Vous êtes sur la page 1sur 258

Disaster Medicine· Volume 3 Editors: R. Frey and P. Safar Sub-Editors: P. Baskett, K. Stosseck, P. Sands, J. Nehnevajsa

Cold and Frost Injuries - Rewarming Damages Biological, Angiological and Clinical Aspects

Hans Killian

In cooperation with T. Graf-Baumann

With 89 Figures

Springer-Verlag Berlin Heidelberg New York 1981

Prof. Dr. Hans Killian

Riedbergstra~e 24

7800 Freiburg/Br.

ISBN-13: 978-3-540-08991-9 DOl: 10.1007/978-3-642-67051-0

e-ISBN-13: 978-3-642-67051-0

Library of Congress Cataloging in Publication Data. Killian, Hans, 1892- Cold and frost injuries. (Disaster medicine; v. 3) Includes bibliographical references and index. I.Frostbite. 2.Cold-Physiological effect.

I. Title. II. Series.

effects. 2. Cold climate. WI Dl727 v.3IWG 530 K48ca)

RC88.5.K54 616.9'88'1 80-26958 ISBN 0-387-08991-8 (U.S.)

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, repro- duction by photocopying machine or similar means, and storage in data banks.

Under § 54 of the German Copyright Law where copies are made for other than private use a fee is payable to ,Verwertungsgesellschaft Wort', Munich.

© Springer-Verlag Berlin Heidelberg 1981

[DNLM: 1. Frostbite cold-Adverse

The use of registered names, trademarks, etc. in this pUblication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

2127/3321

543210

Contents

Preface.

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IX

Introduction.

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1

References.

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14

Clinical Description of Local Cold Injuries.

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16

Internal and External Circumstances Which Encourage Loss of

 

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Regional Causes

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16

General Causes

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17

References.

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22

Terminology and Division Into Groups of Localised Cold

 

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Clinical Manifestations.

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28

Chilblains.

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28

Perniones.

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Perniosis

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29

Erythrocyanosis

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31

. Frostbite, 1st -

Shelter Leg.

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4th Degree.

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Under Nonnal Climatic Conditions.

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32

At High Altitude (The Effects of Dry Cold Accompanied by Hypoxia) Deepseated Cold Injury (Loss of Temperature Due to

 

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Wet-type Cold Damage)

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33

Comments on Deepseated Cold Injuries at Temperatures Around and

 

Above aOc and on Ultra Rapid Cooling.

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34

References.

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37

Historical and Statistical Data on Frostbite. Classification of Cold Injuries Forms of Local Frostbite and Areas Likely to Be Affected

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39

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44

Symptomatology of

. Phase I of Common Forms of Frostbite Classified According

Localised Cold Injuries.

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to Degrees.

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. Phase II: Rewarming and Thawing Out.

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Phase III

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General.

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Phase IV: Phase of Recovery .

First Degree Frostbite

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. Second Degree Frostbite.

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68

Contents

Third Degree Frostbite.

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71

Fourth Degree Frostbite.

Deepseated Cold Injuries Without Marked, Externally Visible

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73

Frostbite Sequelae (Immersion Cold Injuries)

. Symptomatology of Trench Foot, Flanders' Foot and Immersion Hand.

The Problem.

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78

78

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References.

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83

Pathological Physiology and Pathology of Local Cold

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Changes in the Area of the Skin Due to Cold

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86

References.

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90

Damage to the Nerves Due to Exposure to Acute Cold.

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92

Changes to the Muscles Caused by Cold.

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98

References.

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103

Changes in Bones and Joints

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106

References.

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112

Vascular Changes.

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114

Relationship Between Peripheral Reactions to Cold and

Overall State of the Circulation

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114

Phases of Cold Reactions in the Vascular System.

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115

Transient Dilatation as an Initial Reaction

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118

. Irradiation and Consensual Reactions

Vasoconstriction.

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118

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Bright Red Stage.

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123

Waxy Paleness.

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125

Evidence of an Arteriospasm from an Arteriograph and

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Other Test Methods.

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Effects of Cold on Lymph Flow.

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129

. Primary Acidotic Cold Oedema

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Electrolytic Changes

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130

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Manifest Findings Concerning the Vascular System After

. Special Remarks on Vasotrophy, Significance and Nature

Cold Damage.

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137

of the Intima

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Inflammatory Processes in the Vascular Wall. Cold Endangiitis and Its Relationship to Endangiitis

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153

Contents

Eye Disorders Due to Cold

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156

Changes to the Lungs.

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158

References.

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158

Causes of Cold Necrosis

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. Hypoxia and Rewarming Damage.

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. Necrosis Due to Direct Exposure to Cold.

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