Frostbite: a practical approach to hospital management

Handford, C. Robertson; Buxton, Pauline; Russell, Katie W.; Imray, C.; McIntosh, Scott; Freer, Luanne; Cochran, Amalia; Imray, Christopher H.E.

doi:10.1186/2046-7648-3-7

Cited by 105 publications

(109 citation statements)

References 35 publications

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“…7 That work on rewarming established how treatment should begin and led to the current standard of rapid rewarming, débridement and aspiration of clear blisters, and application of dry bulky dressings. [8][9][10][11] The current challenge is to move beyond supportive care in the hospital to treatment that further decreases the amputation rate and long-term sequelae. In severe frostbite (grades 3 and 4), early rapid rewarming and careful tissue management may be augmented by pharmacologic therapy, including topical aloe vera ointment, oral ibuprofen and possibly intravenous therapy.…”

Section: Treatmentmentioning

confidence: 99%

Treatment of severe frostbite with iloprost in northern Canada

Poole

Gauthier

2016

CMAJ

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A 46-year-old man was evacuated by air ambulance to Whitehorse General Hospital from the Yukon Arctic Ultra race, a 692-km running race. He had been running for 27 hours in temperatures ranging from -45°C to -50°C. Wearing only thin gloves, he had repeatedly exposed his hands to cold air and cold objects to drink, eat and adjust his gear. He had been running on snow, wearing cross-country running shoes. Feeling numbness in his hands and feet, he stopped running and passively rewarmed his hands in his sleeping bag while waiting for rescue. He presented to the emergency department with pain and discomfort in his hands and feet.On presentation, the patient's core temperature was 36.8°C. He had evidence of grade 3 frostbite to the right hand, with hemorrhagic blistering into the proximal phalanges of the fourth and fifth digits (Figure 1). His left hand showed evidence of frostbite on the volar aspect of the distal phalanges of the second and fourth digits. He also had frostbite to his left first and second toe, his right foot and his nose. He had no other injuries. He was healthy and athletic, with no contributing medical history. He was a nonsmoker and had not consumed alcohol recently.The patient's hands and feet were placed in a whirlpool bath of water mixed with chlorhexidine at 38°C until they were pink and warm. He was given ibuprofen 600 mg by mouth every six hours and fentanyl and morphine intravenously for pain. Once the patient's hands and feet were rewarmed, the clear blisters were aspirated, after which aloe vera ointment and porous lowadherent wound dressings were applied.The patient was given iloprost intravenously, titrated to the maximum dose of 2 ng/kg per min, for six hours daily for five days. The infusion rate was increased gradually to avoid adverse effects (e.g., headaches or hypotension). He tolerated the infusion well.On follow-up six months later, the patient's hands and feet showed complete healing. Amputation had not been required, but he reported hypersensitivity to touch and temperature. Case 2A 43-year-old man presented to the emergency department of Whitehorse General Hospital after completing the 100-mile (161-km) event of the Yukon Arctic Ultra race. He ran in temperatures ranging from -30°C to -50°C for 64 hours and then rewarmed his feet in a hot tub at his hotel. On presentation, he reported that his toes were numb and white. He was given oral cephalexin and discharged home. He returned to the emergency department 48 hours later concerned about a loss of sensation in his great toes. He recognized that he had frostbite and was seeking an alternative approach to watchful waiting.The patient had grade 3 frostbite to both great toes, with some mild erythematous extension into the metatarsophalangeal area of his right foot (Figure 2).The patient was a healthy and athletic orthopedic surgeon, with no contributing medical history. He was a nonsmoker and consumed alcohol occasionally. He was an experienced adventurer and had travelled to both poles in the past.The oral antibiotic was sto...

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Section: Treatmentmentioning

confidence: 99%

Treatment of severe frostbite with iloprost in northern Canada

Poole

Gauthier

2016

CMAJ

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“…Initial DSA may also uncover areas of impaired perfusion that do not appear necrotic at physical examination (Fig 5). Sequential DSA is then performed at 12-hour increments for up to 48 hours to monitor response to treatment (1,28,29). Increments of 24 hours for a total of up to 72 hours have also been used (1,4,30).…”

Section: Radiographymentioning

confidence: 99%

“…Illicit drug use, homelessness, smoking, immobilizing traumatic injury, and systemic diseases such as peripheral vascular disease, diabetes mellitus, and Raynaud phenomenon also predispose individuals to frostbite (2,4). Frostbite is more likely to occur in males and in adults aged 30-49 years, presumably because of increased occupational exposure to cold and increased risk-taking behavior (1,6). Individuals of African American or Pacific Islander descent may be more susceptible to frostbite injuries than individuals with lighter skin tones (2,10).…”

Section: Introductionmentioning

confidence: 99%

“…Frostbite has historically been most frequently reported among military personnel and in countries with extreme environments (1)(2)(3), although the rise in popularity of winter sports has contributed to a substantial increase in civilian cases (4,5). Frostbite may also occur in the industrial setting from accidental exposure to refrigerant chemicals or dry ice, as well as in households from misuse of cold packs or fire extinguishers (6).…”

Section: Introductionmentioning

confidence: 99%

“…Frostbite is a localized cold thermal injury that results when tissues are exposed to temperatures below their freezing point (typically −0.558C) for a prolonged period (1). Frostbite has historically been most frequently reported among military personnel and in countries with extreme environments (1)(2)(3), although the rise in popularity of winter sports has contributed to a substantial increase in civilian cases (4,5).…”

Section: Introductionmentioning

confidence: 99%

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