Frostbite results from the freezing of tissue in extreme cold temperatures. It frequently occurs in mountaineers, soldiers and the homeless. Frostbite is the most severe form of the cold-induced injuries. Milder forms include trench foot, pernio and frostnip.
Following exposure to subfreezing temperatures, ice crystals form in tissues causing damage to the cell membranes with subsequent cell death.
Frostbite can be limb threatening and in extreme cases amputation of the limb may be necessary. Treatment of frostbite can be divided into pre-hospital interventions and hospital care.
Instructions
1. Get the patient to a warm environment. Remove wet clothing. Use of pad or splint on affected limb will minimize injury while patient is being transferred to a hospital. Avoid walking on frostbitten feet.
2. Rewarm the frostbitten tissue if there is no possibility of refreezing before reaching hospital. Achieve rewarming by placing the affected area in warm water. Do not use hot water. Do not rub frostbitten areas as this can cause further tissue damage.
3. Continue thawing once the patient has reached the hospital. At this point the tissue will become red, friable and soft to the touch. Pain will now start to worsen so appropriate pain medications (generally opioids) should be administered. Apply bulky dressing to the affected area and elevate the limb to reduce edema. Daily hydrotherapy should be done to improve range of motion.
4. Administer a tetanus shot. Tetanus is a well-known complication of frostbite.
5. Administer blood thinners. Intravenous heparin along with an intravenous "clot buster" (tissue plasminogen activator or tPA) should be used. Frostbite may be associated with blood clot formation in the affected tissue.
6. Use antibiotics at the earliest sign of infection. Staphylococci, streptococci and pseudomonas species are most frequent microorganisms. Topical antibiotics can cause maceration and should be avoided.
7. Apply topical aloe and use oral ibuprofen. Both of these medications will limit inflammation associated with frostbite.
8. Use hyperbaric oxygen therapy as an adjunctive therapy to improve blood flow and promote healing of frostbitten tissue.
9. Call for a surgical consultation. Frostbite may require long-term wound care, hydrotherapy, tissue debridement, removal of eschars and possibly delayed amputation. Early surgical consultation should be sought.
Tags: affected area, associated with, frostbitten tissue, surgical consultation