Cold Burn

Cold burn or Frostbite occurs when the skin is in touch with an extremely cold body. Extreme cold can cause damage to the skin and underlying tissues. For example, if there is a prolonged contact of the skin with moderately cold body like snow or very cold bodies like dry ice, liquid helium or liquid nitrogen for a brief period, cold burns or ice burns will occur. Here heat is transferred from the skin and organs to the cold body that is in contact. In other kinds of burns, the body that causes the burn is hotter and heat is transferred to the skin or the organ.

Symptoms of frostbite include pins and needles sensation and then numbness in the area. Initially there may be throbbing or aching. The affected part seems to become insensate. In severe frostbite, when the tissue starts to freeze, the skin at that area may appear white and numb. In areas affected by frost burn, abnormal accumulation of blood takes place. In addition to accumulation of body fluids, a blood clot may form thereby preventing blood circulation around the area resulting in tissue decay. Mottled and violaceous tissue is noticed. Normal functioning of the body is disturbed because of cooling of the internal organs, which will lead to a critical condition called hypothermia. Cooling of the brain or heart is very dangerous.

The accumulated plasma in the blister is intended to prevent further damage and also to help in the healing process. To avoid infection from the blister, it is important that it is not punctured as it would expose the raw skin for further infection. The serous fluid will be reabsorbed by the skin usually after 24 hours if there is no infection.

Severe frostbite may also damage tendons, muscles, nerves and bones. Gangrene is inevitable in the case of very severe frostbite. Frostbite may affect any part of the body.

The most vulnerable parts are hands, feet, nose and ears. Recovery may be significant when the skin and underlying body tissues are injured and it may be permanent if there is injury to the blood vessels. If gangrene follows, the affected part may have to be amputated. When warming up of the affected part begins, the patient will experience intense pain. There will be tingling or burning sensation in the affected area also.

People taking beta-blockers that decrease blood flow to the skin and those who suffer Peripheral Vascular Disease are at risk when exposed to cold for a prolonged period. Any person who is exposed to extreme cold for a long period is susceptible to frostbite. Diabetes, peripheral neuropathy or Raynaud's phenomenon are some conditions that may have increased risk of cold burns. Smoking and windy weather when the rate of heat loss from the skin is more will hinder the healing process. Cold burns at the work place are common. People who work in factories where they may come in contact with metal surfaces that are at extremely cold temperatures are prone to cold burns. When the skin is moist, they may receive almost instantaneous cold burns.

Prevention of freeze burns

Extreme cold, wet clothes, high winds and poor circulation are some of the factors that can contribute to freeze burns. Tight boots or clothing and conditions like cramped positions, some medications, smoking or alcohol can cause frostbite. Wearing appropriate clothing in winter when the temperature goes below normal and will help. Winter clothes like mittens, layered clothing that is wind-proof and water resistant gives good protection.

First Aid for cold burns

It is essential that the ice burn treatment is correctly done as soon as possible.

• If you anticipate prolonged exposure to cold, avoid alcohol or smoking and take sufficient food and rest. Increase physical activity that maintains body temperature and find shelter in a snowstorm as early as possible.
  
  
• Victims should be moved to a warmer place to give shelter from the cold. Constricting jewelry and wet clothes should be removed. If there are symptoms of hypothermia, treat it immediately.
  
  
• Wrap the affected areas using sterile dressings. Dressings should be done after separating affected fingers and toes.
  
  
• In case immediate care is unavailable, you can go for re-warming first aid. This can be done by immersing the affected parts in warm water. Otherwise repeated application of warm clothes to injured ears, cheeks or nose for 20 to 30 minutes helps. Water temperature should be kept between 104 to 108 degrees F. To aid the warming process, the water should be kept circulating. During the warming process, swelling, color changes and severe burning pain may be noticed. The wound will heal when there is a slow heat transfer from water to the affected part.
  
  
• The frost bitten areas should be dressed with dry, sterile dressings. Remembering to keep the fingers or toes separated is important.
  
  
• Thawed areas should not be moved as far as possible.
  
  
• In case of extensive freeze burns, giving warm drinks to the victim helps in replacing lost fluids.
  
  
• Wet clothing must be removed and replaced with warm clothing.
  
  
• Until you reach a warm and safe location, do not go for re-warming process. There is the danger of severe damage because of re-freezing of thawed extremities.
  

Frostnip is the least severe form of cold injury that occurs after the distal extremities are exposed to prolonged period of cold but non-freezing temperatures. Vasoconstriction is felt. Frostnip is a precursor to frostbite and does not involve the same levels of tissue destruction. The affected area appears pale.

Immersion foot is a condition where there is severe tissue injury due to prolonged and persistent exposure to wet conditions, cold or hot. It results in tissue edema and inflammation. This is often seen in homeless persons who are exposed to the elements. The extremities appear swollen and erythematous (skin turning red often manifested in patches). Bad odor is often noticed as also tissue sloughing.

