1. Environmental Injuries
High Altitude Sickness
Frostbite

2. High Altitude Sickness
Resulting from hypoxia
Will show up within the first few days at altitude
3 types:
AMS: Acute Mountain Sickness
HACE: High Altitude Cerebral Edema
HAPE: High Altitude Pulmonary Edema

3. High Altitude Sickness
AMS: Acute Mountain Sickness
Most common
Causes: insufficient hydration, respiration, genetics
Minor brain swelling due to hypoxic stress
HAPE: High Altitude Pulmonary Edema
Increased fluid in alveoli
HACE: High Altitude Cerebral Edema
Advanced brain swelling
10% as frequent as HAPE

4. High Altitude Sickness
Acclimatization
Faster respiration alone cannot compensate for lower O2 levels at higher altitudes.
Body must reset blood chemistry, resulting in increased respiration rate and kidney function, which produces more EPO to increase O2 uptake rate.
Some people acclimatize quickly, and can ascend rapidly; others acclimatize slowly

5. AMS: Acute Mountain Sickness
S&S – What you see
Headache
Dizzy or lightheaded
Nausea
HAPE = AMS + dry cough, respiratory distress, mild chest pain,
Severe Case = cyanosis / sputum / rapid pulse
HACE = AMS + loss of muscle coordination + altered mental state

6. AMS: Acute Mountain Sickness
Assessment
ABCs – listen to breathing sounds
LOR
Vital Signs
OPQRST – When did they get to altitude?
SAMPLE – History of altitude sickness?

7. AMS: Acute Mountain Sickness
Treatment
Descend
O2 if severe S&S, or decreased LOR
Position of comfort
Avoid exercise or exertion
Nonprescription drug for headache
Hydrate
Do not leave alone

8. High Altitude Sickness: Prevention
Gradual ascent
Never ascend with symptoms of AMS
Avoid overexertion
Consider prophylactics:
Acetazikamide (Diamox)
Dexamethasone
Combination of above
Ginko biloba

9. Frostbite
Frostnip
Superficial Frostbite
Deep Frostbite
Rate and Severity depend on ~ wind chill, alcohol a/o drugs, altitude, getting wet or being damp, length of exposure

10. Frostbite – what is happening?
The blood vessels constrict as a natural reaction to prevent body heat loss and hypothermia.
With a loss of warming blood flow the fluids in the body tissues and cellular spaces crystallizes
This freezing can damage the blood vessels causing blood clotting and lack of oxygen to the affected area and deeper tissues.

11. Frostbite – Alcohol & Nicotine?
Vasodilators (eg alcohol) causes blood vessels to stay open taking heat away from inner core. Your body therefore cools down faster, promoting hypothermia, and speeding up the onset of frostbite.
Vasoconstrictors (eg nicotine) constrict the extremity blood vessels even more than the body is already doing to maintain core temperature, thereby speeding up the onset of frostbite.

12. Frostnip (1st degree frostbite)
S&S – What you see
Most often seen on cheeks, earlobes, fingers, toes
Numbed skin that has turned white in color.
Freezing of top layers of skin tissue, usually reversible
As it heals, appearance is similar to that of sunburn (a 1st degree burn).

13. Frostnip (cont’d) Treatment
Rewarm by gently blowing warm air/placing against warm body part.
Don’t rub - can damage tissue.
Watch for S&S of hypothermia

14. Superficial Frostbite
S&S – What you see
The skin will be white or blue and will feel hard and frozen ; but tissue underneath is still soft
Blisters usually appear within 24 hours after rewarming.

15. Superficial Frostbite (cont’d)
Treatment
For resort environments, rewarming should be done under medical supervision
Rapid rewarming by immersion in warm (102° to 108°F) water. Need to monitor temp carefully
Continue for minutes or color goes to deep red or blue
Give hot drinks and keep patient warm
Rewarming hurts! Suggest ibuprofen
Do not allow to rethaw

16. Deep Frostbite S&S – What you see
Affected parts will have no feeling and blisters may be present.
The skin is white, blotchy and/or blue. The tissue underneath is hard and cold to the touch. Think - Frozen Chicken

17. Deep Frostbite (cont’d)
Treatment
Delay rewarming until it can be done once & done well. Refreezing ALWAYS causes gangrene.
If injury is extensive & thawing is difficult, try to keep the area frozen.
For resort environments, rewarming should be done under medical supervision
If injury is small area, field rewarming can be started
Rapidly rewarm in warm water (102° to 108°F)
Completely immerse the frozen tissue
Thaw completely

18. Deep Frostbite (cont’d)
Treatment: post thaw care
Prevent refreezing
Protect the thawed tissue from trauma
Air dry the extremity carefully; don't rub
Elevate to reduce swelling
Use gauze between fingers/ toes to keep areas dry as swelling occurs.
Do not constrict the extremity

19. Frostbite Summary ….DO’s
Have injury rewarmed under medical supervision
Stay warm after thawing.
Rest the injury (avoid walking on frostbitten feet, etc.).
Leave blisters intact & use sterile covering to prevent rupturing.
Keep affected part clean to reduce risk of infection.
Elevate the area above the heart

20. Frostbite Summary ….DON’Ts
Don't allow thawed injury refreeze as this can cause serious/permanent injury. Best to delay warming
Don't use dry heat (sunlamp, heating pad, etc.) to thaw the injured area.
Don't rub the area with snow.
Avoid alcohol, nicotine, other drugs that may affect blood flow.