COLD INJURIES

Regia Anadhia
1410211047
COLD INJURIES
An injury caused by exposure to extreme cold that can
lead to loss of body parts and even to death.

Cold weather-related injuries can be divided into two

general categories :
Conditions that occur without the freezing of body tissue such as:
chilblains, trench foot, and frostnip
Injuries that occur with the freezing of body tissue, such as
frostbite.
CLASSIFICATION
FROSTNIP (the mildest form of cold injury)
CHILLBLAINS (represent a more severe condition due to
prolonged exposure to nonfreezing temperature and
humidity)
TRENCH FOOT (also known as immersion foot, occurs
when the feet are wet, but not freezing, for long periods of
time)
FROSTBITE (the most serious peripheral cold injury,
results in tissue necrosis, and usually occurs after
exposure to freezing temperatures)
FROSTNIP
Frostnip is the mildest form of cold injury and therefore
doesnt cause any irreversible damage.
Symptoms of frostnip usually occur after exposure to cold
weather. The affected area(s) may:
appear pale,
be accompanied by burning, itching or pain;
Tingle
feel numb
The skin appears red or minimally swollen
Erythema of the cheeks, ears, nose, fingers and toes is the
main clinical aspect of this condition

Resolves quickly with warming

 Treatment :
first aid measures (rewarming and use of aloe vera, a
thromboxane inhibitor, which has proven to be a useful topical
agent in superficial frostbite)
CHILLBLAINS/PERNIO
Is an inflammatory skin condition presenting after
exposure to cold as pruritic and/or painful erythematous to
violaceous acral lesions, without any frozen tissue
damage
Chillblains is not necessarily related to very low external
temperature, as it is to prolonged exposure to
moderately low temperatures, humidity, air currents
and sudden shift from hot to cold
Gejala :
Gatal
Nyeri
Kemerahan
Bengkak terutama di bagian pipi, jari, telinga, tangan, kaki
 Treatment :
Gradually rewarm the affected area, and treatment can generally
be accomplished at home.
Some individuals may benefit from various lotions, while others
may require treatment with corticosteroid creams.
If open sores develop, they should remain clean and be monitored
for signs of infection.

Most cases of chillblains resolve within 2-3 weeks

without any adverse reactions.
TRENCH FOOT/IMMERSION FOOT
Trench foot is a nonfreezing cold injury that occurs
when feet are wet, but not freezing (temperatures
between 0-12 C and their freezing point), for long periods
of time
It occurs from wearing wet boots and socks for a
prolonged period
Trench foot develops after a prolonged exposure to a wet,
cold, environment and is typically a more serious
condition than chilblains.
Tight-fitting, constricting boots and footwear serve to
exacerbate the condition. Trench foot does not require
freezing temperatures, and can occur with temperatures
of up to 60 F (15.5 C).
 Symptoms :
Sensation of feet being cold and numb
Itching, numbness, or paraesthesias of the feet
On exam, the foot may appear swollen with the skin mildly blue, red
or black
 Trench foot treatment :
FROSTBITE
Frostbite is a condition caused by the action of cold on the
body, requires there to be frozen tissue and actual
tissue damage
Appearance of frostbite not only depends on temperature
but also on the duration of exposure to cold, humidity,
airflow, possible pre-existing diseases (arterial circulatory
disorders, chronic alcoholism)
Usually, frostbite occurs after exposure to 1C down, but
when there are favorable conditions appear to +1C.
 Symptoms and clinical appearance :
The skin initially becomes numb
The affected limb appears mottled, bluish, or yellowish
The limb feels frozen
The skin feels stiff
 PATHOPHYSIOLOGY
Cedera pada frostbite disebabkan oleh pembekuan secara
langsung pada sel disaat injuri atau karena perfusi jaringan yang
tidak adekuat sebagai akibat dari spasme vaskuler dan oklusi
pembuluh kecil pada area injuri
Crystallization terbentuk kristal es di dalam CES dan secara
osmotik menarik cairan intrasel dehidrasi sel
Setelah pencairan, terjadi stasis vaskuler pada area yang injuri
sebagai akibat obstruksi pada dasar pembuluh darah edema
terjadi pada daerah injuri dan berlangsung selama 2-3 hari setelah
pencairan
 Frostbite classification :
Superficial frostbite injuries involve the skin and subcutaneous
tissues.
Deep frostbite injuries extend beyond the subcutaneous tissues
and involve the tendons, muscles, nerves, and even bone.
 Frostbite grading :
First degree :
occurs in people who
live in very cold climates
or do a lot of outdoor
activity in winter
Erythema/edema at
distal inolved sites, no
vesicles
The skin may feel stiff to
touch, but the tissue
underneath is still warm
and soft.
Blistering, infection or
scarring seldom occurs if
it is treated promptly
 Second degree :
superficial frostbite and presents as white or blue skin that feels
hard and frozen.
Clear fluid filled vesicles, blisters formation
The tissue underneath is still intact but medical treatment is required
to prevent further damage
 Third degree :
also known as deep frostbite, appears as blue skin alternating
with white zones, necrosis
The underlying skin tissue is damaged and feels hard and cold to
touch.

