Winter weather, such as ice, snow, and low temperatures, along with winter activities and exposure, can bring about unique and dangerous seasonal injuries from motor vehicle accidents involving black ice to injuries from falls, cold exposure, and even cardiac events. Let's discuss three major winter-related health concerns and why they can quickly become dangerous: hypothermia, frostbite, and provoked heart attacks.
Hypothermia: Cold to the Core
Hypothermia vs. Hyperthermia - Hypothermia occurs when the body reaches dangerously low temperatures, whereas hyperthermia is the term used to describe dangerously high body temperatures. Hypothermia is a dangerous medical condition that can occur during cold weather or as a result of cold exposure, when the bodys temperature drops below 95 degrees Fahrenheit. It directly impacts the bodys organs and causes complications that affect body functions such as cognitive abilities, heart rhythms, heart rate, and breathing. The body is unable to function in low temperatures, and without reversal, it can result in death.
There are particular risk factors that are linked to hypothermia, such as:
- Exposure to cold temperatures.
- Poor or insufficient clothing to maintain body temperature.
- Submersion in cold water.
- Participation in outdoor activities such as hiking, hunting, or snow sports.
- Wearing wet clothing, especially for a prolonged period of time.
- Young or old age (those within these age groups are unable to regulate body temperature as effectively).
- Homelessness or lack of shelter from cold weather.
- Excess alcohol consumption or drug use that impairs decision-making and is associated with an increased risk for loss of consciousness.
- Sweating in cold temperatures, even above freezing.
- Small children or babies sleeping in cold rooms.
It is important to acknowledge and address signs of hypothermia to promote timely reversal and immediate medical interventions. If any of these signs are noticed, get indoors quickly, work to restore your body temperature to normal, and seek medical attention.
Symptoms of hypothermia include:
- Shivering (may not be present in late-stage hypothermia)
- Confusion
- Slurred speech
- Exhaustion
- Drowsiness
- Altered mental status
- Memory loss
- Bright red, cold skin in children
- Weak pulse or slowed heart rate
- Shallow or slow breathing
- Coordination issues
- Slow movements
There are steps in hypothermia treatment that should be initiated quickly on site, whether by the individual themselves or someone accompanying them, and then by medical professionals once in a healthcare setting. When initiating the rewarming process, there are specific Dos and Donts that should be followed for effective treatment and to avoid additional harm.
Do:
- Remove the individual from the cold weather.
- Remove any wet clothing.
- Wrap up in blankets and dry clothing.
- Apply a dry, warm compress to the neck, chest, or groin to warm the bodys core.
- If using a hot pack, wrap it in a towel to avoid thermal burn injuries.
- Skin-to-skin contact.
Do Not:
- Heat the body too rapidly, such as through a hot bath.
- Heat or massage the limbs first (this causes stress on the heart and lungs), and focus on warming the bodys core.
For those who receive treatment in a medical setting, healthcare professionals have access to additional rewarming measures and increased capabilities, such as warmed IV fluids or warmed oxygen administered through a nasal canula or oxygen mask. In severe cases, hemodialysis or a heart-lung machine may be utilized. Hypothermia is a life-threatening medical condition that should be quickly addressed to prevent irreversible damage and death.
Frostbite - More than Cold Feet
Vasoconstriction, ischemia, hyperviscosity, electrolyte alterations, and intracellular ice crystal formation result in a cold-weather-related tissue injury commonly known as frostbite. Frostbite occurs when the tissues are exposed to temperatures below freezing for a prolonged period of time. While frostbite can affect anyone with cold exposure, there are particular risk factors that place individuals at a higher risk of frostbite, such as psychiatric conditions, diabetes, circulatory compromise, or vascular disease.
