Later Management of Cold InjuriesLEARNING OBJECTIVE: Determine thesteps needed for the later management ofcold-exposure injuries.When the patient reaches a hospital or a facility fordefinitive care, the following treatment should beemployed:1. Maintain continued vigilance to avoid furtherdamage to the injured tissue. In general, this isaccomplished by keeping the patient at bed restwith the injured part elevated (on surgicallyclean sheets) and with sterile pieces of cottonseparating the toes or fingers. Expose all lesionsto the air at normal room temperature. Weightbearing on injured tissue must be avoided.2.Whirlpool baths, twice daily at 98.6F (37C)with surgical soap added, assist in superficialdebridement, reduce superficial bacterialcontamination, and make range of motionexercises more tolerable.3. Analgesics may be required in the early post-thaw days but will soon become unnecessary inuncomplicated cases.4. Encourage the patient to take a nutritious dietwith adequate fluid intake to maintain hydration.5. Perform superficial debridement of rupturedblebs, and remove suppurative scabs andpartially detached nails.MORPHINE USE FOR PAIN RELIEFLEARNING OBJECTIVE:Recallmorphine dosage, administration routes,indications, contraindications, andcasualty marking procedures.As a Corpsman, you may be issued morphine forthe control of shock through the relief of severe pain.You will be issued this controlled drug under very strictaccountability procedures. Possession of this drug is amedical responsibility that must not be taken lightly.Policies pertaining to morphine administration areoutlined in BUMEDINST 6570.2, Morphia Dosageand Casualty Marking.MORPHINE ADMINISTRATIONMorphine is the most effective of all pain-relievingdrugs. It is most commonly available in premeasureddoses in syrettes or tubexes. Proper administration inselected patients relieves distressing pain and assists inpreventing shock. The adult dose of morphine is 10 to20 mg, which may be repeated, if necessary, in no lessthan 4 hours.Morphine has several undesirable effects,however, and a Corpsman must thoroughly understandthese effects. Morphineis a severe respiratory depressant and must notbe given to patients in moderate or severe shockor in respiratory distress.increases intracranial pressure and may inducevomiting. These effects may be disastrous inhead injury cases.causes constriction of the pupils (pinpointpupils). This effect prevents the use of thepupillary reactions for diagnosis in head injuries.is cardiotoxic and a peripheral vasodilator.Small doses of morphine may cause profoundhypotension in a patient in shock.poisoning is always a danger. There is a narrowsafety margin between the amounts of morphinethat may be given therapeutically and theamounts that produce death.causes considerable mental confusion andinterferes with the proper exercise of judgment.Therefore, morphine should not be given toambulatory patients.is a highly addictive drug. Morphine should notbe given trivially and must be rigidly accountedfor. Only under emergency circumstancesshould the Corpsman administer morphine.Rigidly control morphine administration topatients in shock or with extensive burns. Because ofthe reduced peripheral circulation, morphineadministration by subcutaneous or intramuscularroutes may not be absorbed into the bloodstream, andpain may persist. When pain persists, the uninformedoften give additional doses, hoping to bring aboutrelief. When resuscitation occurs and the peripheralcirculation improves, the stored quantities of morphineare released into the system, and an extremely seriouscondition (morphine poisoning) results.4-65
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