Page 104 - PJ MED OPS Handbook 8th Ed

Cold Injury

SPECIAL CONSIDERATIONS:
1. Refreezing after thawing results in a high probability of amputation.
2. Check for 60 seconds for pulse and respirations due to bradycardia.

Signs and Symptoms:
1. Hypothermia (decreased core temperature)
a. Mild – Shivering, poor coordination
b. Moderate – Cessation of shivering, disorientation, slurred speech, confusion
c. Severe – Unconscious
2. Freezing Cold Injury (frostbite)
a. Superficial – Skin is firm but not hard; painful, red skin
b. Deep – Painless, gray appearing skin; skin is hard, white, gray, ashen, waxy in appearance
3. Nonfreezing cold injury
a. Itching; pale, cool, blotchy wet skin; mild ulcerations may be present; numbness and tingling
sensations

Management:
1. Non-freezing Cold Injury
a. Gently dry, do not rub involved area. Elevate feet, warm torso, hydrate orally, dry socks.
NSAIDs may help. Evacuation depends on ambulatory ability.
2. Freezing Cold Injury
a. Do not walk on frozen feet/toes unless necessary for preservation of life
b. Do not rub with snow/ice
c. Do not vigorously massage tissue
d. Do not use space heaters or dry heat sources (fire, MRE heaters, hand-warmers, etc.)
e. Ibuprofen, 800mg PO tid (Consider other NSAIDs if ibuprofen is not available)
f. If thawed, refreezing will most likely result in amputation
g. Once thawing has occurred, expect intense pain requiring narcotic use. Follow Pain Manage-
ment Protocol
h. If refreezing likely:
i) Do not attempt to thaw frostbitten tissue
ii) Protect tissue from further injury by wrapping with dry gauze and separate the digits with
the dressing
i. Refreezing not likely:
i) Superficial
1) Warm water immersion
2) Warm extremity in axilla or groin
3) Drainage of clear blisters may be considered
4) Apply soft Kerlex-type dressing
ii) Deep
1) Warm water immersion (104–108°F) until tissue is soft (approximately 30 minutes)
2) Apply loose dry dressing prior to transport
3) Pain Management per Pain Management Protocol
4) Do not drain hemorrhagic blisters

102 n Pararescue Medical Operations Handbook / 8th Edition