Freezing and Near Freezing Injuries Flashcards
A patient with a white spot on their nose only after being outside in the cold. The freezing is rapidly treated, and there is no swelling, though there is mild pain. What is the diagnosis?
This is likely frostnip. It could be first degree frostbite if it caused more than just the most topical layer of the skin. If it were frostbite, edema, paresthesias, and changed skin texture.
A patient is out in the cold and accidentally pours white gas on his had while trying to fill his MSR bottle. He comes to you with numbness and erythema of his 2nd and 3rd digits as well as clear/mildly red blisters on those digits. What is the diagnosis?
2nd degree frostbite.
Bloody/hemmorhagic blisters are diagnostic of 3rd degree frostbite as opposed to clear blisters in 2nd degree.
A patient is found in the field after being lost in the woods for several days with numb, cold, woody fingers on his hands that are black in color. The patient clearly has mummification of some of his digits. What should you do to treat this patient?
Treat for Hypothermia first.
Then you can transport if the patient can get down in a short period of time (<24 hours). You could also consider rewarming the digits in 104-108 degree water.
For prolonged care, use sterile or clean padding, give oral antibiotics if any blisters are ruptured. Encourage active movement but do not passively move the digits. Prohibit vasoconstrictors (tobacco).
Name some things you should not do with suspected frostbite.
Thaw at all if there is a chance of re-freeze. This is worse than staying frozen.
Use dry heat (fires) to thaw
Rub/massage area with or without snow.
Preferred thaw method: Warm bath (104-108F, 40-42C)
Are blebs on the fingers affected by frostbite that extend to the nailed but then stop a favorable or unfavorable sign?
Unfavorable. As are absence of edema and cyanosis that does not blanch.
Favorable signs include blebs all the way to the tip, sensation to pinprick, and warmth (to the touch).
What are the three phases of immersion injury?
Pre-hyperemic phase: blanched affected areas with minimal pain. Can have sluggish cap refill and absent pulses. Sensation can be absent.
Hyperemic Phase: This is post rewarming, includes hot, erythematous, painful, swollen affected limbs.
Post-Hyperemic phase: May be absent, our may include paresthesias, pains, dull aches, or other neurologic symptoms. Recurrent edema is a common finding.
What is the best treatment for immersion injury?
Slow warming at ambient temperature after removal of all wet clothing. Recovery during post-hyperemic phase can be improved with physical therapy.
A patient comes to you on base with bluish red lesions on his hands. HIs hands look swollen and inflamed with purplish edematous lesions with vesicles on his hands. He has intense burning and itching (pruritis). What does he have?
Pernio/Chilblains. Do not active rewarm above 30C/86F as this will worsen the pain.
Why should we wear sunglasses in snow?
Prevent snow blindness and corneal frostbite.
Snow blindness requires topical antibiotics.
