Cold injuries: Difference between revisions
 
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==Background==
==Background==
[[File:Windchill21.gif|thumb|Whid chill chart]]
*Frostbite occurs only when ambient temperatures are well below freezing
*Frostbite occurs only when ambient temperatures are well below freezing
*Nonfreezing cold injuries occur due to exposure to wet conditions when temper >freezing  
*Nonfreezing cold injuries occur due to exposure to cold conditions above freezing


==[[Trench Foot]]==
{{Swiss staging system}}


==Pernio (Chilblains)==
==Clinical Features==
===Background===
<gallery mode="packed">
*Mild but uncomfortable inflammatory lesions of skin
File:PMC2873703 eplasty10e35 fig1.png|First degree (frostnip) [[frostbite]]
**Caused by long-term intermittent exposure to damp, nonfreezing ambient temperatures
File:PMC3785582 aps-40-510-g001.png|Second degree [[frostbite]]
*Primarily a disease of women and children
File:PMC5286755 IJD-62-59-g009.png|Third degree [[frostbite]]
File:PMC4106255 eplasty14ic20 fig1.png|Fourth degree [[frostbite]]
File:Cold urticaria3.jpg|[[Cold uticaria]]
File:Case of trench feet suffered by unidentified soldier Cas de pieds des tranchées (soldat non identifié).jpg|[[Trench foot]]
File:Chilblains from excessively icing the feet.jpg|[[Chilblains]]
</gallery>


===Clinical Features===
==Differential Diagnosis==
*Hands, ears, lower legs, feet most commonly affected
{{Cold injuries DDX}}
*Symptoms
**Tingling, numbness, pruritus, burning paresthesias
**Cutaneous manifestations appear up to 12hr after acute exposure:
**Localized edema, erythema, cyanosis, plaques, nodules
***May progress in rare cases to ulcerations, vesicles, and bullae
**Rewarming may result in formation of tender blue nodules which may persist for days


===Treatment===
==Management==
*Affected skin should be rewarmed, gently bandaged, and elevated
*Nifedipine 20mg PO TID may be helpful as both prophylactic and therapeutic tx
*Topical corticosteroids and oral steroid burst have been shown to be useful


==Cold Panniculitis==
==Disposition==
*Prolonged exposure to temp >freezing leads to mild necrosis of subcutaneous fat tissue
*Seen in children (popsicles) and women involved in equestrian activities
*Resolution may result in adipose fibrosis w/ cosmetic defects
**There is no treatment


==Cold Urticaria==
==See Also==
*Hypersensitivity to cold air or water which may lead to fatal anaphylaxis
*[[Therapeutic hypothermia]]
*Treat similarly to urticarial lesions from other causes (i.e. antihistamines)
*Avoidance of cold is recommended


==Source==
==External Links==
Tintinalli


[[Category:Environ]]
==References==
<references/>
 
[[Category:Environmental]]

Latest revision as of 20:48, 3 November 2021

Background

Whid chill chart
  • Frostbite occurs only when ambient temperatures are well below freezing
  • Nonfreezing cold injuries occur due to exposure to cold conditions above freezing

Swiss Hypothermia Staging System[1]

Classification Temperature Signs/Symptoms
I / Mild 32-35°C (90-95°F) Shivering, awake
II / Moderate 28-32°C (82-90°F) Shivering, depressed mental status
III / Severe 20-28°C (68-82°F) unconscious/severely depressed mental status, shivering ceases
IV / Profound <20°C (68°F) unobtainable VS

Clinical Features

Differential Diagnosis

Cold injuries

Management

Disposition

See Also

External Links

References

  1. ↑ Brown et al., Accidental Hypothermia. N Engl J Med 2012; 367:1930-1938
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