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MODULE 2 – PHYSICAL TRAUMA

 

ACCIDENT AND INCIDENT MANAGEMENT

 

ACCIDENTS

Accidents may happen at work, in the home, on the sporting field, during leisure activities or while travelling.

Accidents can be minor or life threatening and require appropriate management.

In the case of an accident the basic principles of first aid should be followed:

  • Ensure the safety of yourself, the casualty and bystanders
  • Call for assistance from bystanders and medical professionals
  • Act within your knowledge-preserve, prevent, promote, protect.
  • Document the incident and management
 

PRIORITIES AT THE SCENE OF A ROAD ACCIDENT

 

At the scene of a road accident a person may survive the initial impact, but if unconscious, can die from airway obstruction by foreign material, the tongue or even bleed to death. Action taken by the first person on the scene may prevent avoidable brain damage or loss of life.

first aid accident car carrara daz injury run night city ablaze canberra AT THE SCENE OF A ROAD CRASH

 
Before approaching, check for danger.
  • Make the accident scene as safe as possible for the casualty, first aiders and bystanders.
  • CASUALTIES ON A RAILWAY LINE OR ROAD MAY NEED TO BE MOVED TO SAFETY.
  • If unconscious, the casualty is usually turned onto the side to give a clear airway, while maintaining spinal alignment
  • Check to see if people are injured
  • Send for help
  • Stay with the injured casualty  
MAKE THE SCENE AS SAFE AS POSSIBLE
 To make the area safe you should:
  • Turn off ignition in the crashed vehicle
  • Warn approaching traffic (put on hazard lights)
  • Not touch a vehicle or attempt to rescue a person from within 6 metres of fallen power lines until the electricity authority has declared the area safe.
  • Warn the casualties and bystanders not to smoke
 
IDENTIFY AND ASSIST THE INJURED
 The first aider should
  • Identify the number of people injured and ensure that the ambulance has been called
  • Treat any unconscious casualty first by caring for airway, breathing, circulation.
ATTEND TO THE UNCONSCIOUS CASUALTY FIRST
 The first aider should:
  • Turn the unconscious casualty on the side and clear the airway if blocked
  • If resuscitation is needed follow DRABCD
  • Stop any severe bleeding promptly  
ATTEND THE CONSCIOUS CASUALTY
 The first aider should:
  • Stop bleeding promptly-improvise if necessary
  • Immobilise any obvious fractures
  • Allow the casualty to assume the position of most comfort
  • Talk reassuringly to all casualties
  • Constantly re check airway, breathing and circulation for any deterioration.
 REMEMBER: Prioritise care using the 5 Bs
  • Breathing
  • Bleeding
  • Burns
  • Breaks
  • Bites/stings 

SHOCK

 Shock is the term used to describe loss of effective circulation.

This can be caused by

  • a problem with the pump (heart)

  • a problem with the tubes (veins and arteries)

  • Not enough blood to pump (blood or fluid loss)

  • A combination of the above 

SOME CONDITIONS THAT MAY CAUSE SHOCK
  • Severe blood loss
  • Major or multiple fractures
  • Major trauma
  • Severe burns or scalds
  • Severe diarrhoea and/or vomiting
  • Severe sweating and dehydration
  • Heart disorders (heart attack)
  • Abnormal dilation of blood vessels (eg- severe infection, allergic reactions, severe brain/spinal cord injury 

SIGNS AND SYMPTOMS

The casualty’s condition will depend on the severity of the underlying cause and may include:
SYMPTOMS
Reduced level of consciousness
Faintness
Nausea/vomiting
Shortness of breath
Feeling cold
 
SIGNS
  • Pallor
  • Cold sweaty skin
  • Gasping for breath
  • Confusion or deterioration of level of consciousness
  • Rapid, weak pulse.
  • In early stages of blood loss children and young adults may have a normal pulse rate but pallor is the warning sign.  
MANAGEMENT
Ensure the situation is safe
Care for the airway, breathing and circulation
Manage the cause of the shock.

