Wilderness and Rescue Medicine 8th Edition

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Wilderness and Rescue Medicine

to cold and wet conditions above freezing. It is not limited to feet and often involves the hands of paddlers, fishermen, and others working or playing on the water. Inflammation results from prolonged vasoconstriction and tissue breakdown, an example of ischemia to infarction. Blisters can develop, with the possibility of secondary infec- tion where the dermis has been exposed. Treatment of Trench Foot (or Hand) Because the mechanism for trench foot is ischemia from being wet and cold, the ideal treatment is to improve perfusion by keeping the feet warm and dry. Treat any open wounds to prevent infection and allow for healing. Ibuprofen may help with inflammation and pain. Like rewarmed frostbite, tissue damage can be exacerbated by further use. Walking may be difficult or impossible.

Take your wetsuit booties and gloves off whenever possible. Inside waterproof boots, change your socks frequently to keep your feet as dry as you can.

General Principles

Trench Foot

Inflammation results from prolonged vasoconstriction and tissue breakdown, an example of ischemia to infarction.

© 2018 WMA

General Principles

Trench Hands

The mechanism is prolonged vasoconstriction in cold and wet conditions.

© 2018 WMA

Raynaud’s Phenomenon Raynaud’s is a disorder of the blood vessels near the skin, most often affecting the hands and fin- gers and aggravated by cold exposure. Profound vasoconstriction causes temporary ischemia, with the typical white or blue appearance and numb- ness and tingling. Raynaud’s is usually self-limit- ing if the extremity is protected from further cold exposure. Predisposing factors include repetitive use injury, vibration injury, and previous cold frostbite. Raynaud’s can also be a feature of other systemic illness.

Prevention is well worth the trouble. In “trench” conditions, try to give your hands and feet several dry and warm hours each day. Reverse shell/core compensation by maintaining hydration, calories, and activity. It’s okay to dry your wet socks in your sleeping bag at night, but not while wearing them.