Oropharyngeal Swelling and Airway Obstruction from Environmental Cold Exposure: A Case Report.

A 19-year-old male presented with facial frostbite and severe oropharyngeal edema after prolonged riding of a snowmobile without any facial covering. The diffuse swelling eventually progressed to airway obstruction, requiring a surgical airway. No alternative explanation was found for his presentation, making this the first case found in the literature of airway obstruction secondary to environmental cold exposure.

Convolutional neural network models for automatic diagnosis and graduation in skin frostbite.

The study aimed to develop and validate a convolutional neural network (CNN)-based deep learning method for automatic diagnosis and graduation of skin frostbite. A dataset of 71 annotated images was used for the training, the validation, and the testing based on ResNet-50 model. The performances were evaluated with the test set. The diagnosis and graduation performance of our approach was compared with two residents from burns department. The approach correctly identified all the frostbite of IV (18/18, 100%), but with respectively 1 mistake in the diagnosis of degree I (29/30, 96.67%), II (28/29, 96.55%) and III (37/38, 97.37%). The accuracy of the approach on the whole test set was 97.39% (112/115). The accuracy of the two residents were respectively 77.39% and 73.04%. Weighted Kappa of 0.583 indicates good reliability between the two residents (P = .445). Kendall's coefficient of concordance is 0.326 (P = .548), indicating differences in accuracy between the approach and the two residents. Our approach based on CNNs demonstrated an encouraging performance for the automatic diagnosis and graduation of skin frostbite, with higher accuracy and efficiency.

Pediatric Environmental Cold Injuries.

Cold weather injuries are relevant concerns for children during winter sports and outdoor activities. To mitigate the risk of cold injury in this high-risk population, providers can educate parents on proper outdoor attire as well as the added risks of wind and water exposure. There are 2 types of environmental cold injuries: freezing injuries and nonfreezing injuries. Frostbite is a freezing injury from direct contact with cold air or surfaces. The extent of injury depends on the depth to which the freezing extends. Treatment involves rewarming the frozen tissue with warm water baths and considering analgesia. Hypothermia is a nonfreezing cold injury, and it can occur even when ambient temperatures are above freezing. When there is a decrease in the body's core temperature, hypothermia progresses from mild to severe symptoms. Treatment of hypothermia is threefold but is also dependent on the core body temperature, as colder core temperatures will require more aggressive warming techniques. Hypothermia treatment involves passive protection from further heat loss (ie, removing wet clothing), which helps the body to warm itself. Treatment also involves active external rewarming wherein a heat source, such as a heated blanket, is used to increase body temperature. Active internal rewarming is the delivery of heat inside the patient's body, such as warmed intravenous fluids.

Frostbite: Current status and advancements in therapeutics.

Frostbite is a severe ischemic injury which occurs due to the tissue vascular damage after sub-zero temperature tissue exposure. Deep frostbite can result in necrosis and may need amputation of affected tissue. Though a serious injury, it is not very well understood, and further scientific exploration is needed. This work explores the current understanding of the pathophysiology of frostbite. We reviewed the current status of the diagnostics, the drugs, the therapies and the surgical practices for prevention and management of frostbite. Advances in nanotechnology and drug delivery had improved the therapeutic outcomes significantly. This review also explored the latest advancements and researches done for development of newer therapeutics and diagnostics for frostbite care.

[Two cases of occupational frostbite].

The diagnosis, treatment, operation and diagnosis of two cases of occupational frostbite diagnosed in Shandong Academy of Occupational Healthy Occupational Medicine were analyzed retrospectively. In these two patients working in a low temperature environment, the finger frostbite did not arouse enough attention, one patient did not receive timely diagnosis and treatment, and one patient received timely medical treatment, but did not receive proper treatment, which ultimately led to the adverse consequences of finger amputation. The staff under the low temperature environment should strictly carry out the low temperature operation protection standard and improve their self-protection consciousness. If frostbite occurs, they should seek medical treatment in time, which can effectively reduce the disability rate.

Acute Compartment Syndrome of the Foot Due To Frostbite: Literature Review and Case Report.