FRACTURES AND DISLOCATIONS

 FRACTURE

A fracture is an injury to the BONE, a break in the continuity of the bone. This can be a crack, a splinter a partial separation or complete separation. Some fractures can be complicated, where the surrounding tissue is damaged causing bleeding or where the bone protrudes through the skin. 

SIGNS and SYMPTOMS OF A FRACTURE
  • Pain is the primary symptom
  • Swelling
  • Deformity or shortening of the limb
  • Tenderness
  • Grating
  • Guarding
  • Exposed bone ends 
MANAGEMENT
  • Support and immobilise the limb by splinting. Improvisation may be required to access suitable solid material as a splint.
  • The joints above and below the fracture should be immobilised.
  • Refer the casualty for medical treatment preferably by ambulance.

The aim of management of a fracture is to immobilize the area to:

  • Prevent damage to surrounding nerves, tissue and blood vessels
  • Minimise swelling and bleeding
  • Minimise pain

 DISLOCATIONS

A dislocation is an separation of the bone from its normal position within the joint. The most common joints to suffer dislocation are the shoulder, elbow, finger, hips and ankle.

The principal symptoms of dislocation are pain in the joint and LOSS OF MOTION. The principal sign is deformity. If the dislocated bone is pressing on nerves or blood vessels there may be numbness or paralysis below the dislocation

DO NOT ENCOURAGE OR TRY TO REPLACE THE DISLOCATION.

REFER FOR MEDICAL TREATMENT

Support and immobilise the joint in the position it was found.

 

SOFT TISSUE INJURIES

 

SPRAINSsprain ankle pain first aid ablaze canberra

 
A sprain is an injury to a joint where the ligaments surrounding a joint have been damaged.
This usually occurs from the sudden twisting of the joint beyond its normal range of movement.
Sprains most commonly affect the wrist, knees and ankles.
 
SIGNS AND SYMPTOMS
Pain
Swelling
Discolouration
 
MANAGEMENT
Rest
Ice
Compression
Elevation
And refer for medical treatment.
 

STRAINS

 
A strain is a soft tissue injury, usually affecting the muscles around a joint. A strain is often caused by over exertion or working a muscle too hard.
 
SIGNS AND SYMPTOMS
Pain on active movement
 
MANAGEMENT
Rest
Ice
Compression
Elevation
 
IF YOU ARE UNSURE IF THE INJURY IS A SPRAIN, STRAIN, DISLOCATION OR FRACTURE, TREAT AS A FRACTURE AND SUPPORT AND IMMOBILISE.
 
 
 

BLEEDING

 
THE PRINCIPAL AIM IN THE MANAGEMENT OF BLEEDING IS TO PRESERVE THE VOLUME OF CIRCULATING BLOOD IN THE CASUALTY.
 
The blood volume in an adult is between 41/2 and 6 litres of blood. Loss of blood in a large amount or in a short time can induce shock in the casualty.
400 ml of blood lost in a short time is enough to induce shock. It is critical in any incident that bleeding is managed as soon as possible.
 

EXTERNAL BLEEDING

 
MANAGEMENT
Call for an ambulance
The use of direct sustained pressure is usually the fastest, easiest and most effective way to stop bleeding. However in some cases the use of indirect pressure may be required.
To reduce the risks of cross infection, personal protective equipment should be worn if readily available.
Inspect the wound for embedded objects that may increase damage if pushed further into the wound. If no embedded object is evident, use the direct pressure method. However if there is an embedded object indirect method is appropriate.
 
DIRECT PRESSURE METHOD
To control bleeding:
If a specific bleeding point can be identified, apply direct pressure to this point
Instruct the casualty to place pressure directly onto the wound if able
If the casualty is unable to assist, apply direct pressure using gloved hands or a pad
Squeeze the wound edges together if possible
Elevate the bleeding part if possible
Apply a pad over the wound if not already in place and secure with a bandage ensuring that the pad remains over the wound.
 
