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Overexposure to cold environment
Localized injury (frostbite)
Systemic injury (hypothermia)
Severity of degree is dependent on: ± ± ± ± Amount of heat lost Age Presence of wet clothing Impairment of the circulatory status .FROSTBITE Occurs when body tissue freezes after prolonged exposure to cold temperature. and feet. The most common areas for frostbite to occur are the fingers. toes. Other areas prone to frostbite are the ear lobes. and tip of the nose. cheeks.
Numb. pain-free. Skin appears white. .Frostnip History of gradual onset.
Sensation is absent. . soft. The skin will appear white and waxy. and have its normal bounce.Superficial Frostbite Damage is limited to the skin and subcutaneous tissue. On palpation. the skin will feel stiff but the underlying tissue will be pliable.
.Deep Frostbite Skin will appear white. On palpation. The affected part is completely insensitive to touch. yellow-white. or mottled blue-white. the surface will feel frozen and the underlying tissue will feel frozen and hard.
or mottled blue-white. On palpation. yellow-white. The affected part is completely insensitive to touch. the surface will feel frozen and the underlying tissue will feel frozen and hard.Deep Frostbite Skin will appear white. .
if clothing is frozen to the affected area.TREATMENT OF SUPERFICIAL AND DEEP FROSBITE Immediate First Aid ± Removal of constrictive clothing and jewelry from the area suspected of frostbite (do not want anything to impede blood flow). it should only be removed after rewarming. ± Do not rub frozen area ± Removal from cold environment when possible . however.
TREATMENT OF SUPERFICIAL AND DEEP FROSBITE Immediate First Aid ± A rapid rewarming is better than gradual rewarming ± The affected part should be handled gently and protected ± Fluids and electrolytes must be restored. ± Use body heat or blankets to warm affected area. .
± Narcotics to treat pain brought on by rewarming.May be given IV for immediate pain relief. . dry heat is not used for rewarming.TREATMENT OF SUPERFICIAL AND DEEP FROSBITE Hospital care ± Rewarming of area by submersion of the frostbitten part in a 104(F to 108(F (40(C to 42(C) water bath for 15 to 30 minutes.
using antibiotic ointment with open blister. and monitoring for infection . placing something sterile between fingers and toes to prevent rubbing. ± Meticulous skin care including cleansing with soap or other cleanser and water. avoiding breaking of blisters.TREATMENT OF SUPERFICIAL AND DEEP FROSBITE Hospital care ± Elevation and splinting of the affected part above the level of the heart to decrease edema (swelling). wrapping with sterile bandages.
Escharotomy (if vascular impairment occurs) to relieve tissue pressure and restore circulation. ± ± ± ± ± .TREATMENT OF SUPERFICIAL AND DEEP FROSBITE Hospital care Treat dehydration (IV fluids) and hypothermia. ± Amputation if injury does not respond to other treatments. Antibiotics if infection occurs. Medications to improve circulation (Dextran) Antiinflammatory medications.
but prolonged exposure to any environment colder than your body can lead to hypothermia if you aren't dressed appropriately or can't control the conditions. . The most common causes of hypothermia are exposure to cold weather conditions or cold water.HYPOTHERMIA Hypothermia occurs when your body loses heat faster than it produces it.
especially for older people and infants ± Air conditioning that is too cold. especially for older people and infants . as in a boating accident ± Inadequate heating in the home. Specific conditions leading to hypothermia include: ± Wearing clothes that aren't warm enough for weather conditions ± Staying out in the cold too long ± Unable to get out of wet clothes or move to a warm. dry location ± Accidental falls in water.
The mechanisms of heat loss from your body include the following: ± Radiated heat ± Direct contact ± Wind .
or lack of concern about one's condition Progressive loss of consciousness Weak pulse Shallow breathing . such as trying to remove warm clothes Drowsiness or very low energy Apathy.SIGNS AND SYMPTOMS ± ± ± ± ± ± ± ± ± ± ± Shivering Clumsiness or lack of coordination Slurred speech or mumbling Stumbling Confusion or difficulty thinking Poor decision making.
. because the symptoms often begin gradually and because the confused thinking associated with hypothermia prevents self-awareness. A person with hypothermia usually isn't aware of his or her condition.
RISK FACTORS A number of factors can increase the risk of developing hypothermia: ± Older age ± Very young age ± Mental impairment ± Alcohol and drug use ± Certain medical conditions ± Medications .
usually in the hands or feet after prolonged exposure to above-freezing. including: ± Frostbite.COMPLICATIONS People who develop hypothermia because of exposure to cold weather or cold water are also vulnerable to other cold-related injuries. or freezing of body tissues ± Gangrene. damage to nerves and small blood vessels due to prolonged immersion in water . decay and death of tissue resulting from an interruption in blood flow (possible complication of frostbite) ± Chilblains. cold temperatures ± Trench foot (immersion foot). damage to nerves and small blood vessels.
if the symptoms are mild. however. a part of the diagnostic workup will include a temperature reading with a rectal thermometer that reads low temperatures.DIAGNOSIS The diagnosis of hypothermia is usually apparent based on a person's physical signs and the conditions in which the person with hypothermia became ill or was found. In such cases. as when an older person who is indoors has symptoms such as confusion. A diagnosis may not be readily apparent. lack of coordination and impaired speech. .
TREATMENT First-aid care ± Move the person out of the cold ± Remove wet clothing ± Cover the person with blankets ± Monitor breathing ± Provide warm beverages ± Use warm. dry compresses ± Don't apply direct heat .
Minimize heat loss from the head by providing a hat or scarf to cover the head and neck when possible. minimize the exposure time . particularly when the elderly person is outside. Clothe the person adequately and layer both items of clothing and bedcovers to provide optimum insulation. Limit the time that the elderly person is exposed to a cold area. some very frail elderly people will require higher room temperatures to maintain body warmth and comfort. Whenever it is necessary to remove all the person's clothing.NURSING INTERVENTION Maintain the room temperature at 65 degrees Fahrenheit at a minimum.
Provide hot. dry the person completely. do not let wet hair air dry. a single bath blanket is insufficient protection against hypothermia for a frail elder. Dry wet hair quickly with an electric hair dryer. Following a bath. high protein meals and bedtime snacks to sustain heat production during the day and evening. Cover patients when bathing. . clothe them before leaving the bathing area. use absorbent pads. If the person is incontinent of urine. checking often for wet clothing or bedding. Encourage exercise to help the person generate heat from muscle activity.