It is that time of the year again: cold temperatures, fierce winds, and yes snow are all upon us. The scorching heat of this past summer and our concerns of heat illness are but forgotten.
Let us now turn our attention to the upcoming winter season and the injuries that can occur if we do not remain aware of the signs and symptoms to look for in our athletes and ways to prevent them.
There are two specific cold-related conditions that may result from cold exposure: (1) frostbite and (2) hypothermia. Frostbite is the freezing of fluid in the cells. There are various degrees of frostbite. “Frostnip” refers to a milder form of frostbite in which only the surface cells of the skin freeze, usually on the nose, ears, cheeks, fingers and toes. The affected skin may at first turn become flushed or reddened. Burning and tingling sensations are also common. If exposure continues, the skin may turn white and become numb. Frostnip is the most common type of frostbite affecting athletes and, if identified early, can be reversed without any tissue damage. Superficial frostbite involves the skin, and subcutaneous tissue. The skin becomes firm, white and waxy although the tissue underneath remains soft. Deep frostbite denotes full thickness skin and deeper tissue damage, including muscle and bone.
Hypothermia, very rarely seen in our athletes but extremely important to be familiar with, is a condition in which the core body temperature falls below 95ºF (35ºC). Participation in winter sports, such as cross-country skiing, running, etc., can present opportunities that may result in general cooling of the body to dangerous levels. In most cases of athletic-related hypothermia, exhaustion is a predisposing factor. As exhaustion sets in and the intensity of his/her effort slows down, the athlete’s core temperature starts to fall. Shivering will set in, which is one way the body tries to generate heat. As their temperature starts to fall, the skin will become cold and pale, their respiration will be depressed and a slow irregular pulse will be felt. Continued exposure will cause the athlete to show signs of irritability, incoordination, weakness, clumsiness and difficulty speaking (below 90ºF). If temperature depression continues the athlete will collapse into a coma and failure of the respiratory and cardiovascular systems will ensue.
Treating frostbite can usually be done without the need for emergency medical care. If an athlete has frostnip, the affected part may be warmed by blowing through cupped hands onto the skin, covering the area, or holding the extremity against the body and using body heat for re-warming.