initially reddens, then blanches and becomes white
 Tingling sensation or sharp pain

Deep frostbite:
 Injured person cannot feel the frozen area
 Skin surface is white, hard and tissue underneath is hard
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Deep Frostbite
Picture A: shows lack of blood flow to frozen areas
Picture B: blood flow returning to foot extremity
Picture C: external picture of same stage of healing
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Treatment of Localized
Hypothermia
Remove the patient from the exposure
 Remove wet clothing
 Re-warm the part - this can be done by contact
with a warm body part such as a hand or armpit,
or immersion in warm water
 Additionally with superficial frostbite: protect the
injured area with dressings and elevate
 Deep frostbite: leave frozen until can send
patient to a medical aid facility

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Heat Exposure Injuries
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Body heat cannot be dissipated from the body or
external heat is added
Rise in body temperature results in severe damage to
the central nervous system and the kidneys
The body dissipates heat by:
 Conduction
 Convection
 Radiation
 Evaporation
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Prevention

Heat exposure injuries are relatively easy to
prevent:
 Gradually acclimatize to working in warm or hot
environments
 Wear light-coloured garments made of materials that
allow the easy passage of moisture to facilitate
evaporation (fabrics that ‘breathe’)
 Increase fluid intake, while avoiding those which
contain caffeine
 Schedule peak physical work periods to cooler
periods of the day
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Heat Injuries

Heat exposure injuries, in order of increasing
severity are:
 Heat Cramps
 Heat Syncope
 Heat Exhaustion
 Heat Stroke
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Heat Cramps
Heat cramps are painful muscular cramps that
occur as a result of the depletion of the chemical
stores within the muscles as a result of profound
sweating.
 Usually the cramps occur in the muscles which
perform the most work - those in the legs or
arms.
 The onset of cramps may be delayed into a
resting period.
 Generally, no lasting damage is found

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Heat Syncope (Fainting)
Caused by a decrease in blood volume reaching
the brain
 Hot environment:

 increased movement of blood to the skin and muscles
 results a temporary insufficiency of blood flow to the
brain
A temporary loss of consciousness
 Fainting is usually followed by a fall
 Horizontal position improves the blood flow to
the brain and allows spontaneous recovery
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Heat Exhaustion
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Same mechanism as for heat syncope
The patient, however, may not experience a loss of
consciousness
Because heat exhaustion is usually accompanied by
fluid loss, there may be signs and symptoms of mild
hypovolemic shock
NOTE: The greatest danger of heat exhaustion is that it
may rapidly progress to heat stroke, which can be lifethreatening
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Heat Exhaustion
Signs and Symptoms:
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Pale, cool clammy skin
Body temp normal, but
may be low
Weak rapid pulse
Rapid, shallow respiration
Headache
Nausea
Profuse sweating
Treatment:
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Remove to a cooler
environment
Remove any extra
clothing
If conscious, give cool
water
Give oxygen
Consider transport to
medical aid
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Heat Stroke
Result of the collapse of the body's cooling
system
 Body's temperature rises
 Structures of the central nervous system are
usually affected
 Death may rapidly ensue if conditions are not
corrected
 Heat stroke is fatal if not treated and has a fairly
high mortality rate even when treated
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Heat Stroke
Signs and symptoms:
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Rapid onset of condition
Hot, dry, flushed skin
Full, rapid pulse initially
Deep respiration then shallow
Muscle twitching or
convulsions
Dilated pupils
Very high body temperature
Progressive decrease in LOC
Treatment:

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Remove as much clothing as
possible
Cool the patient down rapidly
(cold shower or immersion in
cold water)
Wrap the patient in a sheet
and sprinkle with water
Place cold packs under the
arms, on the neck, groin and
behind each knee
Oxygen and monitor vital signs
Transport to medical aid
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Burns
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A burn is an injury to the skin, or deeper tissues of the
body, caused by contact with heat, radiation or
chemicals.
The contact causing the burn may be in the form of:
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Hot solids
Liquids
Steam, air or other gases
Sunlight or ultraviolet light
Electricity
X-rays, radium
Chemicals such as strong acids or alkalis
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Classifications of Burns

Burns are classified according to the depth of
tissue damage:
 First Degree Burns
 Second Degree Burns
 Third Degree Burns
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First Degree Burns
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Superficial skin burn,
merely reddens the skin
Minor pain
Could be compared to a
mild sunburn
Heals in two to five days
Leaves no scarring
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Second Degree Burns
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Partial thickness skin burns
that involve both the epidermis
and the dermis, and may
blister the skin
Compared to sunburn with
blistering
Most painful type of burn as
nerve endings are damaged
Take 5 to 21 days to heal,
unless infection occurs
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Third Degree Burns
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Full thickness burns destroy the
skin completely and may extend
into the deeper tissues
Sometimes even charring the
muscle and bone
May not be very painful because
the nerve endings may also have
been destroyed
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Estimating the Size of the Burn
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Any second degree burn involving more than 10% of the
body area, around the mouth or the 1% perineal area is
serious
Any third degree burn regardless of size is serious.
These must be referred to medical aid.
For small areas, it is possible to estimate the size of the
burn by comparing it with the size of the patient's
outstretched palm and fingers, which represents an area
of about 1%.
For larger burn areas, the rule of nines is useful
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Rule of Nine

Head and neck - 9%

Upper limbs - 9% each
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Trunk
 18% front
 18% back

Lower limbs - 18% each
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Shock in Burn Injuries
Is due to a fall in effective circulating blood
volume due to drainage of fluids from the burn
 Drainage of fluid similar to plasma into the area
of a burn causes swelling and blistering
 The greater the area of the burn, the greater the
loss of fluid
 As volume of fluid loss increases, hypovolemic
shock occurs
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Treatment
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Remove the cause
Initiate basic life support if necessary
Cool the burn, using sterile water if available, or cool
clean water
Apply dry, sterile dressings to the burned area
Treat for shock
Transport to medical aid
For burns over 20% of the body, do not use water, due
to the danger of hypothermia. Wrap the patient in clean
sheets and transport to medical aid.
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Electrical Shock

Electrical shock can be caused by contact with
or proximity to:
 High voltage power lines
 Lower voltage used in industrial and house wiring
Current usually travels through the nervous
system and through the heart
 May result in mild shock to respiratory or cardiac
arrest, or cardiac fibrillation
 Monitor and apply AR/CPR as needed

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Lightning Strike
Average voltage may be of the order of 10 to 20
million volts
 Duration is short (0.1 to 1 milliseconds)
 Often little energy is delivered to the body, and
therefore tissue damage and burns tend to be
minor.
 The major effect are cardiac and respiratory
arrest.
 The fatality rate is about 30%.

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Sunburn or Ultraviolet
Light Exposure
Cool the burned area and protect it from further
injury by applying a damp dressing.
 If no other injury exists, encourage a sunburn
patient to take fluids orally to replace lost fluid.
 Transport to medical aid if:

 the burn covers a considerable area
 there are blisters
 the patient develops a fever
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Conclusion
Many cold exposure injuries are the result of a
failure to take proper precautions.
 Most can be prevented by common sense.
 In the case of heat injuries, stress the
importance of adequate fluid replacement.
 Proper first aid treatment of burns will prevent
infection, relieve pain, and maintain blood
volume.
 Consider burns as an emergency potentially
leading to the onset of shock.

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