Freezing cold injury (‘frostbite’) 

Pathophysiology:

• Definition: Hypothermia induced vasoconstriction that results in tissue cooling , ice formation & freezing within the tissue 

Risk factors:

• alcohol consumption
• previous frostbite, 
• drug use, 
• inappropriate clothing, 
• fatigue, dehydration. 

Clinical features:

• initial numbness and woody sensation followed by a 
• severe pain during warming with a persistent throbbing sensation. 
• Pain can endure for months alongside potentially permanent sensory changes. 
• The skin can look waxy, discolored or blistered

Management:

Immediate pre-hospital treatment 

• • shift to warm environment, 
  • warm drinks, 
  • remove shoes, wet clothing and jewelry → warm, dry clothing. 
  • warming the area: placing the area into a companion’s armpit or groin. 
  • Do not rub the area, do not place heat sources directly onto the area. 
  • Aloe vera gel: can be applied before application of a non-adherent dressing, splinting
  • aspirin 75–300 mg and ibuprofen 800 mg
  • Denitive warming: placing the affected area into circulating water between 37°C and 42°C with antiseptic for an hour, avoiding contact with the sides of the container. 
  • Fluid replacement: warmed fluids 

• Strong analgesia 

In-hospital management 

• • Blister management: débridement of all blisters in hospital (likely under GA) with tetanus prophylaxis 
  • Imaging: (e.g. angiography and technetium bone scanning) to inform prognosis. 
  • combination of thrombolysis and vasodilators (such as nitroglycerin), given within 24 hours
  • Iloprost → vasodilator, can be given after 24 hours

• Hyperbaric oxygen treatment 

• Amputations may be needed.