A fracture is a broken bone. It requires medical attention. If the broken
bone is the result of major trauma or injury, call 911 or your local
emergency number. Also call for emergency help if:

• The person is unresponsive, isn't breathing or isn't moving. Begin
  cardiopulmonary resuscitation (CPR) if there's no respiration or heartbeat.
  
• There is heavy bleeding.
  
• Even gentle pressure or movement causes pain.
  
• The limb or joint appears deformed.
  
• The bone has pierced the skin.
  
• The extremity of the injured arm or leg, such as a toe or finger, is
  numb or bluish at the tip.
  
• You suspect a bone is broken in the neck, head or back.
  
• You suspect a bone is broken in the hip, pelvis or upper leg (for
  example, the leg and foot turn outward abnormally).

Take these actions immediately while waiting for medical help:

• Stop any bleeding. Apply pressure to the wound with a sterile
  bandage, a clean cloth or a clean piece of clothing.
  
• Immobilize the injured area. Don't try to realign the bone, but if
  you've been trained in how to splint and professional help isn't readily
  available, apply a splint to the area.
  
• Apply ice packs to limit swelling and help relieve pain until
  emergency personnel arrive. Don't apply ice directly to the skin - wrap the ice in a towel, piece of cloth or some other material.
  
• Treat for shock. If the person feels faint or is breathing in short,
  rapid breaths, lay the person down with the head slightly lower than the trunk and, if possible, elevate the legs.

When exposed to very cold temperatures, skin and underlying tissues may
freeze, resulting in frostbite. The areas most likely to be affected by frostbite are your hands, feet, nose and ears.

You can identify frostbite by the hard, pale and cold quality of skin that
has been exposed to the cold. As the area thaws, the flesh becomes red and
painful.

• If your fingers, ears or other areas suffer frostbite:
  Get out of the cold.
  
• Warm your hands by tucking them under your arms. If your nose, ears
  or face is frostbitten, warm the area by covering it with dry, gloved hands.
  
• Don't rub the affected area. Never rub snow on frostbitten skin.
  
• If there's any chance of refreezing, don't thaw out the affected
  areas. If they're already thawed out, wrap them up so they don't refreeze.
  
• Get emergency medical help if numbness remains during warming. If
  you can't get help immediately, warm severely frostbitten hands or feet in warm - not hot - water. You can warm other frostbitten areas, such as your nose, cheeks or ears, by covering them with your warm hands or by applying warm cloths.

Can weather affect blood pressure? I've noticed that my blood pressure is harder to control in the winter.

Mayo Clinic hypertension specialist Sheldon Sheps, M.D., and colleagues answer select questions from readers.

Answer:

Yes, weather can affect blood pressure. Blood pressure generally is higher
in the winter and lower in the summer. Why? Cold temperatures cause your
blood vessels to narrow (constrict) - which increases blood pressure because
more pressure is needed to force blood through a narrower space. Other
possible causes of higher blood pressure are weight gain and decreased
physical activity in winter.

However, it doesn't take a big cold snap to raise blood pressure. Seasonal
blood pressure changes also are found in climates where temperatures may
change only a few degrees from summer to winter. In fact, a five-year
analysis of the electronic health records of 444,000 adults with high blood
pressure in the United States and its territories found that high blood
pressure was less controlled in winter than in summer in all cities, from
Anchorage, Alaska, to San Juan, Puerto Rico. The implication from such
studies is that it may be necessary to adjust high blood pressure
medications in some people to continue to control blood pressure in
different seasons.

If you have questions about how weather may affect your blood pressure,
consult your doctor.

(c) 2007 Jupiterimages Corporation

People spend hours of recreation time on activities ranging from sledding, snow skiing and tobogganing to ice hockey, ice skating and snow boarding. According to the American Academy of Orthopaedic Surgeons (AAOS), however, if the proper precautions are not taken to ensure warmth and safety, severe injuries can occur.

