Tweens feel the burn: "salt and ice challenge" burns.

PURPOSE: To review our institution's experience with frostbite injury secondary to "salt and ice challenge" (SIC) participation. METHODS: We conducted a retrospective analysis of intentional freezing burns from 2012 to 2014. Demographics, depth and location of burn, total body surface area of burn, treatment, time to wound healing, length of stay, complications, and motives behind participation were analyzed. RESULTS: Five patients were seen in the emergency department for intentional freezing burns that resulted from SIC (all females; mean age: 12.3 years; range age: 10.0-13.2 years). Mean total body surface area was 0.408%. Salt and ice was in contact with skin for >10 min for two patients, >20 min for two patients, and an unknown duration for one patient. Complications included pain and burn scar dyschromia. Four patients cited peer pressure and desire to replicate SIC as seen on the Internet as their motivation in attempting the challenge. CONCLUSION: SIC has become a popular, self-harming behavior among youths. Increased public education, and provider and parent awareness of SIC are essential to address this public health concern.

[Repetitive thermal self-manipulation in borderline personality disorder]. / Die repetitive thermische Selbstverletzung im Rahmen der Borderline-Persönlichkeitsstörung.

Self-mutilations are one of the major characteristics of patients with borderline personality disorder (BPD). Thermal injuries of BPD should be treated by a plastic surgeon who is faced to a challenge in the plastic-reconstructive strategy because of the most complex psychiatric disease. This means the need of a multidisciplinary strategy. Based on 3 case reports such conflict between best plastic reconstructive treatment of the burns wound and the psychiatric limit with the appropriate therapy options are presented.

Psychophysical study of stinging pain evoked by brief freezing of superficial skin and ensuing short-lasting changes in sensations of cool and cold pain.

Psychophysical methods were used to investigate pain in human subjects elicited by controlled freezing of the skin using a novel vortex thermode. When cooling stimuli delivered with a small thermode (7 mm diameter) exceeded the normal cold pain threshold into the sub-zero temperature range (-5 to -11 degrees C), all subjects reported an intense, sharp stinging pain sensation which occurred suddenly and was readily differentiated from normal cold pain. The onset of this stinging 'freezing' pain was closely correlated with a sudden increase in skin temperature beneath the thermode of 4.77+/-0.86 degrees C (+/-SD) associated with the phase transition of supercooled water to ice. The mean intensity of freezing pain was rated as 1.7 times as intense as cold pain at threshold. Subjects' mean reaction-time latency to signal stinging pain following the onset of phase transition on the volar forearm was 687+/-220 ms, which was slower than that for mechanically evoked impact pain. Freezing pain is suggested to be mediated by A-delta fibers, based on estimates of conduction velocity and on the observation that the freezing pain took on a burning quality of slower onset during an A-fiber pressure block of nerve fibers. We also investigated changes in skin sensation following the freezing stimulus, and found that freezing led to (a) an immediate, significant decrease in the cold pain threshold (to higher temperatures), which recovered to baseline in < 16 min, (b) a concomitant change in the quality of cold pain from dull to burning, (c) a significant, parallel increase in the threshold for the perception of cooling (to lower temperatures) which frequently manifested as a complete loss of cold sensation, and (d) a mild heat pain hyperalgesia which was still present 24 h later. The changes in thermal sensitivity were not accompanied by consistent changes in mechanical sensitivity. These results indicate that a characteristic sharp, stinging pain is reliably evoked abruptly at the phase transition of supercooled skin water to ice The ensuing brief decrease in cold pain threshold with burning quality, coupled with decreased sensitivity to cold, are speculated to reflect a central disinhibition of C-fiber nociceptor input due to reduced cold fiber activity. These effects may be relevant to frostbite, and distinguish themselves from the more pronounced thermal and mechanical hyperalgesia seen following intense freeze lesion of the skin.

Frostbite injuries of the hand.

Frostbite may be defined as acute freezing of tissues as a result of exposure to temperatures below the freezing point of intact skin. Severity of injury is due to the degree of cold and the duration of exposure. Tissue injury occurs during freezing due to the actual formation of ice crystals within the extracellular fluid. In addition, ice crystals form in the blood and lead to sludging and cessation of capillary blood flow. However, the most severe tissue damage comes with rewarming the tissues. Reperfused capillaries, with their damaged endothelium, leak fluid and protein leading to edema. Blisters form, and prostaglandins and thromboxanes in the blister fluid cause platelet aggregation. Rapid rewarming of the part is now the acceptable practice. Immersion of the injured part in a whirlpool bath is recommended at a temperature of 100 to 108 degrees Fahrenheit. Eventual care may include debridement and tissue transfers if amputation is required. A case is presented of a woman with frostbitten hands.

Psychological and psychophysiological factors in prevention and treatment of cold injuries.

Cold injured patients in Alaska come from many sources. Although sport and work continues to provide large numbers of cold injured, most severe repeat injuries tend to reflect other biopsychosocial consequences. Certain behaviors can increase the probability of injury, however all persons living in cold climates are potential candidates. One can decrease risk by education, knowledge and intelligent behavior. Proper respect for adequate protection and hydration seem to be critical factors. Understanding the psychological, physiological and psychophysiological aspects of the cold environment performer helps refine the prevention and treatment strategies for cold injury. Skill training with bio-behavioral methods, such as thermal biofeedback, and the value of medical psychotherapy appear to offer continued promise by facilitating physiologic recovery from injury, as well as assisting in long term rehabilitation. Both approaches increase the likelihood of a favorable healing response by soliciting active patient participation. Medical Psychotherapy for traumatic injuries can also help identify and manage cognitive emotional issues for families and patients faced with the permanent consequences of severe thermal injuries. Thermal biofeedback therapy has the potential benefit of encouraging greater self-reliance and responsibility for self-regulating overall health by integrating self-management skills regarding physiology, diet and lifestyle. Inpatient and outpatient biofeedback training offers specific influence over vascular responses for healing, as well as providing an effective tool for pain management. Interest in cold region habitation has continued to expand our study of human tolerance to harsh, extreme environments. Biological, psychological, sociological, and anthropological views on adaptation, habituation, acclimatization, and injury in cold environments acknowledges the role of development, learning and educated responses to cold environments. The study of health, performance, and injury prevention in extreme isolated cold environments has important strategic and scientific implications. What is learned from behavioral studies of cold survival provides an opportunity to increase our scientific knowledge and understanding. These cold research findings can assist in our future exploration of cold, underwater farming at great depths, and to far distance space travel to cold planets. The relatively new research frontier "Polar Psychology" has evolved to study how interactions with cold environments can have both positive and/or negative consequences. This research simulates the psychological factors likely to be encountered while exploring isolated cold regions of distant galaxies. The psychological and psychophysiological correlates of cold experience appear to be a function of four interactive issues: the environment, genetic predisposition, learning or experience, and finally perception or cognition. Individual cold tolerance seems to relate heavily on sensation, perception and behavior.(ABSTRACT TRUNCATED AT 400 WORDS)

Cold injury caused by psychiatric illness: six case reports.

Six patients are reported in whom mental illness led to severe cold injury. The main contributory factors were cold surroundings, inactivity and neglect. The additional factor of impaired microcirculation in these patients may also be significant. In the winter of 1979 two instances of cold injury in patients with mental illness came to our attention. A search of the medical records at the Whittington Hospital revealed a further three cases over a period of 14 years. One patient was seen at the National Hospital for Nervous Diseases, Queen Square.