The most common sites for frostbite are the extremities, including the feet, hands, digits (toes and fingers), ears, nose, and chin. These areas are the most exposed to the cold and tend to have the least blood flow due to their distal location in proximity to the heart. Early recognition of frostbite can lead to improved patient outcomes and decreased chances of long-term effects. There are some general symptoms of frostbite to be aware of, as well as stage/degree-specific symptoms that are indicators of injury progression.
General symptoms of frostbite:
Frostbite can be characterized based on different assessment tools, such as stages of frostbite or degree of injury. There are three stages of frostbite, with each stage involving worsening tissue injury and more severe symptoms.
Stages of frostbite:
- Frostnip: This is the precursor to frostbite, or in other terms, a mild form of frostbite that is reversible.
- Superficial frostbite: During this stage, the top layer of the skin is impacted, and the skin coloring shifts from red to pale, as ice crystals form. The skin may feel warm and swollen, which is the result of tissue damage.
- Deep frostbite: This stage is the most concerning, in which all layers of the skin are impacted, and the injury may reach beyond the skin tissues to the muscles and the joints. There is an absence of sensation, and numbness is present, with skin appearing bluish-gray in color.
In addition to the stages of frostbite, it can also be classified into four degrees of injury, each with associated symptoms and expected rewarming reactions.
Degrees of frostbite injury:
First degree: Partial skin injury without necrosis, superficial.
- Mild swelling, redness, numbness, and central pallor with surrounding erythema.
- Patients experience dysesthesia after rewarming (unpleasant skin sensations due to nerve damage).
Second degree: Injury within the dermis.
- Clear blisters that are surrounded by redness and swelling.
- Patients experience pain when rewarming.
Third degree: Full-thickness injury, including subcutaneous tissue injury.
- Hemorrhagic blisters, skin death, and necrosis.
- Patients experience pain with rewarming.
Fourth degree: Injury is severe and has reached the muscle, bones, and tendons.
- Necrosis and cyanosis are present.
- Lack of pain sensation due to nerve damage and absent blood flow.
Just like in hypothermia treatment, frostbite treatment can be separated into Dos and Donts. What may seem to be an ideal option for rewarming may, in turn, lead to further damage or new injuries. Medical attention should always be sought so that appropriate treatment approaches can be followed and so that the patient can be appropriately monitored. For serious injuries, tissue debridement of dead skin, antibiotic administration, or even amputation may be required.
Do:
- Place frostbitten areas in warm-to-touch water for 15-60 minutes. Do not use hot water, as that can cause burn injuries. A suitable temperature range is 37-39 degrees Celsius.
- Encourage warm fluid intake.
- Apply an antiseptic solution to decrease infection risk.
- Apply topical aloe vera.
- Elevate the affected area above the level of the heart to decrease swelling.
- Avoid smoking, which causes further vasoconstriction.
- Utilize pain analgesics such as NSAIDs.
Do Not:
- Rub or massage the affected area.
- Use a fireplace, radiator, heat lamp, or stove to rewarm tissues due to decreased skin sensation and risk of burn injuries.
- Walk on frostbitten feet or toes.
Prevention Education
In many cases, hypothermia and frostbite can be avoided if proper prevention measures are established and followed. Both of these conditions are linked to cold temperatures, with prevention aimed at avoiding cold exposure and taking appropriate steps to prevent drops in body temperature. Efforts include avoiding prolonged periods of time outside when the temperatures are low, dressing appropriately when encountering cold weather, and recognizing early signs of cold-weather injuries. Dress in warm clothing while exposed to cold temperatures, and wear water-resistant boots and clothing if available. Avoid cold water exposure and make trips in the cold short if possible. Hypothermia and frostbite prevention are critical to avoiding negative outcomes and results.
Snow Shoveling and Cardiac Events: Whats the Connection?
Shoveling after a snowstorm isn't for the faint of heart. Literally. Hypothermia and frostbite arent the only medical emergencies that make their appearance during the cold weather months. When a winter storm brings blistery snowfall and snow-packed driveways, a dangerous condition can make its appearance: myocardial infarctions, commonly known as heart attacks.
