winter wonderland

Having shoveled 4-6 inches of heavy wet snow this morning, I felt that this is an appropriate time to write about the ER in winter. Snow, ice, freezing temperatures, and howling winds are the joys of a New England winter. Layers of warm clothes, insulated boots and a good heating system will get us through the rigors of this season.



The ER is open for the predictable and unexpected consequences of the challenges of winter. The sore back, aching muscles, frost nip and frost bite are quickly diagnosed and treated. Chest pains from angina or a heart attack require more diligence and effort by the ER staff but if you arrive alive, it is highly probable that you will survive the ER and your ischemic heart disease.



The back pain from shoveling or pushing one's vehicle may be more than sore muscles. The discs between our vertebrae are prone to rupture, herniation or degeneration especially as they age beyond their warranty. Nerve impingements from disc disease, arthritis, or shifting of the vetebrae can send lancinating pains into your buttocks, groin or legs. If the nerves that innervate the bladder or bowels are involved urinary retention and constipation may occur.


Time and pain medicine are the main components of treatment. A medical study was done that compared doctor prescribed physical therapy, chiropractic treatment, and simply giving the patient a pamphlet on how to treat their sore back. The results showed that the long term outcome was the same for all three approaches. An MRI is sometimes necessary to get an anatomical diagnosis of the source of the back pain.


Every snow storm, especially if the snow is wet and heavy, guarantees at least one snow blower hand injury. These occur when the snow blower is packed with snow and the operator sticks his ( I have personally never treated a woman for this injury) hand in, to clear the clog. When the obstruction is released, the blades immediately begin to turn and voila, hand salad. X-rays, antibiotics, pain medication, a tetanus shot and a referral to a hand surgeon are the ER docs treatment protocol.


Cold injures can be life threatening. Frost bite is tissue damage from cold exposure. It is often rated like thermal injures from first to third degree, depending on how deep the tissue damage extends. Lower temperatures, wind exposure, time of exposure and water contact all factor into how severe the frost bite will be. Hypothermia is a core (rectal or bladder thermometer) below normal. The factors listed for frost bite, also apply to the risks of hypothermia. Alcohol imbibing predisposes one to cold injuries. Alcohol dilates peripheral blood vessels and reduces shivering and one's awareness of the damage being done.


Hypothermia and cold water drownings are difficult to treat and give rise to prolonged resuscitative efforts. The ER docs' adage is that you're not dead til you are warm and dead. CPR and rewarming techniques are continued until the patient is no longer hypothermic. Brain function, especially in children, may be preserved in cold weather cardiac arrest as the cold itself slows metabolism and limits cellular death.

The ER docs and PA's treat an array of arm and leg injuries from skiing and snowboard mishaps, falls on icy walkways, and MVC's (motor vehicle collisions) on wet and slick roads. X-rays, CAT scans, splints, casts, crutches and pain medication will usually get the patient comfortable and back home.

A word about S.A.D. Seasonal Affective Disorder is a form of depression. It is defined as signs and symptoms of depression that occur during the winter in northern climes. The cause seems to be the lack of sunlight during the short winter days. The farther north one lives, increases the incidence of SAD. Specially tuned lights that mimic the full spectrum of sunlight help to treat this real disorder.

November to March. We who live in the Northeast, love the change of seasons. We relish the mild springs, warm summers, and colorful autumns. Some of us even love the snow and cold. My advice is to dress warmly, be prepared when outdoors, and remember that the Caribbean is only 4 hours by jet.