If the bleeding is not controlled by the initial pad, leave the initial pad in place and apply a second pad and bandage over the first.
If bleeding continues through the second pad, replace the second pad and bandage.
When major bleeding continues it may be necessary to remove the initial pad to ensure that specific bleeding point able to be controlled by direct pressure has not been missed.

EMBEDDED OBJECTS

 
Do NOT attempt to remove embedded object because it may be plugging the wound and restricting bleeding
Place padding such as a ring pad around the object and bandage firmly over the padding
If bleeding is not controlled by the initial pad leave the initial pad in place and apply a second pad over the first.
If bleeding continues through the second pad replace only the second pad and bandage
 
CONSTRICTIVE BANDAGE
 
As a last resort where other methods of controlling bleeding have failed, a constrictive bandage may be applied to a limb to control life threatening bleeding, for example traumatic amputation of a limb or major injuries with massive blood loss.
Apply a WIDE bandage (at least 5cm) directly above the elbow or knee. The bandage should be tight enough to stop circulation to the injured limb and control bleeding.
 

AMPUTATION

 
Amputation is where a limb or part of a limb has been severed from the body.
 
The first priority with an amputation is to manage the bleeding injury. After the bleeding is under control:
Find the amputated part
Wrap the part in clean cloth
Place it in a plastic bag and seal.
Write name of casualty and time of accident on the bag
Keep the part cool by putting it in a container of ice water, or ice slurry. Avoid direct contact between the severed part and the ice.
DO NOT PUT INTO FREEZER
Ensure an ambulance has been called
 

INTERNAL BLEEDING

 
RECOGNITION
Internal bleeding may be difficult to recognise, but should always be suspected after a traumatic or high velocity injury.
 
SIGNS AND SYMPTOMS may include:
Obvious symptoms of shock (pale cold clammy skin, anxiety and restlessness, rapid weak pulse, rapid shallow breathing, fainting)
Pain, tenderness or swelling over or around the affected area
Appearance of blood from a body opening eg
Bright red and/or frothy blood coughed up from the lungs
Vomiting blood which may be bright red or dark brown (coffee grounds)
Blood stained urine
 
Rectal bleeding which may be bright red or black and tarry
 
MANAGEMENT
Internal Bleeding cannot be controlled by a First Aider but the following measures can do much to save a life.
Call for an ambulance
Reassure the casualty
Assist the casualty to lie down
Raise the legs if injuries permit
Monitor airway, breathing and circulation at frequent intervals
Do not give any medications or alcohol
Do not permit the casualty to have anything to eat or drink
 

CRUSH INJURIES

 
The term CRUSH INJURY can occur in a wide range of situations which include a person crushed by a car or by falling masonry, by a mine shaft collapse or a trench cave in, by an industrial accident or by prolonged pressure due to the bodyweight of an unconscious person.
 
MANAGEMENT
If it is safe and physically possible, all crushing forces should be removed as soon as possible after the crush injury
Call an ambulance
Keep the casualty comfortable
DO NOT use a tourniquet for the first aid management of a crush injury
Continue to monitor the casualty’s condition and vital signs
IMPORTANT: Although the casualty may appear alert and not unduly distressed, severe and irreversible damage may have been sustained and the casualty’s condition may deteriorate.
 
If the crushing force is applied to HEAD, NECK CHEST OR ABDOMEN and is not removed promptly death may ensue from breathing failure, heart failure or blood loss.
 
 

WOUNDS

 
A wound is an injury to the skin and soft tissue beneath.
The skin acts as a barrier keeping out infection, it carries blood vessels to warm and nourish the skin, it carries nerves and sweat glands. Any damage to the skin threatens the body as the barrier is broken and infection can enter the body.
 