In some places across the country, wet, heavy snow has been coined the term heart attack snow, because snow-related cardiac events are a reality and not a rare coincidence. Cold weather, shoveling snow, and heart attacks can make for a life-threatening situation. So, what about snow shoveling makes it more likely for a heart attack to occur?
Cold temperatures. Physical exertion. Cardiac stress. All of these factors can lead to an increased chance of a heart attack occurring while shoveling snow, and together they can become dangerous.
The cold temperatures that accompany snowstorms and the winter season have a direct impact on the body. When the body senses cold temperatures, the vessels within the circulatory system vasoconstrict, or become narrower. Vasoconstriction reduces blood flow and increases blood pressure. This is the bodys way of directing and pushing more blood to the bodys core to keep it warm. With more narrowed vessels, there comes more risk for cardiac-related concerns, and narrowed vasculature can be risky for those who may already have more narrowed arteries from plaque.
Moving snow requires physical effort. This physical effort can place added stress on the body and increase the workload on the heart as it works harder to increase its cardiac output. Heart attacks associated with shoveling snow are increased amongst individuals who have underlying cardiac conditions, including coronary artery disease, a history of heart attacks, cardiac surgeries, high cholesterol or blood pressure, and especially amongst individuals who do not typically exercise or participate in activities that require routine physical exertion.
Additionally, the Valsalva maneuver plays a role in an increased risk of a cardiac event when one shoveling snow bends down to lift or toss the heavy snow. The bearing down action causes alterations in pressure and blood flow, including increased blood pressure and heart rate, as well as compensatory reactions that can contribute to cardiac stress and associated responses, including heart attacks.
The constriction, or narrowing of the vessels, combined with the cold temperatures, physical exertion, and stress associated with moving heavy snow, creates an environment that leaves people more vulnerable to experiencing a heart attack. If you experience any signs or symptoms of a heart attack, call 911 immediately.
What are the signs of a heart attack?
- Chest pain or pressure
- Pain in the jaw, shoulder, arm, or back
- Fatigue
- Abdominal discomfort, including nausea, vomiting, or indigestion
- Malaise
- Dizziness
- Lightheadedness
- Shortness of breath
Heart attack symptoms can vary between genders and may appear differently for different individuals, so it is important to recognize what the symptoms could potentially be, and if present, seek medical attention.
If you have underlying cardiac concerns, be especially aware of the risks of shoveling snow and heart attacks. Even if you don't have a history of cardiac disease or heart complications, recognize the risks and try to minimize them. If you are shoveling snow, stretch before shoveling, drink plenty of fluids, take breaks, dress warmly in layers that can be removed if needed to avoid overheating, push snow rather than lifting, and wait an hour after waking up to shovel, seeing as most heart attacks occur in the morning. Using a snow blower can still be associated with heart attacks, but it can be potentially less risky. Ask a family member, friend, or neighbor for help shoveling your driveway if needed, and always prioritize ones health and well-being.
In Review
Hypothermia, frostbite, and snow shoveling provoked heart attacks are all serious issues that require medical attention and proper patient education. Each of these winter weather injuries/conditions involves preventative measures and important treatment considerations for nurses caring for patients in low temperatures, where Mother Nature can show the true dangers of the cold. Put on warm layers, pay attention to your body, and use critical thinking skills to lower the chances of finding oneself in a cold dilemma.
About the Author:
Rachel Pugmire is a registered nurse and freelance writer. She received her Bachelor of Science in Nursing in 2018, with a minor in gerontology. Her areas of expertise include emergency medicine, pediatrics, and pharmaceutical clinical trials. Medical writing has given her a platform to do what she is passionate about, which is educating patients, their families, and other healthcare professionals.
Rachel is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely those of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
If you want to learn more about CEUfast's Nursing Blog Program or would like to submit a blog post for consideration, please visit https://ceufast.com/blog/submissions.
