WINTER-RELATED EMERGENCIES

With the excitement and hustle and bustle of the holidays, it is easy to get caught up in the spirit of the season. Nobody wants to spend the holidays in the Emergency Department (ED), however, every year, EDs are flooded with winter-related illnesses, injuries, and traumas.

As emergency physicians, we see many cases that could have potentially been AVOIDED. Here are the top five pediatric emergency diagnoses and what you can do to lower the risk of your child ending up in the ED this winter:

1. HEAD INJURIES FROM WINTER SPORTS

Millions of children in the U.S. participate in winter sports each year, including skiing, snowboarding, sledding, ice-skating, and hockey. These sports can be thrilling and fun for all ages, however, high speeds and slippery surfaces can lead to serious injuries. Traumatic brain injury is the leading cause of death and disability in children and young adults. According to the National Pediatric Trauma Registry, almost half of winter sports result in head-related injuries.

Signs and symptoms of a mild brain injury, or concussion, can present immediately at the time of impact, or can be delayed for days, or even up to weeks afterward. Concussion symptoms include:

  • Headache

  • Weakness

  • Numbness

  • Decreased coordination or balance

  • Confusion

  • Slurred speech

  • Nausea or vomiting

Sometimes children complain of “just not feeling themselves.” If your child experiences any of these symptoms, proceed to the nearest ED immediately. And if your child loses consciousness, call 911.

Helmets have been shown to be effective in reducing 50% of head injuries in skiing and snowboarding sports. During a fall or collision, most of the impact energy is absorbed by the helmet, rather than by the head/brain. Helmets save lives!

2. BURNS

The idea of a sunburn in the winter can seem unusual, but snow can reflect up to 85% of the sun’s ultraviolet rays. Be sure to protect your kids’ faces with sunscreen.

Other burn injuries that are more common in winter include thermal burns from campfires and heaters, as well as hot liquids. Fireplaces should have proper screens on them and children should always be supervised around any open flames (including gas burners, incense burners, candles, and fire pits). Children should not be left unattended around campfires, even if the fire has been put out, since the embers, coals, and ashes can stay hot for many hours after the fire has been extinguished. Hot drinks and foods should be kept out of reach of children, and parents should use extra precaution when handling hot drinks/foods such as coffee, instant noodles, and soups.

If any child sustains a burn, run the affected area under room temperature (not cold) water, use a burn dressing if available, and head to the nearest ED.

3. HYPOTHERMIA/FROSTBITE

Children are at an increased risk of frostnip/frostbite because they lose heat from their skin faster than adults, and often do not want to come inside when having fun playing outdoors. The best way to prevent this is to make sure they dress warmly in layers, and to ensure they do not spend too much time in extreme weather.

Frostnip is an early warning sign of frostbite. If your child has red skin that feels numb or tingly, bring your child indoors immediately and remove all wet clothing (wet fabric draws heat from the body). Immerse the chilled body parts in room temperature (not hot) water, until they are able to feel sensation again. 

Frostbite occurs mostly on fingers, toes, ear, noses, and cheeks. The frostbitten area is typically very cold and turns a white or yellowish-gray color. If your child has frostbite, quickly proceed to the nearest ER.

4. TOXIC INGESTIONS

Along with bringing holiday cheer, the season’s shrubbery can also be toxic if eaten. Mistletoe berries, holly berries, the fruit of Jerusalem cherry, the leaves and twigs of boxwood, as well as all parts of yew plants can be poisonous to humans (and pets). Despite a long-standing belief of toxicity, the poinsettia is not a poisonous plant. For any concerns of harmful ingestion, call Poison Control immediately at 1-800-222-1222.

Christmas trees and their adornments can pose another risk for potential ingestion. Christmas tree preservatives are usually not toxic, but check the label nonetheless for special ingredients and warnings. Contrary to popular belief, spray-on snow is non-toxic after it is dried. The propellant contains fluorinated hydrocarbon and methylene chloride, whose main risk is from intentional abuse by “huffing.” Old ornaments may be decorated with harmful lead paints and certain types of tree light wires may contain lead as well. Always wash hands after handling tree lighting and discard of any ornaments for which the presence of lead may be a risk. And lastly, remember that small ornaments can pose as a choking hazard for infants and children.

5. RESPIRATORY AND FOOD-BORNE ILLNESS

As emergency physicians, we see an abundance of high fevers, colds, flus, and other viral illnesses during the winter. Although these cannot be entirely prevented, the transmission rate can be dramatically decreased by practicing good hygiene and hand washing, getting family flu shots, and keeping children home when they are sick. Children should stay home at least 24 hours after the fever is gone without the use of any fever-reducing medication.

Also, when preparing holiday foods, be sure to cook meats thoroughly at a temperature above 160 degrees Fahrenheit. Salmonella bacteria are often present in turkey, even when frozen. Wash hands, knives and cutting boards after working with raw meats to reduce the chances of spreading bacteria to uncooked foods.

REMEMBER:

To help avoid visits to the ED this holiday season, remember to wear helmets and dress appropriately when participating in winter sports. Be sure to apply sunscreen during prolonged sun exposure, use caution when handling hot liquids, and limit time outdoors in extreme weather conditions. Also, holiday decorations can be festive, but keep an eye out on young children to avoid any possible toxic ingestions. Lastly, good hand washing helps decrease infectivity of contagious illnesses and it’s not too late to get a flu shot.

HAPPY HOLIDAYS FROM 3MD!

 

References:

http://www.cdc.gov/headsup/index.html

http://www.brainline.org/content/2008/12/winter-sports-injury-prevention-tips.html

https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/pages/Winter-Safety-Tips.aspx

http://kidshealth.org/parent/firstaid_safe/outdoor/winter_safety.html#

http://www.calpoison.org/public/winter-holidays.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555592/

http://www.cdc.gov/foodsafety/foodborne-germs.html