Wounds can be
open (when there is a break in the outer layer of skin) or
closed ( when there is damage but the skin is still in tact)
 
Types of wounds are
Bruise- bleeding and tissue damage under the skin
Abrasion- (graze) the outer layers of skin have been scraped away. Bleeding is not usually severe, but as the skin is broken, care needs to be taken in cleaning the wound
Incision- cut, often from a sharp object. If the incision is deep then the underlying layers of tissue, muscle and fat may be damaged. There may be profuse bleeding.
Laceration-cut with jagged edges. This is often caused by a blow where the skin has split. There could be profuse bleeding
Avulsion-Part of the skin tissue is folded back or torn away completely. As an avulsion may involve deeper body tissues the bleeding could be severe.
Puncture wound-piercing of the skin with a pointed object. Because the skin will often close around the object bleeding may not be severe. If the object is still embedded DO NOT remove it.
Management
Follow DRABCD
Manage bleeding
If bleeding is severe call an ambulance
 

WOUNDS THAT NEED SPECIAL CARE

 

ABDOMINAL WOUNDS

The abdomen is the area between the chest and the pelvis. There is little protection for the abdomen. Vital organs are contained in the abdomen-liver, spleen, stomach, pancreas, kidneys and intestine.
Abdominal wounds may or may not be externally visible.
Signs and symptoms of a severe abdominal injury could include:
Nausea and vomiting
Pain, tenderness or discomfort in the abdomen
External bleeding
Bruising
Severe pain
Skin redness
If the wound is open with internal organs exposed:
The casualty should be placed in a half sitting position, with legs slightly raised.
Do Not attempt to replace organs that are protruding
Cover the wound with a moist dressing to prevent the wound drying out
Secure the dressing with a broad bandage
Do Not apply pressure to the wound. Attempt to pinch the edges of the wound together to control bleeding
Call an ambulance
Continue to monitor- do not leave casualty alone
 

PENETRATING CHEST WOUNDS

If an object penetrates the chest wall and punctures the chest cavity allowing air to enter the chest through the wound, this can cause the lung to collapse.
If air is entering the chest cavity through the wound you may hear air movement with every breath.
You may see bubbly bright blood coming from the wound and the casualty will have distressed breathing.
Management of penetrating chest wounds:
Ask the casualty to cover the wound with his hand temporarily
Place the casualty in a comfortable position, usually semi-sitting
Cover the wound with a sterile dressing. Make a valve, using a non absorbent material eg cling wrap, foil.
Monitor the casualty and seek urgent medical assistance.
If casualty becomes unconscious place on affected side and follow DRABCD

SCALP WOUNDS

 
Scalp wounds can bleed profusely or little. In managing a scalp wound you must be aware that any feeling of swelling, sponginess, movement or pain under the wound could indicate a skull fracture and must be managed accordingly.
 
Management:
Control bleeding with direct pressure
Apply a pad and bandage
Assist the casualty to a comfortable position
Monitor the casualty for changes in conscious state
Refer to medical assistance
If the casualty becomes unconscious manage as DRABCD
 

EYE INJURY

 
SIGNS & SYMPTOMS
Loss of blood or fluid from the eye
Unusually profuse tears
Impaired or loss of vision
Pain
MANAGEMENT
Cover the affected eye with a pad and bandage lightly
Do Not put pressure on the eye
Ask casualty to keep eyes still, suggest focus on a point in the distance
Refer to medical assistance
If an object is protruding from the eye DO NOT attempt to remove it.
Stabilise the object (eg with a paper cup) before bandaging.
 
A foreign object on the surface of the eye should be flushed. Tilt the head with the injured eye down and flush downwards. Chemicals in the eye must be flushed until ambulance arrives
 

EAR WOUNDS

 
In any management of wound to the ear it is important not to plug the ear.
Allow the fluid to drain, catching it in a pad. Bandage lightly and monitor casualty’s condition (DRABCD)
 
 

HEAD INJURY

 
Injury to the head may cause loss of consciousness, damage to the brain, eyes, ears, teeth, airways, mouth.
Severe head injury may lead to death or permanent brain damage.
 
