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COLD

INJURIES

SALSA NABILA - 1510211058


COLD • Freezing  frostbite
INJURIES • nonfreezing injuries
– Frostnip
trauma yang – Chillblains
disebabkan adanya – Trenchfoot
paparan thdp suhu
dingin dalam waktu
yang lama
ETIOLOGI FAKTOR INDIVIDU
• BAJU BASAH

/ FAKTOR • LEMAK TUBUH SEDIKIT

PREDISPO • JARANG GERAK


FAKTOR LINGKUNGAN

SISI • SUHU SEKITAR O ºC


• HUJAN, ANGIN KENCANG
• CUKUP LAMA KONTAK DENGAN SUHU RENDAH
NON
FREEZING
INJURIES
FROSTNIP
• Bentuk paling ringan trauma dingin yang mengenai
wajah, telinga, kaki, jari
• Tidak menyebabkan kerusakan irreversible
GEJALA
• numbness,white, waxy skin-top layer feels hard, rubbery
but deepertissue is still soft.
• It occurs typically on cheek, earlobes,fingers and toes.
TATA LAKSANA
• Rewarm by immersing the affected part into a waterbath
of 105°-110°F for 25-40 minutes. This is the temperature
which feels warm to the skin. using aloe vera topical
• Gentle rewarming e.g. by blowing warm air on it or
placing thearea against a warm body part (partner’s
stomach orarmpit).
• Avoid rubbing as this can damage the tissue by having ice
crystals tear the cells.
CHILL- • Chilblains (erythema pernio) is a superficial tissue injury
that occurs after prolonged or intermittentexposure to

BLAINS temperatures above freezing and high humidity with


high winds.
• Results from sudden shift from hot to cold
GEJALA
• erythema and pruritus
• Erythematous to violaceous acral lesions
• It occurs typically on cheek and ears, fingers and toes.
TATA LAKSANA
• Rewarm dalam air hangat
• Monitoring infeksi sekunder
• Sembuh dalam 2-3minggu
TRENCH • prolonged immersion of the feet in cool, wet conditions.
(0-12 C)

FOOT • Since wet feet lose heat 25 times faster than dry, the body
uses vasoconstriction to shut down peripheral circulation
in the foot to prevent heat loss. Skin tissue begins to die
because of lack of oxygen and nutrients and due to
buildup of toxic products.
• reddened with numbness, tingling pain, and itching, then
becomes pale and mottled and finally dark purple, grey or
blue. The affected tissue generally dies and sloughs off.
• In severe cases trench foot can involve the toes, heels, or
the entire foot.
• If circulation is impaired for over 6 hours there will be
permanent damage to tissue.
• If circulation is impaired for over 24 hours the victim may
lose the entire foot.
TRENCH TATA LAKSANA
• gentle drying, elevation, and exposure of the extremity

FOOT in an environmental temperature of 64°-72°F, while


keeping the rest of the body warm.
• Since the tissue is not frozen as in severe frostbite, it is
more susceptible to damage by walking on it.
• Bed rest, cleanliness, and pain relief with NSAIDs are
essential.
• The prognosis depends upon the extent of the original
tissue and nerve damage. Minimal and mild cases can
resolve in hours to days or weeks and most eventually
return to full duty. However, moderate to severe cases
can take months to heal and most of these patients do
not return to full duty.
TRENCH PENCEGAHAN
• Keep feet dry by wearing appropriate footwear. Check

FOOT feet regularly to see if they are wet. If feet get wet
(through sweating or immersion), stop and dry the feet
and wear dry socks. This applies especially to people
who sweat more than usual. Change socks at least once
a day and avoid sleeping with wet socks. Tight socks
can further impair peripheral circulation. Periodic air
drying, elevation, and massage will also help.
• Foot powder with aluminium hydroxide can help. High
altitude mountaineers put antiperspirant on their feet
for a week before the trip. The active ingredient,
aluminium hydroxide will keep the feet from sweating
for up to a month and there are no confirmed
contraindications for using antiperspirant.
FROSTBITE
FROSTBITE
Kondisi yang disebabkan oleh paparan berkepanjangan terhadap suhu dingin,
yang menyebabkan jaringan tubuh membeku dan mengalami kerusakan jaringan
ETIOLOGI
• Paparan berkepanjangan suhu < - 1 ºC

FAKTOR PREDISPOSISI
• Kegagalan aklimatisasi
• Gangguan sirkulasi/ penyakit vaskular (aterosklerosis, DM, Raynaud’s syndrome)
• Alkohol
• Nikotin
• Hipoksia
• Kulit basah
KLASIFIKASI

