RT Book, Section A1 Wadman, Michael C. A2 Cline, David M. A2 Ma, O. John A2 Cydulka, Rita K. A2 Meckler, Garth D. A2 Handel, Daniel A. A2 Thomas, Stephen H. SR Print(0) ID 56277041 T1 Chapter 118. Frostbite and Hypothermia T2 Tintinalli's Emergency Medicine Manual, 7e YR 2012 FD 2012 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-178184-8 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=56277041 RD 2024/03/29 AB Trench foot is a direct soft tissue injury that results from prolonged exposure to nonfreezing cold and moisture. The foot is initially pale, mottled, pulseless, and anesthetic and does not improve quickly with rewarming. Several hours after rewarming, the foot becomes hyperemic and painful and perfusion returns after 2 to 3 days. Bullae and edema are late findings. Chilblains (pernio) are painful inflammatory lesions typically affecting the ears, hands, and feet caused by chronic exposure to intermittent damp, nonfreezing conditions. Localized edema, erythema, and cyanosis appear up to 12 hours after the exposure and are accompanied by pruritis and burning paresthesias. Tender blue nodules may form after rewarming. Treatment of trench foot and chilblains include elevation, warming, and bandaging of the affected body part. Nifedipine 20 milligrams PO 3 times daily, pentoxifyline 400 milligrams PO 3 times daily, or limaprost 20 micrograms PO 3 times daily, as well as topical corticosteroids, such as 0.025% fluocinolone cream or a brief burst of oral steroids may be added.