Winter sports injuries get a lot of attention at hospital emergency rooms,
doctors' offices and clinics. Injuries include sprains and strains,
dislocations and fractures. In 2004, the U.S. Consumer Product Safety
Commission reported:

• 51,524 injuries from ice hockey
  
• 49,600 injuries from ice skating
  
• 74,000 injuries from sledding, snow tubing and tobogganing
  
• 35,483 injuries from snowmobiling
  
• 143,990 injuries from snow boarding
  
• 144,379 injuries from snow skiing

Many winter sports injuries happen at the end of the day, when people
overexert themselves to finish that one last run before the day's end. A
majority of these injuries can easily be prevented if participants prepare
for their sport by keeping in good physical condition, staying alert and
stopping when they are tired or in pain.

The AAOS urges children and adults to follow these tips for preventing
winter sports injuries:

• Never participate alone in a winter sport.
  
• Keep in shape and condition muscles before partaking in winter
  activities.
  
• Warm up thoroughly before playing. Cold muscles, tendons and
  ligaments are vulnerable to injury.
  
• Wear appropriate protective gear, including goggles, helmets, gloves
  and padding.
  
• Check that equipment is in good working order and used properly.
  
• Wear several layers of light, loose and water- and wind-resistant
  clothing for warmth and protection. Layering allows you to accommodate your body's constantly changing temperature. Wear proper footwear that provides warmth and dryness, as well as ample ankle support.
  
• Know and abide by all rules of the sport in which you are
  participating.
  
• Take a lesson (or several) from a qualified instructor, especially
  in sports like skiing and snow boarding. Learning how to fall correctly and safely can reduce the risk of injury.
  
• Pay attention to warnings about upcoming storms and severe drops in
  temperature to ensure safety.
  
• Seek shelter and medical attention immediately if you, or anyone
  with you, is experiencing hypothermia or frostbite. Make sure everyone is aware of proper procedures for getting help, if injuries occur.
  
• Drink plenty of water before, during and after activities.

Cold Emergencies can be grouped into three categories:

• Frostnip
  
• Frost bite
  
• Hypothermia
  

Frostnip is a group of cold injuries (including chilblains and trench foot
["cold immersion foot"]) which occur without freezing of body tissue. It is
the beginning of a process that, left uncorrected, will lead to greater
injury. To treat the victim of frostnip, protect the patient from further
cold exposure, remove wet clothing and gently dry and re-warm the affected
part. Taking warm fluids by mouth may help the re-warming process.

Frost bite is a move (from frostnip) toward greater damage, in-as-much-as
some freezing has occurred. To treat this victim, the provider should make
available a warm environment and the frozen parts should be allowed to warm naturally. Do not manipulate the frozen parts, this will only lead to
cellular damage and muscle tearing. If there is any possibility that the
frozen part will re-freeze, DO NOT thaw. The re-freezing will cause larger
crystals to form and the resulting damage will be greater than if the part
had been left frozen a little while longer.

Hypothermia presents with a patient that is initially alert and shivering.
As the process progresses, the patient's level of consciousness deteriorates
and the shivering stops. At the later stages of hypothermia the patient is
in a state of extreme medical emergency. Most patients encountered by the
first aid provider will be in a mild state of hypothermia (characterized by
shivering) and should be provided with a warm environment and given warm fluids by mouth. If possible wet warm cloths should be placed under the patient's armpits and in the patient's groin (near the top of the legs.)
Once the patient has begun to feel some relief, then start warming the
extremities (arms & legs.) If the patient is in a state of profound
hypothermia (characterized by altered consciousness and lack of shivering,)
the patient needs to transported immediately to a critical care facility
where "core warming" can be initiated with warm IV fluids, warm oxygen,
peritoneal lavage, and warm saline insufflations. None of these therapies
are available outside the critical care facility and the only thing that a
first aider can do for this patient would be to offer an environment that is
just slightly warmer than the outside environment. It is essential that this
patient's core be warmed first and to place this patient is a "comfortably
warm" environment would tend to warm the extremities first.

Head injuries are always spectacular.

The scalp is loaded with blood vessels and a relatively small wound to the
top of the head will bleed excessively. Closed head injuries (injury to the
brain, with no associated skull fracture,) can cause abnormal behavior
and/or breathing irregularities. Injuries to the face are considered by most
providers as the most difficult to look at, I guess, because it's an area
associated with visual and verbal communication and the thought of being
unable to communicate some dire need makes us feel uncomfortable in the
presence of "all that blood." The head is a very heavy part of the body
supported by the weakest part of the spinal column (consider supporting a
bowling ball on top of a pencil) and associated neck injury is common.
Therefore, treat any head injury (or suspected head injury, in the case of
closed head injury) by first monitoring the patient's breathing. As
discussed earlier, breathing can be monitored in several different ways.

