DVBCWCI1 ;ALB/CMM COLD INJURY PROTOCOL EXAM WKS TEXT - 1 ; 7 MARCH 1997
 ;;2.7;AMIE;**12**;Apr 10, 1995
 ;
 ;
TXT ;
 ;;Narration:  Veterans during World War II, the Korean War, and in smaller 
 ;;numbers during other campaigns, have suffered cold injuries, including
 ;;frostbite (freezing cold injury or FCI) and immersion foot (nonfreezing 
 ;;cold injury or NCI).  Documentation of such injuries may be lacking 
 ;;because of battlefield conditions.  A number of long-term and delayed
 ;;sequelae to cold injuries are recognized, including peripheral neuropathy, 
 ;;skin cancer in frostbite scars, and arthritis in involved limbs.
 ;;
 ;;Review Examination:  Any veteran examined for residuals of cold injury
 ;;should undergo a cold injury protocol examination IF it has not already 
 ;;been carried out.  If the veteran has already had a cold injury protocol 
 ;;examination, only an interval history is required, and the extent of 
 ;;the examination, laboratory tests performed, etc., will be determined
 ;;by the examiner based on the history, and as requested.
 ;;
 ;;A.  Review of Medical Records:
 ;;
 ;;
 ;;
 ;;B.  Medical History (Subjective Complaints):
 ;;
 ;;HISTORY OF COLD INJURY:  If the cold injury protocol form has been 
 ;;filled out by the veteran, most details about the circumstances of the
 ;;acute cold injury and its subsequent course will be recorded.  Review
 ;;for any needed expansion or clarification by the veteran.  If the 
 ;;protocol history form has not been completed, obtain the following 
 ;;history and comment on each:
 ;;
 ;;    1.  Description of the circumstances of the cold injury.
 ;;
 ;;
 ;;    2.  Parts of the body affected.
 ;;
 ;;
 ;;    3.  Signs and symptoms - at time of acute injury.
 ;;
 ;;
 ;;    4.  The type of treatment and where it was administered.
 ;;
 ;;
 ;;    5.  Any treatment since service - where and what type.
 ;;
 ;;
 ;;    6.  Current symptoms - specifically inquire about:
 ;;
 ;;        a.  Amputations or other tissue loss.
 ;;
 ;;
 ;;        b.  Cold sensitization.
 ;;
 ;;
 ;;        c.  Raynaud's phenomenon.
 ;;
 ;;
 ;;        d.  Hyperhidrosis.
 ;;
 ;;
 ;;        e.  Paresthesias, numbness.
 ;;
 ;;
 ;;        f.  Chronic pain resembling causalgia or reflex sympathetic dystrophy.
 ;;
 ;;
 ;;        g.  Recurrent fungal infections.
 ;;
 ;;
 ;;        h.  Breakdown or ulceration of frostbite scars.
 ;;
 ;;
 ;;        i.  Disturbances of nail growth.
 ;;
 ;;
 ;;        j.  Skin cancer in chronic ulcers or scars.
 ;;
 ;;
 ;;        k.  Arthritis or joint stiffness, including limitation of 
 ;;            motion of affected areas.
 ;;
 ;;
 ;;        l.  Edema.
 ;;
 ;;
 ;;        m.  Changes in skin color.
 ;;
 ;;
 ;;        n.  Skin thickening or thinning.
 ;;
 ;;
 ;;        o.  Any sleep disturbance due to associated symptoms.
 ;;
 ;;
 ;;        p.  Cold feeling (relationship to season or not).
 ;;
 ;;
 ;;        q.  Numbness, tingling, burning.
 ;;
 ;;
 ;;        r.  Excess sweating.
 ;;
 ;;
 ;;        s.  Pain - location, intensity, constancy, precipitating 
 ;;            factors (cold, walking, standing, night pain); type 
 ;;            (sharp burning, etc.).
