Cold injuries: Difference between revisions
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*Nonfreezing cold injuries occur due to exposure to wet conditions when temper >freezing | *Nonfreezing cold injuries occur due to exposure to wet conditions when temper >freezing | ||
==Trench Foot== | |||
===Background=== | |||
*Develops slowly over hours-days when foot is exposed to cold/wet conditions | *Develops slowly over hours-days when foot is exposed to cold/wet conditions | ||
*Reversible injury may progress to irreversible injury | *Reversible injury may progress to irreversible injury | ||
==Clinical Features== | ===Clinical Features=== | ||
*Tingling/numbness is initial symptom | *Tingling/numbness is initial symptom | ||
*Foot appears pale, mottled, anesthetic, pulseless, and immobile | *Foot appears pale, mottled, anesthetic, pulseless, and immobile | ||
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*Anesthesia persists for weeks and may be permanent; gangrene may occur | *Anesthesia persists for weeks and may be permanent; gangrene may occur | ||
==Treatment== | ===Treatment=== | ||
*Keep feet clean, warm, dryly bandaged, elevated | *Keep feet clean, warm, dryly bandaged, elevated | ||
*Monitor for signs of infection | *Monitor for signs of infection | ||
==Pernio (Chilblains)== | |||
===Background=== | |||
*Mild but uncomfortable inflammatory lesions of skin | *Mild but uncomfortable inflammatory lesions of skin | ||
**Caused by long-term intermittent exposure to damp, nonfreezing ambient temperatures | **Caused by long-term intermittent exposure to damp, nonfreezing ambient temperatures | ||
*Primarily a disease of women and children | *Primarily a disease of women and children | ||
===Clinical Features=== | |||
*Hands, ears, lower legs, feet most commonly affected | *Hands, ears, lower legs, feet most commonly affected | ||
*Symptoms | *Symptoms | ||
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**Rewarming may result in formation of tender blue nodules which may persist for days | **Rewarming may result in formation of tender blue nodules which may persist for days | ||
===Treatment=== | |||
*Affected skin should be rewarmed, gently bandaged, and elevated | *Affected skin should be rewarmed, gently bandaged, and elevated | ||
*Nifedipine 20mg PO TID may be helpful as both prophylactic and therapeutic tx | *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 | *Topical corticosteroids and oral steroid burst have been shown to be useful | ||
==Cold Panniculitis== | |||
*Prolonged exposure to temp >freezing leads to mild necrosis of subcutaneous fat tissue | *Prolonged exposure to temp >freezing leads to mild necrosis of subcutaneous fat tissue | ||
*Seen in children (popsicles) and women involved in equestrian activities | *Seen in children (popsicles) and women involved in equestrian activities | ||
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**There is no treatment | **There is no treatment | ||
==Cold Urticaria== | |||
*Hypersensitivity to cold air or water which may lead to fatal anaphylaxis | *Hypersensitivity to cold air or water which may lead to fatal anaphylaxis | ||
*Treat similarly to urticarial lesions from other causes (i.e. antihistamines) | *Treat similarly to urticarial lesions from other causes (i.e. antihistamines) | ||
Revision as of 19:22, 26 August 2011
Background
- Frostbite occurs only when ambient temperatures are well below freezing
- Nonfreezing cold injuries occur due to exposure to wet conditions when temper >freezing
Trench Foot
Background
- Develops slowly over hours-days when foot is exposed to cold/wet conditions
- Reversible injury may progress to irreversible injury
Clinical Features
- Tingling/numbness is initial symptom
- Foot appears pale, mottled, anesthetic, pulseless, and immobile
- Initially does not change after rewarming
- Hyperemic phase begins w/in hr after rewarming
- Assoc w/ severe burning pain and reappearance of proximal sensation
- As perfusion returns to foot over 2-3d edema and possibly bullae may form
- Anesthesia persists for weeks and may be permanent; gangrene may occur
Treatment
- Keep feet clean, warm, dryly bandaged, elevated
- Monitor for signs of infection
Pernio (Chilblains)
Background
- Mild but uncomfortable inflammatory lesions of skin
- Caused by long-term intermittent exposure to damp, nonfreezing ambient temperatures
- Primarily a disease of women and children
Clinical Features
- Hands, ears, lower legs, feet most commonly affected
- 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
- 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
- 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
- Hypersensitivity to cold air or water which may lead to fatal anaphylaxis
- Treat similarly to urticarial lesions from other causes (i.e. antihistamines)
- Avoidance of cold is recommended
Source
Tintinalli