Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Freezing and Near Freezing Tissue
Injuries
TLO
• Given a simulated casualty, treat cold
injuries, in accordance with the references.
ELO’s
• From a given list select the correct definition of
frostbite.
• From a given list select the correct two
mechanism...
ELO’s
• From a given list select the correct
unfavorable post thaw signs of a frostbite
injury.
• From a given list select...
ELO’s
• From a given list select the correct methods
to reduce the chance of becoming a frostbite
casualty.
• From a given...
ELO’s
• Given a list of categories and characteristics
match the category of immersion foot to its
characteristics.
• From...
Napoleon’s Retreat from
Russia
Napoleon Retreats from Russia
• Entered Russia with an
army of 250,000
• Retreated with only
20,000 soldiers (only
350 wer...
WWII
• In November and December 1942, the
Germans performed 15,000 amputations for
cold injuries.
FROSTBITE
• Definition: Frostbite
is the actual freezing
of tissue.
Mechanisms of Injury
• Actual freezing of the tissues.
– Ice crystals form extracellularly and grow by
extracting water fr...
Mechanisms of injury
• Obstruction of blood supply
– Cells lining the capillaries and small veins are
damaged, this allows...
Frostbite Signs and Symptoms
• Sensation
– Numbness
– Paresthesias
– Pain – after extremity is rewarmed
Frostbite Signs and Symptoms
Appearance:
• Pale/White to yellowish
white to gray
• Bluish tinge/mottled blue
• Erythematou...
Frostbite Signs and Symptoms
• Sensation
– Loss of pliability
– Waxy
– “frozen chicken”
– “block of wood”
Late Frostbite Signs and
Symptoms
• Blisters/edema will
occur approximately
6-24 hrs after injury
• Black hard eschar
appe...
Frostbite Classification
• Classification must be done retrospectively.
• 1st- Erythema, edema, tingling, burning.
• 2nd- ...
Baron de Larrey
• Chief of the Medical
Corps for Napoleon’s
Army
• Organized the concept
of the “flying
ambulance”
• Captu...
Baron de Larrey
• Made observations
about frostbite
• Soldiers who thawed
hands over bonfires
and allowed them to
refreeze...
Baron de Larrey
• Made correct
conclusion that
frostbite victims
should not rewarm the
affected extremity and
allow it to ...
Baron de Larrey
• However, his
recommendation was to
rub the frostbitten
extremity with snow.
• “when some external part
o...
Primary Consideration
• Do not rewarm the extremity if there is a
chance of it refreezing.
• This will greatly increase th...
Field Treatment
(Frostbite)
• Rapid rewarming produces the best results.
• Immersion of the affected part in warm
water.
•...
Frostbite Treatment
• Forced hydration- IV fluid
if necessary
• Motrin 400mg BID before
rewarming if possible
• Aloe Vera ...
Frostbite Treatment
• No nicotine
Blister Management
• Do not aspirate
hemorrhagic blisters
• Leave intact
• If blisters rupture
apply topical antibiotic
Amputation
• Keep orthopedic surgeons away from
patient
• Amputate late
Experimental Treatments
• Vasodilators
• Heparin
• Hyperbaric oxygen
• Topical nitrates
Favorable Signs
(Frostbite)
• Warmth of tissue.
• Normal tissue color.
• Preservation of sensation.
• Blisters extending a...
Unfavorable Signs
• These signs indicate a poor prognosis with
probable tissue loss.
– Complete absence of edema.
– Cyanot...
QUESTIONS?
Frostbite Risk
Factors/Prevention
Frostbite Risk
Factors/Prevention
• Vasoconstriction
caused by
hypothermia
• Cold Induced
Vasodilation (CIVD)
- 59F
Frostbite Risk
Factors/Prevention
• Keep whole body
warm- “if feet are cold
put on a hat”
• Adequate clothing
• Activity
•...
Frostbite Risk
Factors/Prevention
• Inadequate Blood
Supply
– Fractures
– Dislocations
– Shock
– Dehydration
Frostbite Risk
Factors/Prevention
• Inadequate Blood
Supply
– Tight boots/gloves
– Tight harness/pack
• Ensure fingers and...
Frostbite Risk
Factors/Prevention
• Inadequate Blood
Supply
– Nicotine – potent
vasoconstrictor
– Avoid nicotine-
• Must h...
Frostbite Risk
Factors/Prevention
• Increased Heat Loss
– Inadequate insulation
– Wet gloves
– Gloves versus mittens
Frostbite Risk
Factors/Prevention
• Keep clothing/gloves dry
– Off the deck
– Dry in the evenings
– Secure straps
– Fleece...
Frostbite Risk
Factors/Prevention
• Increased conductive heat
loss when in contact with
metals and fuels
• Do not touch me...
Rewarming Cold Hands
• Set an acceptable time
period for “cold
hands”
• Whole body warmth
• Conduction- skin to
skin – axi...
Frostbite Risk
Factors/Prevention
• Hand/Foot checks
Frostbite Risk
Factors/Prevention
• Unwashed skin
protective – minimizes
insensible heat loss
Frostbite Risk
Factors/Prevention
• Peak times
– Completion of
movements
– Night movements
– Displacement- digging
in
– In...
Questions?
Immersion Foot (Trenchfoot)
• Original term from
WWI trench warfare
Immersion Foot
• 4500 American
soldiers suffered from
trenchfoot from 1943-
1944 in WWII
Immersion Foot
• Falklands War
– Trenchfoot prevalent –
70%
Immersion Foot
• Vapor Barrier boots
can cause immersion
foot
IMMERSION FOOT
• DEFINITION: Immersion foot is a non-
freezing injury of the extremities in which
the tissues are damaged.
Mechanism of Injury
• Occurs in wet cold (nonfreezing)
environment
• Prolonged exposure
• Cold induced vasoconstriction
– ...
Timeline of Injury- Signs and
Symptoms
• Prehyperemic Phase
– “cold and numb”
– Pulses may be initially absent
– Blanched,...
Timeline of Injury- Signs and
Symptoms
• Hyperemic Phase- after rewarming
– Can last 6-10 weeks
– Characterized as deep, b...
Immersion Foot
Category(Immersion Foot)
• Minimal- reddening of skin, slight sensory
changes.
• Mild- Edema, sensory changes (reversible)...
Field Treatment
(Immersion Foot)
• Pat drying of extremity.
• Gentle rewarming- damage may occur secondary
to reperfusion....
Treatment of Immersion Foot
• Significant Risk of Infection
• Pain is difficult to control
– Neurogenic pain
• Wet gangren...
Prevention
• Change out socks frequently
• Dry out feet at night
• Antiperspirants
• Do not wear boots while in the sleepi...
Review
• Frostbite Definition
• Frostbite Diagnosis / Treatment
• Frostbite Risk Factors / Prevention
• Immersion Foot Def...
Cold Injuries
Cold Injuries
Cold Injuries
Cold Injuries
Cold Injuries
Cold Injuries
Cold Injuries
Cold Injuries
Cold Injuries
Cold Injuries
Upcoming SlideShare
Loading in …5
×

