Later Management of Cold Injuries
LEARNING OBJECTIVE: Determine the
steps needed for the later management of
When the patient reaches a hospital or a facility for
definitive care, the following treatment should be
1. Maintain continued vigilance to avoid further
damage to the injured tissue. In general, this is
accomplished by keeping the patient at bed rest
with the injured part elevated (on surgically
clean sheets) and with sterile pieces of cotton
separating the toes or fingers. Expose all lesions
to the air at normal room temperature. Weight
bearing on injured tissue must be avoided.
Whirlpool baths, twice daily at 98.6F (37C)
with surgical soap added, assist in superficial
debridement, reduce superficial bacterial
contamination, and make range of motion
exercises more tolerable.
3. Analgesics may be required in the early post-
thaw days but will soon become unnecessary in
4. Encourage the patient to take a nutritious diet
with adequate fluid intake to maintain hydration.
5. Perform superficial debridement of ruptured
blebs, and remove suppurative scabs and
partially detached nails.
MORPHINE USE FOR PAIN RELIEF
morphine dosage, administration routes,
indications, contraindications, and
casualty marking procedures.
As a Corpsman, you may be issued morphine for
the control of shock through the relief of severe pain.
You will be issued this controlled drug under very strict
accountability procedures. Possession of this drug is a
medical responsibility that must not be taken lightly.
Policies pertaining to morphine administration are
outlined in BUMEDINST 6570.2, Morphia Dosage
and Casualty Marking.
Morphine is the most effective of all pain-relieving
drugs. It is most commonly available in premeasured
doses in syrettes or tubexes. Proper administration in
selected patients relieves distressing pain and assists in
preventing shock. The adult dose of morphine is 10 to
20 mg, which may be repeated, if necessary, in no less
than 4 hours.
Morphine has several undesirable effects,
however, and a Corpsman must thoroughly understand
these effects. Morphine
is a severe respiratory depressant and must not
be given to patients in moderate or severe shock
or in respiratory distress.
increases intracranial pressure and may induce
vomiting. These effects may be disastrous in
head injury cases.
causes constriction of the pupils (pinpoint
This effect prevents the use of the
pupillary reactions for diagnosis in head injuries.
is cardiotoxic and a peripheral vasodilator.
Small doses of morphine may cause profound
hypotension in a patient in shock.
poisoning is always a danger. There is a narrow
safety margin between the amounts of morphine
that may be given therapeutically and the
amounts that produce death.
causes considerable mental confusion and
interferes with the proper exercise of judgment.
Therefore, morphine should not be given to
is a highly addictive drug. Morphine should not
be given trivially and must be rigidly accounted
Only under emergency circumstances
should the Corpsman administer morphine.
Rigidly control morphine administration to
patients in shock or with extensive burns. Because of
the reduced peripheral circulation, morphine
administration by subcutaneous or intramuscular
routes may not be absorbed into the bloodstream, and
pain may persist. When pain persists, the uninformed
often give additional doses, hoping to bring about
relief. When resuscitation occurs and the peripheral
circulation improves, the stored quantities of morphine
are released into the system, and an extremely serious
condition (morphine poisoning) results.