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Two phases of damage in frostbite

By Helen Ferguson,2014-02-10 00:15
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Two phases of damage in frostbite

WESTAC Trauma Care Resource

    (WESTAC Level III & IV Trauma Centers)

FROSTBITE MANAGEMENT

Background: There are two phases of damage in frostbite.

    1. Damage occurs through freezing of tissues

    2. Damage occurs through ischemia from thrombosis of microcirculation

    ; Upon thawing and restoration of blood flow, inflammatory mediators often initiate thrombosis of

    the microcirculation within the affected tissues.

    Initial Stabilization of Frostbite (PREHOHOSPITAL AND/OR EMERGENCY ROOM) A) Calculate and record total body surface area involved, as in a burn

B) Estimate and record stage of the injury

    Stage 1: Area is numb; A central white plaque exists with surrounding erythema and edema.

    Stage 2: Clear or white blisters are present with surrounding erythema and edema. Blisters

    develop over the first 24 hours of the injury.

    Stage 3: Hemorrhagic blisters are present.

    ; Tissues necrosis and tissue loss is likely to occur.

    Stage 4: Necrosis and tissue loss are already present.

    C) Initial Frostbite Management in the PREHOSPITAL AND TRANSFER SETTING

    1. Lightly wrap frostbit areas with Kerlex/gauze and protect from mechanical trauma.

    2. Treat hypothermia first (LIFE OVER LIMB) by raising temperature of ambulance.

    ; Allow passive re-warming of frostbite during transport.

    ; Do not apply warming devices to frostbitten areas.

    D) Initial Frostbite Management in the CRITICAL ACCESS HOSPITAL EMERGENCY ROOM

    1. Rewarm area rapidly by applying warm water (40?C or 104?F) to the affected area until

    thawing has occurred.

    ; Rewarming is complete when skin is pliable and has a reddish/purple appearance

    ; Do not massage or rub the affected area

    2. Wound care after rewarming:

    ; Leave blisters intact

    ; Apply protective dry gauze dressing

    ; Elevate affected extremity

    Dr. Steven Briggs and Sanford Health make no representations on the accuracy of information contained herein and accept no liability - 1 - for any loss or damage arising from any content error or omission.

    FROSTBITE MANAGEMENT (continued):

3. Assess vascular status of affected extremity

    ; Pulses palpable?

    ; Is capillary refill < 2 seconds?

    ; Skin color black?

    ; If clinical exam supports ischemia, transfer to higher level of care should be initiated.

    - Apply protective dressing and facilitate transfer.

    ; If clinical exam does not support ischemia, outpatient arrangements for evaluation of

    frostbite by wound specialist in next 48 hours should be made.

    - Apply protective dry gauze dressing and instruct patient as follows:

    ; change dressing daily or when dirty

    ; elevate extremity

    ; protect from temperature extremes

    E) Medications

    1. Anti-inflammatory agents (NSAIDS) are first line. Consider NSAIDs a therapy.

    Ibuprofen should be scheduled. Unless contraindicated, all patients should receive NSAIDS

    as they are an important inhibitor of the inflammatory process involved in reperfusion of the

    frozen tissues.

    ; Ibuprofen 600 mg PO every 6 hours x 8 doses scheduled

    - Contraindicated in multi-system trauma

2. Pain Control (Second line agents)

    ; Acetaminophen 650 mg PO every 4 - 6 hours as needed for mild pain

    ; Vicodin 5/500 mg 1 - 2 tabs PO every 4 hours as needed for moderate pain

    ; Fentanyl/Morphine as needed for severe pain

    F) Other issues

    1. Prohibit tobacco use by patient.

    ; Vasoconstriction is bad!

Dr. Steven Briggs and Sanford Health make no representations on the accuracy of information contained herein and accept no liability - 2 - for any loss or damage arising from any content error or omission.

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