RISK FACTORS: Impaired cerebral function, Under the effects of alcohol or drug abuse, Underlying psychiatric disturbance, Ambient temperature less than 0Β°F (-17.8Β°C), Smoker, Elderly, Raynaud phenomenon
GENERAL MEASURES
β’ Emergency measures for patient without pulse or respiration. Such measures may include CPR and internal warming with warm IVβs and warm oxygen
β’ Prevent refreezing. May be necessary to keep frostbitten part frozen until patient can be transported to a care facility.
β’ Treat for hypothermia
β’ Treat for pain, NSAIDs, and/or narcotics if needed
β’ Cautious rewarming. May immerse frozen body part for several minutes in water no hotter than 40-42Β°C (104-
107Β°F).
β’ After rewarming, injured parts should be covered with nonadhesive dressings, splinted, and elevated.
β’ Application of aloe vera, administration of non-steroidal anti-infl ammatory drugs are considered helpful in
removal and inhibition of deleterious prostaglandins (eg ibuprofen 400-800 mg orally bid or a systemic antiinfl
ammatory given as early as possible)
β’ Keep patient dry. If conscious, give warm fluids with high sugar content.
β’ Amputation not to be considered until it is defi nite that tissues are dead. May take about 3 weeks to know if
the tissue is permanently injured.
β’ Prevention of infection, once treatment begins
β’ Ongoing whirlpool therapy for cleansing and debridement
β’ Prevention of damage to other body parts
ACTIVITY
β’ As tolerated, protect injured body parts
β’ Initiate physical therapy once healing progresses sufficiently
DIET :
β’ As tolerated
β’ Warm oral fluids
PATIENT EDUCATION :
β’ Local library
β’ Exposure protection
β’ Early signs and symptoms of frostbite
DRUG(S) OF CHOICE :
β’ Warm IV fluids via central venous pressure (CVP) line
β’ Heated oxygen
β’ For myxedema coma - Levothyroxine 500 Γ¬g IV plus 300 mg hydrocortisone IV diluted in D5W or NS
β’ Tetanus toxoid
β’ For severe pain - analgesics or narcotics
β’ Antibiotics may be required for infection
β’ Maintenance - gastric lavage, peritoneal dialysis, hemodialysis, and mediastinal lavage if needed (using
warmed fluids)
ALTERNATIVE DRUGS: Consider nifedipine 10 mg po tid 30 mg XL po qd or pentoxifylline 400 mg po tid
PATIENT MONITORING:
β’ Preferably electronic probe for temperature monitoring (rectal or vascular)
β’ Followup for physical therapy progress, infection, other complications
PREVENTION/AVOIDANCE:
β’ Dress in layers with appropriate cold weather gear. Cover exposed areas and extremities appropriately.
β’ Proper preparation for trips to cold climates. Avoid alcohol.
POSSIBLE COMPLICATIONS :
β’ Hyperglycemia
β’ Acidosis
β’ Refractory arrhythmias
β’ Tissue loss. Distal parts of an extremity may undergo spontaneous amputation.
β’ Gangrene
β’ Death
EXPECTED COURSE/PROGNOSIS:
β’ Anesthesia and bullae may occur
β’ The affected areas will heal or mummify without surgery. The process may take 6-12 months for healing.
Patient may be sensitive to cold and experience burning and tingling.