COLD INJURIES

Epidemiology
Caused by the inability to physiologically
compensate for cold that produces injury.
Duration of exposure, humidity, wind, altitude,
clothing, medical conditions, behavior, and
individual variability are contributing factors.
Inadequate clothing is the most preventable
cause of cold related injuries with exposed head
and neck accounting for 80% of heat loss.

Epidemiology
Disease states as atherosclerosis,
arteritis, hypovolemia, diabetes, vascular
injury may predispose to cold-related
injury.
Dark-skinned people and those from
warmer climates are more susceptible to
frostbite

Local cold injuries result from

decreased blood flow to, or
freezing of, a body part.

These injuries are often

called frostbite or frostnip.

Local cold injury after

thawing.

Frostbit
e

Frostbite
Symptoms
initially redness in light skin or grayish in dark
skin
tingling, stinging sensation
turns numb, yellowish, waxy or gray color
feels cold, stiff, woody
blisters may develop

Clinical features
Classification of frostbite
first degree is characterized by partial skin
freezing, erythema, mild edema, lack of blisters,
and occasional skin desquamation, has
excellent prognosis.

Clinical features
second degree is characterized by full-thickness
skin freezing, formation of substantial edema
over 3 to 4 h, and formation of clear blisters that
desquamate to form black eschars and has
good prognosis.

Clinical Features
third degree injury is characterized by damage
that extends into the subdermal plexus and
leads to formation of hemorrhagic blisters, skin
necrosis and a blue-gray discoloration of skin,
has poor prognosis

Clinical Features
fourth degree injury is characterized by
extension into subcutaneous tissues, muscle,
bone, and tendon, there is little edema,
nonblanching cyanosis, bloody blebs, has
extrememly poor prognosis

Treatment in the field

Remove wet and
constrictive clothing.
Elevate and wrap in dry
sterile gauze the involved
extremities.
Rapid rewarming if rapid
access to hospital
400 to 420 C clean water
should be used

There is controversy with

regards to debridement of
clear blisters on the field
Pain management should
start with NSAIDS to
counteract the
arachidonic acid cascade,
in addition to opioids
Smoking should be
discouraged

Treatment in the ED
Injured extremity should
be placed in circulating
water at a temperature of
400 to 420 C for
approximately 10-30 min
until the distal extremity is
pliable and erythematous
Pain should be treated
with parenteral antibiotics
Clear blisters should be
debrided or aspirated

Hemorrhagic blisters
should not be debrided
Alo vera cream should be
applied to the blisters
Role of antibiotics is
unclear.
Staph aureus, Staph epi,
beta-hemolytic Strep,
Pseudomonas, and
Enterococus are
important pathogens.

Treatment in ED
Infection prophylaxis
using topical
bacitracin is as good
as IV penicillin.
Tetanus immunization
status should be
assessed.
Ibuprofen

Early surgical
intervention is not
indicated in treatment
of frostbite
Amputation if needed
within 3 weeks

Chilblains
Nonfreezing cold injury
Cold, wet conditions (between 32-60oF, high
humidity)
Repeated, prolonged exposure of bare skin
Can develop in only a few hours
Ears, nose, cheeks, fingers, and toes

 Chilblains is a condition that usually occurs in

temperatures above freezing, accompanied by
high humidity. It appears as red, swollen skin
which is tender, hot to the touch and may itch.
This can worsen to an aching, prickly (pins and
needles) sensation and then numbness. It can
develop in only a few hours in skin exposed to
cold. In severe cases, blistering may appear.
The most commonly affected areas are the ears,
nose, fingers and toes.

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

Chilblains
Treatment
prevent further exposure
wash, dry gently
rewarm (apply body heat)
dont massage or rub
dry sterile dressing
seek medical aid

Trench/Immersion Foot
Potentially crippling, nonfreezing injury
(temps from 50oF-32oF)
Prolonged exposure of skin to moisture
(12 or more hours, days)
High risk during wet weather, in wet areas,
or sweat accumulated in boots or gloves

Trench/Immersion Foot
Symptoms
initially appears wet, soggy, white, shriveled
sensations of pins and needles, tingling, numbness,
and then pain
skin discoloration-red, bluish, or black
becomes cold, swollen, and waxy appearance
may develop blisters, open weeping or bleeding
in extreme cases, flesh dies

Extremity appears cold, swollen, mottled. Cyanosis, a blueness of

the skin resulting from imperfectly oxygenated blood, is usually
present.

Usually occurs in 3 stages:

1st stage: affected part is cold, w/o pain. Weak pulse at the site.
2nd stage: affected limb feels hot, as though burning, has shooting
pains.
3rd stage: casualty has pale skin, cyanosis around the nailbeds and
lips, decreased pulse strength.
When the extremity rewarms, the skin becomes warm, dry, and red.
The pulse bounds and the injury is painful. The injured area may
itch, tingle, and exhibit increased sensitivity to cold, possibly
permanently. Recovery can last weeks. Nerve damage may be
permanent. Development of blisters, ulcers, and gangrene is
possible. Amputation may be necessary.

Trench/Immersion Foot

Trench/Immersion Foot
Treatment
prevent further exposure
dry carefully
DO NOT break blisters, apply lotions, massage,
expose to heat, or allow to walk on injury
rewarm with body heat
clean and wrap loosely
elevate feet to reduce swelling
evacuate for medical treatment

Trench/Immersion Foot
Prevention
keep feet dry
change socks at least every 8 hours or
whenever wet and apply foot powder
bring extra boots to field
no blousing bands

Care for Local Cold Injuries

Remove patient from cold environment

Protect the cold extremity from injury

Administer oxygen

Remove wet or restrictive clothing and all jewelry

Splint if extremity involved, and cover with dry, sterile dressing

Place
dressings
between those
fingers
affected by
local cold
injury.