COLD INJURY : LOCAL

TISSUE

COLD INJURY
Freezing
Frostnip
Frostbite
Non Freezing
Trench foot Immersion
foot
Childblains

Patophysiology of Tissue
Freezing
Temperature below -2C
Distal area of body and area with high
surface to volume ratio; ears, nose,
fingers and toes
As tissue begins to freeze, ice crystals
are formed within cells. As intracellular
fluids freeze, extracellular fluid enters
cell and extracellular salts increase
due to the water transfer.

 Cells may rupture due to the increased

water and/or from tearing by the ice
crystals.
Do not rub tissue; it causes cells
tearing from the ice crystals
As the ice melts, there is an influx of
salts into the tissue further damaging
the cells membrane.
Cells destruction results in tissue death
and loss of tissue.

Cold
Mild
Superf Deep
Respon Frostni cial
Frostbi
se
p
Frostbit te
e
Sensati Painful
on

May
Numb
have
sensatio
n

Numb

Feels

Normal

Normal

Soft

Hard

Color

Red

White

White

White

Frostnip
Freezing of top layers of skin tissue
Reversible
White, waxy skin, top layer feels
hard, rubbery but deeper tissue is
still soft
Numbness
Most typically seen on cheeks,
earlobes, fingers and toes

Treatment of Frostnip
Rewarm the area gently, by blowing
warm air on it or placing the area
against a warm body part (partners
stomach or armpit)
Do not rub the area this can
damage the effected tissue by
having ice crystals tear the cell

Frostbite
Skin is white and wooden feel all
the way through
Numbness, possible anesthesia

Superfcial Frosbite (2nd degree

Frosbite)
Destruction of skin layers,
resulting blistering &
minor tissue loss.
Blisters are formed from
the cellular fluid released
when cells rupture.

Skin redness in fair individuals, Grayish

discoloration in darker skinned
individuals.
Persistent cold sensitivity in the area

Deep Frosbite
Loss of sensation with pale,
yellow, waxy look if unthawed.
Poor capillary refill.
Tissue loss, can involve muscle
and bone
Hemorrhagic bullae form in 3rd
degree injuries at 12-35 hours
unless re-warming is rapid.
Red discoloring 1-5 days after
injury.

4th degree characterized by gangrene,

necrosis, auto-amputation.
Permanent anatomic and functional loss.

Rewarming of Frosbite
By immersion the effected part into a
water bath of 40.5 43.3 C.
Remove constricting clothing
Monitor and maintain the warm water
bath temperature
Thawing is complete when the part is
pliable and color and sensation has
returned
Discontinue the warm water bath when
thawing is complete

 Once rewarming is complete, the

injured area should be wrapped in
strile gauze and protected from
movement and further cold
If the person is hypothermic and
frosbitten, the first concern is core
rewarming. Do not rewarm the
frostbitten areas until the core temp
approaches 35 C

Trench Foot Immersion

Foot
Caused by prolonged exposure of feet
to cool, wet condition
Occur at temperature as high as 15.5
C if the feet are constantly wet
Mechanism of injury: wet feet lose
heat 25x faster than dry, therefore
body uses vasoconstriction to shut
down peripheral circulation in the foot
to prevent heat loss

 Skin tissue begins to die because lack

of oxygen and nutrients and due to
buildup of toxic products
Skin is initially reddened with
numbness, tingling pain, and itching
then becomes pale and mottled and
finally dark purple, grey or blue
The effected tissue generally dies and
sluff off

 Involve toes, heels or entire foot

If circulation is impaired for > 6
hours there will be permanent
damage to tissue
If circulation is impaired for > 24
hours the victim may lose the entire
foot

Treatment Trench Foot

Careful washing and drying of feet,
gentle rewarming and slight
elevation
Give Ibuprofen or other pain
medication

Prevention of Trench
Foot
Keep feet dry by wearing appropriate foot
wear, check feet regularly to see if they are
wet
If feet get wet (through sweating or
immersion), stop and dry feet and put on
dry socks
Periodic air drying, elevation and massage
will also help
Change socks at least once a day and do
not sleep with wet socks.

Chillblains
Caused by repeated exposure of bare
skin to temperature below 15.5 C
Redness and itching of the effected area
Particularly found on cheeks and ears,
fingers and toes
Cold exposure causes damage to the
peripheral capillary beds, this damage
is permanent and redness and itching
will return with exposure

Childblains
Symptoms:
initially pale and colorless
worsens to achy, prickly sensation then
numbness
red, swollen, hot, itchy, tender skin upon
rewarming
blistering in severe cases

Childblains

Treatment

prevent further exposure

wash, dry gently

rewarm (apply body heat)

dont massage or rub

dry sterile dressing

seek medical aid

Childblains
Prevention
keep dry and warm
cover exposed skin
wear uniform properly
use the Buddy System