The maintenance of a clear airway is the first priority in the care of a head injury casualty and takes precedence over the management of associated injuries.
 
Head injury may be associated with
Altered level of consciousness
Bleeding
Damage to the upper airway
Spinal and other injuries
 

SIGNS AND SYMPTOMS

 
Casualties suffering from a head injury may be:
Conscious
Unconscious
Subject to changing levels of consciousness
 
An assessment by a medical practitioner is essential in all cases where a casualty has been unconscious.
 
The casualty who has not lost consciousness due to a head injury requires urgent medical assessment if any of the following symptoms are displayed.
 
The casualty may :
Become unconscious, drowsy or vague
Have memory impairment
Appear agitated or irritable
Have slurred speech
Show incoordination or loss of power in limbs
Complain of headache or giddiness
Vomit or complain of nausea
Have a seizure
Have bleeding or fluid discharge from nose, ears or mouth
Develop changes in size of pupils
 
 

 MANAGEMENT

 
Management of unconscious casualty follow DRABCD
 
The First Aider should
Turn the casualty onto the side and obtain a clear airway
Check for breathing
Check and control bleeding and cover wounds
Arrange transport to hospital by ambulance
 
While waiting for ambulance you should note any:
Change in level of consciousness
Bleeding from ears, nose mouth
Seizures
 
While regaining consciousness after a head injury a casualty may:
Vomit
Have blurred vision
Be irrational or uncooperative
Have memory lapse
Be dizzy
Unable to recall events surrounding the accident
 
The casualty should not be left alone.
If consciousness returns, the casualty should be given reassurance, kept lying down at rest and ambulance called.
 
BLEEDING AFTER HEAD INJURY may occur:
From scalp and facial wounds
Inside the skull
Under the skin
 
Significant blood loss can occur from scalp and facial wounds. Obvious bleeding can be controlled by direct pressure: use a dressing and bulky padding, where those are available.
 
Serious bleeding can occur beneath the skin, especially in children, producing a large lump (haematoma). This bleeding should be controlled by direct pressure.
 
 
 
 
The effect of bleeding inside the skull putting pressure on the brain, may be indicated by deterioration of the casualty’s condition. For this reason the casualty’s conscious state should be monitored continuously.
Bleeding from the ear canal may indicate a fracture of the skull. The ear canal should not be plugged, but the external ear may be loosely covered with a dressing. If bleeding from one ear only, place bleeding ear down to allow drainage.
 

AIRWAY PROBLEMS

 
Airway problems associated with head injuries may include:
Fractures and lacerations around the mouth or nose
Bleeding into the airway
Foreign bodies including vomit, partial dentures or dislodged teeth
 
 
ASSOCIATED INJURIES
 
Casualties with head injuries often have other major injuries which require recognition and appropriate management.
 
In any unconscious casualty avoid twisting or bending the neck because of the risk of associated injuries of the cervical spine. Handle the casualty with care but airway management ALWAYS takes priority.
 

BURNS

 
DEFINITION
 
A burn is an injury resulting from heat, chemical, electrical or radiation energy or a combination of these agents
 
A significant burn, for the purpose of this course includes:
A flame/scald injury greater than the size of the casualty’s palm or any size involving hands, face or perineum
Chemical Burns
Electrical Burns
Inhalation injuries
 

ALL INFANTS AND CHILDREN WITH BURNS SHOULD BE MEDICALLY ASSESSED

 

GENERAL PRINCIPLES OF MANAGEMENT

 
Ensure safety of both first aiders and bystanders
 
Do not enter a burning or toxic atmosphere without appropriate protection
This is the role of fire-fighters
 
Stop the burning process-stop, drop, roll
 
A rescued person should be moved to a safe cool environment as soon as possible.
 
