Cold Injuries

It’s summer time now, the spring is all but gone, many of my friends are right now struggling to stay alive in the higher echelons of Everest and some of the other highest peaks in the world as many of you are now gearing up for the summer treks, and planning your holiday in the hills. Any trip to the mountains, high or low, alpine or Himalayan proportions certainly calls for some experience and expertise to deal with personal injuries and health conditions that may arise on ground. The entire field of mountain medicine is too vast and yet uncharted for me to discuss here, so maybe I would break it down in smaller segments. The majority of the casualties and deaths that do take place in high altitudes are due to just that, the altitude, which plays havoc with the human body and mind. But even in the lower hills, a sudden chilly downpour, an accidental fall in a river or storm can catch you unawares and lead to cold injuries. While not fatal (like high altitude ailments) by themselves, cold injuries are not a pleasant thing to happen and may lead to death if not anticipated and dealt with in the early stage. In this post I will briefly touch upon the three most frequently encountered cold injuries at cold places.


Hypothermia

Everyone, who climbs or goes into the hills, especially in the winters, has certainly experienced hypothermia, including yours truly. It’s a common phenomenon that occurs when the core temperature of our body drops below the normal of 37 deg C. As the body temperature falls to 36 deg C, the body starts to shiver uncontrollably, in order to generate core heat through muscular actions. At this stage more than the cold, it is the reduction in our capacity to judge and act, which is more dangerous and lethal. A drop to 35 deg C leads to confusion and disregard to one’s safety.

These physiological alterations clubbed with slow and delayed mental reactions can quickly lead to potent disasters. We make navigational errors, we may not realize that our skins, gloves, or clothes are cold and need to be changed, and we may forget to eat some high calorie food. This personal neglect can then spiral the degeneration effect. If you allow the core temperature of your body to fall around 30 deg C then the shivering will stop and the body and mind would start to lapse into unconsciousness. And by this stage your mind will be so numb and disjointed that you will not realize that you are slowly but surely dying. Sadly many people, mostly inexperienced hikers and hill walkers sustain grave and irreparable damage due to hypothermia and sometimes death, while the preventive measures are easy to follow. While you are moving and climbing up, your body must feel warm from inside, but the moment you feel cold setting inside, around the area of your lungs and heart, even when your outer body is sweating, and you feel the beginning of a shiver, it is time to act. Here’s what needs to be done.

Prevent further loss of body heat: Cover your head with a cap / hat / scarf / balaclava etc covering the ears as well. Roll down your sleeves and cover any exposed part of your hand. Remember, you must always keep your head covered. We lose more than 30% of our body heat and moisture solely through the head and ears. Change into dry inner clothes / base layers if you have spare. Get a windproof jacket on like Gore Tex / Wind cheater etc. While resting stay out of the sun and shelter under a tree or rock etc.

Hydrate: As I have said time and again, plain and simple water is the ultimate elixir in the mountains and if you keep on hydrating regularly you will avoid nearly all medical conditions. Standard measure is to drink 1 liter of water every hour. Keep refilling your bottle wherever and whenever you can. We dehydrate in the cold, even when we do not visibly sweat and with that we lose a lot of body heat as well. Drinking is the best habit in the mountains.
Eat: The only way to truly generate body heat from the core is to feed it with fuel and oxygen to burn it deep inside, like burning a furnace. For instant generation of energy and heat one must take more of carbohydrates and less of protein. Believe it or not, potato chips are excellent for such purpose and so are mars chocolate bars. Glucose too helps.

If none of the above help, then you must stop and get some hot fluid inside you, change into dry clothing and put on extra down jackets and ask your team mates to literally beat you up.

Frostnip

This happens mostly when there’s a sudden cooling of the body’s exposed parts due to a sudden snow, blizzard or a strong gust of cold wind. Most susceptible body parts to frostnip are the exposed parts of your face like nose, lips, cheek, ear and fingers. The easiest way to prevent frostnip is to wear ski mask or balaclava and gloves. We often can’t feel the tip of our nose, and that’s frostnip. It is easy to detect by the numbness and the white or waxy appearance of the affected part. If it happens cover the affected part, rub it gently to get blood circulation going and warm compress may also be given if the condition does not improve. Frostnip is the pre-frostbite stage and hence it must be detected and prevented at the earliest possible stage.

Frostbite

Frostbite is the worse of the cold injuries and is rarely encountered in lower altitudes or cool places. It is mostly seen in high altitudes, above snow line, serious ice climbing, etc where the body is exposed to cold for prolonged duration. Third degree frostbite would need amputation and may even lead to death due to blood and tissue poisoning if not treated in time. Mostly the fingers, and toes, nose and the ears are affected by frostbite. The initial stage is similar to frostnip as the parts would become numb, lose sensation and would appear hard to touch and the skin will turn white and waxy. Thereafter the skin will begin to turn grey, charcoal and black and very hard to touch. The extreme stages of frostbite is gangrene when the dead tissues would start rotting the neighboring body tissues and the putrid smell of rotting flesh is the obvious tell-tale sign that now the limb needs amputation to prevent further loss of other body parts. Frostbite happens due to prolonged exposure to cold and wet conditions like when one keeps wearing a wet boot for long or fingers are immersed in ice or cold water for extended durations. The prevention is obvious and simple, do change your socks and gloves and allow your extremities to be exposed to healthy air and dry them out thoroughly after any climb. If frostbite sets in then very slow and gradual warming of the tissues by dipping the injured parts in lukewarm water are recommended though make sure, if you can, that the water temperature is not above 40 deg C max. There are medicines and injections that can be taken but that’s only if you have a doctor in the team. If you don’t have enough experience in such matters then the best thing to do is to dry out the part and keep it warm and prevent from further freezing and return to the nearest medical center at the earliest.

To summarize, all cold injuries are caused by a combination of any of these factors: low temperatures, wind-chill, wet conditions, inadequate intake of food, your morale, exhaustion or tiredness and lack of experience. Steps to prevent cold injuries are obvious and simple: prevent loss of body heat, keep yourself dry, eat and hydrate, rest and recuperate, go with someone experienced and keep your morale high. Never ever touch metal with bare fingers or skin.

I hope when out in the mountains next time you would be cold but not cold enough and enjoy your adventure with a warm heart. Happy climbing!