FROSTBITE PRACTICAL SUGGESTIONS

Frostbite means that skin and underlying tissue actually freeze. This condition rarely occurs in still air above -10°C but may do so at higher temperatures in high winds due to the wind chill effect). It cannot be emphasised strongly enough that frostbite need not happen even at extremes of altitude, temperature and fatigue: frequently a degree of carelessness is the chief cause.

Recognition

Below minus 10°C, any tissue that feels numb for more than a few minutes may become frostbitten. Although all climbers are well aware of having suffered from numb cold feet or hands for hours at a time with no ill effects, it is important to realise that while being frost-bitten the subject is senses no more than this familiar numbness. It is wise therefore to have some idea of the temperatures in unfamiliar terrain: many miniature portable thermometers are available, so clip one on your sack or outer jacket zipper tab. If you feel the numbness and the temperature is particularly low it's time to act - flexing the fingers and toes, stamping the feet, clapping your hands or placing them in the armpits or groin should all bring back some sensation. If not, assume some degree of frostbite (probably frostnip) and perform more specific re-warming with warm water as below.

In early (superficial) frostbite in the unthawed state, the skin is yellow-grey, painless, numb and leathery to the touch - pain (lots of it!) occurs as re-warming takes place. In deep frostbite, the tissue is hard, white and obviously frozen like a piece of chicken from a freezer, and medical advice must be sought as soon as possible.

Emergency treatment

For all but trivial frostbite (e.g. a cheek, a fingertip) evacuation to a place of safety is essential. If the feet are frostbitten the difficult decision has to be made about the patient moving on foot. There are no absolute rules but in general, it is better to move for six hours with frozen feet to a place of safety than to thaw the feet at a high camp. Walking on vulnerable inflamed unfrozen tissue can cause further injury.

Once safe, re-warming should begin immediately. Avoid smoking (nicotine contracts blood vessels), but alcohol may be helpful (it dilates blood vessels) - however only provided hypothermia does not co-exist. If possible, immerse the frostbitten area in a saucepan of hand hot water - 39-42°C is optimal. If you have no thermometer heat the water until it is "really quite hot" to the touch, about as hot as your elbow can stand: take great care not to scald the patient! Immerse for periods of 20 minutes, moving fingers and toes if possible, but do not knock or rub the frozen tissue.

Thawing may be extremely painful, but perseverance is the key! After thawing, wrap gently in clean bandages, separating fingers and toes. The victim must use thawed tissue as little as possible - this may require them being nursed, fed and helped at the lavatory by colleagues. If a hot water container is not available, warm the affected parts in a warm sleeping bag (or on the abdomen, groin or armpits) for several hours. Above 5500m, oxygen should be given if it is available.

Further progress of frostbite

A few hours after thawing the tissue swells and during the first two days giant blisters form. Try not to break them, these blisters will settle during the first week albeit to leave tissue hideously discoloured, and if gangrenous, shrunken and black. This carapace, or shell separates in several weeks. If the frostbite is superficial, pink new skin will appear beneath the carapace, if deep, the end of a toe or finger will gradually separate off - an unsightly but usually painless process.

By far the most important emergency treatment after re-warming is to keep the skin as clean as possible to avoid any infection.

Risks and implications of frostbite

The disability caused by frostbite often leads to increased risks in descending difficult ground and usually means abandoning a climb. Anything more than very trivial frostbite means the end of climbing for the patient for a few months at least. It is wise to warn newcomers to cold conditions of these implications - adequate clothing, spare gloves and dry socks should always be carried; boots should not be too tight and if using plastic boots, consider carrying spare inners.

Long term management

There are widely disparate views on the use of drugs in frostbite, a tacit admission that few are really effective. It is imperative to keep damaged tissue free of infection: antibiotics may be necessary, and tetanus toxoid prophylaxis is often recommended.

It is extremely difficult to predict the outcome in the first few weeks after frostbite, and remarkable recoveries occur. Surgery is usually best avoided for several weeks or even months, until it is clear that there is no other alternative.

Summary

Frostbite on a climb is a major emergency, yet with competent nursing care most cases can be looked after in the field, e.g. at a Himalayan base camp. Frostbite can frequently be avoided, but when it does occur, it increases the risks both to the sufferer and their colleagues. Rapid re-warming is recommended and strict adherence to hygiene, but surgery is usually best delayed for at least several weeks, or months.

