Cold Injuries: Regia Anadhia 1410211047
Cold Injuries: Regia Anadhia 1410211047
Regia Anadhia
1410211047
COLD INJURIES
An injury caused by exposure to extreme cold that can
lead to loss of body parts and even to death.
Fourth degree :
Involvement of deeper structures,
may be difficult to determine
initially
Kerusakan jaringan lunak,
gangren pada jari atau ekstrmitas
Blood-filled blisters form black
thick scabs over a matter of
weeks.
Amputation may be required to
prevent severe infection or when
damage affects muscles, tendons,
and bone, with resultant tissue
loss
3 steps of frostbite treatment :
Field management
Rewarming
Postrewarming management
Field Management
Rapid evacuation
As a general principle, always address the ABCs and treat any life-
threatening conditions (eg, hypothermia) first.
Correct any systemic hypothermia to a core temperature of 34C
before treating the frostbite.
Remove the patient from cold.
Replace wet and constrictive clothing with dry loose clothing.
Remove jewelry from the affected area.
Dress the extremity in a manner that minimizes mechanical trauma.
Rewarming
Rapid rewarming by immersing the extremity in gentling circulating
water at 40-42 C. The extremity is rewarmed until pliable and
erythematous at the most distal areas
Warming is continued for 15-30 minutes or until thawing is, by
clinical assessment, complete (ie, when the distal area of the
extremity is flushed, soft, and pliable).
The addition of an antiseptic solution such as povidone-iodine or
chlorhexidine to the bath may be beneficial.
Constantly monitor water temperature. Thawing takes about 20-40
minutes for superficial injuries and as long as 1 hour for deep
injuries.
AVOID massaging or rubbing
Postrewarming management
Once the skin is thawed, protect the area from further injury and
reexposure to cold.
Elevate the area and splint the extremity. Sterile, nonadherent
dressings should be applied. They should be changed 2-4 times a
day and local wound care performed. The injured area should be
closely monitored for signs of infection.
Treatment of vesicles :
Debride clear or milky vesicles and apply topical aloe vera
Utilize IV or PO NSAIDs simultaneously : ibuprofen is an effective
thromboxane inhibitor
DO NOT debride hemorrhagic vesicle
Pharmacological treatment :
Analgesics (eg, ibuprofen and morphine) for pain relief are
indicated during and after rewarming.
Apply topical aloe vera cream to all frostbitten areas every 6 hours
to inhibit the arachidonic cascade, especially thromboxane
synthesis.
Administer tetanus prophylaxis (tetanus toxoid or immune
globulin).
Antibacterial prophylaxis is recommended. Frostbite infections
tend to involve staphylococci, streptococci, enterococci, and
Pseudomonas pathogens. If infection develops, oral or parenteral
antibiotics should be administered based on local sensitivities
(Penicillin G 500.000 units every 6 hours, continued for 72 hours)
infusion of low-molecular-weight dextran may be beneficial by
preventing erythrocyte clumping in cold-injured blood vessels, with
an associated decrease in tissue necrosis.
intravenous or intra-arterial thrombolysis with tissue plasminogen
activator (tPA) in the management of frostbite. When administered
within 24 hours of thawing, it has been shown to decrease
amputation rates
PREVENTION
Seek shelter from wind and cold
Wear several layers of light, loose clothing, which traps air
for insulation yet provides for adequate insulation; such
layering provides better protection than a single bulky
layer of heavy clothing
Wear mittens instead of gloves because they decrease
surface area exposure to the cold
Wear at least 2 pairs of socks
Cover the face and head
Choose fabrics suited for the cold (eg, fleece,
polypropylene, wool)
Avoid restrictive and tight clothing that reduces peripheral
circulation
Avoid getting clothing wet
Avoid remaining in the same position for prolonged
periods
Check skin every 10-20 minutes for frostbite
Avoid smoking, because it causes peripheral
vasoconstriction