Acute compartment syndrome of the foot and ankle is a relatively rare clinical finding. Lower extremity compartment syndrome is customarily due to vascular or orthopedic traumatic limb-threatening pathologic issues. Clinical correlation and measurement of intracompartmental pressure are paramount to efficient diagnosis and treatment. Delayed treatment can lead to local and systemically adverse consequences. Frostbite, a comparatively more common pathologic entity of the distal extremities, occurs when tissues are exposed to freezing temperatures. Previously found in military populations, frostbite has become increasingly prevalent in the general population, leading to more clinical presentations to foot and ankle specialists. We present a review of the published data of acute foot compartment syndrome and pedal frostbite, with pathogenesis, treatment, and subsequent sequelae. A case report illustrating 1 example of bilateral foot, atraumatic compartment syndrome, is highlighted in the present report. The patient presented with changes consistent with distal bilateral forefoot frostbite, along with gangrenous changes to the distal tuft of each hallux. At admission and evaluation, the patient had increasing rhabdomyolysis with no other clear etiology. Compartment pressures were measured in the emergency room and were >100 mm Hg in the medial compartment and 50 mm Hg dorsally. The patient was taken to the operating room urgently for bilateral pedal compartment release. Both pathologic entities have detrimental outcomes if not treated in a timely and appropriate manner, with amputation rates increasing with increasing delay.

Frostbite following cryolipolysis treatment in a beauty salon: a case study.

This case study describes frostbite, a previously unreported complication following cryolipolysis, which resulted in substantial necrosis of the flank. Medical attention was not sought until one week after treatment. On examination, two distinct areas of significant frostbite in the left flank with surrounding erythema were revealed. Surgical intervention was avoided, as is recommended in cases of frostbite, and conservative treatment resulted in recovery of the affected area. Here, the authors highlight the adverse effects related to cryolipolysis, analysing the pathogenesis, clinical manifestations and management of this injury. The necessity of regulation within the cosmetic sector and the challenges associated with its implementation are also described. The authors believe emphasis must be placed on increasing patient awareness on the potential hazards of seeking cosmetic treatment from unregulated providers.

A 3D thermal model to analyze the temperature changes of digits during cold stress and predict the danger of frostbite in human fingers.

The existing computational models of frostbite injury are limited to one and two dimensional schemes. In this study, a coupled thermo-fluid model is applied to simulate a finger exposed to cold weather. The spatial variability of finger-tip temperature is compared to experimental ones to validate the model. A semi-realistic 3D model for tissue and blood vessels is used to analyze the transient heat transfer through the finger. The effect of heat conduction, metabolic heat generation, heat transport by blood perfusion, heat exchange between tissues and large vessels are considered in energy balance equations. The current model was then tested in different temperatures and air speeds to predict the danger of frostbite in humans for different gloves. Two prevalent gloves which are commonly used in cold climate are considered for investigation. The endurance time and the fraction of necrotic tissues are two main factors suggested for obtaining the response of digit tissues to different environmental conditions.

[The forensic medical assessment of the causes and conditions of the formation of the chilling injury]. / Sudebno-meditsinskaia otsenka prichin i uslovii vozniknoveniia kholodovoi travmy.

The authors present the data of the literature publications and theoretical considerations concerning the causes and conditions behind the formation of the chilling injury. It is demonstrated that the chilling injury develops as a consequence of a disturbance in the relationship between the hypothermic protection of the organism and the cooling potential of its environment. The thermal balance of the human organism depends not only on the natural mechanisms of physical and chemical thermoregulation but also on the character of artificial thermoregulation including the man-made means of cold protection. The critical evaluation of all the available data on chilling injuries to the human body gave evidence that the causes and conditions of their development can be highly multivarious which does not however exclude the possibility of their systematization.

Freezing and non-freezing cold weather injuries: a systematic review.

INTRODUCTION: The debilitating impact of cold weather on the human body is one of the world's oldest recorded injuries. The severe and life-changing damage which can be caused is now more commonly seen recreationally in extreme outdoor sports rather than in occupational settings such as the military. The diagnosis and treatment of these injuries need to be completed carefully but quickly to reduce the risk of loss of limb and possibly life. Therefore, we have conducted a systematic review of the literature surrounding cold weather injuries (CWIs) to ascertain the epidemiology and current management strategies. SOURCES OF DATA: Medline (PubMED), EMBASE, CINHAL, Cochrane Collaboration Database, Web of Science, Scopus and Google Scholar. AREAS OF AGREEMENT IMMEDIATE FIELD TREATMENT: The risk of freeze thaw freeze injuries. Delayed surgical intervention when possible. Different epidemiology of freezing and non-freezing injuries. AREAS OF CONTROVERSY: Prophylatic use of antibiotics; the use of vasodilators surgical and medical. GROWING POINTS: The use of ilioprost and PFG2a for the treatment of deep frostbite. AREAS TIMELY FOR DEVELOPING RESEARCH: The treatment of non-freezing CWIs with their long-term follow-up.

