baby, it’s cold outside

Tuesday, January 18, 2011

There is a fine line between bravado and stupidity and crossing that line can be watched at any NFL football game played in the middle of winter. While players bare their arms in subfreezing weather, television cameras routinely highlight shirtless fans showing their disdain for common sense. While football players bundle up in parkas and stand beside heaters on the sideline, bare-chested fans are left to face the elements alone except perhaps for the liquid courage of alcohol. Frostbite and hypothermia are the consequences of cold exposure and both can have long lasting effects.

Not all organs in the body are created equal. While the body tries to maintain a constant temperature where heat production is balanced by heat loss, it is quite willing to sacrifice expendable parts like arms and legs to protect vital organs like the heart and brain. When exposed to a cold environment, the body tries to keep blood circulating away from the skin where it can be cooled by the outside weather. Shivering starts to generate heat and can compensate well if the cold exposure is short lived. If, however, the body remains in the cold, bad things can happen very quickly.

The electrical conducting systems of the brain and heart are very sensitive to decreasing core body temperatures and start to fail as the body cools. Hypothermia is defined as a body temperature less than 95ºF (35ºC) and mild hypothermia can present with lethargy and confusion. The colder the body gets, the more confused the person gets and decision making begins to suffer. Instead of coming out of the cold, apathy sets in and the patient may become delirious.

Interestingly, there is a phenomenon called paradoxical undressing, where the cold person actually undresses instead of trying to bundle up more. It is not uncommon for the hypothermic victim to just curl up in a snow bank and die. The heart also does strange things when it gets cold. A normal heart rhythm can become irritable and eventually degenerate into ventricular fibrillation, where the bottom chambers of the heart jiggle like a bowl of jello. That lack of electrical impulse doesn’t allow the heart to beat and pump blood to the body and is one of the causes of sudden death.

Alcohol consumption is an important risk factor for getting cold. Aside from impairing judgment, it causes blood vessels in the skin to dilate, sending blood to the body’s surface where it is exposed to the cold weather and causing just the opposite effect of what the body wants to do to preserve heat. Alcohol also makes shivering less effective, decreasing heat production. Paradoxical undressing does not necessarily apply to football fanatics who decide to bare all in support of their local team, but the liquid courage of alcohol is a poor partner.

With decreased blood supply to the skin, the far reaches of the body’s circulation are at risk for damage. Fingers, toes, ears and nose are the first parts of the body to be at risk for frostbite. Without adequate blood supply to provide internal heat, water crystals in the tissue can form small ice crystals and the first signs of frostbite begin. The skin becomes cold, numb and hard. The hands or feet can become clumsy and after a time, the skin can blister.

The stages of frostbite are similar to those of burns. Frostnip or first degree frostbite is superficial and reversible but may cause significant pain when the extremity rewarms. Second degree frostbite is characterized by blisters that form a few hours to a day after injury and signify deeper tissue damage. Third degree frostbite describes skin that has been damaged though all its layers and tissue that turns black and hard as it dies.

For some reason, football players have decided that it is a sign of strength to ignore the cold and show their opponents that they are mentally stronger than the environment. Not too long ago, this was the same mentality that caused players to deny themselves water on hot days. Common sense prevailed and a player dying of heat stroke is now a rarity and a case of heat exhaustion often leads to an inquiry.

Cold is a dangerous element. When the media celebrates the bad decision making of player and fan alike, it can lead to the misperception that frigid temperatures are not lethal. Of course, if you see it on television, it must be true…not.

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