Fourth degree :
Involvement of deeper structures,
may be difficult to determine
initially
Kerusakan jaringan lunak,
gangren pada jari atau ekstrmitas
Blood-filled blisters form black
thick scabs over a matter of
weeks.
Amputation may be required to
prevent severe infection or when
damage affects muscles, tendons,
and bone, with resultant tissue
loss
 3 steps of frostbite treatment :
Field management
Rewarming
Postrewarming management
 Field Management
Rapid evacuation
As a general principle, always address the ABCs and treat any life-
threatening conditions (eg, hypothermia) first.
Correct any systemic hypothermia to a core temperature of 34C
before treating the frostbite.
Remove the patient from cold.
Replace wet and constrictive clothing with dry loose clothing.
Remove jewelry from the affected area.
Dress the extremity in a manner that minimizes mechanical trauma.
 Rewarming
Rapid rewarming by immersing the extremity in gentling circulating
water at 40-42 C. The extremity is rewarmed until pliable and
erythematous at the most distal areas
Warming is continued for 15-30 minutes or until thawing is, by
clinical assessment, complete (ie, when the distal area of the
extremity is flushed, soft, and pliable).
The addition of an antiseptic solution such as povidone-iodine or
chlorhexidine to the bath may be beneficial.
Constantly monitor water temperature. Thawing takes about 20-40
minutes for superficial injuries and as long as 1 hour for deep
injuries.
AVOID massaging or rubbing
 Postrewarming management
Once the skin is thawed, protect the area from further injury and
reexposure to cold.
Elevate the area and splint the extremity. Sterile, nonadherent
dressings should be applied. They should be changed 2-4 times a
day and local wound care performed. The injured area should be
closely monitored for signs of infection.
 Treatment of vesicles :
Debride clear or milky vesicles and apply topical aloe vera
Utilize IV or PO NSAIDs simultaneously : ibuprofen is an effective
thromboxane inhibitor
DO NOT debride hemorrhagic vesicle
 Pharmacological treatment :
Analgesics (eg, ibuprofen and morphine) for pain relief are
indicated during and after rewarming.
Apply topical aloe vera cream to all frostbitten areas every 6 hours
to inhibit the arachidonic cascade, especially thromboxane
synthesis.
Administer tetanus prophylaxis (tetanus toxoid or immune
globulin).
Antibacterial prophylaxis is recommended. Frostbite infections
tend to involve staphylococci, streptococci, enterococci, and
Pseudomonas pathogens. If infection develops, oral or parenteral
antibiotics should be administered based on local sensitivities
(Penicillin G 500.000 units every 6 hours, continued for 72 hours)
 infusion of low-molecular-weight dextran may be beneficial by
preventing erythrocyte clumping in cold-injured blood vessels, with
an associated decrease in tissue necrosis.
intravenous or intra-arterial thrombolysis with tissue plasminogen
activator (tPA) in the management of frostbite. When administered
within 24 hours of thawing, it has been shown to decrease
amputation rates
PREVENTION
Seek shelter from wind and cold
Wear several layers of light, loose clothing, which traps air
for insulation yet provides for adequate insulation; such
layering provides better protection than a single bulky
layer of heavy clothing
Wear mittens instead of gloves because they decrease
surface area exposure to the cold
Wear at least 2 pairs of socks
 Cover the face and head
Choose fabrics suited for the cold (eg, fleece,
polypropylene, wool)
Avoid restrictive and tight clothing that reduces peripheral
circulation
Avoid getting clothing wet
Avoid remaining in the same position for prolonged
periods
Check skin every 10-20 minutes for frostbite
Avoid smoking, because it causes peripheral
vasoconstriction