A 49-year-old man, a professional alpinist, brought to the base field by his colleagues after 48 hours of exciting exercise, 24 of them above 8,000 meters high.
During the descent medicated with mask Venturi 5 lpm (FIO2 0.28 at sea level), 300 mg triflusal every 12 hours, and 8 mg dexamethasone intramuscularly.
Upon arrival, the patient was conscious although with signs of extreme exhaustion, shock and hypothermia.
His blood pressure was measured 110 mmHg, his heart rate was 95 bpm and his axillary temperature was below 35o C. O2 saturation measured by pulse oximetry was 68% lower than 5,000 meters above normal oxygen saturation at 70%.
The patient was conscious and without signs of neurological focality; on auscultation he presented wheezing dispersed by both lung fields, and on examination signs of freezing in the nose and in both feet that exceeded the articulation.
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A peripheral venous access was channeled and fluid therapy was initiated with 1000 ml of saline solution, 1000 ml of Ringer lactate and 500 ml of previously warmed hydroxyethyl starch, as well as 35% venturing effect.
Given the conditions of the patient's low body temperature, the stage of saturation base, the pulmonary exercise and the clinical signs and symptoms of the patient's low body temperature, it was considered that the values measured by pulse oximetry were unreliable and that they did not reach.
After administration of supplementary oxygen and rehydration, saturation rapidly increased to levels above 90%.
After initial stabilization, analgesia was prescribed with intravenous tramadol and dexketoprofen, anticoagulation with enoxaparin (1 mg/kg/12 h), and treatment with 900 mg of pentoxyphylline in 24 hours.
At this time, the treatment of local lesions was approached.
We initially appreciate freezings in the nose and lower limbs.
The extremities were warmed with water at a temperature between 40 and 42 oC, mixed with a povidone-iodine solution.
After warming up, a mild edema without blisters appeared.
Fourth grade freezing in lower limbs and probable third degree freezing in the nose were diagnosed.
The next morning, the patient was treated with ibuprofen (400 mg/6 h) and trifusal (300 mg/12 h).
The subsequent evolution required amputation of 10 toes with preservation of the first digit of the first toe of both feet.
He is currently in rehabilitation.