To avoid additional injury to the neck, move the patient as little as
possible. If the injury to the head is significant enough to convince you
that there is neck injury, have someone hold the head so that it does not
move from the position in which it was found.

Control bleeding (if any) by applying direct pressure over the site of the
wound. Do not, however, apply pressure over the area of a suspected skull
fracture. A skull fracture may be indicated by a painful swollen area, a
soft spot in the skull, or a section of the skull that moves independently
from the rest of the skull. In the event that this bleeding is associated
with a fractured skull, apply a bulky dressing (without pressure) over the
wound.

If the head injury includes eye injury, cover the uninjured eye as well as
the injured eye. Covering the "good eye" will help prevent involuntary
movement in the injured eye and minimize the damage, but will also render
the patient "blind." Being "blind" is initially very frightening, therefore,
stay with the patient after the "onset of their blindness" and maintain
physical contact with them even if it is just a hand on their shoulder.
Trust me, it will make them feel better.

If the head injury includes an impaled object, remember we do not remove any impaled objects. (Can you imagine if a telephone pole that had impaled the patient's face? Ooooh Boy! "So, just what was going through his mind at the time of the accident?")

Keep the patient calm, maintain any corrective action that you have
initiated and wait for the ambulance.

How can I plan ahead to protect my family before a cold winter strikes?

There are steps you can take in advance for greater wintertime safety in your home and in your car.

• You can avoid many dangerous winter travel problems by planning
  ahead.
  
• Have maintenance service on your vehicle as often as the
  manufacturer recommends.
  
• During winter, keep the gas tank near full to help avoid ice in the
  tank and fuel lines.

In addition, every fall:

• Have the radiator system serviced, or check the antifreeze level
  yourself with an antifreeze tester. Add antifreeze, as needed.
  
• Replace windshield-wiper fluid with a wintertime mixture.
  
• Replace any worn tires, and check the air pressure in the tires.

Winter Survival Kit for Your Car

Equip your CAR with these items:

• blankets
  
• first aid kit
  
• a can and waterproof matches (to melt snow for water)
  
• windshield scraper
  
• booster cables
  
• road maps
  
• mobile phone
  
• compass
  
• tool kit
  
• paper towels
  
• bag of sand or cat litter (to pour on ice or snow for added traction)
  
• tow rope
  
• tire chains (in areas with heavy snow)
  
• collapsible shovel
  
• container of water and high-calorie canned or dried foods and a can
  opener
  
• flashlight and extra batteries
  
• canned compressed air with sealant (for emergency tire repair)
  
• brightly colored cloth

• Listen to weather forecasts regularly, and check your emergency
  supplies whenever a period of extreme cold is predicted.Insulate any water lines that run along exterior walls so your water
  supply will be less likely to freeze.
• To the extent possible, weatherproof your home by adding weather-stripping, insulation, insulated doors and storm windows, or thermal-pane windows.

Equip your HOME with these items:

• an alternate way to heat your home during a power failure:
  - dry firewood for a fireplace or wood stove, or
  - kerosene for a kerosene heater
  
• furnace fuel (coal, propane, or oil)
  
• electric space heater with automatic shut-off switch and non-glowing
  elements
  
• blankets
  
• matches
  
• multipurpose, dry-chemical fire extinguisher
  
• first aid kit and instruction manual
  
• flashlight or battery-powered lantern
  
• battery-powered radio
  
• battery-powered clock or watch
  
• extra batteries
  
• non-electric can opener
  
• snow shovel
  
• rock salt
  
• special needs items (diapers, hearing aid batteries, medications,
  etc.)

Keep several days' supply of these items:

• Food that needs no cooking or refrigeration, such as bread,
  crackers, cereal, canned foods, and dried fruits. Remember baby food and formula if you have young children.
  
• Water stored in clean containers, or purchased bottled water (5
  gallons per person) in case your water pipes freeze and rupture.
  
• Medicines that any family member may need.