COLD INJURY: DR. ANAND SINGH BHADORIYA (MBBS).pptx

SHORT DESCRIPTION ABOUT COLD INJURY BY DR. ANAND SINGH BHADORIYA (MBBS)

1. EFFECTS OF COLD PRESENTATION BY DR. ANAND SINGH BHADORIYA MBBS (GRMC, GWALIOR)

2. What is cold injury? Cold injury is a tissue trauma produced by exposure to freezing temperatures and even brief exposure to a severely cold and windy environment.

3. Characteristics of cold region Low humidity in Ladakh region High Humidity in Sikkim, Kashmir & Arunanchal Pradesh Temp may go below -20 degree C to -40 degree C Less vegetation Wind Chill factor Summer – Avalanches (Glaciers) Sun (UV Radiation) - Snow blindness

4. WIND-CHILL FACTOR Wind Chill factor (at -1 degree C with wind velocity at 50 Kmph effective temp becomes minus 10 degree C The  felt air temperature  on exposed skin due to wind

5. Cold Injuries Generalized – Hypothermia Localized NON-FREEZING - Chilblain - Trench foot FREEZING - Frostbite Others Snow blindness Sunburns

6. HYPOTHERMIA CORE BODY TEMP  35 o C OR  95 oF MILD : 32 - 35 C MODERATE : 32 - 28 C SEVERE :  28 C

7. Hypothermia BODY CORE - Heart - Brain - Lungs - Liver - Kidneys EXTREMITIES - Legs & feet - Arms & hands Normal core body temperature: 98.6°F

8. CLINICAL FEATURES Effects – Mental processes are slowed, Shivering becomes violent – Later on, Ability to shiver lost, – Coma supervenes Lethal temperature can be highly variable, and survival has been recorded at deep body temperature as low as 20`C

9. TREATMENT EXTERNAL REWARMING Apply warm packs at axillae, groin and neck ‘Insulatory wrap’ (4 inches) Give warm sweetened tea, coffee or milk DON’T WARM EXTREMITIES DON’T massage the limbs No physical activity No alcohol & tobacco

10. 5 % IV Dextrose warmed upto 37- 41 degree C 500ml to 1 ltr in half to one hr Oxygen inhalation by face mask Catheterize, monitor urine output Monitoring temp CPR if no carotid pulse CORE REWARMING

11. Declare DEAD only after re-warming to 36 degrees C of core temp DICTUM : “A patient of hypothermia, in finality, is never “Cold and Dead” but is “WARM AND DEAD”

12. Local Cold Injuries

13. COMMONLY AFFECTED AREAS Fingers Toes Ear lobes Nose Cheeks Chin Soles, heel Dorsal surface of foot Male genitalia Buttocks

14. CHILLBLAINS - Nonfreezing cold injury - Cold, wet conditions (high humidity) - Repeated, prolonged exposure of bare skin - Can develop in only a few hours - Ears, nose, cheeks, fingers, and toes

15. CHILLBLAINS SYMPTOMS: Initially pale and colorless worsens to achy, prickly sensation then numbness red, swollen, hot, itchy, tender skin upon rewarming Blistering in severe cases

16. TRENCH FOOT Potentially crippling, nonfreezing injury 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

17. TRENCH FOOT

18. TRENCH FOOT SYMPTOMS: Initially appears wet, soggy, white, shriveled Sensations of pins and needles, tingling, numbness and then pain Skin discoloration - red, bluish, or black Becomes cold, swollen and waxy appearance May develop blisters, open weeping or bleeding

19. FROSTBITE Exposure to below freezing temperatures Can occur in above freezing temperatures due to wind chill factors and wetness Contact with extremely cold objects (especially metal)

20. CLINICAL CLASSIFICATION FIRST DEGREE - Erythema - Edema - Itching - No blisters/necrosis - Recovers completely

21. CLINICAL CLASSIFICATION SECOND DEGREE - Vesicles with clear or milky fluid - Edema

22. CLINICAL CLASSIFICATION THIRD DEGREE - Skin Necrosis - Blue grey discolouration - Presence of blood filled blisters

23. CLINICAL CLASSIFICATION FOURTH DEGREE - Minimal oedema - Initially mottled , deep red/cyanotic - Full thickness damage affecting muscles, tendons & bones - Later stages mummified - Auto amputation

24. Frostbite Face

25. TREATMENT PRE-HOSPITAL - Prevent further cold injury - Prevent mechanical trauma - Avoid rubbing - Restore general body warmth - Analgesics - Tetanus toxoid

26. TREATMENT Re-warming - 37 – 41 c for about 30 mins/ till flushed - Analgesics/sedatives Sterile loose dressings Prophylactic antibiotics

27. TREATMENT SURGERY - Excision - Skin graft - Amputation - Reconstruction procedures

28. PRIMARY PREVENTION Health promotion - General Hygiene - Nutrition - Exercise - Avoid Smoking Specific protection - Shelter - Clothing, boots & socks - Foot hygiene

29. SECONDARY PREVENTION Early Diagnosis First Aid Prompt treatment

30. DO’S & DON’T’S DO’S - Remove tight shoes, socks etc. - Warm the injured parts (Not by direct heat) - Cover the body with blankets - Provide hot drinks and rest - Cover blisters with dry dressing - Treat as a stretcher patients DON’T’S - Don’t massage or rub the parts - Don’t smoke or drink

31. THANK YOU