Parish Nurse – Educational Update 

WINTER EMERGENCIES 

Winter is here again with freezing temperatures, ice, snow and the health threats of frostbite and hypothermia. Frostbite is defined as the freezing and crystallizing of fluids in the interstitial and cellular spaces due to exposure to freezing temperatures.  Frostbite is a result of the body’s survival mechanisms.  When exposed to freezing temperatures, the body decreases the circulation to peripheral body parts such as the feet and hands in an attempt to protect the vital inner organs.  This results in ice crystals developing in the fluid in and around skin cells.  Also red blood cells and platelets may clump and obstruct the capillaries resulting in decreased blood supply to the affected area. Risk factors include –·         Age                      Adolescents may not dress adequately for the cold                      The elderly lose heat from their skin more rapidly and impaired              peripheral circulation is often common in the elderly

• Environment

          People who work outside in the winter are at increased risk

• Dehydration

                Hydration helps prevent frostbite                Avoid caffeinated drinks because they constrict blood vessels and can                    impair peripheral circulation                Also avoid alcohol because alcohol reduces shivering which is the body’s                    attempt to keep warm

• Altered mental status

                Altered mental status may result in careless behavior or                       the inability to recognize the warning signs of frostbite

• Cigarette smoking

                Smoking causes vasoconstriction

• Insufficient or restrictive clothing

                Areas most prone to frostbite are fingers, toes, hands, feet,                   chin, tip of the nose, earlobes and cheeks – these areas                    should be protected.  Boots that are too tight may also                    impair circulation.  Mittens are more effective for keeping                    warm than gloves.  Wet clothing should be changed                    immediately. Degrees of frostbite –

• First degree frostbite involves the outer layer of skin, the epidermis –

      the area may be pale, prickly and may also be painful

• Second degree frostbite involves the epidermis and the next layer of skin, the dermis – the area may be yellowish, gray or white in color with large filled blisters and severe pain.  Swelling may also be present
• Third degree frostbite involves freezing of all layer of skin extending to the muscles, tendons, nerves and bone – the area is cold, numb, painless and bloodless

 The main priority in treating frostbite is to re-warm the area affected as soon as possible.  Do not use direct heat such as fire or a heating pad.  Do not rub the affected area.  Do not put snow on the affected area or immerse it in cold water and do not thaw the area if refreezing is at risk. What you should do is get the person into dry clothing and remove any jewelry from the affected area.  Warm the frostbitten area by immersing in a tub or basin of lukewarm water (105 F), immersing the affected body part for periods of 20-30 minutes.  If the nose, cheek or ear would be involved use a warm compress.  A burning sensation typically occurs as the area warms.  Rehydrate the victim with de-caffeinated beverages, keep the affected area dry and clean.  If an extremity is involved keep it elevated and as still as possible.  To prevent infection and for medical management you should follow up with your physician as soon as possible. Progressive signs of frostbite are – ·         Coldness·         Numbness·         Stinging, burning and throbbing·         Loss of fine muscle dexterity·         Loss of large muscle dexterity such as ambulating·         Complete loss of function and sensation Frostbite is preventable, if you have to be out in the extreme cold, check your skin every 10-20 minutes for signs of frostbite. Source:  Growing Up With Us…, Inc January 2003 Winter Emergencies- Frostbite