SUPERFICIAL FROSTBITE
• Epidermis – subkutan
• Area injuries berwarna putih spt lilin
• X capillary refill
• Saat pencairan  area injury menjadi merah,
edema, nyeri, belang keunguan
• Blistering/ vesicle terbentuk dalam 24 jam,
pecah dalam 10 hari, (+) scar hitam
• Nyeri berdenyut & nyeri terbakar
KLASIFIKASI

DEEP FROSTBITE
• Injuri pada > jar. Subkutan (otot, tendon, struktur
neurovaskular)
• Bagian yang injury tetap biru/ kelabu setelah
pencairan
• Blister kadang terbentuk di jaringan yang masih
visible
• Edema biasanya 1 tubuh (generalisata) & butuh 1
bulan untuk recovery
GRADING • Terjadi pada orang-orang yang tinggal di lingkungan
dingin
GRADE I • Cedera mengakibatkan eritema setelah dihangatkan
kembali
• Kulit terasa kaku, namun jaringan dibawahnya masih
teraba lembut & hangat
• similar to mild chilblain with hyperemia, mild itching,
and edema. No blistering or peeling of skin occurs.
GRADING • Terjadi pembentukan blister / vesicle (clear-fluid filled)
& deskuamasi
GRADE II • Area injury ungu – biru, dikelilingi zona putih
GRADING • necrosis of skin and subcutaneous tissue with
ulceration.
GRADE III
GRADING • Involvement of deeper structure
• destruction of connective tissues and bone, with
GRADE IV gangrene.
• Blood-filled blisters
• Membentuk keropeng hitam setelah 2 minggu
PATHO
PHYSIOLOGY
TATA 1. RAPID EVACUATION

LAKSANA
2. Mengganti baju yang basah dan ketat dengan baju
longgar kering

1. FIELD MANAGEMENT

2. REWARMING

3. POSTREWARNING MANAGEMENT

4. PHARMACOLOGY

5. VESICLE TREATMENT
TATA • RAPID REWARMING: merendam ekstremitas di air
bersuhu 40-42 ºC sampai eritema, lembut
LAKSANA • ANTI SEPTIK: povidone-iodine
• AVOID MASSAGING & RUBBING
• THAWING
1. FIELD MANAGEMENT
– Superficial  20-40 mins
2. REWARMING
– Deep  1 jam
3. POSTREWARNING MANAGEMENT

4. PHARMACOLOGY

5. VESICLE TREATMENT
TATA • Once the skin is thawed…
• Lindungi area dari injuri berkelanjutan & reexposure
LAKSANA thdp dingin
• Elevasi area
• Monitoring infeksi sekunder
1. FIELD MANAGEMENT

2. REWARMING

3. POSTREWARNING MANAGEMENT

4. PHARMACOLOGY

5. VESICLE TREATMENT
TATA 1. Analgesik: ibuprofen saat & setelah rewarm

LAKSANA
2. Aloe vera cream setiap 6 jam
3. Imunisasi booster tetanus 0.5 mL IM
4. Antibiotik: Pencillin G 500.000 U setiap 6 jam, lanjut
72 jam
1. FIELD MANAGEMENT
5. Plasma expander: Dextran 40, 30 mL/kg setiap 24 jam
2. REWARMING (untuk mencegah penggumpalan darah)
3. POSTREWARNING MANAGEMENT 6. Aspirin 600 mg PO setiap 3 jam
4. PHARMACOLOGY

5. VESICLE TREATMENT
TATA 1. CLEAR/ MILKY VESICLE  DEBRIDEMENT, ALOE
VERA
LAKSANA 2. HEMORRHAGIC VESICLE  DO NOT
DEBRIDEMENT

1. FIELD MANAGEMENT

2. REWARMING

3. POSTREWARNING MANAGEMENT

4. PHARMACOLOGY

5. VESICLE TREATMENT
1. Menggunakan pakaian tipis namun berlapis banyak,
dibandingkan satu lapis tebal
2. Wear mittens, instead of gloves
3. Gunakan minimal 2 kaos kaki
4. Cover the face & head
5. Hindari pakaian ketat
6. Hindari baju basah, posisi stasis
7. Mengecek keadaan kulit tiap 10-20 menit
8. Hindari rokok (>> peripheral constriction)

PENCEGAHAN
COLD INJURIES
RE
• Cold Injuries, The Chill Within 2004
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC49230
33/pdf/main.pdf

FE • Materi dasar Ilmu Kesehatan Militer Matra Darat

REN
CE
THANK
YOU!