 ;;
 ;;
 ;;    7.  Current treatment, including nonmedical measures taken - moving 
 ;;        to warmer climate, wearing multiple pairs of socks, etc.
 ;;
 ;;
 ;;OTHER MEDICAL HISTORY:
 ;;
 ;;    1.  Major illnesses, surgery, current medical conditions and their
 ;;        treatment, including diabetes mellitus or hypertension.  
 ;;
 ;;
 ;;    2.  Smoking history, other risk factors for vascular disease, 
 ;;        history of skin cancer.
 ;;
 ;;
 ;;C.  Physical Examination (Objective Findings):
 ;;
 ;;    Address each of the following and fully describe current findings:
 ;;    1.  General:  Carriage, gait, posture.
 ;;
 ;;
 ;;    2.  Skin:
 ;;        a.  Color.
 ;;        b.  Edema.
 ;;        c.  Temperature.
 ;;        d.  Atrophy.
 ;;        e.  Dry or moist.
 ;;        f.  Texture.
 ;;        g.  Ulceration.
 ;;        h.  Hair growth.
 ;;        i.  Evidence of fungus or other infection.
 ;;
 ;;
 ;;    3.  Scars:
 ;;        a.  Location.
 ;;        b.  Length.
 ;;        c.  Width.
 ;;        d.  Color.
 ;;        e.  Tenderness.
 ;;        f.  Raised or depressed.
 ;;        g.  If of head or neck, any disfigurement.
 ;;
 ;;
 ;;    4.  Nails:
 ;;        a.  All or part missing. 
 ;;        b.  Evidence of fungus infection. 
 ;;        c.  Deformed or atrophic. 
 ;;
 ;;
 ;;    5.  Neurological:
 ;;        a.  Reflexes.
 ;;        b.  Sensory  -  subjective complaints of pain, numbness, etc., 
 ;;            Objective sensory changes - pinprick, touch.
 ;;        c.  Motor  -  weakness, atrophy.
 ;;
 ;;
 ;;    6.  Orthopedic:
 ;;        a.  Pain or stiffness of any joints affected by cold injury.
 ;;        b.  Deformity or swelling of any joints.
 ;;        c.  Measure range of motion of all affected joints.
 ;;        d.  Strength of ligaments in affected areas.
 ;;        e.  Pes planus.
 ;;        f.  Callus.
 ;;        g.  Pain on manipulation of joints.
 ;;        h.  Loss of tissue of digits or other affected parts.
 ;;
 ;;
 ;;    7.  Vascular:
 ;;        a.  Status of peripheral pulses.
 ;;        b.  Doppler study to confirm vascular compromise, if indicated.
 ;;        c.  Evidence of vascular insufficiency - edema, hair loss, 
 ;;            shiny atrophic skin, etc.
 ;;        d.  Blood pressure in arms and legs (is ratio normal?)
 ;;        e.  Evidence of Raynaud's phenomenon.
 ;;
 ;;
 ;;D.  Diagnostic and Clinical Tests:
 ;;
 ;;    Provide:
 ;;    1.  X-rays of affected areas of extremities if never done or if 
 ;;        not done in past five years.
 ;;    2.  Doppler study of blood vessels, if indicated.
 ;;    3.  Nerve conduction of studies, if indicated.
 ;;    4.  Biopsy of any area suspicious for malignancy.
 ;;    5.  Scrapings to confirm fungus infection.
 ;;    6.  Include results of all diagnostic and clinical tests conducted
 ;;        in the examination report.
 ;;
 ;;
 ;;E.  Diagnosis:
 ;;
 ;;    1.  List each diagnosis and state whether related to cold injury 
 ;;        (if that can be determined).
 ;;    2.  Specialty exams that might be needed:
 ;;
 ;;        a.  Neurology.
 ;;        b.  Podiatry.
 ;;        c.  Dermatology.
 ;;        d.  Rheumatology.
 ;;        e.  Others as needed.
 ;;
 ;;
 ;;Signature:                             Date:
 ;;END