TAILIEUCHUNG - Chapter 020. Hypothermia and Frostbite (Part 6)

Frostbite with vesiculation, surrounded by edema and two most common nonfreezing peripheral cold injuries are chilblain (pernio) and immersion (trench) foot. Chilblain results from neuronal and endothelial damage induced by repetitive exposure to dry cold. Young females, particularly those with a history of Raynaud's phenomenon, are at greatest risk. Persistent vasospasticity and vasculitis can cause erythema, mild edema, and pruritus. Eventually plaques, blue nodules, and ulcerations develop. These lesions typically involve the dorsa of the hands and feet. In contrast, immersion (trench) foot results from repetitive exposure to wet cold above the freezing point. The feet initially appear. | Chapter 020. Hypothermia and Frostbite Part 6 Frostbite with vésiculation surrounded by edema and erythema. The two most common nonfreezing peripheral cold injuries are chilblain pernio and immersion trench foot. Chilblain results from neuronal and endothelial damage induced by repetitive exposure to dry cold. Young females particularly those with a history of Raynaud s phenomenon are at greatest risk. Persistent vasospasticity and vasculitis can cause erythema mild edema and pruritus. Eventually plaques blue nodules and ulcerations develop. These lesions typically involve the dorsa of the hands and feet. In contrast immersion trench foot results from repetitive exposure to wet cold above the freezing point. The feet initially appear cyanotic cold and edematous. The subsequent development of bullae is often indistinguishable from frostbite. This vesiculation rapidly progresses to ulceration and liquefaction gangrene. Patients with milder cases complain of hyperhidrosis cold sensitivity and painful ambulation for many years. Frostbite Treatment Frozen tissue should be rapidly and completely thawed by immersion in circulating water at 37 -40 C. Rapid rewarming often produces an initial hyperemia. The early formation of large clear distal blebs is more favorable than smaller proximal dark hemorrhagic blebs. A common error is the premature termination of thawing since the reestablishment of perfusion is intensely painful. Parenteral narcotics will be necessary with deep frostbite. If cyanosis persists after rewarming the tissue compartment pressures should be monitored carefully. Numerous experimental antithrombotic and vasodilatory treatment regimens have been evaluated. There is no conclusive evidence that dextran heparin steroids calcium channel blockers hyperbaric oxygen or prostaglandin inhibitors salvage tissue. A treatment protocol for frostbite is summarized in Table 20-4. Table 20-4 Treatment for Frostbite Before Thawing During Thawing After Thawing Remove .

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