What are the guideline sources, guidelines and references for Immersion foot syndromes ?
Guideline sources The following summarized guidelines for the evaluation and management of immersion foot syndromes are prepared by our editorial team based on guidelines from the Wilderness Medical Society (WMS 2023). 1 Guidelines 1. Screening and diagnosis Diagnosis (nonfreezing cold injuries): consider diagnosing nonfreezing cold injury in patients with an extremity being cold and numb for hours to days in conditions sufficient to cause significant peripheral cooling, especially in a wet, cold environment with a water temperature < 15 C (59 F). B Show 2 more Diagnosis (warm water immersion injuries): consider diagnosing warm water immersion foot in patients with feet immersed in warm water for 3 days and having painful, white, wrinkled soles and paresthesias. B Show 2 more https://web.pathway.md/diseases/recZuawLeq2edAEX0 1/4 6/24/23, 2:28 PM Immersion foot syndromes Pathway 2. Diagnostic investigations History and physical examination: Elicit environmental exposure history, assess for clinical manifestations, and perform a physical examination to distinguish nonfreezing cold injuries from frostbite, pressure necrosis, infection, and Raynaud's phenomenon. B Assess for other causes in case of worsening of symptoms attributed to nonfreezing cold injuries after the first 2-3 days following the injury. B Diagnostic imaging: Obtain X-rays of affected extremities in patients with suspected or known trauma. A Obtain CT or MRI to assess coexisting conditions when indicated. A 3. Medical management Prehospital care: advise patients with swollen feet not to walk unless walking is necessary for evacuation. Advise wearing thick socks for padding in nonconstricting footwear, if possible, if patients must walk. B Show 4 more Management of hypothermia: treat hypothermia before treating nonfreezing cold injuries. A Management of pain: administer analgesia for pain as needed. A Show 2 more Antibiotic therapy: do not use prophylactic antibiotics in patients with nonfreezing cold injuries D or warm water immersion injuries. D Show 3 more Tetanus prophylaxis: administer tetanus prophylaxis according to standard guidelines if skin integrity is compromised. B Therapies with no evidence for benefit: Insufficient evidence to support the use of iloprost in patients with nonfreezing cold injuries. Insufficient evidence to support the use of iloprost or capsaicin patches for chronic neuropathic pain associated with nonfreezing cold injuries. I 4. Nonpharmacologic interventions Passive rewarming: allow extremities with nonfreezing cold injury to rewarm passively at room temperature, A with bed rest, elevation, and air drying at room temperature. B Drying: dry feet and keep them dry for 2-3 days for the treatment of warm water immersion foot. B Elevation and protection: https://web.pathway.md/diseases/recZuawLeq2edAEX0 2/4 6/24/23, 2:28 PM Immersion foot syndromes Pathway Elevate affected extremities with nonfreezing cold injury and protect them from constriction. Keep affected extremities open to the air or lightly dressed using loose dressings. A Dry feet, keep them dry, and place the patient on bed rest with the feet elevated for 4-5 days for the treatment of tropical immersion foot. B 5. Surgical interventions Indications for surgery: obtain emergent surgical consultation for suspected tissue necrosis. B 6. Preventative measures Primary prevention (nonfreezing cold injuries): Advise the following measures to prevent nonfreezing cold injuries: limit exposure to cold, wet conditions A ensure adequate nutrition B wear insulating, nonconstricting clothing to keep personnel hands and feet warm and dry B keep feet as dry as possible A keep hands dry and warm B change into dry socks 2-3 times daily in wet conditions apply asbestos-free talcum powder in addition to regular changes of socks when using vapor barrier boots do not use neoprene socks B do not use grease or oils on feet or hands A rotate personnel regularly out of cold, wet environments A encourage personnel to move around frequently and to avoid having the legs and feet dependent B train personnel for operations in cold, wet conditions B do not re-expose patients with previous nonfreezing cold injuries to cold environments. A Primary prevention (warm water immersion injuries): dry feet every night or apply silicone grease when feet are continuously wet to prevent warm water immersion injuries. Keep feet dry for 1 day between exposures if feet must be continuously wet for 2-3 days. B 7. Follow-up and surveillance Recovery: Obtain an assessment, including intraepidermal nerve fiber density, to aid in the diagnosis and prediction of recovery time in patients with neuropathy. B Refer patients with chronic neuropathic pain and complex regional pain syndrome to a pain specialist. B https://web.pathway.md/diseases/recZuawLeq2edAEX0 3/4 6/24/23, 2:28 PM Immersion foot syndromes Pathway Return to normal activities: follow a standard regimen for post-discharge management of patients with nonfreezing cold injuries. B Show 2 more References 1. Ken Zafren, Sarah Hollis, Eric A Weiss et al. Prevention and Treatment of Nonfreezing Cold Injuries and Warm Water Immersion Tissue Injuries: Supplement to Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite. Wilderness Environ Med. 2023 Apr 30;S1080 6032 23 00042 X. Open https://web.pathway.md/diseases/recZuawLeq2edAEX0 4/4