title: The Triaging and Treatment of Cold-Induced Injuries.
abstract: BACKGROUND
  In Central Europe, cold-induced injuries are much less common than burns. In a burn center in western Germany, the mean ratio of these two types of injury over the past 10 years was 1 to 35. Because cold-induced injuries are so rare, physicians often do not know how to deal with them.
  
  
  METHODS
  This article is based on a review of publications (up to December 2014) retrieved by a selective search in PubMed using the terms "freezing," "frostbite injury," "non-freezing cold injury," and "frostbite review," as well as on the authors' clinical experience.
  
  
  RESULTS
  Freezing and cold-induced trauma are part of the treatment spectrum in burn centers. The treatment of cold-induced injuries is not standardized and is based largely on case reports and observations of use. distinction is drawn between non-freezing injuries, in which there is a slow temperature drop in tissue without freezing, and freezing injuries in which ice crystals form in tissue. In all cases of cold-induced injury, the patient should be slowly warmed to 22°-27°C to prevent reperfusion injury. Freezing injuries are treated with warming of the body's core temperature and with the bathing of the affected body parts in warm water with added antiseptic agents. Any large or open vesicles that are already apparent should be debrided. To inhibit prostaglandin-mediated thrombosis, ibuprofen is given (12 mg/kg body weight b.i.d.).
  
  
  CONCLUSIONS
  The treatment of cold-induced injuries is based on their type, severity, and timing. The recommendations above are grade C recommendations. The current approach to reperfusion has yielded promising initial results and should be further investigated in prospective studies.
authors.affiliation: Clinic for Plastic Surgery and Severe Burn Injuries, Hand Surgery Center, Operative Sarcoma Reference Center, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum.
authors.forename: Christoph
authors.initials: C
authors.lastname: Sachs
authors.forename: Marcus
authors.initials: M
authors.lastname: Lehnhardt
authors.forename: Adrien
authors.initials: A
authors.lastname: Daigeler
authors.forename: Ole
authors.initials: O
authors.lastname: Goertz
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D000067390:Cold Injury / Q000175:diagnosis* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods / Q000592:standards; D003646:Debridement / Q000592:standards*; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D006979:Hyperthermia, Induced / Q000592:standards*; D007052:Ibuprofen / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D015424:Reperfusion / Q000592:standards*; D016896:Treatment Outcome; D014218:Triage / Q000592:standards*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007052:Ibuprofen