17 - 98 - COLD INJURIES Flashcards
Superficial frostbite involves the skin and immediately subcutaneous tissues.
It includes the previously described signs but with the pain subsiding to feelings of warmth. This is a sign of severe involvement.
The skin has a waxy appearance, but deeper tissues remain soft and resilient.
Clear blebs form, accompanied by edema and erythema within 24 to 36 hours after thawing. Lesions may become eroded (Fig. 98-4).
Frostnip involves only the skin and damage is reversible (Fig. 98-3).
There is a sensation of severe cold progressing to numbness followed by pain.
Erythema is usually present on the cheeks, ears, nose, fingers, and toes.
There is no edema or bleb formation.
Deep frostbite extends to the deep subcutaneous tissue. The injured skin becomes white or bluish white with a variable degree of anesthesia.
Most often the affected skin becomes deceptively pain free, and the discomfort of feeling cold vanishes.
The tissue is totally numb, indurated with immobility of joints and extremities. Muscles may be paralyzed. Nerves, large blood vessels, and even bone may be damaged.
Large blisters form 1 to 2 days after rewarming, and they can be classified according to depth, as in heat-induced burns (Fig. 98-5).
the only form of frostbite that can be treated safely in the field with first aid measures
Frostnip
Good prognostic signs of Frostbite
Poor prognostic signs of Frostbite
Large, clear blebs extending to the tips of the digits.
Good or Poor prognostic sign?
GOOD
True or False: Rewarming should be done slowly to decrease tissue damage
FALSE
Slow rewarming increases tissue damage, making rapid rewarming the keystone of treatment.
Rewarming should be performed in a water bath between 37°C and 39°C (98.6°F and 102.2°F) until the most distal parts of the body are flushed.
Because of the low temperatures of inhalants, frostbite has been observed on the face, fingers, forearms, oral, laryngeal, and tracheal surfaces (Fig. 98-8A).
This may present as well-demarcated edema, erythema, cyanosis, and vesiculation concentrated around the nose, mouth, or even periorbital area (Fig. 98-8B).
Because of the low temperatures of inhalants, frostbite has been observed on the face, fingers, forearms, oral, laryngeal, and tracheal surfaces (Fig. 98-8A).
This may present as well-demarcated edema, erythema, cyanosis, and vesiculation concentrated around the nose, mouth, or even periorbital area (Fig. 98-8B).
presence of hand edema superposed on acrocyanosis
“puffy hand syndrome”
Diagnosis of cold urticaria is confirmed by a cold challenge induced by an ice cube wrapped in a plastic bag placed on the skin of the forearm for periods varying from 30 seconds to 10 minutes (Fig. 98-14). Wheals form on rewarming. Sometimes water at 7°C (44.6°F) is more effective, presumably because it causes lesssevere vasoconstriction.
Desensitization to cold
immersing 1 arm into water at 15°C (59°F) for 5 minutes daily
This disease is characterized by acral eruption of edematous violaceous papules occurring in cool rather than freezing exposures, and is seen more frequently in lean persons.
a. Frostbite
b. Pernio
c. Acrocyanosis
d. Polymorphous cold eruption
B
This disease occurs after exposure to intensely cold air, liquids, or metals
a. Frostbite
b. Pernio
c. Acrocyanosis
d. Polymorphous cold eruption
A
It is a rare autosomal dominant disease characterized by childhood onset of nonpruritic, erythematous patches often accompanied by influenza-like symptoms and leukocytosis after generalized exposure to cold
a. Frostbite
b. Pernio
c. Acrocyanosis
d. Polymorphous cold eruption
D
This disease is characterized by bilateral dusky mottled or confluent red to blue discoloration of the hands, feet, nailbeds, and face that occurs due to vasoconstriction
a. Frostbite
b. Pernio
c. Acrocyanosis
d. Polymorphous cold eruption
C
The following are good prognostic signs of frostbite except?
a. Large, clear blebs extending to the tips of the digits
b. Hard, white, cold insenstivie skin
c. Rapid return of warm temperature to the injured area
d. Pink skin after rewarming
B
T/F
Slow freezing results in extracellular formation of ice whereas fast freezing tends to produce intracellular ice.
True
Slow - extracellular ice
Fast - intracellular
occurs when tissue freezes after exposure to extremely cold air, liquids, or metals
Frostbite
The clinical effects of accidental injury that lead to the death of tissues are similar to those caused by cryosurgery.
Frostbite
frostbite that nvolves only the skin and damage is reversible
Frostnip
- There is a sensation of severe cold progressing to numbness followed by pain.
- Erythema is usually present on the cheeks, ears, nose, fingers, and toes.
- There is no edema or bleb formation.
Frostnip
the only form of frostbite that can be treated safely in the field with first aid measures
Frostnip
- frostbite involves the skin and immediately subcutaneous tissues
- pain subsiding to feelings of warmth - sign of severe involvement
- The skin has a waxy appearance, but deeper tissues remain soft and resilient
* Clear blebs form, accompanied by edema and erythema within 24 to 36 hours after thawing. - Lesions may become eroded
Superficial frostbite
- extends to the deep subcutaneous tissue.
- injured skin becomes white or bluish
- white with a variable degree of anesthesia
- most often the affected skin becomes deceptively pain free, and the discomfort of feeling cold vanishes
- The tissue is totally numb, indurated with immobility of joints and extremities.
- Muscles may be paralyzed.
- Nerves, large blood vessels, and even bone may be damaged.
- Large blisters form 1 to 2 days after rewarming
Deep frostbite
Good or poor prognostic sign?
Cold and cyanotic skin without blebs after rewarming
Poor
keystone of treatment in frostbite injury
rapid rewarming
- Slow rewarming increases tissue damage
*
Rewarming should be performed in a water bath between what temperature until the most distal parts of the body are flushed
37°C and 39°C
T/F
In frostbite injury, surgical debridement is often best delayed until 1 to 3 months after demarcation.
TRUE
Nonfreezing cold injury occurs when tissues are cooled to temperatures between?
0°C and 15°C (32°F and 59°F) for hours to days
Cold urticaria also may be a sign of what syndrome that associates urticaria, deafness, and amyloidosis
Muckle-Wells syndrome
Bacteria that been suggested as a causative agent in some cases of acquired cold urticaria
Helicobacter pylori
Desensitization to cold
immersing 1 arm into water at 15°C (59°F) for 5 minutes daily
