Frostbite - Revision history

Rossdonaldson1: /* Video */

2024-04-17T20:11:20Z

Video

← Older revision		Revision as of 20:11, 17 April 2024
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	==External Links==		==External Links==
	*[http://www.emdocs.net/brrr-ed-presentation-evaluation-and-management-of-cold-related-injuries/ emDOCs: Brrr! ED Presentation, Evaluation, and Management of Cold Related Injuries]		*[http://www.emdocs.net/brrr-ed-presentation-evaluation-and-management-of-cold-related-injuries/ emDOCs: Brrr! ED Presentation, Evaluation, and Management of Cold Related Injuries]

	~~==Video==~~
	~~{{#widget:YouTube\|id=P3RDlV76d4c}}~~

	==References==		==References==
	<references/>		<references/>
	[[Category:Environmental]]		[[Category:Environmental]]

Neil.m.young: /* Management */

2022-03-06T13:44:04Z

Management

← Older revision		Revision as of 13:44, 6 March 2022
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	*Systemic care		*Systemic care
	**[[Ibuprofen]] may be helpful in interrupting arachidonic cascade		**[[Ibuprofen]] may be helpful in interrupting arachidonic cascade
	**IV Iloprost (not available in US) ~~or [[tPA]]~~, followed by several days of heparin, reduces digit amputation rate for 3rd and 4th degree frostbite<ref>Bruen KJ et al. Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy. Arch Surg. 2007;142(6):546</ref>		**[[tPA]] or IV Iloprost (not available in US), followed by several days of heparin, reduces digit amputation rate for 3rd and 4th degree frostbite<ref>Bruen KJ et al. Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy. Arch Surg. 2007;142(6):546</ref>
	**Hyperbaric oxygen therapy is of theoretical benefit but no randomized trials have been performed		**Hyperbaric oxygen therapy is of theoretical benefit but no randomized trials have been performed
	*[[Tetanus]]		*[[Tetanus]]

Elcatracho: /* See Also */

2021-05-31T10:23:37Z

Dcpinzonc: /* Zones of Injury */

2021-05-28T20:42:01Z

Zones of Injury

← Older revision		Revision as of 20:42, 28 May 2021
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	#*Most severe and usually most distal		#*Most severe and usually most distal
	#*Damage is irreversible		#*Damage is irreversible
			#Zone of Stasis
			#*Middle zone characterized by severe, but possibly reversible, cell damage
			#*It is this zone for which treatment may have benefit
	#Zone of Hyperemia		#Zone of Hyperemia
	#*Least severe and usually most proximal		#*Least severe and usually most proximal
	#*Generally recovers without treatment in <10d		#*Generally recovers without treatment in <10d
	~~#Zone of Stasis~~
	~~#*Middle zone characterized by severe, but possibly reversible, cell damage~~
	~~#*It is this zone for which treatment may have benefit~~

	==Clinical Features==		==Clinical Features==

Bobbycarey: /* Disposition */

2021-03-02T20:32:49Z

Disposition

← Older revision		Revision as of 20:32, 2 March 2021
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	==Disposition==		==Disposition==
	*Patients with superficial local frostbite may be discharged home if social circumstances allow		*Patients with superficial local frostbite may be discharged home if social circumstances allow
			*Significant injuries will require ICU admission

	==Complications==		==Complications==

Bobbycarey: /* Management */

2021-03-02T20:30:22Z

Management

← Older revision		Revision as of 20:30, 2 March 2021
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	**[[Ibuprofen]] may be helpful in interrupting arachidonic cascade		**[[Ibuprofen]] may be helpful in interrupting arachidonic cascade
	**IV Iloprost (not available in US) or [[tPA]], followed by several days of heparin, reduces digit amputation rate for 3rd and 4th degree frostbite<ref>Bruen KJ et al. Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy. Arch Surg. 2007;142(6):546</ref>		**IV Iloprost (not available in US) or [[tPA]], followed by several days of heparin, reduces digit amputation rate for 3rd and 4th degree frostbite<ref>Bruen KJ et al. Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy. Arch Surg. 2007;142(6):546</ref>
	**~~[[Heparin]] and hyperbaric~~ oxygen of ~~little value~~		**Hyperbaric oxygen therapy is of theoretical benefit but no randomized trials have been performed
	*[[Tetanus]]		*[[Tetanus]]
	**Reported complication of frostbite; provide prophylaxis		**Reported complication of frostbite; provide prophylaxis