The UIAA Mountain Medicine Centre is supported by:

Mount Everest FoundationFoundation of Sport and the ArtsBritish Mountaineering Council.

Reference: UIAA Mountain Medicine Centre

FOOT INJURIES

The body's foundation originates with the feet, which support the body weight in a myriad of positions and function over a multitude of surfaces and contours. Most athletic activity begins with and is dependent on the feet. As such, the feet continually bear the brunt of physical stresses and rapidly changing forces thrust on them from all directions.

Injuries involving an athlete's feet are often magnified in severity because the feet are weight bearing structures. A relatively minor injury of the foot can impair an athlete's performance as dramatically as a major injury to another body area. Proper and adequate care should be given all injuries and athletic related conditions of the feet, no matter how minor they appear. 

THE FEET CAN MEASURE THE HEIGHT ( Forensics )

The bones of the feet can tell a lot about a person. What do feet reveal about a person's height? Forensic anthropologists team up with law enforcers to help solve crimes.

Bones of the feet can reveal an interesting fact about an individual. Let's combine math with forensics to see how.

Create a spreadsheet.

List the individuals name, height, and foot length.

Have some adults remove their shoes and measure their height.

Measure the length of the adult's left foot from the wall to the tip of the big toe.

Examine the numbers. Do you see a pattern?

Divide the length of each person's left foot by his/her height. Multiply the quotient by 100. What do you get? You may also want to use the calculator on a computer for this activity.

The results of your calculations should be about 15, illustrating that the length of a person's foot is approximately 15 percent of his or her height.

Find out the approximate height of each of your classmates by measuring their foot and charting it on a spreadsheet. Use this proporation for your calculations: 15/100 = Length of Foot/x (person's height)

When a forensic scientist has the length of a foot, the forensic scientist will be able to approximate the height of the individual. This works best on a full grown individual for the ratio of body parts is slightly different in growing children.

Reference Cyberbee

Sterile environments anything but routine

"There is no such thing as a sterile operating room environment," said Dale Bratzler, MD, of the Oklahoma Foundation for Medical Quality, who helped write national guidelines for reducing infection after surgery. "We make things as clean as possible, but most hospital surfaces still contain bacteria."

This chilling quote comes from a November Boston Globe article about a series of infections at a New England hospital. One of the infections may have been responsible for a patient's death. And this hospital, it should be noted, has a national reputation for an aggressive approach to infection control, according to the article.

In the situation cited in the Globe, the surgeon unknowingly had a staphylococcal infection, which went into his nose. The bacteria then went through his surgical mask and into the patient's lower back through the incision.

Podiatry Source Journal : Foot care

Foot care is quite essential, even for those holidaying and relaxing at beaches and resorts in Southern Europe for the winter. If taking the occasional walk on the beach or a leisurely swim in the ocean is the extent of your vacation activity, be sure to listen to your feet. The following footcare tips are by Steve Kite will help you to live enjoy yourself safely when travelling in Southern Europe.
Always wear shoes or sandals while walking on sand, in order to prevent foot injuries from hot sand and objects that may be hidden beneath the sand. Make sure your sandals are well secured too, especially around the ankle.
Be sure to apply sunscreen to feet while basking in the sun; the skin on the feet is very sensitive and needs to be protected against the sun's harmful rays and you should wear a sunscreen no less that 30 Spf.
When buying sandals, be sure to look for ones that are comfortable and have plenty of arch support to prevent foot problems such as tired, achy feet and corns, calluses and blisters. . Fungus infections, which are responsible for Athlete's Foot, thrive in warm, moist environments including pool decks.

Podiatry Source Journal : Agility

Agility:In sport, agility is characterised by fast feet, body coordination during change of direction and sports skill performance, and reaction time/ ability. It is an amalgam of balance, speed, strength, flexibility and coordination. Although a performer’s agility relies heavily on the acquisition of optimum sports technique, it can also be enhanced by specific conditioning.

A variety of performance-enhancing agility drills, systems and items of equipment are available to the sportsmen of today and their coaches. The ‘science’ of agility (and speed and power) training has made rapid strides recently, especially in terms of its accessibility to the mainstream sporting world.