Cold exposure injuries and the winter athlete

The winter athlete is faced with the hazards of injuries from exposure to low temperatures. Physicians who treat winter sports trauma must be prepared to manage the spectrum of these injuries including hypothermia, frostbite, and the combination of both. Hypothermia is primarily a problem of mortality, which can be lowered by gentle handling, close cardiac and electrolyte monitoring, and appropriate rewarming. Frostbite, a problem of morbidity from local tissue loss, can be treated most effectively with rapid rewarming in a water bath of 40 degrees-42 degrees. Spontaneous thawing with further injury to insensitive frostbitten members and refreezing injuries give a poor prognosis. The management of hypothermia and frostbite is directed first to hypothermia to lessen mortality and second to frostbite to decrease the morbidity.