Bobbycarey: /* Management */

2021-03-02T20:27:54Z

Management

← Older revision		Revision as of 20:27, 2 March 2021
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	***Consider drainage of nonhemorrhagic bullae that interfere with movement		***Consider drainage of nonhemorrhagic bullae that interfere with movement
	***Never debride hemorrhagic bullae		***Never debride hemorrhagic bullae
			**[[Compartment Syndrome]] is a known complication; maintain a high suspicion
	*Systemic care		*Systemic care
	**[[Ibuprofen]] may be helpful in interrupting arachidonic cascade		**[[Ibuprofen]] may be helpful in interrupting arachidonic cascade
			**IV Iloprost (not available in US) or [[tPA]], followed by several days of heparin, reduces digit amputation rate for 3rd and 4th degree frostbite<ref>Bruen KJ et al. Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy. Arch Surg. 2007;142(6):546</ref>
	**[[Heparin]] and hyperbaric oxygen of little value		**[[Heparin]] and hyperbaric oxygen of little value
	**IV [[tPA]] reduces digit amputation rate
	*[[Tetanus]]		*[[Tetanus]]
	**Reported complication of frostbite; provide prophylaxis		**Reported complication of frostbite; provide prophylaxis

Bobbycarey: /* Management */

2021-03-02T20:10:36Z

Management

← Older revision		Revision as of 20:10, 2 March 2021
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	==Management==		==Management==
	*If hypothermia present, must rewarm to a core temperature of at least 35°C before treating frostbite<ref>Handford C, Thomas O, Imray CHE. Frostbite. Emerg Med Clin N Am. 2017;35(2):281–299.</ref>		*If hypothermia present, must rewarm to a core temperature of at least 35°C before treating frostbite<ref>Handford C, Thomas O, Imray CHE. Frostbite. Emerg Med Clin N Am. 2017;35(2):281–299.</ref>
			*Remove all wet or constrictive clothing
	*Thawing		*Thawing
	**Do NOT attempt until the risk of refreezing is eliminated		**Do NOT attempt until the risk of refreezing is eliminated

Bobbycarey: /* Background */

2021-03-02T19:28:38Z

Background

← Older revision		Revision as of 19:28, 2 March 2021
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	*It is a disease of morbidity, not mortality		*It is a disease of morbidity, not mortality
	*Risk correlated with temperature and wind speed		*Risk correlated with temperature and wind speed
	*Wetness and humidity increase the risk (water has 25x thermal conductivity of air)
	**Risk is <5% when ambient temperature (includes wind chill) is > –15°C (5°F)		**Risk is <5% when ambient temperature (includes wind chill) is > –15°C (5°F)
	**Most often occurs at ambient temperature < –20°C (–4°F)		**Most often occurs at ambient temperature < –20°C (–4°F)
			*Wetness and humidity increase the risk (water has 25x thermal conductivity of air)
	*Can develop within 2-3sec when metal surfaces that are at or below –15°C (5°F) are touched		*Can develop within 2-3sec when metal surfaces that are at or below –15°C (5°F) are touched
	*Most commonly affects distal part of extremities, face, nose, and ears		*Most commonly affects distal part of extremities, face, nose, and ears

Bobbycarey: /* Background */

2021-03-02T19:27:58Z

Background

← Older revision		Revision as of 19:27, 2 March 2021
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	*It is a disease of morbidity, not mortality		*It is a disease of morbidity, not mortality
	*Risk correlated with temperature and wind speed		*Risk correlated with temperature and wind speed
			*Wetness and humidity increase the risk (water has 25x thermal conductivity of air)
	**Risk is <5% when ambient temperature (includes wind chill) is > –15°C (5°F)		**Risk is <5% when ambient temperature (includes wind chill) is > –15°C (5°F)
	**Most often occurs at ambient temperature < –20°C (–4°F)		**Most often occurs at ambient temperature < –20°C (–4°F)
	*Can develop within 2-3sec when metal surfaces that are at or below –15°C (5°F) are touched		*Can develop within 2-3sec when metal surfaces that are at or below –15°C (5°F) are touched
	*Most commonly affects distal part of extremities, face, nose, and ears		*Most commonly affects distal part of extremities, face, nose, and ears
	*High-risk groups: outdoor workers, elderly, homeless, drug or alcohol abusers, psychiatric disease, high-altitude or cold-weather athletes		*High-risk groups: outdoor workers, elderly, homeless, drug or alcohol abusers, psychiatric disease, high-altitude or cold-weather athletes, military personnel
			*"Hunter's response" - prolonged repeated exposure to cold is protective

	===Pathophysiology===		===Pathophysiology===

← Older revision		Revision as of 10:23, 31 May 2021
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	==See Also==		==See Also==
	*[[Cold injuries]]		*[[Cold injuries]]

			==External Links==
			*[http://www.emdocs.net/brrr-ed-presentation-evaluation-and-management-of-cold-related-injuries/ emDOCs: Brrr! ED Presentation, Evaluation, and Management of Cold Related Injuries]

	==Video==		==Video==