COLD OR HEAT LESIONS

1. Lesions due to cold
   
   The lesions caused may be:


• General: Cooling or Hypothermia (which will be dealt with in the section ASSISTANCE TO SHIPWRECK AND RESCUED VICTIMS, Chapter 7.12).



• Local: frostbite (refer to TABLE: FROSTBITES).

The cold lesions rarely occur if the crewmember is protected against it, hence the importance of adopting preventive measures in future cases:


1. Warm clothing (with high isolating effect and low wind and water permeability).
2. Loose clothing, not tight.
3. Wide shoes and double socks.
4. Do not remove gloves.
5. Remain exposed to cold for the shortest possible time. Short work shifts.
6. Avoid getting wet (major body heat loss) or get dry as soon as possible.
7. Protection from the wind.
8. Fight against immobility and fatigue.
9. Refrain from smoking and drinking alcohol (false short term effect).
10. If there is the slightest numbness or pins and needles, warm the limbs by moving them.



TABLE: LOCAL LESIONS BY COLD (FROSTBITE)

FIRST DEGREE	SECOND DEGREE	THIRD DEGREE
Pale skin or red-bluish spots and cold. Pins and needles and numbness. Redness and pain after reheating.	Red-purple skin. Cold oedema (swelling). Vesicles yellowish liquid content (blisters), at times haemorrhagic.	Intense blue colour. Skin scab gangrene mutilation.

FIRST AID:

1. Protect the victim from exposure to cold.
2. .Before transporting, check that there are no associated lesions (fractures, haemorrhage…) and take measures as necessary.
3. Remove with utmost care all that may compress the affected area (shoes, gloves, socks, etc.) and wet and cold clothes.
4. Encourage the victim to move the affected area.
5. Avoid massage, rubbing with snow or exposure to fire.
6. DO NOT OPEN THE BLISTERS. If they break, treat as a BURN.
7. PROTECT THE AREA WITH STERILE GAUZES. Place gauzes between each of the fingers.
8. Give warm drinks (soup, tea, coffee) with plenty of sugar. NEVER ALCOHOL OR TOBACCO. Give preheated clothing and blankets for the rest of the body, which is not frozen.
9. Defrost the affected area: water bath at 40 to 44 ºC; make sure there will be no further cold exposure; a refreezing of the area may be very severe. Stop when the area becomes congested (20 minutes). Dry with extra care. Warm environment.
10. Keep the affected area raised and covered with sterile pads and a non compressive bandage, protected against contact with clothing (protection arch) (refer to section IMMOBILISATION AND BANDAGES).
11. Prophylaxis against tetanus, analgesia and antibiotics as provided by MEDICAL ADVICE VIA RADIO .


2. Heat lesions
   
   Failure in the body regulatory mechanisms causes the different degrees of damage due to excessive heat in the human being. For emergency assistance, refer to Chapter 2.7, ACCIDENTS DUE TO HEAT: HEAT STROKE).
   
   Here are the most important:
   
   HEAT EXHAUSTION




• Consequence of exposure to excessive heat, with water and salt loss.



• Symptoms:
  
  
  • Skin: PALE, COLD, SWEATY.
  • Normal TEMPERATURE or slightly raised.
  • Fast pulse, above 100.
  • Systolic blood pressure below 100. Shock symptoms (ver Chapter 2.1, SHOCK).
  • Fast breathing.
  
  
• FIRST AID:
  
  
  • Lie patient down.
  • Cool environment.
  • Cool drink with salts (if conscious): saline sips (DRAWER 13, first aid kits A and B).
  • If this is not enough, MEDICAL ADVICE VIA RADIO .




HEAT SHOCK



• Caused by :
  
  
  • Longstanding influence of high temperatures.
  
  
• Symptoms:
  
  
  • Skin: at first RED, DRY, HOT, NOT SWEATY. Further on, greyish or bluish.
  • Temperature above 40 º C.
  • Headache - Dizziness - Nausea.
  • From impairment to loss of consciousness.
  • Fast breathing and pulse.
  • High blood pressure at an early stage (difference between maximum and minimum).
  
  
• FIRST AID:
  
  
  • Undress the patient.
  • Cool environment, horizontal position, raised head.
  • Cold water showers (20 º C), cold pads.
  • Continuous check of blood pressure, pulse and rectal temperature (every 10 minutes).
  • Lower temperature to 38,5 º C and check every 10 minutes.
  • Avoid temperature rise during transport.
  • Give cold drinks.
  • Give oxygen (Chapter 6.8, OTHER NURSING PROCEDURES).
  • Do not give any medication which is absolutely counter indicated: Opiates, adrenaline, sedatives.
  • If in doubt, ask for MEDICAL ADVICE VIA RADIO .





PREVENTION OF HARMFUL EFFECTS OF HEAT

• Give small amounts (quarter of a litre approximately) of water or slightly acid infusions several times a day.
• Avoid cold drinks.
• Give salt tablets as prophylaxis in case of prolonged sun exposure, unless chronic diseases which counter indicate it.
• Adequate clothing:
  
  
  • Head protection.
  • Garments which ease the heat exchange and reflect radiation (loose and ventilated, light colours, natural fabrics: cotton, linen…, avoiding man-made materials).
  • Absorbent underwear (change frequently).
  
  
• Reasonable timetable and work environment, including rest periods.
• Remember that people with heart or circulatory problems, or whose lung function is restricted (asthma), must not work in an excessively hot environment.