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FROSTBITE Classification:
- Trench foot-
exposure to wet cold above freezing temperature.
- Pernio =
chilblain. Exposure to dry cold above freezing temperature. Presents as superficial ulcerations on erythematous skin.
- Frostbite -
exposure to freezing temperature that damages both vessels and cells. Ice crystal deposition , venous sludging and platelet aggregation impede blood flow with consequent stasis, protein denaturation and tissue necrosis.
S & S / Stages:
- Frostnip -
blanched and numb skin. If pt is capable to feel the cold, the damage is reversible. If pt loses pain and cold sensation, the frostnip has progressed to frostbite.
- Superficial frostbite
- clear fluid blisters for 48hrs hard and black skin demarcation in 3-4 weeks (dry gangrene) pink new skin in few month that is hypersensitive.
- Deep frostbite -
involves deeper structures ® purple, painless and cold to touch®
bloody blisters in 10 days ®
mummification in few months and autoamputation.
Reexposure of frostbitten area to cold causes even more severe damage.
Treatment:
- Frostnip -
hide the area in warm areas of the body without rubbing. When blood flow is restored, the pt feels needles and tingling to the affected areas.
- Frostbite -
Rapid rewarming by immersion into 42°C whirlpool
x 20min is best method of treatment. Analgesic is given if pt starts to experience pain with rewarming.
Blisters
- are not removed whether clear or bloody as long they are intact, to prevent infections. Some authors suggest, on the other hand, that clear blisters are filled with thromboxane and prostaglandines and, being injurious to tissue, should be removed.
NSAID - it was found that inhibition of cyclooxygenase activity and prostaglandine synthesis, would decrease frost induced inflammation. Thus, NSAIDs and Aloe Vera
(thromboxane inhibitor) are used.
Pt with multiple medical problems, involvement of joints, homeless patient that may re-expose frost bitten and rewarmed areas to cold and thus worsen the damage, should be admitted.
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