frostbite and immersion foot care

Question 1

The ultimate mechanism of cold injury involves a combination of

Answer 1

direct cold injury to the cells, direct intracellular and intercellular ice formation, ischemia from thrombosis of the vasculature, and reperfusion injury

Question 2

T/F Increased rates of frostbite occur at extreme high altitude secondary to ambient temperature decreases and microcirculatory changes that occur at altitudes less than 17,00ft.

Answer 2

false

Question 3

T/F All patients with identified cold injury should be considered trauma patients first to identify other life threatening injuries.

Answer 3

true

Question 4

_________ must be established prior to making the diagnosis of cold injury.

Answer 4

Normothermia

Question 5

a patient is experiencing Superficial skin injury; pain on re-warming, numbness, hyperemia, occasional blue mottling, swelling and superficial desquamation. What degree injury is this?

Answer 5

1st

Question 6

a patient is experiencing Partial thickness injury to skin; vesiculation of the skin surrounded by erythema and edema. what degree injury is this?

Answer 6

2nd

Question 7

a patient is experiencing Entire thickness of skin extending into subcutaneous tissue; bluish to black and non- deformable skin, hemorrhagic blisters, vesicles may not be present, eventual ulcerations can be expected; . what degree injury is this

Answer 7

3rd

Question 8

a patient is experiencing full thickness damage including bone. Area may be cold to touch and may feel stiff or woody. what degree injury is this?

Answer 8

4th

Question 9

T/F for the sake of caution in the field, the recommendation is to treat all acute presentations as frostnip

Answer 9

false, treat it as a 1st degree frostbite

Question 10

_________ is a syndrome related to prolonged exposure to moisture causing water logging of the feet

Answer 10

immersion foot

Question 11

what is the best treatment when attempting to re-warm a patient with frostbite?

Answer 11

Rapid active re-warming is done in 104-108°F (40- 42°C) water for 15- 30 minutes

Question 12

during the rewarming process for frostbite which medications should be utilized liberally for pain management?

Answer 12

Ibuprofen/Aspirin and/or Ketamine

Question 13

after rewarming from a cold injury what measures should you take during the course of treatment?

Answer 13

limit tobacco or nicotine use, elevate the limb, electrolytes should be balanced, hyperbaric O2 if available,

Question 14

what 3 factors make a patient a candidate for thrombolytic therapy

Answer 14

Within 24 hours of start of injury.
severe frostbite
Evidence of injury with vascular compromise.

Question 15

for a patient that has severe frostbite on 2 extremities what is the maximum rate of tissue plasminogen activator?

Answer 15

0.5 mg/h

Question 16

T/F if a Third degree frostbite forms an eschar it should be immediately derided even if in a operational environment

Answer 16

false

Question 17

T/F In general, surgical debridement should be done at a definitive care site outside of theater

Answer 17

true

Question 18

For minor injuries, local wound care can be performed with the addition of _________

Answer 18

topical antibiotic and aloe vera gel or a sterile topical emollient every 6 hours.

Question 19

what is the process of rewarming the extremity of a patient diagnosed with immersion foot?

Answer 19

air drying at room temperature

Question 20

if concerned that infection is present, treatment should target__________

Answer 20

streptococcal, staphylococcal, and P aeruginosa