Cold injury
Cold exposure damages skin through freezing and nonfreezing mechanisms.
Cold injury, also known as cold weather injury, is damage to the body from cold exposure, encompassing hypothermia and several skin injuries. These injuries are categorized into freezing and nonfreezing types, with freezing injuries occurring below 0 degrees Celsius and nonfreezing injuries between 0-15 degrees Celsius for extended periods. While historically affecting military members, recreational winter activities have increased risk in civilian populations, with additional risk factors including homelessness, inadequate clothing, and alcohol or tobacco abuse.
Quick Facts
- Treatment
- Move to warm and dry environment
- rewarming
- medication
- wound care
- surgery
- Field
- Emergency medicine
- Symptoms
- Numbness
- skin discoloration
- blisters
- swelling
- cold sensation
- Causes
- Exposure to cold temperatures
- Diagnosis
- Based on symptoms
- Differential
- Hypothermia
- Raynaud's phenomenon
- chilblains (pernio)
- cold urticaria
- Complications
- Necrosis
- gangrene
- chronic pain
- amputation
- Types
- Freezing, nonfreezing
Facts from the source article.
Freezing cold injuries
Comprehensive data on the overall incidence of freezing cold injuries, including frostbite, is lacking. Military populations have been disproportionally affected due to prolonged cold exposure from work requirements, with the United States military reporting 1,120 frostbite cases from 2015 to 2020. Increased incidence has been noted among individuals participating in winter recreational activities, especially mountaineering. Risk factors include homelessness, inadequate clothing, high altitude, dehydration, alcohol or tobacco abuse, previous cold injury, and pre-existing conditions such as diabetes, Raynaud syndrome, and peripheral vascular disease. Damage occurs through direct freezing of tissue, disrupted blood flow, and rewarming injury. Freezing causes ice crystal formation that disrupts cell membranes and blood vessels, leading to electrolyte imbalances, edema, and inflammation. Blood vessel constriction can cause necrosis in severe cases. During rewarming, restored blood flow induces further inflammatory damage via reactive oxygen species and molecules such as prostaglandins, thromboxanes, bradykinin, and histamine, potentially causing blood clot formation. Diagnosis is based on symptom presentation, with several weeks often needed to determine full tissue injury extent. In severe cases, magnetic resonance angiography or Technetium-99 bone scan may assess tissue recovery likelihood and need for amputation. Other cold-induced conditions should be evaluated and treated appropriately.
Nonfreezing cold injuries
Nonfreezing cold injuries occur in individuals with cold, wet skin for prolonged periods of several hours to days. These injuries have been characterized in military populations unable to frequently change their environment or wet clothing, but civilian populations with occupations exposing them to cold standing water, such as hikers, or those participating in winter recreational activities are also at risk. Additional risk factors include immobility, homelessness, alcohol or tobacco abuse, elderly age, dehydration, and underlying conditions like peripheral vascular disease and diabetes. The underlying mechanism is not fully understood but involves poor blood flow into tissue exposed to cold, wet conditions, potentially causing destruction of small blood vessels, swelling, nerve damage, and tissue breakdown from pressure injury. Distinction between acute and chronic mechanisms has been discussed: acute cases involve disruption of blood flow with tissue breakdown and nerve damage, while chronic cases can occur after multiple acute episodes with partial blood flow restoration but persistent long-term symptoms. Nonfreezing cold injury commonly affects the feet due to prolonged exposure to wet socks or cold standing water. Symptoms progress through four stages: during cold exposure, skin becomes numb and transitions from red to pale; after cold exposure, skin appears pale blue, cold, numb, and swollen; hyperemia follows with redness, swelling, bounding pulses, and increased pain sensitivity; after hyperemia, skin changes resolve unless necrosis has occurred, but the injured limb remains sensitive to cold.
History
Cold injuries are not a modern phenomenon; the earliest known case comes from a 5,000-year-old mummy found in the Chilean mountains. The first large-scale outbreak was recorded by Baron Larrey during Napoleon’s disastrous retreat from Russia in the winter of 1812–1813. These injuries also caused immense suffering in both World Wars. Trench foot, named for its link to trench warfare, is believed to have caused up to 75,000 deaths among British soldiers in World War I. During World War II, over 25,000 cases of trench foot were reported in the U.S. military. To combat this, troops rotated trench positions, changed socks several times daily, and applied whale oil to their feet. Cold injuries remain a concern today: between 2015 and 2020, the U.S. military recorded 1,120 cases of frostbite and 590 cases of trench foot.
Frequently Asked Questions
What are the symptoms of Cold injury?
Symptoms of Cold injury include Numbness, skin discoloration, blisters, swelling and cold sensation.
How is Cold injury treated?
Treatment of Cold injury includes Move to warm and dry environment, rewarming, medication, wound care and surgery.
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