Frostbite and Hypothermia. March 10 th , 2005 Tintinalli Chapters 191 and 192 George Filiadis. Epidemiology. Frostbite is the inability to physiologically compensate for cold that produces injury.
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March 10th, 2005
Tintinalli Chapters 191 and 192
Elevate and wrap in dry sterile gauze the involved extremities.
Rapid rewarming if rapid access to hospital
400 to 420 C clean water should be used
There is controversy with regards to debridement of clear blisters on the field
Pain management should start with NSAIDS to counteract the arachidonic acid cascade, in addition to opioids
Smoking should be discouragedTreatment in the field
Injured extremity should be placed in circulating water at a temperature of 400 to 420 C for approximately 10-30 min until the distal extremity is pliable and erythematous
Pain should be treated with parenteral antibiotics
Clear blisters should be debrided or aspirated
Hemorrhagic blisters should not be debrided
Alo vera cream should be applied to the blisters
Role of antibiotics is unclear.
Staph aureus, Staph epi, beta-hemolytic Strep, Pseudomonas, and Enterococus are important pathogens.Treatment in the ED
Infection prophylaxis using topical bacitracin is as good as IV penicillin.
Tetanus immunization status should be assessed.
Early surgical intervention is not indicated in treatment of frostbite
Amputation if needed within 3 weeksTreatment in ED
“Accidental”(enviromental) IV penicillin.
Hypothalamic and CNS dysfunction
Acute incapacitating illness
Iatrogenic (fluid resuscitation)Etiology