Caused by vasoconstriction (blood is heat), Hunting response, impaired vasodilation secondary to hypoxia at altitude. Cover all exposed skin. Must stay hydrated or the body will constrict blood vessels. Trauma blocks distal blood flow.
Frozen tissue is white, waxy and hard and becomes cyanotic and ecchymotic when thawing. Formation of blebs indicates living tissue underneath.
Rapid rewarming with water 37-41° C. Soak in hot water with small amount of betadine. Most important is to make sure part is not refrozen.
ASA/Topical Aloe Vera=excellent results.
Parenteral Toradol if not thawed, Ibuprofen if thawed. NSAIDs work much better before thawing.
MRI is good test to predict eventual tissue damage.
TPA and Heparin
Intravenous tPA and heparin after rapid rewarming is safe and reduced predicted digit amputations considerably. Patients with no response to thrombolytic therapy were those with more than 24 hours of cold exposure, warm ischemia times greater than 6 hours, or evidence of multiple freezethaw cycles. Our algorithm for treatment of severe frostbite now includes use of i.v. tPA for patients without contraindications. (J Trauma 2005;59(6):1350)
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