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Evaluation of a patient with an apparent freezing cold injury

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

evaluation of a patient with an apparent freezing cold injury

History

  • obtain information on how and when the cold injury occurred
  • focus on factors which affects the severity e.g. - likely temperature, wind chill, and duration of exposure
  • additional information should focus on finding predisposing factors e.g - patient’s premorbid state, particularly history of peripheral vascular disease and smoking status

Examination

  • early features
    • affected parts feel cold and possibly painful
    • continued freezing produce a paraesthesia or numbness (or both)
    • areas of blanching blending into areas of apparently uninjured skin

  • late features
    • white and waxy skin with distinct demarcation from uninjured tissues
    • woody, insensate tissue
    • progression to bruising and blister formation (usually on thawing)

Note

  • full extent of the injury may not be visible initially for few days. Therefore close observation is required

In true freezing cold injury, clinical appearance of the tissue can be used to identify the degree of injury:


clinical appearance

mild frostbite injury

severe frostbite injury

first degree

second degree

third degree

fourth degree

depth of tissue freezing

partial thickness skin freezing

full thickness skin freezing

freezing of the skin and subcutaneous tissue

freezing of the skin, subcutaneous tissue, muscle, tendon, and bone

colour of tissues

erythematous or hyperaemic

erythematous

blue or black

initially deep red and mottled; eventually black and mummified

blistering or necrosis

none

blisters containing clear fluid

haemorrhagic blisters and some tissue necrosis

profound necrosis

oedema

minor

substantial

substantial

little or none

Reference:

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