Frostbite: a practical approach to hospital management.
Frostbite presentation to hospital is relatively infrequent, and the optimal management of the more severely injured patient requires a multidisciplinary integration of specialist care. Clinicians with an interest in wilderness medicine/freezing cold injury have the awareness of specific potential interventions but may lack the skill or experience to implement the knowledge. The on-call specialist clinician (vascular, general surgery, orthopaedic, plastic surgeon or interventional radiologist), who is likely to receive these patients, may have the skill and knowledge to administer potentially limb-saving intervention but may be unaware of the available treatment options for frostbite. Over the last 10 years, frostbite management has improved with clear guidelines and management protocols available for both the medically trained and winter sports enthusiasts. Many specialist surgeons are unaware that patients with severe frostbite injuries presenting within 24 h of the injury may be good candidates for treatment with either TPA or iloprost. In this review, we aim to give a brief overview of field frostbite care and a practical guide to the hospital management of frostbite with a stepwise approach to thrombolysis and prostacyclin administration for clinicians.
Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
Charles
C
Handford
University Hospital Coventry & Warwickshire, Coventry CV2 2DX, UK.
Pauline
P
Buxton
University of Utah, Salt Lake City, UT 84112, USA.
Katie
K
Russell
Sheffield University Medical School, Sheffield S10 2TN, UK.
Caitlin Ea
CE
Imray
Division of Emergency Medicine, University of Utah Health Care, Salt Lake City, UT 84112, USA.
Scott E
SE
McIntosh
FAWM, Yellowstone National Park, WY 82190, USA ; Everest ER, Himalayan Rescue Association, P.O. Box 4944, Kathmandu 44601, Nepal.
Luanne
L
Freer
University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
Amalia
A
Cochran
Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK ; University Hospital Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK.
Christopher He
CH
Imray
Frostbite; Heparin; Hypothermia; Iloprost; Rewarming; TPA; Thrombolysis