SHORT DESCRIPTION ABOUT COLD INJURY BY DR. ANAND SINGH BHADORIYA (MBBS)

1. EFFECTS OF COLD

2. What is cold injury?
Cold injury is a tissue trauma produced by
exposure to freezing temperatures and even
brief exposure to a severely cold and windy
environment.

3. Characteristics of cold region
• Low humidity in Ladakh region
• High Humidity in Sikkim, Kashmir & Arunanchal
Pradesh
• Temp may go below -20 degree C to -40 degree C
• Less vegetation
• Wind Chill factor
• Summer – Avalanches (Glaciers)
• Sun (UV Radiation) - Snow blindness

4. WIND-CHILL FACTOR
Wind Chill factor (at -1 degree C with wind velocity
at50 Kmph effective temp becomes minus 10 degree C
The felt air temperature on exposed skin due to wind

5. Cold Injuries
Generalized – Hypothermia
Localized
NON-FREEZING
- Chilblain
- Trench foot
FREEZING
- Frostbite
Others
Snow blindness
Sunburns

6. HYPOTHERMIA
CORE BODY TEMP 35o
C OR  95oF
• MILD : 32 - 35 0
C
• MODERATE : 32 - 28 0
C
• SEVERE :  280
C

7. Hypothermia
BODY CORE
- Heart
- Brain
- Lungs
- Liver
- Kidneys
EXTREMITIES
- Legs & feet
- Arms & hands
Normal
core body
temperature:
98.6°F

8. CLINICAL FEATURES
• Effects
– Mental processes are slowed, Shivering becomes violent
– Later on, Ability to shiver lost,
– Coma supervenes
Lethal temperature can be highly variable, and survival has
been recorded at deep body temperature as low as 20`C

9. TREATMENT
• EXTERNAL REWARMING
– Apply warm packs at axillae, groin and neck
– ‘Insulatory wrap’ (4 inches)
– Give warm sweetened tea, coffee or milk
– DON’T WARM EXTREMITIES
– DON’T massage the limbs
– No physical activity
– No alcohol & tobacco

10.  5 % IV Dextrose warmed upto 37- 41 degree C
 500ml to 1 ltr in half to one hr
 Oxygen inhalation by face mask
 Catheterize, monitor urine output
 Monitoring temp
 CPR if no carotid pulse
CORE REWARMING

11. Declare DEAD only after re-warming to 36
degrees C of core temp
DICTUM : “A patient of hypothermia, in finality, is
never “Cold and Dead” but is
“WARM AND DEAD”

12. Local Cold Injuries

13. COMMONLY AFFECTED AREAS
 Fingers
 Toes
 Ear lobes
 Nose
 Cheeks
 Chin
 Soles, heel
 Dorsal surface of foot
 Male genitalia
 Buttocks

14. CHILLBLAINS
- Nonfreezing cold injury
- Cold, wet conditions (high humidity)
- Repeated, prolonged exposure of bare skin
- Can develop in only a few hours
- Ears, nose, cheeks, fingers, and toes

15. CHILLBLAINS
SYMPTOMS:
– Initially pale and colorless
– worsens to achy, prickly sensation then
numbness
– red, swollen, hot, itchy, tender skin upon
rewarming
– Blistering in severe cases

16. TRENCH FOOT
• Potentially crippling,
nonfreezing injury
• Prolonged exposure of
skin to moisture (12 or
more hours, days)
• High risk during wet
weather, in wet areas, or
sweat accumulated in
boots or gloves

17. TRENCH FOOT

18. TRENCH FOOT
SYMPTOMS:
– Initially appears wet, soggy, white, shriveled
– Sensations of pins and needles, tingling,
numbness and then pain
– Skin discoloration - red, bluish, or black
– Becomes cold, swollen and waxy appearance
– May develop blisters, open weeping or bleeding

19. FROSTBITE
• Exposure to below freezing
temperatures
• Can occur in above freezing
temperatures due to wind
chill factors and wetness
• Contact with extremely
cold objects (especially
metal)

20. CLINICAL CLASSIFICATION
FIRST DEGREE
- Erythema
- Edema
- Itching
- No blisters/necrosis
- Recovers completely

21. CLINICAL CLASSIFICATION
SECOND DEGREE
- Vesicles with clear or
milky fluid
- Edema

22. CLINICAL CLASSIFICATION
THIRD DEGREE
- Skin Necrosis
- Blue grey
discolouration
- Presence of blood
filled blisters

23. CLINICAL CLASSIFICATION
FOURTH DEGREE
- Minimal oedema
- Initially mottled, deep
red/cyanotic
- Full thickness damage affecting
muscles, tendons & bones
- Later stages mummified
- Auto amputation

24. Frostbite Face

25. TREATMENT
PRE-HOSPITAL
- Prevent further cold injury
- Prevent mechanical trauma
- Avoid rubbing
- Restore general body warmth
- Analgesics
- Tetanus toxoid

26. TREATMENT
• Re-warming
- 37 – 410 c for about 30 mins/ till flushed
- Analgesics/sedatives
• Sterile loose dressings
• Prophylactic antibiotics

27. TREATMENT
SURGERY
- Excision
- Skin graft
- Amputation
- Reconstruction procedures

28. PRIMARY PREVENTION
Health promotion
- General Hygiene
- Nutrition
- Exercise
- Avoid Smoking
Specific protection
- Shelter
- Clothing, boots & socks
- Foot hygiene

29. SECONDARY PREVENTION
• Early Diagnosis
• First Aid
• Prompt treatment

30. DO’S & DON’T’S
DO’S
- Remove tight shoes, socks etc.
- Warm the injured parts (Not by direct heat)
- Cover the body with blankets
- Provide hot drinks and rest
- Cover blisters with dry dressing
- Treat as a stretcher patients
DON’T’S
- Don’t massage or rub the parts
- Don’t smoke or drink