evaluation of a patient with an apparent freezing cold injury

Last reviewed 02/2021

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:

Reference:

• (1) Hallam MJ et al. Managing frostbite. BMJ. 2010;341:c5864.