Interactive Ready for Review: Interactivities

Cold illness can be either a local or a systemic problem. Local cold injuries include frostbite, frostnip, and immersion foot.

is the most serious because tissues actually freeze with this injury, causing cellular damage. All patients with a local cold injury should be removed from the cold environment and protected from further exposure.

You can rewarm frostnipped parts, including immersion foot, with your warm hands or breath. On the other hand, you can cause further damage to a frost-bitten part by attempting to rewarm it in the field. If this is necessary because you cannot transport the patient to the hospital, immerse the part in water at a temperature between 100°F and 112°F (38°C and 44.5°C).

Patients who are exposed to the cold can also become . The key to treating such patients is to stabilize vital functions and prevent further heat loss. Do not attempt to rewarm patients who have moderate to severe %%2%%, because they are prone to developing arrhythmias unless handled very carefully.

Even if you cannot find a pulse, do not consider a patient dead until he or she is "warm and dead." Local protocol will dictate whether or not such patients receive CPR or defibrillation in the field.

The body's regulatory mechanisms normally maintain body temperature within a very narrow range around 98.6F (37C). The body can increase its core temperature by increasing its , for example, by shivering. In general, however, body temperature is regulated by losing heat to the atmosphere.

Regulation of body temperature can occur via five mechanisms: conduction, convection, evaporation, radiation, and respiration. Of these, are the most important.

The very young and the very old, as well as patients with certain diseases and medication regimens, are at increased risk of heat or cold injuries because their mechanisms are not as efficient as those of other patients.

Heat illness can take three forms: heat cramps, heat exhaustion, and heatstroke.

are painful muscle spasms that occur with vigorous exercise. They usually go away if you remove the patient from the hot environment, rest the affected muscles, and replace lost fluids (by drinking a lot of water).

, a more systemic illness, occurs when the body loses so much water and so many electrolytes that it becomes dehydrated.

Patients with heat exhaustion may be cool and clammy, weak or faint, confused, and have a headache. The pulse is often rapid. Body temperature can be high, and the patient may or may not still be sweating. Treatment includes removing the patient, if feasible, from the heat. IV fluids are usually necessary as the patient will typically complain of nausea.

Heat exhaustion can progress to . This is a life-threatening emergency, usually fatal if untreated. Patients with %%8%% may or may not still be sweating, but they will usually be dry and will have high body temperatures. Changes in mental status can include coma. Rapid lowering of the body temperature in the field can save the life of a patient with %%8%%. Fanning dampened skin and placement of cold packs around the neck, armpits, and groin are key.

Drowning and near-drowning incidents can occur even in areas that are not associated with water recreation. The first rule in caring for victims of such incidents is to be sure not to become a victim yourself. Take care to protect the spine when removing patients from the water, since spinal cord injuries, especially cervical spine injuries, are often involved in drownings. Be aware of the possibility of , especially in cold water immersions.

While some injuries associated with scuba diving are immediately apparent, others may show up hours later. Most significant injuries occur during ascent. Patients with or decompression sickness may have pain, paralysis, or altered mental status. Be prepared to transport such patients to a recompression facility with a hyperbaric chamber.