Gordon Giesbrecht - Hypothermia Frostbite And Other Cold Injuries: Prevention, Recognition, Rescue, and Treatment

Figure A. Wind chill equivalent temperatures using the new calculations. Green indicates low risk of frostbite; yellow indicate increasing risk within thirty minutes of exposure; orange indicates high risk within ten minutes of exposure; darker orange indicates high risk within five minutes of exposure; and the red zone indicates high risk within two minutes of exposure.

Figure B. Violaceous discoloration of the tips of the first three toes indicating mild frostbite. (This injury occurred in a young climber who was unaware that he had frostbite until he took off his boots in camp. No tissue loss resulted.) Photograph courtesy of Cameron C. Bangs, M.D.

Figure C. Very early, mild frostbite of the toes and distal foot (blanched area) during rapid rewarming. Eventual tissue loss was limited to toe nails. Photograph courtesy of Bruce C. Paton, M.D.

Figure D. Blisters filled with clear fluid and blisters filled with bloody fluid, neither extending to tips of toes, in relatively severe frostbite of the feet. (This injury resulted from sitting in the snow, meditating, with no protection for the feet but sneakers, for four hours.) Photograph courtesy of Bruce C. Paton, M.D.

Figure E. Bluish discoloration of the thumbnail and fingertips and a blister filled with clear fluid proximal to the nail (not extending to the tip of the thumb) in frostbite of moderate severity. (This injury occurred when a male climber took off one mitten only for long enough to urinate during a severe blizzard. The other hand was not injured. The photograph was taken one day later.)

Figure F. Blackened thumb tip and dark purple finger tips of the same hand one week later. (The site of the blister has a normal color and was less severely injured than the more distal tissues, which did not blister.)

Photographs courtesy of Cameron C. Bangs, M.D.

Figure G. Bluish discoloration, distal areas with no blisters, and more proximal areas covered by blisters, some filled with bloody fluid, on feet that have suffered severe frostbite. (This injury occurred in a man who spent twelve hours in a refrigerated railroad boxcar at 0 F (-18 C) wearing snugly laced, high top boots. His feet and ankles, which had their circulation impaired by the boots, were the only tissues that suffered cold injury. Seven weeks after injury, the tissues not covered by blisters in this photograph are those that died, illustrating the difficulty of predicting the severity of tissue loss. Tissues covered by blisters containing bloody fluid usually die. Photograph courtesy of Cameron C. Bangs, M.D.

Figure H. Immersion foot. The arrow indicates the top of the boot.

Figure I. Severe immersion foot in an Argentine soldier of the Falklands war who wore his boots constantly for forty-four days without taking them off.

Photograph courtesy of the Argentine Navy Medical Department

Figure J. Rescuer using a throw bag to pull an immersed subject to shore. The victim has been instructed to wrap the rope around his arm because he may be unable to hold on to the rope if he is cold.

Figure K. Fully equipped rescuer with insulated dry suit and helmet, flotation sling, and flotation sled.

Floatingwater level below the bottom of the side windows.

Sinkingwater level above windows with water rising in the car but below the outside water level; pressure differences prevent the door from being opened.

Submergedwater has filled the car, the doors can easily be opened but no air is available for individuals to breathe. The best strategy is to exit during the floating stage following the sequence: Seat belts off; Children unbuckled; Windows open; Out, children first, through windows as quickly as possible.

Figure L. Three phases of vehicle submersion.

Theres a lot to be learned about remaining warm in cold weather and how to deal with emergencies when they arise.

Idaho Statesman

In the wilderness, sudden or prolonged chilling can combine with wetness to threaten the life of the hardiest hiker. Dr. Wilkerson and his colleagues educate you to prevent cold-related injuries where possible, and to treat them in the field when they do occur. A most valuable contribution.

Sierra, review by Jonathan King

A wonderful book that clearly describes cold injuries and their treatments.

Associated Press

SECOND EDITION

Gordon G. Giesbrecht, Ph.D.

James A. Wilkerson, M.D.

With the Assistance of

Andrea R. Gravatt, M.D.

Murray P. Hamlet, D.V.M.

Frank R. Hubbell, D.O.

CONTENTS

James A. Wilkerson and Gordon G. Giesbrecht

James A. Wilkerson

James A. Wilkerson

Gordon G. Giesbrecht and James A. Wilkerson