(BMJ)—A male w/ alcoholism who was in his 70s was found in the bathtub w/ wet clothing after being missing for 3 days. He had delirium & hypothermia. Recent outside temps were 50°F. He had loss of sensation in his feet, w/ areas of ulceration & necrosis. What is the dx?
Frostbite
Trench foot
Necrotizing fasciitis
Disseminated intravascular coagulation
Pernio
You are correct. Loss of sensation, w/ areas of ulceration & necrosis, are all features of “trench foot,” or nonfreezing immersion injury. It occurs after prolonged exposure to cold & wet conditions in soldiers or in pts w/ physical or mental health problems. During rewarming, the feet are extremely painful, & some pts develop long-term pain & impairment of vascular fxn. The pt was given warmed IV fluid & a forced-air warming blanket, keeping his feet outside of the warm airflow to avoid further damage due to overheating poorly perfused tissue. With specialized wound care nursing, his altered sensation improved, & his pain resolved in 10 days. The pt was discharged 7wk later & was able to walk 80 m. Two months later, he was abstinent from alcohol & had recovered, apart from some healing foot ulcers.