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Disaster surgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Frost bite occurs when a part of the body freezes. The cells are disrupted and the tissue dies. It is in effect a ‘cold’ burn and can be categorised according to the depth that it affects in the same way as a conventional burn. Other mechanisms at play include vasoconstriction caused by cold, capillary sludging and reperfusion injury with the release of free radicals, which occurs on rewarming the part. It commonly involves the fingers, toes, cheeks, the tip of the nose and the ears. When frozen the tissue feels hard and cannot be indented. Immersion injury is a cold injury, which does not involve actual freezing of the tissue and is commonly caused by prolonged immersion in cold water (hence trench foot). The patient may also be hypothermic. Warming should be gentle as the heat used may actually cause a burn! Rehydration with warm fluids and use of non-steroidal anti-inflammatory drugs like ibuprofen are beneficial. Demarcation will occur between dead and viable tissue and at this stage no surgery should be undertaken as there is often considerable deep recovery. The injured area should be kept clean and dry and efforts made to prevent further injury, as well as to prevent infection. Definitive surgery to excise dead tissue can be left for many months. Recent developments, such as the use of tissue plasminogen activator (TPA) and nerve blocks, show promising results in reducing amputations, but have to be started within 24 hours and are seldom possible in the field.
Water and hydration in the workplace *
Published in Jamie Bartram, Rachel Baum, Peter A. Coclanis, David M. Gute, David Kay, Stéphanie McFadyen, Katherine Pond, William Robertson, Michael J. Rouse, Routledge Handbook of Water and Health, 2015
Besides hypothermia, workers exposed to high winds and cold temperatures can suffer from frostbite and trench foot which are exacerbated by wet conditions (National Institute for Occupational Safety and Health 2014a). Frostbite develops when ice crystals form in the fluids and underlying soft tissues of the skin, causing tissue destruction. Exposed areas, such as ears, nose, mouth, cheeks, fingers, and toes, are most commonly affected. Frostbitten skin is hard, pale, cold, and lacks feeling. When the affected area thaws, it becomes red and painful and may cause permanent damage to body tissues. Symptoms of frost bite are reduced blood flow to hands and feet, numbness, tingling, throbbing sensation, and bluish or pale waxy skin. Trench foot or immersion foot is an injury to the feet caused by prolonged exposure to wet and cold conditions. Skin tissue will die because of a lack of oxygen and nutrients to the feet, and buildup of toxic products. Symptoms include reddened skin, numbness, leg cramps, edema, tingling pain, blisters, bleeding under the skin, and gangrene.
The management of major injuries
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Localized cold injury is seen in three forms: Frostnip – the mildest form, which is reversible on warming.Frostbite – due to freezing of tissue and resultant damage from intracellular ice crystals and micro-vascular occlusion. This can be classified as two types and four degrees: Superficial frostbite: – First-degree – hyperaemia and oedema without skin necrosis.– Second-degree – vesicle formation with partial-thickness skin necrosis.Deep frostbite: – Third-degree – full-thickness and subcutaneous tissue necrosis, with haemorrhagic vesicle formation.– Fourth-degree – full-thickness necrosis, including muscle and bone gangrene.Non-freezing injury – trench foot or immersion foot, with microvascular endothelial damage, stasis and vascular occlusion.
A review of construction workforce health challenges and strategies in extreme weather conditions
Published in International Journal of Occupational Safety and Ergonomics, 2023
Sanjgna Karthick, Sharareh Kermanshachi, Apurva Pamidimukkala, Mostafa Namian
A major increase (15%) in emergency room visits by workers for cold-related injuries such as slips and falls (CP11) has been observed with every degree that the temperature falls during cold weather, and an increase in wind speed further increases the number of visits by 6% [49,50,51]. The rising number of slips, trips and fall-related accidents is attributed to ice, snow, limited visibility and cooling of the body [37,49]. Two-thirds of all fall events in cold weather occur on ice that is coated with snow [60]. Trench foot or immersion foot are also the result of working in cold environments [62,63]. Trench foot (CP12) is a condition in which blood vessels are inflamed to the extent that they damage organs and tissues; it is common among those who work for prolonged periods of time in temperatures that are above 0° C (32 °F). Immersion foot develops when workers stand in the same position for long periods of time, especially in cold, wet environments [61]. The terms trench foot and immersion foot are often used interchangeably; immersion foot, formerly known as trench foot, is considered a non-freezing cold injury. It is experienced by many outdoor workers, and often occurs when construction workers perform jobs, such as excavating a hole for a foundation, in cold, muddy water [63]. The symptoms of immersion foot begin with numbness and white or pale skin that changes to a shade of blue. It is often characterized by numbness and severe pain, even after heat has been restored [64,65]. Table 5 presents the physical challenges and health issues that workers encounter in extremely cold temperatures.
Blind and partially sighted physiotherapy in the United Kingdom. A century of development, success and challenge. Will it still belong?
Published in Physiotherapy Theory and Practice, 2021
Due to the appalling injuries and debilitating illnesses caused by the war there was a rapid expansion of massage and remedial exercise. There were 30,000 amputations resulting from trench foot (French, 2001) and many soldiers returned from the trenches with respiratory illness due to gassing by phosgene, chlorine and mustard gasses and others returned with wounds, burns and other serious injuries.