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Frostbite management

Larry M Jones, Rebecca A Coffey, Mona P Natwa, J Kevin Bailey
OBJECTIVE: tPA and anticoagulation for treatment of severe frostbite have been reported suggesting differences in imaging techniques, route of tPA administration and management of patients after tPA infusion. This is a report of our results following a protocol of Tc-99m scanning, intravenous tPA administration, followed by either systemic anticoagulation or antiplatelet therapy. METHODS: Patients admitted to our burn center between February 13, 2015 and February 13, 2016 for frostbite who met inclusion criteria were treated with Tc-99m scan and intravenous tPA followed by systemic anticoagulation or antiplatelet therapy...
January 31, 2017: Burns: Journal of the International Society for Burn Injuries
H Tang, Y Shi, N Z Qu
No abstract text is available yet for this article.
June 20, 2016: Chinese Journal of Industrial Hygiene and Occupational Diseases
John D Millet, Richard K J Brown, Benjamin Levi, Casey T Kraft, Jon A Jacobson, Milton D Gross, Ka Kit Wong
Frostbite is a localized cold thermal injury that results from tissue freezing. Frostbite injuries can have a substantial effect on long-term limb function and mobility if not promptly evaluated and treated. Imaging plays a critical role in initial evaluation of frostbite injuries and in monitoring response to treatment. A multimodality approach involving radiography, digital subtraction angiography (DSA), and/or multiphase bone scintigraphy with hybrid single photon emission computed tomography (SPECT)/computed tomography (CT) is often necessary for optimal guidance of frostbite care...
November 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Sidhartha Tavri, Suvranu Ganguli, Roy G Bryan, Jeremy Goverman, Raymond Liu, Zubin Irani, T Gregory Walker
PURPOSE: To evaluate intraarterial catheter-directed thrombolysis for prediction and prevention of delayed surgical amputation as part of multidisciplinary management of frostbite injury. MATERIALS AND METHODS: A retrospective review was performed of 13 patients (11 men, 2 women; median age, 33.4 y; range, 8-62 y) at risk of tissue loss secondary to frostbite injury and treated with catheter-directed tissue plasminogen activator (t-PA) thrombolysis. Amputation data were assessed on follow-up (mean, 23 mo; range, 9-83 mo)...
August 2016: Journal of Vascular and Interventional Radiology: JVIR
Casey Kraft, John D Millet, Shailesh Agarwal, Stewart C Wang, Kevin C Chung, Richard K J Brown, Benjamin Levi
Frostbite remains a challenging clinical scenario with multiple treatment algorithms and variable results. Currently, frostbite management often follows a conservative approach with rewarming followed by wound care and delayed amputation. We review seven patients where single-photon emission computed tomography (SPECT) fused with conventional computed tomography was used to evaluate tissue viability for earlier directed debridement and limb salvage. The goal of this report is to evaluate SPECT/CT as an appropriate modality for the screening of necrotic bone for earlier amputation in patients with frostbite...
January 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
Anna Martel-Arquette, Christoph Mans, Kurt Sladky
An approximately 5-year-old female grey-headed parrot (Poicephalus fuscicollis suahelicus) was evaluated after exposure to outdoor temperatures below -20°C (-4°F) for approximately 22 hours. Severe frostbite affecting multiple digits, as well as dehydration and a depressed attitude, were diagnosed. Treatment included oral antibiotics, antifungals, nonsteroidal anti-inflammatories (NSAIDs), pentoxifylline, and topical aloe vera. Surgical amputation of the affected toes was not performed. Mild to moderate pododermatitis over the intertarsal joints developed because of a shift in weight bearing after the loss of most digits...
March 2016: Journal of Avian Medicine and Surgery
Emmanuel Cauchy, Christopher B Davis, Mathieu Pasquier, Eric F Meyer, Peter H Hackett
Despite advances in outdoor clothing and medical management of frostbite, individuals still experience catastrophic amputations. This is a particular risk for those in austere environments, due to resource limitations and delayed definitive treatment. The emerging best therapies for severe frostbite are thrombolytics and iloprost. However, they must be started within 24 hours after rewarming for recombinant tissue plasminogen activator (rt-PA) and within 48 hours for iloprost. Evacuation of individuals experiencing frostbite from remote environments within 24 to 48 hours is often impossible...