Assessment and management of the airway, breathing and circulation takes priority
 
Call an ambulance to facilitate rapid transfer of casualties with significant burns injuries to hospital
 
Ascertain the mechanism of the burn injury to determine the likelihood of other coincident injuries or the inhalation of hot gases, flame or toxic substances
 
Immediate cooling of the affected area with water may be necessary depending on the cause of the burn injury
 
If possible remove all rings, watches, jewellery or other constricting items from the affected area without causing further tissue damage
 
Where feasible elevate burnt limbs
 
Cover the burnt area with a loose and light non stick dressing, preferable sterile or clean dry lint free material eg plastic cling wrap, handkerchief, sheet, pillow case.
 
DO NOT peel off adherent clothing or other substances
DO NOT use ice to cool the burn because frostbite may result
DO NOT break blisters
DO NOT apply lotions, ointments, gels, creams, powders
 

THERMAL BURNS

Ablaze First Aid burn fire arm funny kitchen sleeveThermal burns include flame, scald blast (hot gas) inhalation injury and direct heat contact.
 
FLAME: STOP, DROP, ROLL the casualty to put out the flame
Smother flames with a blanket, coat or other appropriate item and assist the casualty to lie on the ground or floor.
Immediately cool the area with cool water for up to 20 minutes to reduce further tissue damage and to help relieve pain.
 
If water is not available, remove smouldering clothing if it is not stuck to the skin. Synthetic fabric burns at a high temperature and melts into a hot plastic residue which will continue to burn the casualty. Avoid pulling burnt clothing across the casualty’s face or unburnt areas.
 
 
SCALD
Immediately cool the burnt area with cool water for up to 20 minutes. After covering the burn the casualty may then be warmed with a blanket.
 
If cool water is not available, remove all wet non adherent clothing immediately because clothing soaked in hot liquids retains the heat.
 
Take care when removing hot, wet clothing over casualty’s face or unburnt areas. Hot liquid may be retained in natural body creases eg neck, groin, thus delaying the dispersion of heat.
 

ELECTRICAL BURNS

 
Typically, electrical burns injuries are more severe than is apparent from external appearance. Electrical injuries are associated with high or low voltage (the latter being defined as less than 1000 volts) and either DC or AC current. Electrical injuries from DC are unusual unless very high voltages and currents are involved. Lightning is an example of this. Household supply in Australia is 240 volts AC at 50 cycles per second (hertz).
 
High current flow may be associated with an entry and exit wound where the current density is highest, but most of the damage is to the deep unseen tissues which can be severely and extensively damaged by heat.
 
Flow of current through the heart ,particularly AC may cause a cardiac arrest.
 
Priorities in management of a casualty of electric shock are:
Ensure the safety for first aider and bystanders
Disconnect the casualty from the power source without directly touching the casualty
Commence CPR if required
Use water to cool entry and exit wounds or wounds from electrical flash burns.
Avoid contact with conductive material (metal, water etc) when dealing with electricity.
 
 

LIGHTNING BURNS

 
The mechanism for lightning burns can either be a direct strike or a side flash.
 
A direct strike will be associated with high current flow and heating. Lightning is direct current (DC) with voltages in the order of 100,000,000 volts and a current flow of up to 200,000 amps
 
A side flash is a current flow between an object struck by lightning and a nearby person. This current can travel on the surface of the body causing superficial spidery patterned burns to the skin.
 
The priorities of management of lightning burns are to:
Commence resuscitation if required
Cool superficially burnt areas with cool water
Assess and manage any other injuries

RADIATION BURNS

 
May be caused by solar ultraviolet radiation (sunburn), welders arc lasers, industrial microwave equipment, nuclear radiation.
 
MANAGEMENT
 
Cool any locally burnt areas with water up to 20 minutes.
 
Offer drinks of clear fluid.
 

CHEMICAL BURNS

 
Acids and alkalis react with body tissue causing direct tissue damage and releasing heat. Alkali burns can be more serious than acid burns as they penetrate more deeply.
 
