2. Rewarm the victim as soon as possible. It maybe necessary to treat other injuries before thevictim can be moved to a warmer place. Severebleeding must be controlled and fracturessplinted over clothing before the victim ismoved.3. Replace wet or frozen clothing and removeanything that constricts the victim’s arms, legs,or fingers, interfering with circulation.4. If the victim is inside a warm place and isconscious, the most effective method ofwarming is immersion in a tub of warm (100to105F or 38to 41C) water. The water shouldbe warm to the elbownever hot. Observeclosely for signs of respiratory failure andcardiac arrest (rewarming shock). Rewarmingshock can be minimized by warming the bodytrunk before the limbs to prevent vasodilation inthe extremities with subsequent shock due toblood volume shifts.5. If a tub is not available, apply external heat toboth sides of the victim. Natural body heat (skinto skin) from two rescuers is the best method.This is called “buddy warming.” If this is notpractical, use hot water bottles or an electricrewarming blanket. Do not place the blanket orbottles next to bare skin, however, and becareful to monitor the temperature of theartificial heat source, since the victim is verysusceptible to burn injury. Because the victim isunable to generate adequate body heat,placement under a blanket or in a sleeping bag isnot sufficient treatment.6. If the victim is conscious, give warm liquids todrink. Never give alcoholic beverages or allowthe victim to smoke.7. Dry the victim thoroughly if water is used forrewarming.8. As soon as possible, transfer the victim to adefinitive care facility. Be alert for the signs ofrespiratory and cardiac arrest during transfer,and keep the victim warm.Local CoolingLocal cooling injuries, affecting individual partsof the body, fall into two categories: freezing andnonfreezing injuries. In the order of increasingseriousness, they include chilblain, immersion foot,superficial frostbite, and deep frostbite. The areasmost commonly affected are the face and extremities.CHILBLAIN.—Chilblain is a mild cold injurycaused by prolonged and repeated exposure for severalhours to air temperatures from above freezing 32F(0C) to as high as 60F (16C). Chilblain ischaracterized by redness, swelling, tingling, and painto the affected skin area. Injuries of this nature requireno specific treatment except warming of the affectedpart (if possible use a water bath of 90F to 105F),keeping it dry, and preventing further exposure.IMMERSION FOOT.—Immersion foot, whichalso may occur in the hands, results from prolongedexposure to wet cold at temperatures ranging from justabove freezing to 50F (10C). Immersion foot isusually seen in connection with limited motion of theextremities and water-soaked protective clothing.Signs and symptoms of immersion foot aretingling and numbness of the affected areas; swellingof the legs, feet, or hands; bluish discoloration of theskin; and painful blisters. Gangrene may occur.General treatment for immersion foot is as follows:1. Get the victim off his feet as soon as possible.2. Remove wet shoes, socks, and gloves toimprove circulation.3. Expose the affected area to warm, dry air.4. Keep the victim warm.5. Do not rupture blisters or apply salves andointments.6. If the skin is not broken or loose, the injured partmay be left exposed; however, if it is necessaryto transport the victim, cover the injured areawith loosely wrapped fluff bandages of sterilegauze.7. If the skin is broken, place a sterile sheet underthe extremity and gently wrap it to protect thesensitive tissue from pressure and additionalinjury.8. Transport the victim as soon as possible to amedical treatment facility as a litter patient.FROSTBITE.—Frostbite occurs when icecrystals form in the skin or deeper tissues afterexposure to a temperature of 32F (0C) or lower.Depending upon the temperature, altitude, and windspeed, the exposure time necessary to producefrostbite varies from a few minutes to several hours.4-63
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