This document discusses cold related injuries including hypothermia, frostnip, and frostbite. It defines each condition and provides details on assessment, risk factors, classification, goals of treatment, and nursing interventions. Hypothermia is categorized as mild, moderate, or severe based on core temperature. Signs and symptoms vary with each category. Rewarming methods depend on severity, with external warming used for mild cases and internal core rewarming for more severe hypothermia. Frostnip causes pain and numbness and is treated by rewarming the affected area. Frostbite classification is based on depth of tissue damage. Nursing interventions aim to prevent further injury and include rapid rewarming, analgesia,

1. Cold Related Injuries (CRI)
Medical-Surgical Nursing
Sharon King, RN

2. Cold Related Injuries
 Hypothermia
 Frostnip
 Frostbite

3. CRI Hypothermia: RN Focus
 Core temp < 95 F
 Environmental temp. below 82 F
 Wind chill: heat loss increases as wind speed rises
 Predisposition:
 Cold water immersion
 Acute illness (i.e flu)
 Trauma
 Shock
 Cold weather
 Age
 Malnutrition
 Hypothyroidism
 Inadequate clothing

4. Hypothermia
 3 categories
 Mild 90-97 F
 Moderate 82-90 F
 Severe < 82 F

5. Hypothermia
 Presentation:
 Mild Mod. Severe
 Shivering muscle weakness bradycardia
 Dysarthia ↑ loss of coordination severe hypotension
 ↓muscle coordination acute confusion ↓RR
 “mental slowness” apathy cardiac dysrhythmias
 Diuresis d/t shunting incoherence ↓neurologic reflexes
 stupor ↓pain response
 ↓clotting d/t thrombocytopenia acid-base imb.

6. Hypothermia
 Intervene: Mild
 Sheltered from cold environment
 Remove wet clothing
 Passive (warm clothing, blanket) or active (heating blanket, warm pack,
convective air heaters/warlmers rewarming
 Monitor skin @ least Q15-30 min
 Uncomplicated: warm high-carbohydrate liquid
 Avoid alcohol or caffeine (diuretics worsen dehydration & hypothermia)

7. Hypothermia
 Intervene: Mod—Severe
 Protect against furthered heat loss
 Handle gently 2 prevent Vfib
 Position supine (prevents OH)
 ABC
 Administer drugs w/caution
 Consider w/holding IV drugs until core temp. 86 F
 CPR 4 those w/o circulation

8. Hypothermia
 Intervene: Moderate
 Active & core rewarming: trunk b4 extremeties
 Monitor/prevent “After-Drop” (d/t cold blood return from peripheral 2 central
circulation)
 Core rewarming: warmed IV fluids, heated O2, heated peritoneal, pleural, gastric
or bladder lavage

9. Hypothermia
 Intervene: Severe
 Avoid external rewarming w/heating devices d/t rapid vasodilation
 Use internal rewarming: cardiopulmonary bypass, hemodialysis, venovenous or
arteriovenous, or intravascular via a closed-loop indwelling catheter
 Cardiopulmonary bypass: fastest core rewarming
 Complications:
 Fluid, electrolyte, metabolic abnormalities
 ARDS
 ARF
 Pneumonia

10. Frostnip
 Superficial
 Produces: pain, pallor, numbness
 Apply warmth!
 Usual Areas: face, nose, finger or toes

11. Frostbite
 Risk Factor: inadequate insulation against cold
 Contributing Factors: fatigue, dehydration, poor nutrition, alcoholism,
smoking
 Body tissue freezes
 Superficial, partial or full thickness

12. Frostbite
 Classification:
 1st degree hyperemia & edema
 2nd degree large fluid-filled blisters w/partial thickness skin necrosis
 3rd degree small blisters w/dark fluid affected body part cool,
numb, blue or red; non-blanching; full-thickness &
subQ tissue necrosis; debridement
 4th degree no blisters or edema, the part is numb, cold &
bloodless; full-thickness necrosis 2 bone & muscle;
gangrene develop

13. Frostbite
 Goal of tx: prevent further tissue damage
 Early signs: white waxy skin
 Seek shelter from wind & cold
 Superficial: use body heat to warm affected area

14. Frostbite
 Intervene: More Severe Forms
 Rapid Rewarming H20 bath @ temp. 104-108 F
 Hot Towel can be used
 Administer analgesic: IV opiates
 IV rehydration
 ! Don’t apply dry heat or massage during warming !
 Handle gently
 Elevate above heart level if possible
 Assess hrly for compartment syndrome (↑ pain after analgesics & paresthesia)
 Compare 2 assess 4 pallor
 Assess pulses & muscle weakness
 Immunized against tetanus
 Apply only loose nonadherent sterile dressings
 Avoid compression
 Topical & systemic antibiotic (as indicated)
 Antiprostaglandin tx: ibuprofen
 Severe Frostbite: debridement of necrotic tissue

15. Thank You!!!!