Drowning First Aid

Drowning is one of the most evaluated emergency cases in life guard training centers. Emergency medicine and paramedical support have significant roles to play while attending to a case of drowning, as it involves many primary to complex medical procedures to save a life in a short duration of time.

The primary objective of a rescue worker is to make sure that the victim gets adequate amount of oxygen in his lungs through methods such as cardiopulmonary restoration. Proper precautions are taken to avoid any kind of neck injuries during the procedure. Mouth to mouth breathing technique can be administered in water if the victim has already stopped breathing. The victim has to be moved to the shore slowly with mouth to mouth breathing at regular intervals, like five seconds. In case of obstructed airway, the Heimlich maneuver is performed by holding the victim from behind and thrusting to release the blocked airway. In certain scenarios such as spine injuries, the victim is made to lie on his stomach with his head tilted to one side and arms, torso and legs in proper position. Victims have to be covered with warm clothing to prevent hypothermia and shock. Cardiac compressions in water should not be administered as it is difficult and the risk involved is greater.

Events post first aid in drowning are evaluated by the physician and treated accordingly. Antibiotics and steroids are given in case of lung infection and inflammation. Airway obstruction post first aid is treated using bronchodilators and heated IV fluids are administered to lower the blood pressure. Stomach tubes are inserted in case of vomiting. Neck injuries and spine injuries are treated. Total immobilization of the neck is required until proper scans are taken to evaluate the intensity of the injury.

Neutrophilia

High levels of neutrophil in the blood results in neutrophilia; neutrophils are White Blood Cells or WBC that are assigned the task of killing/fighting off foreign matter like fungi and bacteria in the body. They are an important part of the body's defense force. An adequate amount of production and distribution of neutrophils is very important. However during an infection in the body, an elevated level of neutrophils can be found, with equal numbers in marginal and circulating pool.

The site of infection generates chemotactic agents and attracts neutrophils to the affected part. During recovery the flow of cells decreases from the marrow and this in turn decreases the amount of neutrophils. Neutrophilia is the most common form of leukocytosis - a condition wherein the blood has an increased number of leukocytes. When the cells shift from the marginal to circulating pool without an increase in the total blood granulocyte pool or if there is an increase in size of the TGBP, it could result in Neutrophilia.

Women in their childbearing age have a higher neutrophil count when compared to men. Pregnancy also leads to high neutrophil count and this may tend to increase during childbirth.

Neutrophilia occurrence

True Neutrophilia: True Neutrophilia occurs in most cases of infection and total blood granulocyte pool, the TGBP, may increase 5-6 times the normal level. At the onset of the infection, Neutrophilia count decreases and then it rises to very high levels.

Shift Neutrophilia: Shift Neutrophilia as the name indicates is transient (e.g. during heavy exercise) and may occur in association to other conditions. The change in numbers may last only for a few minutes. There is no change in the inflow of neutrophils from the bone marrow.

Causes for Neutrophilia

Neutrophilia is caused due to increase in bone marrow output or redistribution of white cells. Though there are numerous possibilities for an elevated level of neutrophils in the blood, the most common causes include:

• Infections, caused by cocci, certain fungi, bacteria (local or generalized), viruses (chickenpox, herpes simplex) and parasites (hepatic amebiasis, Pneumocystis carinii) lead to Neutrophilia
  
  
• Non-infectious inflammation like burns, post surgery, acute attack of gout, asthma, rheumatic fever, autoimmune conditions, any kind of trauma, tissue damage, myocardial infarction can also lead to Neutrophilia
  
• Acute and sudden hemorrhage can lead to inflammation and thus lead to Neutrophilia.
  
  
• Poisoning from sources like mercury, lead, digitalis, camphor, quinidine and certain insects can also lead to Neutrophilia
  
  
• Metabolic changes in the body like diabetic ketoacidosis, uremia, etc can cause Neutrophilia
  
  
• Malignancies and other kinds of spreading cancer, where the tumor outgrows the blood supply can lead to neutrophilia
  
  
• Physiologic Neutrophilia is also caused by heavy exercise, epinephrine injections, etc
  
  
• Other causes for Neutrophilia could include seizures, anemia, increase or decrease in platelet count, short or long term usage of corticosteroids, Cushing disease etc
  
  
• Cigarette smoking can cause inflammation and thus lead to Neutrophilia.
  
  
• High levels of stress can also lead to increase in levels of neutrophils and thus cause Neutrophilia.
  
  
• Neutrophilia may be present without any particular cause that can be identified, this type of neutrophilia is called chronic idiopathic neutrophilia.

Diagnosis

Most often neutrophilia is a reactive phenomenon and can be diagnosed through blood tests. A physical examination is done and the medical history of the patient is studied. A complete blood count investigation and a series of blood tests are ordered for. In a few cases bone marrow aspiration is ordered for. The commons symptoms reported include decreased body temperature or hypothermia, dyspnea (labored breathing) or tachypnea (rapid breathing) and sometimes bleeding.