hospital care of frostbite
Seek expert advice.
Early management of frostbites after the patient reaches the hospital follow the same principles as the early management in the field:
- treat hypothermia or serious trauma
- systemic hydration with IV fluids
- assess the affected area
- if tissue is completely thawed, rewarming will not be beneficial
- if tissue is partially or completely frozen, follow recommendations and carry out rapid rewarming
- ibuprofen at a lower dose of 12 mg/kg divided twice daily (1)
Additional measures to consider include (1):
- opiate analgesics if indicated
- tetanus prophylaxis
- broad spectrum prophylactic antibiotics - reserved for patients with any risk of infection of necrotic tissue e.g. - patients with significant trauma, other potential infectious sources, or signs and symptoms of cellulitis or sepsis
- debridement
- although there is no clear evidence, selective drainage of clear/cloudy blisters by needle aspiration (especially if bullae restrict movement) while leaving shohemorrhagic blisters intact is the common practice
- topical aloe vera cream or gel - should be applied to the thawed tissue before applying a loose, protective dressings
- elevation of the affected limb to prevent further tissue oedema and venous stasis.
- thrombolysis
- acute intra-arterial or intravenous thrombolysis should be considered in patients who present within 24 hours of an acute, severe frostbite injury, in whom major tissue loss is predicted
- should be undertaken in a facility with intensive-care monitoring capabilities
- vasodilatory therapy
- phosphodiesterase inhibitor pentoxifylline can be considered to increase blood flow and reduce platelet activity
- imaging
- Technetium 99 (Tc-99) triple phase scanning or magnetic resonance angiography is useful to assess the severity and depth of tissue injury in order to predict the need for and extent of debridement
- best reserved for severe frostbite, the few patients who might need early surgery, or those where thrombolysis is being considered
Surgery
- early surgical debridement is contraindicated in frostbite
Notes:
- a systematic review regarding interventions for frostbite injuries concluded (2)
- is a paucity of evidence regarding interventions for frostbite injuries. Very low-quality evidence from a single small trial indicates that iloprost, and iloprost plusrtPA, in combination with buflomedil may reduce the need for amputation in people with severe frostbitecompared to buflomedil alone. However, buflomedil has been withdrawn from use
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