The important priorities of management for the first aider are to :
AVOID CONTACT WITH ANY CHEMICAL OR CONTAMINATED MATERIAL (USE CHEMICAL RESISTANT INDUSTRIAL GLOVES)
Remove the chemical and any contaminated clothing as soon as practical taking care to avoid contact with the chemical.
Brush powdered chemicals from the skin prior to flooding the area with copious amounts of water, preferably with shower or hose for 20 to 30 minutes. This will allow maximum dilution of the chemical.
Pay particular attention to skin folds and creases.
 
DO NOT attempt to neutralise either acid or alkali burns because this will increase heat generation which may cause more damage.
 
Chemical burns to the eyes require continuous irrigation until medical assistance has been obtained. Ensure irrigation includes under lids.
 
 

PHOSPHORUS BURNS

 
Phosphorus may be found in flares, fireworks or made in chemistry labs. When exposed to the air phosphorus may ignite spontaneously.
It is therefore important to keep the area wet, if possible by immersion in water. If forceps are available, remove any obvious particles. DO NOT USE FINGERS.
 
 

HYDROFLUORIC ACID BURNS

 
Hydrofluoric acid is used as a cleaning agent by jewellers, in glass etching and in other industries. It is one of the most penetrating and tissue reactive acids which causes a full thickness skin burn and exceptional pain- even a small area or persistent pain needs urgent medical assessment.
Early and copious irrigation with water is needed.
 
If available an early application of calcium gluconate gel to the affected area may form an insoluble salt and reduce further pain and damage.
DO NOT USE FINGERS
Calcium gluconate should be available at all worksites where hydrofluoric acid is used.
 

BITUMEN BURNS

 
Bitumen or any other hard, hot, stuck substance should not be removed from the casualty’s skin unless it is obstructing the airway because it may cause more damage. As it will hold much more heat, irrigation with cool water should continue for 30 minutes.
 
Consider scoring or cracking the bitumen if it is encircling a limb or digit.
 

PETROLEUM PRODUCTS

Petroleum “burns” may cause chemical burn due to the direct toxic effects. Prolonged contact has been associated with organ failure and death. Copious irrigation with water is required.
 
 
 
COLD INJURY
 
Exposure to cold conditions can lead to generalised cooling of the body or localised cold injury. The latter may be Freezing cold injury (frostbite) or Non freezing cold injury (NFCI or Trenchfoot)

FREEZING COLD INJURY

 
Frostbite results from the freezing of the tissues causing ice crystals formation and blocking of small blood vessels. The areas most commonly affected are those exposed to cold windy conditions eg face, ears and those with the most peripheral blood supply eg fingers and toes. Frostbite can most simply and usefully be classified into superficial frostbite in which only the skin is frozen and can still be moved in relation to underlying tissue; and deep frostbite involving deeper tissue. The vast majority of cases occurring in Australia are of the superficial type.

SUPERFICIAL FROSTBITE

Seek shelter. Get out of the cold and wind
DO NOT rub frozen tissue
DO NOT use radiant heat to warm affected part
Rewarm the affected part immediately by gently placing the affected fingers in the opposite armpit or by placing a warm hand over the frostbitten cheek or ear. Rewarming can be very painful.

DEEP FROSTBITE

Seek shelter
REMOVE CONSTRICTIVE OR DAMP CLOTHING IF DRY REPLACEMENT CLOTHING IS AVAILABLE
Wrap in warm blankets and give warm fluids by mouth
If tissue is frozen at time of presentation the best tissue survivability results from placing the injured part in a warm water bath with circulating water (40-42c)until the affected part thaws. This may take 30 minutes or more. This is best done in controlled conditions in hospital.
If tissue has spontaneously thawed at time of presentation affected tissue can be bathed at a more comfortable temp(30-35C)
Elevate the affected part
DO NOT use radiant heat
DO NOT break blisters
NEVER thaw apart if there is any likelihood of refreezing.



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