March 2016: Wilderness & Environmental Medicine
Kieran Heil, Rachel Thomas, Greg Robertson, Anna Porter, Robert Milner, Alexander Wood
INTRODUCTION: The debilitating impact of cold weather on the human body is one of the world's oldest recorded injuries. The severe and life-changing damage which can be caused is now more commonly seen recreationally in extreme outdoor sports rather than in occupational settings such as the military. The diagnosis and treatment of these injuries need to be completed carefully but quickly to reduce the risk of loss of limb and possibly life. Therefore, we have conducted a systematic review of the literature surrounding cold weather injuries (CWIs) to ascertain the epidemiology and current management strategies...
March 2016: British Medical Bulletin
Jessie Fudge
CONTEXT: Hypothermia and frostbite injuries occur in cold weather activities and sporting events. EVIDENCE ACQUISITION: A PubMed search was used to identify original research and review articles related to cold, frostbite, and hypothermia. Inclusion was based on their relevance to prevention and treatment of cold-related injuries in sports and outdoor activities. Dates of review articles were limited to those published after 2010. No date limit was set for the most recent consensus statements or original research...
March 2016: Sports Health
Y Wang, T Jackson, L Cai
BACKGROUND: Numerous studies have found appraisals of pain as a source of potential threat or tissue damage influence pain perception and coping. Conversely, causal effects of challenge appraisals reflecting potential future benefits of bearing pain have received little attention. This experiment was designed to elucidate effects of appraising laboratory pain as a source of potential threat and challenge on pain perception and coping. METHODS: Before engaging in a cold pressor test (CPT), young adult women (N = 112) and men (N = 49) were randomly assigned to one of three conditions: a higher threat group in which participants read an orienting passage describing symptoms and consequences of frostbite (pain as a signal for nociception), a lower threat group in which participants read about CPT safety (pain independent of nociception) or a challenge appraisal group in which participants read a passage describing how persistence in the face of discomfort predicts future life success and satisfaction...
August 2016: European Journal of Pain: EJP
Rachel M Nygaard, Angela B Whitley, Ryan M Fey, Anne Lambert Wagner
For those at risk for cold-related injury, frostbite contributes significant morbidity through loss of limbs and digits. Frostbite injury generally affects distal extremities first and spreads proximally as the time of exposure increases. The Hennepin score is a tool to quantify injury and tissue loss of frostbite injury, similar to TBSA calculators in burn patients. Application of the Hennepin score allows for a clear picture of the effect of treatment through calculation of a salvage rate. The authors found high reliability between raters using the Hennepin score worksheet, suggesting consistency with applying the score to frostbite injury and outcomes (intraclass correlation, 0...
July 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
Stathis J Poulakidas, Areta Kowal-Vern, Corinne Atty
Frostbite injury in children can lead to abnormal growth and premature fusion of the epiphyseal cartilage with long-term sequela including, but not limited to, arthroses, deformity, and amputation of the phalanges. This was a retrospective chart review of pediatric frostbite identified in an in-house burn center registry from March 1999 to March 2014. Therapeutic management included negative pressure wound therapy (NPWT). Three patients (age 16-31 months) had frostbitten hands because they were outside in cold weather without gloves...
September 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
Brian Higdon, Laura Youngman, Michelle Regehr, Andy Chiou
The authors present a case of deep frostbite treated with both hyperbaric oxygen and thrombolytic therapies. Both of these therapies are experimental and have not yet achieved widespread clinical use. The patient described in this paper sustained frostbite after becoming intoxicated and falling unconscious in a snowy field. He was treated acutely for hypothermia and came into the authors' care for wound management. Of his 6 digits with extensive, deep frostbite, 1 digit eventually required partial amputation, and another had protracted osteomyelitis treated with intravenous antibiotics...
