UMEM Educational Pearls

"Frozen in January, Amputate in June"  - By Kinjal Sethuraman and Doug Sward
Frostbite can lead to major tissue damage even if initial presentation does not look so severe. Treatment is NOT the same as for burns. 

Treatment of Major Frostbite:
1.  Rapid rewarming ASAP of affected area in 40 Celsius degree water until area is thawed (pink and pliable) Logistics are difficult because you have to maintain a constant water temperature- but only if you can maintain same degree of warmth.  Rewarming and refreezing will lead to inevitable tissue death.
2. Wound care, Aloe Vera, ASA 
3.  DELAY surgery except in cases of sepsis or compartment syndrome.
  • If less than 24 hours since injury, consider diagnostic angiography and  intra-arterial TPA, and heparin infusion, Prostacyclin infusion.
  • Angiography and Bone Scan can be used to prognosticate clinical course.
  • Consider Hyperbaric Oxygen Therapy for moderate to severe frostbite- multiple case reports of significant improvement with HBOT even if delayed by several days. 
Treatment of  Minor Frostbite:
1. Rewarm area
2. Ibuprofen
3. Aloe Vera and dressing changes
Reference attached from Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite