17 - 98 - COLD INJURIES

Question 1

Question 2

Question 3

Question 4

Answer 4

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).

Question 5

Answer 5

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.

Question 6

Answer 6

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).

Question 7

the only form of frostbite that can be treated safely in the field with first aid measures

Answer 7

Frostnip

Question 8

Question 9

Good prognostic signs of Frostbite

Answer 9

Question 10

Poor prognostic signs of Frostbite

Answer 10

Question 11

Large, clear blebs extending to the tips of the digits.

Good or Poor prognostic sign?

Answer 11

GOOD

Question 12

True or False: Rewarming should be done slowly to decrease tissue damage

Answer 12

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.

Question 13

Question 14

Answer 14

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).

Question 15

Answer 15

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).

Question 16

Question 17

Question 18

Question 19

Question 20

presence of hand edema superposed on acrocyanosis

Answer 20

“puffy hand syndrome”

Question 21

Question 22

Question 23

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.

Question 24

Desensitization to cold

Answer 24

immersing 1 arm into water at 15°C (59°F) for 5 minutes daily

Question 25

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

Answer 25

B

Question 26

This disease occurs after exposure to intensely cold air, liquids, or metals a. Frostbite b. Pernio c. Acrocyanosis d. Polymorphous cold eruption

Answer 26

A

Question 27

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

Answer 27

D

Question 28

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

Answer 28

C

Question 29

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

Answer 29

B

Question 30

T/F Slow freezing results in extracellular formation of ice whereas fast freezing tends to produce intracellular ice.

Answer 30

True Slow - extracellular ice Fast - intracellular

Question 31

occurs when tissue freezes after exposure to extremely cold air, liquids, or metals

Answer 31

Frostbite

Question 32

The clinical effects of accidental injury that lead to the death of tissues are similar to those caused by cryosurgery.

Answer 32

Frostbite

Question 33

frostbite that nvolves only the skin and damage is reversible

Answer 33

Frostnip

Question 34

* 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.**

Answer 34

Frostnip

Question 35

the only form of frostbite that can be treated safely in the field with first aid measures

Answer 35

Frostnip

Question 36

* 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

Answer 36

Superficial frostbite

Question 37

* 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

Answer 37

Deep frostbite

Question 38

# Good or poor prognostic sign? Cold and cyanotic skin without blebs after rewarming

Answer 38

Poor

Question 39

keystone of treatment in frostbite injury

Answer 39

rapid rewarming ## Footnote * Slow rewarming increases tissue damage *

Question 40

Rewarming should be performed in a water bath between what temperature until the most distal parts of the body are flushed

Answer 40

37°C and 39°C

Question 41

T/F In frostbite injury, surgical debridement is often best **delayed** until 1 to 3 months after demarcation.

Answer 41

TRUE

Question 42

Nonfreezing cold injury occurs when tissues are cooled to temperatures between?

Answer 42

**0°C and 15°C** (32°F and 59°F) for hours to days

Question 43

Cold urticaria also may be a sign of what syndrome that associates urticaria, deafness, and amyloidosis

Answer 43

Muckle-Wells syndrome

Question 44

Bacteria that been suggested as a causative agent in some cases of acquired cold urticaria

Answer 44

Helicobacter pylori

Question 45

Desensitization to cold

Answer 45

immersing 1 arm into water at 15°C (59°F) for 5 minutes daily