A local cold injury is also referred to as "frostbite "and results from freezing of body tissue. Local cold injury requires much colder temperatures than are needed to produce generalized hypothermia. This condition occurs when ice crystals form between the cells of the skin (interstitial spaces containing fluid), then expand as they pull fluid from the cells. Circulation is obstructed causing additional damage to the tissue.
Typically, we see these injuries on the hands, feet, ears, nose, and cheeks.
Predisposing factors include trauma, extremes in age, tight or tightly laced footwear (inhibiting circulation), alcohol use, wet clothing, high altitude, loss of blood, and arteriosclerosis
During the scene size up an EMT should decide if they need additional assistance, such as a dry team to work on shore and a wet team to immobilize the patient in the water. Be aware that rescues in swift water require specialized techniques and training. If an EMT is not qualified to undertake a rescue, that EMT must contact rescue teams trained in swift water rescue.
SECONDARY- LOOK FOR INJURYS AND SIGNS OF DROWNING. signs are airway absent or inadequate breathing, pulseless, spinal injury or head injury, soft tissues injuries, musculoskeletal injuries, external or internal bleeding, shock, hypothermia, alcohol or drug abuse, drowning or submersion. Asymptomatic: patient displays no signs or symptoms of the drowning event Symptomatic: the patient exhibits signs and symptoms as a result of the drowning Cardiac arrest: the patient is unresponsive, pulseless, and apneic Obviously dead: the patient exhibits rigor mortis or depended lividity
CARE- Remove the patient from the waters safely as possible If a spine injury is suspected, maintain in-line stabilization and then secure the patient to a backboard before removing that patient from the water. If spine injury is not suspected, place the patient on the left side Suction often as these patients have water in the airways and have a tendency to vomit because of the water that has been swallowed Establish an open airway and begin PPV with supplemental oxygen If the patient is pulseless and apneic and is older than one year of age, begin CPR, apply the AED, and proceed with AED protocol. AHA standards allow for AED use on patients less than one year of age. Apply pressure only if gastric distention interferes with your ability to ventilate the patient Always transport a drowning patient. During reassessment, be especially alert for signs that the patient is deteriorating into respiratory or cardiac arrest, especially if you have previously resuscitated the patient.
Type I Decompression Sickness (mild) Signs and symptoms Pain (often joint) Itching (pruritus) or burning of the skin Skin rash Pitting edema that is painless
Type II Decompression Sickness (serious) Signs and symptoms Nervous system - most common and includes: Weakness Paralysis Numbness and tingling Loss of anal sphincter control Headache Tinnitus Altered mental status Partial deafness Respiratory system Substernal burning upon inspiration Dyspnea / respiratory distress Nonproductive cough Circulatory system Signs and symptoms of hypoperfusion due to fluid shift from intravascular to extravascular spaces Thrombus formation due to blood coagulation
ARTERIAL GAS EMBOLISM- itchy blotchy or mottled skin, difficulty in breathing, dizziness, chest pain, severe deep arching pain in the muscles joints and tendons, blurred or disoriented vision, numbness or paralysis, weakness or numbness on one side of the body, staggering gait or lack of coordination, frothy blood in the nose or mouth, swelling and crepitus in the neck, coma, cardiac or respitory arrest, behavioral changes.
barotruama- Feeling of pressure in the ear.
Feeling like you have a blocked ear.
Bleeding from the ears or into the middle ear.
Ringing in your ears.
7th EditionGary A. Thibodeau, Kevin T. Patton
7th EditionJulie S Snyder, Linda Lilley, Shelly Collins
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