Cold Illnesses

Question 1

Local cold injuries

Answer 1

Only effect specific parts like limbs

Question 2

Examples of local cold injuries

Answer 2

Frostbite
Frost nip
Tranchfoot
Chilblains

Question 3

Systemic cold injuries

Answer 3

Effect the CBT, like hypothermia

Question 4

What is frostbite

Answer 4

An injury caused by freezing of the skin and underlying tissues. Develops within minuets to hours depending on circumstance and risk factors. Usually isolated to areas that have been exposed. Ocuurs when tissue has been super cooled to temperatures of at least -4

Question 5

What is cutaneous circulation?

Answer 5

The key player in thermoneutrality
Acts as a radiator
Cold stress causes vasoconstriction, during long periods of envrionmental stress the body uses A/V stoma’s to create a life over limb effect

Question 6

At what temperature does maximal vasoconstriction occur?

Answer 6

15C

Question 7

What triggers huntings response

Answer 7

Further exposure to cold temperatures (10C). Cold induced vasodilation occurs (huntings response) resulting in 5-10min rotations of vasoconstriction and dilation to prevent ischemic injuries and local cold injuries

Question 8

Three phases of frost bite

Answer 8

1. Pre freeze
2. Freeze thaw
3. Vascular stasis and progressive ischemia

Question 9

Pre-freeze phase

Answer 9

Superficial tissue cooling
Increased viscosity of vascular contents
Microvascualr constriction

Question 10

Freeze-Thaw phase

Answer 10

Extracellular fluid ice crystal formation
Cell shrinkage and collapse

Question 11

Vascular stasis and progressive ischemia

Answer 11

Vasopasticity and stasis coagulation
Arteriovenous shunting
Necrosis, demarcation, mummification or slough

Question 12

Ice crystal formation in the freeze thaw stage

Answer 12

Crystals initially start extracellularly
-this results in the diepedesis or water exiting the cell to maintain equilibrium. When 1/3 of the cellular volume is lost the cell collapses and dies
Crystals also increase the tissue pressure on cell membranes and vascualature leading to cellular damage, stasis, sludging and eventually cessation

Question 13

Superficial frost bite

Answer 13

Altered sensation of numbness, burning
Skin is waxy and white, firm to palp
Thawing causes cyanotic skin and a hot stinging sensation

Question 14

Deep frostbite

Answer 14

White, yellow or mottled blue-white skin, Feels hard, cold no sensation
Major damage when tissues thaw may cause gangrene

Question 15

Frostbite treatment

Answer 15

Remove from cold and remove wet clothing
Do not rub or massage the area
Transport with the area elevated
Pain management
Cover blisters with dry dressing
Consider rewarming

Question 16

Principles of rewarming frostbite

Answer 16

Water bath - ensure Emerson without touching the container
Temp between 36-37
IV analgesia
Avoid dry heat

Question 17

Trenchfoot

Answer 17

From prolonged exposure to cool, wet conditions
Keep the feet warm and dry

Question 18

Chilblains

Answer 18

Itchy reddish or purple lesions on face or extremities
Long expose to temperatures just above freezing

Question 19

Frost nip

Answer 19

Superficial cold insult causes numbness and tingling that resolves after rewarming

Question 20

Hypothermia

Answer 20

The CBT is below 35C

Question 21

Symptoms of hypothermia

Answer 21

Tachycardia followed by bradycardia (heart rate drops by 50%
Refractory to atropine
Afib
J waves
CNS dysfunction
Cold diuresis
RR slows
Cold muscles become progressively weaker

Question 22

Mild hypothermia

Answer 22

32-35C

Question 23

Moderate hypothermia

Answer 23

28-32

Question 24

Severe hypothermia

Answer 24

Less than 28C

Question 25

Hypothermia risk factors

Answer 25

Alcohol is the biggest
Improper gear
Wetness and dehydration
Length of exposure
Intensity of weather conditions

Question 26

What effect does alcohol have?

Answer 26

-lowers inhibtion
-impairs shivering
-promotes vasodilation
-subnormal nutritional status
-Stops ADH

Question 27

What does UMBLES stand for

Answer 27

-Stumbling
-Mumbling
-Fumbling
-Grumbling

Question 28

What to do in a hypothermic arrest

Answer 28

-identify the rhythm
-one defibrillator attempt
-IV access and infuse warm NaCl
-Attempt advanced airway, give warm humid oxygen

Question 29

What happens when we get cold?

Answer 29

-Adaptive behavioural reactions
-neurological response (shivering)
-endocrine response (TH release)
-Cardiovascular response (vasoconstriction)