Frostbite

Frostbite is, for obvious reasons, a common problem. If someone is in a village with frostbite and there is a chance of refreezing - DO NOT THAW. If you can guarantee the affected extremity can be kept warm and at body temperature (95-100 degree) a bath can be used to rewarm the affected area. If it’s just blisters, they usually stay in the village with local (pun intended) care there. If you elect to transport the patient in, don’t let the affected area get bumped on the way.

Once here, the patient may need daily whirlpools, they will need NSAIDS and avoidance of all pressure to the area. Bear in mind that the longer you wait and treat conservatively, the less tissue damage will occur. A foot that initially looks bad enough that all the toes may be lost will often do much better than expected. (A toe saved, a toe earned - be patient and do no harm). Both clear and hemorrhagic blisters often occur-the books will tell to unroof the hemorrhagic blisters; practical experience shows that keeping them intact until they break on their own is better. Debride as needed to prevent bacterial trapping. Of note, aloe gel is helpful as a dressing. We also have very experienced physical therapists skilled in wound care. Use these resources.

Warn patients that paresthesias are common and they have a high risk of re-injuring the area in future exposures. Avoid all tobacco to increase blood flow.

Update Tetanus vaccination.

Resources/References

• Gross, E. et al. Using thrombolytics in frostbite injury. J Emerg Trauma Shock 2012;5:267-71.
• Yafi, M.N. et al. Using Intra-arterial tPA for Severe Frostbite Cases. An Observational Comparative Retrospective Study. Journal of Burn Care & Research, Volume 40, Issue 6, November/December 2019, Pages 907–912, https://doi.org/10.1093/jbcr/irz118
• Hutchison, R. et al. The Use of tPA in the Treatment of Frostbite: A Systematic Review. HAND. 2019;14(1):13-18. doi:10.1177/1558944718800731
• McIntosh et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite. WILDERNESS & ENVIRONMENTAL MEDICINE, 22, 156–166 (2011).
• Poole and Gauthier. Treatment of severe frostbite with Iloprostin Northern Canada. Whitehorse General Hospital. 2016.
• Lindford et al. The evolution of the Helsinki frostbite management protocol. Burns43 (2017) 1455-1463.
• Handford et al. Frostbite. EmergMed ClinN Am 35 (2017) 281-299.
• Frostbite 2018 Powerpoint presentation by Jesse Gefroh
• ANMC Frostbite Protocol
• Frostbite YKHC Clinical Guideline

category:YKHC Guidelines
Common/Unique Medical Diagnoses