Cold Injuries

5,510 views

Published on

Dealing with cold environment related issues.

Published in: Healthcare
  • Login to see the comments

Cold Injuries

  1. 1. Freezing and Near Freezing Tissue Injuries
  2. 2. TLO • Given a simulated casualty, treat cold injuries, in accordance with the references.
  3. 3. ELO’s • From a given list select the correct definition of frostbite. • From a given list select the correct two mechanisms of injury for frostbite. • From a given list select the correct signs and symptoms of frostbite. • From a given list select the correct favorable post thaw signs of a frostbite injury.
  4. 4. ELO’s • From a given list select the correct unfavorable post thaw signs of a frostbite injury. • From a given list select the correct field treatment for frostbite. • From a given list select the correct primary field treatment consideration when treating frostbite in the field.
  5. 5. ELO’s • From a given list select the correct methods to reduce the chance of becoming a frostbite casualty. • From a given list select the correct definition of immersion foot. • From a given list select the correct mechanism of injury for immersion foot.
  6. 6. ELO’s • Given a list of categories and characteristics match the category of immersion foot to its characteristics. • From a given list select the correct field treatment of immersion foot.
  7. 7. Napoleon’s Retreat from Russia
  8. 8. Napoleon Retreats from Russia • Entered Russia with an army of 250,000 • Retreated with only 20,000 soldiers (only 350 were combat effective) • Temperatures dropped to –38 degrees C
  9. 9. WWII • In November and December 1942, the Germans performed 15,000 amputations for cold injuries.
  10. 10. FROSTBITE • Definition: Frostbite is the actual freezing of tissue.
  11. 11. Mechanisms of Injury • Actual freezing of the tissues. – Ice crystals form extracellularly and grow by extracting water from the cells. – Cells are injured by dehydration and electrolyte disturbances. – Ice crystals that form intracellularly are much more damaging, but this requires much colder temperature and faster freezing time.
  12. 12. Mechanisms of injury • Obstruction of blood supply – Cells lining the capillaries and small veins are damaged, this allows serum to leak out into the tissues and activates coagulation cascade – Serum leakage increases viscosity and reduces blood flow. – The reduced fluid volume and activation of coagulation cascade causes obstruction. – This obstructs blood flow and circulation, this produces irreversible damage.
  13. 13. Frostbite Signs and Symptoms • Sensation – Numbness – Paresthesias – Pain – after extremity is rewarmed
  14. 14. Frostbite Signs and Symptoms Appearance: • Pale/White to yellowish white to gray • Bluish tinge/mottled blue • Erythematous ( after rewarming) • Blisters- clear to hemorrhagic • Black (days to weeks out)
  15. 15. Frostbite Signs and Symptoms • Sensation – Loss of pliability – Waxy – “frozen chicken” – “block of wood”
  16. 16. Late Frostbite Signs and Symptoms • Blisters/edema will occur approximately 6-24 hrs after injury • Black hard eschar appears within 4-10 days if severe frostbite
  17. 17. Frostbite Classification • Classification must be done retrospectively. • 1st- Erythema, edema, tingling, burning. • 2nd- CLEAR BLISTERS, edema, anesthesia or paresthesias. • 3rd- Entire thickness of skin and subcutaneous tissue. Hemorrhagic blisters. • 4th- Entire thickness of skin including bone.
  18. 18. Baron de Larrey • Chief of the Medical Corps for Napoleon’s Army • Organized the concept of the “flying ambulance” • Captured by the Prussians and sentenced to death
  19. 19. Baron de Larrey • Made observations about frostbite • Soldiers who thawed hands over bonfires and allowed them to refreeze did worse than those who did not rewarm them
  20. 20. Baron de Larrey • Made correct conclusion that frostbite victims should not rewarm the affected extremity and allow it to refreeze nor should they rewarm it over open flames
  21. 21. Baron de Larrey • However, his recommendation was to rub the frostbitten extremity with snow. • “when some external part of the body is caught by the cold…it is necessary to rub the affected part with substances containing very little calorick”
  22. 22. Primary Consideration • Do not rewarm the extremity if there is a chance of it refreezing. • This will greatly increase the amount of tissue damage.
  23. 23. Field Treatment (Frostbite) • Rapid rewarming produces the best results. • Immersion of the affected part in warm water. • Water temperature: 99-102 (F) until tissues of distal extremities are flush • This is extremely painful: NARCOTIC ANALGESIA.
  24. 24. Frostbite Treatment • Forced hydration- IV fluid if necessary • Motrin 400mg BID before rewarming if possible • Aloe Vera 99% tid • Daily Betadine Soaks • Daily dressing/bandage changes • Denali Protocols:Toradol
  25. 25. Frostbite Treatment • No nicotine
  26. 26. Blister Management • Do not aspirate hemorrhagic blisters • Leave intact • If blisters rupture apply topical antibiotic
  27. 27. Amputation • Keep orthopedic surgeons away from patient • Amputate late
  28. 28. Experimental Treatments • Vasodilators • Heparin • Hyperbaric oxygen • Topical nitrates
  29. 29. Favorable Signs (Frostbite) • Warmth of tissue. • Normal tissue color. • Preservation of sensation. • Blisters extending all the way distally on the affected part. • Edema persisting more than 24 hours. • Good capillary refill.
  30. 30. Unfavorable Signs • These signs indicate a poor prognosis with probable tissue loss. – Complete absence of edema. – Cyanotic tissue. – Continued loss of sensation. – Affected areas continue to stay cold.
  31. 31. QUESTIONS?
  32. 32. Frostbite Risk Factors/Prevention
  33. 33. Frostbite Risk Factors/Prevention • Vasoconstriction caused by hypothermia • Cold Induced Vasodilation (CIVD) - 59F
  34. 34. Frostbite Risk Factors/Prevention • Keep whole body warm- “if feet are cold put on a hat” • Adequate clothing • Activity • Maintain nutrition status • Maintain hydration
  35. 35. Frostbite Risk Factors/Prevention • Inadequate Blood Supply – Fractures – Dislocations – Shock – Dehydration
  36. 36. Frostbite Risk Factors/Prevention • Inadequate Blood Supply – Tight boots/gloves – Tight harness/pack • Ensure fingers and toes can move freely
  37. 37. Frostbite Risk Factors/Prevention • Inadequate Blood Supply – Nicotine – potent vasoconstrictor – Avoid nicotine- • Must have strong command interest
  38. 38. Frostbite Risk Factors/Prevention • Increased Heat Loss – Inadequate insulation – Wet gloves – Gloves versus mittens
  39. 39. Frostbite Risk Factors/Prevention • Keep clothing/gloves dry – Off the deck – Dry in the evenings – Secure straps – Fleece liners are not an outer layer • Wear mittens instead of gloves – trigger finger • Have dry gloves readily available
  40. 40. Frostbite Risk Factors/Prevention • Increased conductive heat loss when in contact with metals and fuels • Do not touch metals and fuel with bare hands- always use contact gloves. • Avoid placing hands in “splash” zone • Insulation for ice axes
  41. 41. Rewarming Cold Hands • Set an acceptable time period for “cold hands” • Whole body warmth • Conduction- skin to skin – axilla, groin • Isometrics • Windmilling
  42. 42. Frostbite Risk Factors/Prevention • Hand/Foot checks
  43. 43. Frostbite Risk Factors/Prevention • Unwashed skin protective – minimizes insensible heat loss
  44. 44. Frostbite Risk Factors/Prevention • Peak times – Completion of movements – Night movements – Displacement- digging in – Inexperienced leadership
  45. 45. Questions?
  46. 46. Immersion Foot (Trenchfoot) • Original term from WWI trench warfare
  47. 47. Immersion Foot • 4500 American soldiers suffered from trenchfoot from 1943- 1944 in WWII
  48. 48. Immersion Foot • Falklands War – Trenchfoot prevalent – 70%
  49. 49. Immersion Foot • Vapor Barrier boots can cause immersion foot
  50. 50. IMMERSION FOOT • DEFINITION: Immersion foot is a non- freezing injury of the extremities in which the tissues are damaged.
  51. 51. Mechanism of Injury • Occurs in wet cold (nonfreezing) environment • Prolonged exposure • Cold induced vasoconstriction – Nerve Injury – Epidermal Damage – ? Reperfusion Injury
  52. 52. Timeline of Injury- Signs and Symptoms • Prehyperemic Phase – “cold and numb” – Pulses may be initially absent – Blanched, yellowish/white appearance – “walking on wooden limbs”
  53. 53. Timeline of Injury- Signs and Symptoms • Hyperemic Phase- after rewarming – Can last 6-10 weeks – Characterized as deep, burning, throbbing ache – Erythematous initially- may become diffusely blue/mottled/deep purple red – Increased warmth – Swelling – Blister/Intracutaneous Hemmorhage
  54. 54. Immersion Foot
  55. 55. Category(Immersion Foot) • Minimal- reddening of skin, slight sensory changes. • Mild- Edema, sensory changes (reversible). • Moderate- Edema, redness, blisters, intracutaneous hemorrhage, irreversible nerve damage. • Severe- Severe edema, massive intracutaneous hemorrhage, necrosis, gangrene.
  56. 56. Field Treatment (Immersion Foot) • Pat drying of extremity. • Gentle rewarming- damage may occur secondary to reperfusion. • Elevation of affected extremity. • Bed rest. • Treatment after this is supportive. – debridement, resection. – tetanus booster. – no nicotine.
  57. 57. Treatment of Immersion Foot • Significant Risk of Infection • Pain is difficult to control – Neurogenic pain • Wet gangrene- – Look for fever, increased CPK and leukocytosis. – Treatment is early surgical intervention and sequential amputations. Do not put these patients in water! – Severe chronic pain syndromes may develop.
  58. 58. Prevention • Change out socks frequently • Dry out feet at night • Antiperspirants • Do not wear boots while in the sleeping bag!
  59. 59. Review • Frostbite Definition • Frostbite Diagnosis / Treatment • Frostbite Risk Factors / Prevention • Immersion Foot Definition • Immersion Foot Diagnosis / Treatment • Immersion Foot Risk Factors / Prevention

×