Immersion Injury

Immersion injury (trench foot, immersion foot, wet-cold injury, shelter leg.) Press here for the patient handout.

Begin here if patient has a body part exposed to the cold and wet for a long time, had pain when he warmed it, or if you think he may have immersion injury.

1. History 1.1 History of present illness Get a general history of present illness (inside cover). Also ask the following specific questions:

  1. If the patient was in water: for how long was the patient immersed?
  2. How cold was the water?
  3. What does the part feel like?
  4. Does patient have any other injuries or complaints?

1.2 Past Health History

  1. Illnesses?
  2. What medicines is the patient taking now?
  3. Allergies?
  4. When was last TETANUS shot?

Exam

2.1 General appearances

2.2 Vital signs: T, P, R, BP.

2.3 Examine the problem area.

Compare the appearance of one side of body to the other.

Feel it. Is it soft or firm? warm or cool?

Check to see if the patient has feeling (sensation) with light touch and also with firm touch. Check blood supply: press on the skin. When you let go, skin color will look white. Does color return normally, within two seconds (good capillary refill)?

If an arm or leg, check pulse on both sides of body. if pulse NOT felt on top of foot (dorsalis pedis), check pulse behind medial ankle bone (posterior tibial).

Assessment

3.1 your assessment should be immersion injury if patient has typical findings listed: immersion injury:

Typical findings: History: Exposure to cold and wet (not freezing) for 12 hours or more. This is often found in patients that have been in cold water for a long time. At first, the skin felt numb. After the part was warmed, it became swollen and painful.

Exam: an area that is soft, moist, warm, reddened, and swollen, usually on the foot, but can be found in other places.

Plan

4.1 Report to your referral doctor, unless he has signed for you to treat this problem without contacting him. While you are waiting to report, use the following plan.

4.2 Patient education should include information in chart 4.2.

4.3 Medicine should include the following:

If patient has NOT had a TETANUS booster shot in the past 10 years: Give I.M. booster shot of TETANUS TOXOID and DIPHTHERIA (Td). Dose 0.5 cc I.M.

If needed for pain, give ASPIRIN or ACETAMINOPHEN (Tylenol) (p416).

4.4 Recheck as follows: Recheck every 1-2 days, until the skin is healed. If skin is getting infected (getting more tender, warm, red swollen, or pus seen), treat as on p321, "Infected Wound".