complicated by the fact that white phosphorus particles
ignite upon contact with air.
Superficial burns caused by simple skin contact or
burning clothes should be flushed with water and treated
like thermal burns.
Partially embedded white
phosphorus particles must be continuously flushed with
water while the first aid provider removes them with
whatever tools are available (i.e., tweezers, pliers,
forceps). Do this quickly, but gently. Firmly or deeply
embedded particles that cannot be removed by the first
aid provider must be covered with a saline-soaked
dressing, and this dressing must be kept wet until the
victim reaches a medical treatment facility. The wounds
containing embedded phosphorus particles may then be
rinsed with a dilute, freshly mixed 1% solution of copper
sulfate. This solution combines with phosphorus on the
surface of the particles to form a blue-black cupric
phosphite covering, which both impedes further
oxidation and facilitates identification of retained
particles. Under no circumstances should the copper
sulfate solution be applied as a wet dressing. Wounds
must be flushed thoroughly with a saline solution
following the copper sulfate rinse to prevent absorption
of excessive amounts of copper. (Copper has been
associated with extensive intravascular hemolysis.) An
adjunct to the management of phosphorus burn injuries is
the identification of the retained phosphorescent particles
in a darkened room during debridement.
NOTE: Combustion of white phosphorus
results in the formation of a severe pulmonary
irritant. The ignition of phosphorus in a closed
space (such as the BAS tent or sickbay) may
result in the development of irritant
concentrations sufficient to cause acute
inflammatory changes in the tracheobronchial
tree. The effects of this gas, especially during
debridement, can be minimized by placing a
moist cloth over the nose and mouth to
inactivate the gas and by ventilating the tent.
HEAT EXPOSURE INJURIES
LEARNING OBJECTIVE: Identify the
signs, symptoms, and emergency treatment
of heat cramps, heat exhaustion, and heat
stroke.
Excessive heat affects the body in a variety of
ways. When a person exercises or works in a hot
environment, heat builds up inside the body. The body
automatically reacts to get rid of this heat through the
sweating mechanism. This depletes water and
electrolytes from the circulating volume. If they are
not adequately replaced, body functions are affected,
and, initially, heat cramps and heat exhaustion
develop. If the body becomes too overheated or water
or electrolytes too depleted, the sweat-control
mechanism of the body malfunctions and shuts down.
The result is heat stroke (sunstroke). Heat exposure
injuries are a threat in any hot environment, but
especially in desert or tropical areas and in the boiler
rooms of ships.
Under normal conditions, it is a
preventable injury.
Individual and command
awareness of the causes of heat stress problems should
help eliminate heat exposure injuries.
Heat Cramps
Excessive sweating may result in painful cramps
in the muscles of the abdomen, legs, and arms. Heat
cramps may also result from drinking ice water or other
cold drinks either too quickly or in too large a quantity
after exercise. Muscle cramps are often an early sign
of approaching heat exhaustion.
To provide first aid treatment for heat cramps,
move the victim to a cool place. Since heat cramps are
caused by loss of salt and water, give the victim plenty
of cool (not cold) water to drink, adding about one
teaspoon of salt to a liter or quart of water. Apply
manual pressure to the cramped muscle, or gently
massage it to relieve the spasm. If there are indications
of anything more serious, transport the victim
immediately to a medical treatment facility.
Heat Exhaustion
Heat exhaustion (heat prostration or heat collapse)
is the most common condition caused by working or
exercising in hot environments. In heat exhaustion,
there is a serious disturbance of blood flow to the brain,
heart, and lungs. This causes the victim to experience
weakness, dizziness, headache, nausea, and loss of
appetite. The victim may faint but will probably regain
consciousness as the head is lowered, which improves
the blood supply to the brain. Signs and symptoms of
heat exhaustion are similar to those of shock; the
victim will appear ashen gray, the skin cool, moist, and
clammy and the pupils may be dilated (fig. 4-50). The
vital signs usually are normal; however, the victim
may have a weak pulse, together with rapid and
shallow breathing. Body temperature may be below
normal.
4-60