Cold Injury

Cold injury is damage to the peripheral tissues due to the direct effects. The milder form is known as “frost nip”, where the skin will become white and numb. This is fully reversible on warming. The more severe form is known as “frost bite”, where the affected area becomes white on freezing, but on rewarming will become blue/purple and may progress to be black and thickened. This area will eventually separate away and in most patients this will reveal healthy tissues beneath.

Treatment of Cold Injury

The patient should be removed from the cold environment and rewarmed. Rewarming should not be attempted until it is sustainable and when the patient will not be re-exposed to the same cold conditions. In milder cases, passive rewarming may be appropriate, but in more severe cases active rewarming using circulating warm water should be considered. Rewarming can be extremely painful and adequate analgesia will be required.

It is worth considering the use of nonsteroidal anti-inflammatory drugs to inhibit prostaglandin actions.

Near Drowning

For the purposes of Immediate Care in Rugby, the term “near drowning” refers to a patient who has suffered an immersion or a submersion injury.

Rescuer safety is paramount, it is important that you do not put yourself in danger.

The exact pathophysiology is variable, but it is important to assess for hypoxia, hypothermia, or aspiration in this group.

When removed from the water, it is important that these patients are kept horizontal where possible. In the water, the patient will be exposed to significant hydrostatic pressure. If this is suddenly removed and the patient is in an upright position, this may cause a dramatic fall in blood pressure.

Treatment of near drowning.

The patient should be rescued and kept in the supine position.

An assessment of ABCDE should take place and any interventions carried out. It is particularly important to ensure that any period of hypoxia is minimised and particular attention must be paid to ensuring airway patency, adequate respiratory effect and rate and good oxygenation. In an adequately self-ventilating patient, high flow oxygen must be delivered via a non-rebreathe mask. Vomiting is a significant problem in individuals who have suffered near drowning, and it is important that the practitioner is aware of this and prepared to deal with this immediately, to minimise the risk of aspiration. If appropriate the patient should be managed in the recovery position.

In the event of cardiac arrest, the rescuer should be aware of the risk of hypothermia and make any necessary adjustments to the resuscitation, as per the hypothermia guidelines.