August 2015: Wounds: a Compendium of Clinical Research and Practice
V Assi-Dje Bi Dje, C M Abhe, J B Sie-Essoh, K Kouamé, B Vilasco
Cold burns are still exceptional in sub-Saharan Africa. However, the promotion of a wider use of domestic gas (commercial butane) has led to the growth of petrochemical industries. As a consequence, there is an increased risk of the occurrence of such burns (referred to as frostbite). We report a case of a cold burn injury caused by liquefied petroleum gas (LPG) in the workplace. The diagnosis of severity and management later complicated the local evolution. Compliance with safety measures in factories remains the main means of preventing this rarely seen type of burn...
September 30, 2014: Annals of Burns and Fire Disasters
J S Glennie, R Milner
Non-freezing cold injury can be a diagnostic challenge for clinicians in the United Kingdom Armed Forces. It is associated with operations in adverse climatic conditions, and may result in significant long-term morbidity. In this article we discuss the operational importance of this condition and the current best practice in its management and prevention.
2014: Journal of the Royal Naval Medical Service
A Marchal, E Mahé, C Sin, P Bagan, P Bilan, J-F Linder, J-C Couffinhal, M-L Sigal
BACKGROUND: Acute ischemia of the upper limbs is rare in comparison with ischemia of the lower limbs. The origins of this condition are varied. GOALS: We retrospectively analyzed cases of acute finger ischemia (Raynaud's phenomena was excluded) in a dermatology department between 2008 and 2013 in order to evaluate the etiology and management of this phenomenon. RESULTS: Thirteen cases of finger ischemia were reported. The mean age was 54 years...
May 2015: Annales de Dermatologie et de Vénéréologie
Amir E Ibrahim, Jeremy Goverman, Karim A Sarhane, Jill Donofrio, T Gregory Walker, Shawn P Fagan
This article presents a small case series demonstrating clinical success with thrombolytic agents for severe frostbite injury to the lower extremities. The authors report three patients with severe frostbite injuries to their distal lower extremities who were managed with urgent interventional radiology and intra-arterial tissue plasminogen activator infusion according to a prespecified protocol. Limbs and digits were successfully salvaged and patients returned to normal activity within 2 weeks. Although further studies are needed, results of this study support a new approach in the management of frostbite: from conservative management and observation to urgent interventional radiology and possible tissue plasminogen activator infusion...
March 2015: Journal of Burn Care & Research: Official Publication of the American Burn Association
Therese Simonsen Straarup, Anders Olsen Fink, Jens Kjærgaard Rolighed Larsen
We describe a case report of a 23-year-old man with acute pharyngeal injuries due to frostbite subsequent to inhalation of propane. He was fiber-optically intubated on admission to hospital since his airways were considered acutely compromised. He was subsequently kept intubated for 11 days due to persistent pharyngeal oedema and frostbite injuries. The latter is caused by low temperature of propane upon release from a pressurized container. Injuries caused by frostbite often gradually progress and thus caution should be exerted in regards to airway management...
January 5, 2015: Ugeskrift for Laeger
Bruno Durrer
Frostbite is most likely to happen in combination with accidents, intoxications or psychiatric emergencies and typically affects smaller, more exposed areas of the body, such as fingers, toes, nose, ears, cheeks and chin. The preclinical treatment consists of rapid rewarming of the injured tissue in a water-bath that is held between 38 - 42 °C (hand-hot) in a stable, warm environment. A new clssification allows a faster assessment of the outcome. New retrospective studies suggest the efficacy of thrombolysis or prostacyclin analogues against spasm and thrombosis for a better outcome...
January 2015: Therapeutische Umschau. Revue Thérapeutique
Scott E McIntosh, Matthew Opacic, Luanne Freer, Colin K Grissom, Paul S Auerbach, George W Rodway, Amalia Cochran, Gordon G Giesbrecht, Marion McDevitt, Christopher H Imray, Eric L Johnson, Jennifer Dow, Peter H Hackett
The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians...
December 2014: Wilderness & Environmental Medicine
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