COLD INJURIES-1.ppt [Read-Only]ocw.usu.ac.id/.../emd166_slide_cold_injuries.pdf · compensate for...
Transcript of COLD INJURIES-1.ppt [Read-Only]ocw.usu.ac.id/.../emd166_slide_cold_injuries.pdf · compensate for...
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COLD INJURIESCOLD INJURIES
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Epidemiology
• Caused by the inability to physiologically compensate for cold that produces injury.
• Duration of exposure, humidity, wind, altitude, clothing, medical conditions, behavior, and clothing, medical conditions, behavior, and individual variability are contributing factors.
• Inadequate clothing is the most preventable cause of cold related injuries with exposed head and neck accounting for 80% of heat loss.
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Epidemiology
• Disease states as atherosclerosis, arteritis, hypovolemia, diabetes, vascular injury may predispose to cold-related injury.
• Dark-skinned people and those from • Dark-skinned people and those from warmer climates are more susceptible to frostbite
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Local cold injuries result from Local cold injuries result from
decreased blood flow to, or freezing decreased blood flow to, or freezing
of, a body part.of, a body part.
These injuries are often called
frostbite or frostnip.
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Local cold injury after thawing.Local cold injury after thawing.
FrostbiteFrostbite
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FrostbiteFrostbite
�Symptoms
– initially redness in light skin or grayish in
dark skindark skin
– tingling, stinging sensation
– turns numb, yellowish, waxy or gray color
– feels cold, stiff, woody
– blisters may develop
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Clinical features
• Classification of frostbite
• first degree is characterized by partial skin freezing, erythema, mild edema, lack of blisters, and occasional skin desquamation, has excellent and occasional skin desquamation, has excellent prognosis.
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Clinical features
• second degree is characterized by full-thickness
skin freezing, formation of substantial edema over
3 to 4 h, and formation of clear blisters that
desquamate to form black eschars and has good desquamate to form black eschars and has good
prognosis.
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Clinical Features
• third degree injury is characterized by damage that extends into the subdermal plexus and leads to formation of hemorrhagic blisters, skin necrosis and a blue-gray discoloration of skin, has poor and a blue-gray discoloration of skin, has poor prognosis
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Clinical Features
• fourth degree injury is characterized by extension into subcutaneous tissues, muscle, bone, and tendon, there is little edema, nonblanching cyanosis, bloody blebs, has extrememly poor prognosis
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Treatment in the field
• Remove wet and
constrictive clothing.
• Elevate and wrap in dry
sterile gauze the involved
• There is controversy with
regards to debridement of
clear blisters on the field
• Pain management should sterile gauze the involved
extremities.
• Rapid rewarming if rapid
access to hospital
• 400 to 420 C clean water
should be used
• Pain management should
start with NSAIDS to
counteract the arachidonic
acid cascade, in addition
to opioids
• Smoking should be
discouraged
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Treatment in the ED
• Injured extremity should be placed in circulating water at a temperature of 400 to 420 C for approximately 10-30 min
• Hemorrhagic blisters should not be debrided
• Alo vera cream should be applied to the blisters
approximately 10-30 min until the distal extremity is pliable and erythematous
• Pain should be treated with parenteral antibiotics
• Clear blisters should be debrided or aspirated
• Role of antibiotics is unclear.
• Staph aureus, Staph epi, beta-hemolytic Strep, Pseudomonas, and Enterococus are important pathogens.
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Treatment in ED
• Infection prophylaxis
using topical
bacitracin is as good
as IV penicillin.
• Early surgical
intervention is not
indicated in treatment
of frostbiteas IV penicillin.
• Tetanus immunization
status should be
assessed.
• Ibuprofen
of frostbite
• Amputation if needed
within 3 weeks
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ChilblainsChilblains
� Nonfreezing cold injury
� Cold, wet conditions (between 32-60oF, high
humidity)
� Repeated, prolonged exposure of bare skin
� Can develop in only a few hours
� Ears, nose, cheeks, fingers, and toes
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ChilblainsChilblains
�Symptoms:
– initially pale and colorless
– worsens to achy, prickly sensation then – worsens to achy, prickly sensation then
numbness
– red, swollen, hot, itchy, tender skin upon
rewarming
– blistering in severe cases
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ChilblainsChilblains
�Treatment
– prevent further exposure
– wash, dry gently– wash, dry gently
– rewarm (apply body heat)
– don’t massage or rub
– dry sterile dressing
– seek medical aid
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Trench/Immersion Foot Trench/Immersion Foot
�Potentially crippling, nonfreezing injury (temps from 50oF-32oF)
�Prolonged exposure of skin to moisture �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
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Trench/Immersion FootTrench/Immersion Foot
� Symptoms
– initially appears wet, soggy, white, shriveled
– sensations of pins and needles, tingling,
numbness, and then painnumbness, and then pain
– skin discoloration-red, bluish, or black
– becomes cold, swollen, and waxy appearance
– may develop blisters, open weeping or bleeding
– in extreme cases, flesh dies
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Trench/Immersion FootTrench/Immersion Foot
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Trench/Immersion FootTrench/Immersion Foot
� Treatment
– prevent further exposure
– dry carefully
– DO NOT break blisters, apply lotions, massage, – DO NOT break blisters, apply lotions, massage,
expose to heat, or allow to walk on injury
– rewarm with body heat
– clean and wrap loosely
– elevate feet to reduce swelling
– evacuate for medical treatment
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Trench/Immersion FootTrench/Immersion Foot
� Prevention
– keep feet dry
– change socks at least every 8 hours or – change socks at least every 8 hours or
whenever wet and apply foot powder
– bring extra boots to field
– no blousing bands
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Care for Local Cold Injuries Care for Local Cold Injuries
�� Remove patient from cold environmentRemove patient from cold environment
�� Protect the cold extremity from injuryProtect the cold extremity from injury
�� Administer oxygenAdminister oxygen�� Administer oxygenAdminister oxygen
�� Remove wet or restrictive clothing and all jewelryRemove wet or restrictive clothing and all jewelry
�� Splint if extremity involved, and cover with dry, Splint if extremity involved, and cover with dry,
sterile dressingsterile dressing
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Place dressings Place dressings
between those between those
fingers affected by fingers affected by
local cold injury.local cold injury.
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