What are the ethical issues in treating a patient with bilateral leg gangrene incapable of consenting to amputation secondary to psychiatric illness?

BACKGROUND: Bilateral and simultaneous lower extremity amputations unrelated to diabetes and peripheral vascular disease are uncommon, although they may be necessary in patients with severe blast injuries. Such amputations, however, usually are performed in patients who are able to understand and consent to the treatment. CASE DESCRIPTION: We present the case of a 29-year-old woman who experienced drug-induced psychosis and underwent substantial hypothermic injuries; most notably, irreversible frostbite injuries to both lower extremities, leading to dry and mummified gangrene. As a result of her psychiatric illness, fluctuating catatonic state, and lack of insight into her clinical condition, she was deemed incapable of making decisions regarding her medical care and her mother was made substitute decision maker. The orthopaedic service was consulted regarding possible surgical treatment of her gangrenous feet that were stable and aseptic after limb preservation efforts (including hyperbaric oxygen) had been tried without success. They recommended close clinical monitoring and continued psychiatric treatment. The family, including the substitute decision maker, citing the patient's best interest, rejected the recommendations of the surgical team and demanded immediate surgical transtibial amputation of both lower legs. LITERATURE REVIEW: To our knowledge, such a unique case has not been reported. CLINICAL RELEVANCE: We examined the decision-making process, the difficulties of caring for such a patient, and the ethical issues that arose.

[Management of frostbite in and outside of the doctor's surgery]. / Management von lokalen Kälteschäden in und außerhalb der Praxis.

Frostbite is most likely to happen in combination with accidents, intoxications or psychiatric emergencies and typically affects smaller, more exposed areas of the body, such as fingers, toes, nose, ears, cheeks and chin. The preclinical treatment consists of rapid rewarming of the injured tissue in a water-bath that is held between 38 - 42 °C (hand-hot) in a stable, warm environment. A new clssification allows a faster assessment of the outcome. New retrospective studies suggest the efficacy of thrombolysis or prostacyclin analogues against spasm and thrombosis for a better outcome.

Frostbite of the hand.

Frostbite is damage caused by the freezing of tissue owing to exposure to extreme cold. Clinically, it is often difficult to identify the severity of frostbite injury. There may be a wide discrepancy between the extent of damage to the skin versus that to the deeper structures. The initial clinical impression is usually worse than actual tissue damage. In addition to physical examination, diagnostic imaging, especially triple-phase bone scan, has been proposed to help differentiate between superficial and deep damage. Principles of treatment involve rapid rewarming to thaw the tissues and halt direct cellular damage, methods to minimize progressive dermal ischemia, and active wound care to promote timely healing. Pharmacological adjuncts, such as fibrinolytics, have been proposed to minimize tissue damage. Surgical therapy is postponed until there is clear demarcation between healthy and necrotic tissue.

Non-freezing cold injury.

Non-freezing cold injury can be a diagnostic challenge for clinicians in the United Kingdom Armed Forces. It is associated with operations in adverse climatic conditions, and may result in significant long-term morbidity. In this article we discuss the operational importance of this condition and the current best practice in its management and prevention.

Cold Injury.

Cold injury has been documented for centuries and remains a concern for military personnel, winter recreationalists, and urban homeless populations. Treatment advances in the last decades have included thrombolytic and prostaglandin therapies however the mainstay remains early recognition and rapid rewarming. This chapter focuses on frostbite, with a brief overview of other cold related conditions.

Kite skier's toe: an unusual case of frostbite.

Frostbite is a well-known occurrence in outdoor winter activity and exploration. We report the first documented case of frostbite associated with kite skiing. Kite skiing is an emerging sport that uses a kite to harness wind power for recreation and to travel long distances on skis. Certain characteristics of this sport may predispose athletes to frostbite injury. The stance required to resist and redirect the force created by the wind and kite puts constant pressure and repetitive trauma on the downwind great toe. This can compromise blood flow and increase risk of cold injury. Future kite skier expeditions should focus on specific prevention methods including properly fitting boots, adequate boot insulation, and frequent rest periods to inspect and warm toes.