Constitutional signs of tissue necrosis such as fever and tachycardia
Cyanotic or dark red skin persisting after pressure.
Freeze-thaw- refreeze injury.
Treatment:BEFORE THAWING1.remove from environment2.prevent partial thawing and refreezing3.stabilize core temp. and treat hypothermia4.protect frozen part ---- no friction or messageDURING THAWING5.rapid rewarming is the keystone of treatment ---- with water bath no warmer than 40-42 degrees until themost distal part is flushed (10-45 min).6.administer ibuprofen 400mg PO 8-12 hourly.7.large amount of narcotic analgesics are needed.
encourage patient to gently move the part.9.several adjunctive treatments like vasodilators, throbolysis and hyperbaric oxygen are sometimes useful.AFTER THAWING
the damaged part is elevated and blisters left as it is, pledgets are put between the fingers if macerated.11.consider TT and streptococcal prophylaxis.12.hydrotherapy at 37 degrees to continue.13.surgical debridement is often delayed by 1-3 months after demarcation.
Sequelae of frostbite include:
Hypersensitivity to cold
Hyperhidrosis These occur because of neuronal injury and persistently abnormal sympathetic tone. SYMPATHECTOMY AND VASODILATORS AREHELPFUL.
EPIPHYSEAL PLATE DAMAGE or premature fusion may occur in children. Premature fusion can result in shorteneddigits, joint deviation and dystrophic nails.
Frostbite arthritis resembling osteoarthritis may occur weeks or years later. TRENCH FOOT OR IMMERSION FOOT:
It results from repetitive exposure to wet cold above the freezing point.
Limb dependency due to immobility and constrictive footwear were important pathogenic factors.
Stage I: Foot folds cold, cyanotic and anaesthetic
Stage II: It followed within 24 hours with paresthesia, marked edema, numbness and sometimes blisters.
Stage III: Progression to superficial gangrene.
Smoking and Peripheral vascular disorders predispose.
Nonfreezing cold injury may be followed by cold sensitivity and hyperhidrosis which may persist for years.
Treatment consists of --------- rest, analgesics and antibiotics. Surgery should be delayed.CHILBLAINS:
SYNONYM: Pernio or perniosis
These are localized lesions caused by continued exposure to cold above the freezing point.
Absolute temperature is less important than cooling of nonadapted tissue.
Dampness and wind increase the chances
It shows a genetic predisposition
It is described mostly in temperate regions where the winters are occasionally cold and damp (humidity is an important factoras it increases the conductivity of air). It is seen less often in very cold climates where the people take adequate precautionsagainst cold and are acclimatized.
Both acrocyanosis and chilblains are more common in women, children and persons with low body mass. Anorexia nervosa isalso a predisposing factor.
It also shows a genetic predisposition.
It is also seen in hypothyroidism and myeloproliferative disorders.
Chilblains tend to start in early part of winter in children and women with obvious erythrocyanosis and in spring months inadults who work outdoors and are exposed to a combination of greater cold and light.
They develop acultely as single or multiple, erythematous or purplish swellings.
Patients may complain of burning, itching or pain
In severe cases, blisters pustules and ulceration may occur.
The characteristic locations include the proximal phalanges of the fingers and toes (dorsal aspect) and the planter aspect of toes, heels, nose and ears.
Lesions usually resolve in 1-3 weeks.
In presence of arterial disease, systemic disease or prolonged exposure to cold or friction, irreversible changes of fibrosis,hyperkeratosis and lymphoedema may occur and lesions may persist for many weeks or months. E.g. senile perniosis.
Less common forms of chilblains: