Materiały źródłowe

• #1 Treating frostbite

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2278351/

  Frostbite is a cold-induced injury of tissue characterized by freezing and ischemic necrosis. It is most commonly observed in the extremities and is usually seen in those between the ages of 30 and 49 years. […] Knowledge of its treatment is crucial for family physicians who work in areas where cold weather can occur. In this report, we will present our treatment of 7 frostbite cases. […] Rewarming of the affected extremities began immediately upon admission to the hospital by immersion in water with 10% povidone-iodine at 40C for about 20 minutes, keeping the extremity elevated immediately afterward. This procedure was performed twice daily. Further medical treatment included a single injection of tetanus toxoid; 12 mg/kg of ibuprofen by mouth daily; 100 mg of acetylsalicylic acid by mouth daily; and 500 mg of pentoxifylline and 100 mg of bencyclane-hydrogen-fumarate in a 500 mL low-molecular-weight dextran solution (ie, dextran 40) by intravenous infusion every 24 hours for 5 to 7 days.

• #2 Frostbite – Wikipedia

  https://en.wikipedia.org/wiki/Frostbite

  Frostbite is a skin injury that occurs when someone is exposed to extremely low temperatures, causing the freezing of the skin or other tissues, commonly affecting the fingers, toes, nose, ears, cheeks and chin areas. The initial symptoms are typically a feeling of cold and tingling or numbing. This may be followed by clumsiness with a white or bluish color to the skin. Swelling or blistering may occur following treatment. Complications may include hypothermia or compartment syndrome. […] Treatment is by rewarming, by immersion in warm water (near body temperature) or by body contact, and should be done only when consistent temperature can be maintained so that refreezing is not a risk. Rapid heating or cooling should be avoided since it could potentially cause burning or heart stress. Rubbing or applying force to the affected areas should be avoided as it may cause further damage such as abrasions. The use of ibuprofen and tetanus toxoid is recommended for pain relief or to reduce swelling or inflammation. For severe injuries, iloprost or thrombolytics may be used. Surgery, including amputation, is sometimes necessary.

• #2 Frostbite – Wikipedia

  https://en.wikipedia.org/wiki/Frostbite

  Individuals with frostbite or potential frostbite should go to a protected environment and get warm fluids. If there is no risk of re-freezing, the extremity can be exposed and warmed in the underarm of a companion or the groin. If the area is allowed to refreeze, there can be worse tissue damage. If the area cannot be reliably kept warm, the person should be brought to a medical facility without rewarming the area. Rubbing the affected area can also increase tissue damage. Aspirin and ibuprofen can be given in the field to prevent clotting and inflammation. Ibuprofen is often preferred to aspirin because aspirin may block a subset of prostaglandins that are important in injury repair. […] Other considerations for standard hospital management include: wound care: blisters can be drained by needle aspiration, unless they are bloody (hemorrhagic). Aloe vera gel can be applied before breathable, protective dressings or bandages are put on. antibiotics: if there is trauma, skin infection (cellulitis) or severe injury. tetanus toxoid: should be administered according to local guidelines. Uncomplicated frostbite wounds are not known to encourage tetanus. pain control: NSAIDs or opioids are recommended during the painful rewarming process.

• #3 Frostbite – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/997

  Frostbite severity is determined by the depth of the freezing and subsequent injury. Grading scales are sometimes used to guide therapy. […] The mainstay of treatment is rapid initial rewarming of the injured tissue. […] Being a thermal injury, wound management is similar to the management of burns and involves debridement of white blisters (in hospital), regular aloe vera application, and regular hydrotherapy. Early therapy with a non-steroidal anti-inflammatory drug is advised. […] Iloprost and thrombolytic therapy have been shown to be of benefit in severe frostbite where there is a risk of amputation, particularly if given within 24 hours of injury. […] It usually takes 1 to 3 months to determine the viability of the surrounding injured tissue and surgery should normally be delayed.

• #4 Frostbite | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20372638/

  Learn how to prevent cold injury to the skin when outdoors in freezing temperatures and how to treat and recover from frostbite. […] Mild frostbite gets better with rewarming. Seek medical attention for anything more serious than mild frostbite because the condition can cause permanent damage to skin, muscle, bone and other tissue. […] While you wait for emergency medical help or an appointment with a healthcare professional, take these steps as needed: Get out of the cold and remove wet clothing. […] After providing first aid, seek treatment from a healthcare professional if you have frostbite. Treatment may involve rewarming, medicine, wound care, surgery or other steps depending on how serious the injury is. […] For frostbite, some basic questions to ask your healthcare team include: What are my treatment options and the pros and cons for each?

• #5 Hypothermia and Frostbite | Winter Storm Safety | Red Cross

  https://www.redcross.org/get-help/how-to-prepare-for-emergencies/types-of-emergencies/winter-storm/hypothermia-and-frostbite.html?srsltid=AfmBOooBibQiZi63V_tcK6MDe2cF4hYzXrSwytsKXYFbAmEXb8IPQitF

  Frostbite and hypothermia are cold-related emergencies that may quickly become life or limb threatening. […] Frostbite is the freezing of a specific body part such as fingers, toes, the nose or earlobes. […] What should you do if someone has frostbite? Move the person to a warm place. Handle the area gently; never rub the affected area. Warm gently by soaking the affected area in warm water (100-105 degrees F) until it appears red and feels warm. Loosely bandage the area with dry, sterile dressings. If the person’s fingers or toes are frostbitten, place dry, sterile gauze between them to keep them separated. Avoid breaking any blisters. Do not allow the affected area to refreeze. Seek professional medical care as soon as possible.

• #6 Frostbite: Recommendations for Prevention and Treatment from the Wilderness Medical Society | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0401/p440.html

  To prevent worsening tissue damage, a frostbitten extremity should be rewarmed only if there is no risk of refreezing. […] Rapid rewarming via water bath immersion and intravenous low-molecular-weight dextran leads to improved outcomes in frostbite. […] To limit tissue loss, oral ibuprofen should be started as soon as available and continued until surgery or complete healing. […] Tissue plasminogen activator improves outcomes for deep frostbite extending to proximal interphalangeal joints if given within 24 hours. […] If early frostbite is recognized, exercise can be protective by enhancing cold-induced peripheral vasodilation and elevating core and peripheral temperatures. […] Mild hypothermia can be treated concurrently with frostbite. Moderate to severe hypothermia should be treated before initiating frostbite treatment.

• #6 Frostbite: Recommendations for Prevention and Treatment from the Wilderness Medical Society | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0401/p440.html

  Ibuprofen should be given in the field at standard dosages (up to 600 mg four times daily) to decrease vasoconstriction and further tissue damage. […] Although outcomes are better with rapid rewarming, frostbite should be allowed to thaw spontaneously if rapid rewarming is not possible. […] Rewarming is complete when the injured extremity appears red or purple and becomes soft and pliable, typically within 30 minutes depending on the extent and depth of frostbite. […] Daily or twice-daily hydrotherapy at 98.6 to 102.2F has been recommended in the post-thaw period. […] Chemical or surgical sympathectomy is not recommended because it has not been shown to reduce tissue loss in immediate postexposure phases. […] Complete demarcation of tissue necrosis after frostbite may take up to three months. Until demarcation is complete, amputation should be performed only if signs of sepsis are present.

• #7

  https://www.nhs.uk/conditions/frostbite/treatment/

  Treatment for frostbite depends on the severity of your symptoms. Always get medical attention if you think you or someone else has frostbite. […] If the warming process is started and the frozen parts are then re-exposed to the cold, it can cause further, irreversible damage. […] Rewarming should ideally be carried out under medical supervision it can be a painful process requiring painkillers and expert medical assessment. […] The affected area should be rewarmed slowly by immersing it in warm, but not hot, water. […] Rewarming should last at least 30 minutes and only be stopped once the affected body part is a red-purple colour and can be easily moved. […] Depending on the severity of pain, strong painkillers, such as morphine, may be needed. Ibuprofen should also be taken as it has additional protective properties for frostbite.

• #7

  https://www.nhs.uk/conditions/frostbite/treatment/

  In the most serious cases of frostbite, an entire part of the body, such as the fingers or toes, may need to be removed (amputated). […] A decision to perform debridement or amputation is usually delayed for several weeks, as often what appears to be dead tissue can heal and recover over time. […] A medicine called amitriptyline can sometimes be effective at controlling the pain associated with the long-term effects of frostbite.

• #8 Frostbite Treatment & Management: Approach Considerations, Field Management, Rewarming

  https://emedicine.medscape.com/article/926249-treatment

  The goal of frostbite treatment is to salvage as much tissue as possible, to achieve maximal return of function, and to prevent complications. […] If treating personnel are unfamiliar with the management of frostbite and its sequelae, transfer of the patient to another facility should be considered. […] In some settings, burn units have particular expertise in managing severe frostbite injuries. […] Prehospital care starts with taking the patient to a warm environment. […] Avoid walking on frostbitten tissue. […] Do not rewarm frostbitten tissue if there is a possibility of refreezing before reaching definitive care. […] Lastly, do not rub or use a stove/fire to rewarm frostbitten tissues. […] Rewarm the frostbitten area as quickly as possible to salvage as much tissue and function as possible.

• #8 Frostbite Treatment & Management: Approach Considerations, Field Management, Rewarming

  https://emedicine.medscape.com/article/926249-treatment

  Rewarming is most effectively accomplished by immersing the affected area in water heated to 37-39 C (98.6-102.6 F). […] Avoid premature termination of the rewarming process. […] Remember to treat pain associated with rewarming. […] Avoid early amputation until after the nonviable tissue is clearly demarcated. […] The management of frostbite itself may be divided into 3 phases: field management, rewarming, and postrewarming management. […] Rapid rewarming is the single most effective therapy for frostbite. […] On admission, rapidly rewarm the affected area in circulating water (ie, a whirlpool bath) at 37-39C. […] The addition of an antiseptic solution such as povidone-iodine or chlorhexidine to the bath may be beneficial. […] The most common error in this stage of treatment is premature termination of the rewarming process because of reperfusion pain.

• #8 Frostbite Treatment & Management: Approach Considerations, Field Management, Rewarming

  https://emedicine.medscape.com/article/926249-treatment

  Partial thawing and refreezing generate more damage than does prolonged freezing alone, through the release of multiple inflammatory mediators. […] Once the skin is thawed, protect the area from further injury and reexposure to cold. […] Elevate the area and splint the extremity. […] Analgesics (eg, ibuprofen and morphine) for pain relief are indicated during and after rewarming. […] Apply topical aloe vera cream to all frostbitten areas every 6 hours to inhibit the arachidonic cascade, especially thromboxane synthesis. […] Vasodilators have shown in multiple studies to reduce amputation rates. […] The FDA approved IV administration of iloprost (Aurlumyn) in February 2024 for severe frostbite to reduce the risk of digit amputation. […] Early surgery usually is contraindicated in frostbite, because of the time the nonviable tissue takes to demarcate.

• #8 Frostbite Treatment & Management: Approach Considerations, Field Management, Rewarming

  https://emedicine.medscape.com/article/926249-treatment

  The only indication for early surgical intervention is postthaw compartment syndrome warranting fasciotomy. […] Because of the extreme difficulty in differentiating viable tissue from nonviable tissue in the first few weeks after frostbite injury, amputation surgery is best avoided until complete demarcation and separation of gangrenous tissue occurs. […] In a report of a single patient treated with vacuum-assisted closure (VAC) therapy, Poulakidas et al described improved tissue salvage and early reepithelialization, suggesting that VAC may be of some benefit in the management of frostbite-induced tissue damage. […] Most patients with frostbite must be hospitalized for 24-48 hours to assess the extent of injury. […] Daily wound care includes bivalving of any constricting eschars. […] Use hydrotherapy (ie, whirlpool bath filled with lukewarm water [40C] and surgical soap) for 30-45 minutes twice daily until the eschar sloughs off. […] When frostbite injuries do occur, expeditious treatment at a specialty center results in the least amount of permanent disability and tissue loss.

• #9 Frostbite Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/condition/frostbite

  If frostbite has caused tissue death in any area, such as a hand or foot, amputation may be necessary. The decision to amputate is taken over a period of 4 to 8 weeks after the injury. However, in patients with serious infection, wet gangrene, or pain that won’t respond to treatment, surgery may be required sooner. […] It is important to seek conventional care for frostbite as soon as possible to prevent tissue damage. While nutritional supplements may enhance conventional treatment, maintaining the body’s core temperature by dressing warmly, drinking fluids, and eating plenty of food before and during exposure to cold are critical to preventing and treating frostbite. […] Frostbitten areas should never be massaged or vigorously rubbed.

• #9 Frostbite Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/condition/frostbite

  Seek emergency medical care to treat frostbite as soon as possible. Your health care provider will ask about your exposure to cold, including what the temperature was and length of exposure. Your provider will also examine your skin, looking for signs of superficial and deep injury. You may not be able to see the extent of your injury until the area rewarms. Doctors may run blood tests and imaging studies, such as magnetic resonance imaging (MRI), to determine the severity of your injury, as well as any complications, such as infection. […] Frostbite is a medical emergency. It is important to get conventional medical care as soon as possible. Remove constricting or wet clothing and immobilize and insulate the affected areas. Your health care provider will treat mild frostbite by rewarming the affected area, washing it with an antiseptic, and applying a sterile dressing. If medical care is not available immediately, seek shelter and rewarm a mildly frostbitten area by immersing it in warm water (98.6 to 102.24°F or 37 to 39°C), or by repeatedly applying warm cloths to the area for 30 minutes. Never use hot water, fire, a heating pad, or other dry heat because these methods may burn the skin before the feeling returns. Remove any jewelry from the affected area before rewarming because the area may swell. Never rub or massage frozen body parts, and avoid walking on a frostbitten foot, if possible (however, if you are far from help, it is better to walk on frozen feet than to thaw them out). Wrap the area in dry dressings, putting dressings between fingers and toes to keep them separated. If there is any danger of refreezing, it is best not to thaw the area until you reach warm shelter. Thawing and refreezing can seriously damage tissue.

• #10 Frostbite: First aid

  https://www.mayoclinic.org/first-aid/first-aid-frostbite/basics/art-20056653

  Be ready to help if someone has frostbite. […] You can treat mild frostbite (frostnip) yourself. All other frostbite requires medical attention. First-aid steps for frostbite are as follows: Protect your skin from further damage. If there’s any chance the affected areas will freeze again, don’t thaw them. If they’re already thawed, wrap them up so that they don’t refreeze. […] Gently rewarm frostbitten areas. If possible, soak the skin with frostbite in a tub or sink of warm water for about 30 minutes. For frostbite on the nose or ears, cover the area with warm, wet cloths for about 30 minutes. […] Don’t rewarm frostbitten skin with direct heat, such as a stove, heat lamp, fireplace or heating pad. This can cause burns. […] Don’t apply direct heat. For example, don’t warm the skin with a heating pad, a heat lamp, a blow-dryer or a car heater.

• #11 Frostbite – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/frostbite/diagnosis-treatment/drc-20372661

  First aid for frostbite is as follows: […] After providing first aid, seek treatment from a healthcare professional if you have frostbite. Treatment may involve rewarming, medicine, wound care, surgery or other steps depending on how serious the injury is. […] Rewarm the skin. If the skin hasn’t been rewarmed already, your healthcare team rewarms the area using a warm-water bath for 15 to 30 minutes. The skin may turn soft. You may be asked to gently move the affected area as it rewarms. […] Take pain medicine. Because the rewarming process can be painful, you may be given a pain reliever. […] Protect the injury. Once the skin thaws, your healthcare team may loosely wrap the area with sterile sheets, towels or dressings to protect the skin. You may need to raise the affected area to reduce swelling.

• #11 Frostbite – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/frostbite/diagnosis-treatment/drc-20372661

  Remove damaged tissue. To heal properly, frostbitten skin needs to be free of damaged, dead or infected tissue. This procedure to remove this tissue is called debridement. […] Tend to blisters and wounds. Blisters can act as a natural dressing. Depending on the type of blisters, your healthcare team may leave them to heal on their own or drain them. A variety of wound care techniques may be used depending on the extent of injury. […] Undergo surgery. People who have experienced severe frostbite may in time need surgery or amputation to remove dead or decaying tissue.

• #11 Frostbite – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/frostbite/diagnosis-treatment/drc-20372661

  Soak in a whirlpool. Soaking in a whirlpool bath can aid healing, as it keeps the skin clean and naturally removes dead tissue. […] Take infection-fighting drugs. If the skin or blisters look infected, your healthcare team may prescribe antibiotic medicine taken by mouth. […] Take medicine. You may receive an injection of medicine in a vein that helps restore blood flow. This type of medicine is called a thrombolytic. One example is tissue plasminogen activator, also called TPA. Studies of people with severe frostbite show that TPA may lower the risk of amputation. But this medicine can cause serious bleeding. It’s sometimes used in serious situations and within 24 hours of cold exposure. […] Another medicine that improves blood flow is iloprost (Aurlumyn). It was recently approved by the FDA for severe frostbite in adults. It can reduce the risk of finger or toe amputation. Side effects of this medicine include headache, flushing and heart palpitations.

• #12

  https://wms.org/magazine/magazine/1250/frostbite-cgp/default.aspx

  Therapeutic options for frostbite in Scenario 1 include: Dressings […] Therapeutic options for frostbite in Scenario 2 include: Rapid field rewarming of frostbite […] During rewarming, pain medication (e.g., NSAIDs or an opiate analgesic) should be given to control symptoms as dictated by individual patient situation. […] According to the foregoing guidelines, rapid rewarming is strongly recommended. If field rewarming is not possible, spontaneous or slow thawing should be allowed. […] Topical aloe vera should be applied to thawed tissue before applying dressings. […] Bulky, dry gauze dressings should be applied to the thawed parts for protection and wound care. […] If possible, the thawed extremity should be elevated above the level of the heart, which might decrease formation of dependent edema.

• #13 Frostbite: pathophysiology and treatment options

  https://www.oatext.com/frostbite-pathophysiology-and-treatment-options.php

  Hyperbaric oxygen therapy (HBO2) is approved for number of different diagnoses including chronic wounds. Frostbite represents a unique type of wound that disrupts tissue due to ice crystals forming followed by ischemic/reperfusion damage as the circulation returns during rewarming. […] The benefit of HBO2 for treating frostbite results from the mechanisms of how this treatment works. The increased oxygen delivery helps to resolve the ischemia and increases the antioxidants to deal with the potential oxidative damage. […] The evidence-based approach is to immerse the body part with frostbite in a warm water bath at a temperature of 37oC (98.6oF) for at least 30 min. More warm water should be added to maintain the optimal temperature range. Since rewarming is painful, ibuprofen should be started. This can provide some pain relief as well possible supporting tissue viability by decreasing the production of thromboxane and other inflammatory mediators.

• #13 Frostbite: pathophysiology and treatment options

  https://www.oatext.com/frostbite-pathophysiology-and-treatment-options.php

  Thrombolytic therapy in frostbite injury is used to address microvascular thrombosis. Bruen, et al. determined that the digital amputation rates were reduced from 41% to 10% in patients who received tPA within 24 h of injury. […] Hyperbaric oxygen therapy (HBO2) initially, seems counterintuitive for use with an injury such as frostbite where tissue damage results from ischemia, because high levels of oxygen are linked to vasoconstriction and reduced blood flow. […] HBO2 reverses vasoconstriction in ischemic tissue and the resulting hyperoxia, from oxygen dissolved in plasma, surpasses any potential reduction in blood flow. […] It has been determined that the use of HBO2 delineates viable from necrotic tissues. […] von Heimburg, et al. suggests that with the low risk associated with HBO2 and its potential benefit, it should be recommended as adjunct therapy in the treatment of deep frostbite.

• #14 FDA Approves First Medication to Treat Severe Frostbite | FDA

  https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-treat-severe-frostbite

  The U.S. Food and Drug Administration approved Aurlumyn (iloprost) injection to treat severe frostbite in adults to reduce the risk of finger or toe amputation. […] This approval provides patients with the first-ever treatment option for severe frostbite, said Norman Stockbridge, M.D., Ph.D., director of the Division of Cardiology and Nephrology in the FDAs Center for Drug Evaluation and Research. Having this new option provides physicians with a tool that will help prevent the lifechanging amputation of ones frostbitten fingers or toes. […] Iloprost, the active ingredient in Aurlumyn, is a vasodilator (a drug that opens blood vessels) and prevents blood from clotting. […] Aurlumyn received Priority Review and Orphan Drug designations for this indication.

• #15

  https://abc7.com/frostbite-fda-aurlumyn-iloprost-injection/14427673/

  There are not many effective treatments for severe frostbite. […] In contrast, he said, iloprost does not carry a risk of bleeding and can be used up to three days after the injury. […] Its efficacy in treating severe frostbite was demonstrated in a small clinical trial that showed that no participants who had severe frostbite and received injections of iloprost alone needed an amputation after a week, compared with 19% of those receiving iloprost and other unapproved medications for frostbite and 60% of those receiving only other medications. […] „Really, frostbite is an injury that needs to be prevented, not treated,” Hackett said.

• #16 First FDA-approved treatment for severe frostbite now commercially available in the US  – SERB PharmaceuticalsClose Close

  https://serb.com/news/first-fda-approved-treatment-for-severe-frostbite-now-commercially-available-in-the-us/

  Aurlumyn™ is indicated for the treatment of severe frostbite in adults to reduce the risk of digit amputations. The most recent Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite strongly recommends considering Aurlumyn™ as a first-line therapy for Grades 3 and 4 frostbite <48 hours after thawing, and possibly for up to 72 hours. [...] Aurlumyn™ is a prostacyclin mimetic indicated for the treatment of severe frostbite in adults to reduce the risk of digit amputations. Effectiveness was established in young, healthy adults who suffered frostbite at high altitudes. Aurlumyn™ was granted priority review and orphan drug designation (ODD) and was approved by the FDA in February of 2024 for the treatment of severe frostbite in adults to reduce the risk of digit amputations. A published case series review showed that Aurlumyn™ can be effective up to 72 hours after rewarming of a frostbite patient begins.

• #17 First FDA-Approved Treatment for Severe Frostbite Now Commercially Available in the US

  https://www.fffenterprises.com/news/articles/first-fda-approved-treatment-for-severe-frostbite-now-commercially-available-in-the-us-12-2024.html

  SERB Pharmaceuticals, a global specialty pharmaceutical company, is proud to announce that Aurlumyn (iloprost) Injection, the first FDA-approved treatment for severe frostbite in adults to reduce the risk of digit amputations, is now commercially available in the US. […] This marks a significant milestone in the field of frostbite treatment in the United States, and represents a new era of hope for patients at risk of digit amputations. […] Aurlumyn is indicated for the treatment of severe frostbite in adults to reduce the risk of digit amputations. […] The most recent Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite strongly recommends considering Aurlumyn as a first-line therapy for Grades 3 and 4 frostbite 48 hours after thawing, and possibly for up to 72 hours.

• #18 Interventions for frostbite injuries

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8092677/

  Frostbite is a thermal injury caused when tissue is exposed to subzero temperatures (in degrees Celsius) long enough for ice crystals to form in the affected tissue. […] Several interventions for frostbite injuries have been proposed, such as hyperbaric oxygen therapy, sympathectomy (nerve block), thrombolytic (bloodthinning) therapy and vasodilating agents such as iloprost, reserpine, pentoxifylline and buflomedil, but the benefits and harms of these interventions are unclear. […] The results suggest that iloprost and iloprost plus rtPA may reduce the rate of amputations in people with severe frostbite compared to buflomedil alone, RR 0.05 (95% CI 0.00 to 0.78; P = 0.03; very low-quality evidence) and RR 0.31 (95% CI 0.10 to 0.94; P = 0.04; very low-quality evidence), respectively. […] There is a paucity of evidence regarding interventions for frostbite injuries. Very low-quality evidence from a single small trial indicates that iloprost, and iloprost plus rtPA, in combination with buflomedil may reduce the need for amputation in people with severe frostbite compared to buflomedil alone.

• #18 Interventions for frostbite injuries

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8092677/

  Hyperbaric oxygen therapy might have potential benefits in frostbite. […] It is preferable to permit autoamputation (i.e. allowing the demarcation between vital and nonvital tissue to occur naturally, and allowing the necrotic tissue to fall off without surgery), as tissue that appears to be nonvital may recover. […] More high-quality randomised trials are needed to establish firm evidence for the treatment of frostbite injuries.

• #19 Severe Frostbite Gets a Treatment That May Prevent Amputation – The New York Times

  https://www.nytimes.com/2024/02/24/health/frostbite-treatment-amputation.html

  Last year, a paper in The International Journal of Circumpolar Health, a publication devoted to health issues affecting people living in the Arctic Circle, found similar results in subsequent research. It noted that use of iloprost “demonstrated a decrease in amputation rates relative to untreated patients.” […] In cases where frostbite is caught more immediately, a stroke drug called tissue plasminogen activator, or tPA, can be used to limit clot formation and reduce the risk of amputation. However, that drug, if not administered within hours, can lead to severe complications and death. […] Dr. Hackett said the universe of people who suffer severe frostbite includes “mountaineers, snowmobilers getting stuck out, mushers, the military” and other people working in frigid conditions, along with those who are homeless and “people with drug and alcohol problems who are exposed to cold for long periods.” […] So as small as the market might be for the new drug, Dr. Hackett hopes it might save a few digits. “It’s fabulous,” he said. “It might change the old adage.”

• #20

  https://wms.org/magazine/magazine/1494/Frostbite-Summary-2024/default.aspx

  The Wilderness Medical Society (WMS) convened an expert panel to develop a set of evidence-based guidelines for prevention and treatment of frostbite to guide clinicians and first responders and disseminate knowledge about best practices in this area of clinical care. Summarized here are the main pre-hospital prophylactic and therapeutic modalities and recommendations about their role in injury management. […] If a body part is frozen in the field, the frozen tissue should be protected from further damage. Remove jewelry or other constrictive extraneous material from the body part. Do not rub or apply ice or snow to the affected area. […] Appropriate hydration and avoiding hypovolemia are important for frostbite recovery. Oral fluids may be given if the patient is alert, capable of purposeful swallowing, and is not vomiting. If the patient is nauseated or vomiting or has an altered mental status, IV normal saline should be given to maintain normal urine output.

• #21 Frostbite: Signs, stages, symptoms, management and prevention

  https://www.webmd.com/first-aid/frostbite

  After rewarming, post-thaw care is provided to prevent infection and a continuing lack of oxygen to the area. This process includes: […] Care for blisters. Small clear blisters are left intact. Draining is sometimes recommended for blisters that are cloudy or white, and blisters that are bloody may be left intact to protect the underlying blood vessels and decrease the risk of infection. […] A tetanus booster. This may be needed because people with frostbite are at risk of developing bacterial infections. […] Hospital care. People with frostbite are hospitalized for at least one to two days to determine the extent of injury and to receive further treatment, which may include: […] – Aloe vera cream. This cream is applied every six hours, and the area is elevated and splinted. […] – Ibuprofen. This medication may be given to combat inflammation, and an antibiotic may be given if an infection develops.

• #21 Frostbite: Signs, stages, symptoms, management and prevention

  https://www.webmd.com/first-aid/frostbite

  – Water therapy. For deep frostbite, you may be treated with daily water therapy in a 37-39 C (98.6-102.2 F) whirlpool bath to remove any dead tissue. […] Several experimental therapies also exist, many of which aim to further treat the inflammation or decreased blood flow seen in frostbite. […] Frostbite Recovery […] Frostbite symptoms usually follow the same course. At first, you’ll feel numbness, followed by a throbbing feeling that happens with rewarming and may last weeks to months. This is then typically replaced by a persistent tingling with occasional electric shock sensations. Cold sensitivity, sensory loss, chronic pain, and a variety of other symptoms may last for years. […] The treatment of frostbite is done over a period of weeks to months. Definitive therapy, possibly in the form of surgery, may not be performed for up to six months after the initial injury.

• #21 Frostbite: Signs, stages, symptoms, management and prevention

  https://www.webmd.com/first-aid/frostbite

  Is frostbite permanent? […] It often takes months before doctors can find out which tissue is healthy or dead. If surgery is performed too early, there is a high risk of removing tissue that might recover or leaving behind tissue that may die. Researchers are exploring new imaging techniques that may be able to identify this sooner, allowing for earlier definitive treatment. In some cases, bone scans are used to help predict the viability of tissue. […] Beyond this waiting period, 65% of people will suffer long-term symptoms because of their frostbite. Common symptoms include pain or abnormal sensations in the extremities, extra sensitivity to heat or cold, excessive sweating, and arthritis. […] Other complications of frostbite include: […] – Nerve damage (neuropathy) […] – Long-term numbness […] – Problems with nail growth or nail loss […] – Stiff hands and feet […] – Skin discoloration […] – Scarring […] – Secondary infections […] – Loss of fingers and toes […] – Tetanus […] – Damage to tissues such as muscles and bones […] – Amputation […] – Gangrene or tissue death

• #22

  https://www.orthobullets.com/hand/12105/frostbite

  debride clear blisters and apply aloe vera reduces high levels of prostaglandin F2 and thromboxane B2. […] drain/aspirate hemorrhagic blisters represents deep injury but leave intact prevents dessication of underlying dermis. […] late debridement/amputation for necrosis frostbite in January, amputate in July after demarcation occurs at 1-3months. […] surgical sympathectomy reduces duration of pain and time to demarcation of tissue.

• #23 Frostbite – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/frostbite

  Frostbite is injury due to freezing of tissue. Treatment is rewarming in warm (37 to 39 C) water, local care, and pain management. Surgical amputation may occasionally be indicated. Diagnosis is based on clinical findings. Rewarming in warm (37 to 39 C) water. Supportive measures. Local wound care. Sometimes surgery. In the field, frostbitten extremities should be rewarmed rapidly by totally immersing the affected area in water that is tolerably warm to the touch (37 to 39 C). Once the patient is in the hospital, core temperature is stabilized and extremities are rapidly rewarmed in large containers of circulating water kept at about 37 to 39 C; 15 to 30 minutes is usually adequate. For severe injury presenting within 48 to 72 hours, infusion of a prostacyclin analog, such as iloprost, is indicated after rewarming. Anti-inflammatory measures (eg, ibuprofen and topical aloe vera) are helpful. Preventing infection is fundamental; empiric prophylaxis is not indicated, unless there is gross contamination, crush injury, or wet gangrene. Optimal long-term management includes whirlpool baths at 37 C 3 times a day followed by gentle drying, rest, and time. No totally effective treatment for the long-lasting symptoms of frostbite (eg, numbness, hypersensitivity to cold) is known.

• #24 Frostbite: Signs & Symptoms, Stages, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/15439-frostbite

  If you have signs or symptoms of surface or deep frostbite, which are the second and third stages of frostbite, visit a healthcare provider immediately for treatment. Time is critical with frostbite. You may experience severe pain with frostbite as your skin thaws. […] To treat frostbite, a healthcare provider will: Raise your body temperature in lukewarm water or by applying warm, wet packs to your skin for up to 30 minutes. Apply wound dressings to your frostbitten skin with sterile bandages, keeping your fingers and toes separated to avoid rubbing. Test blood flow in the affected area of your body. If you have stage three frostbite, your provider may also connect you to an IV (a needle that enters a vein in your arm to deliver fluids) to improve your circulation. […] For severe cases of frostbite, your provider may need to perform surgery to remove any dead skin and tissue after you heal.

• #25 Frostbite : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/frostbite/

  Prostacyclin (vasodilator) therapy: consider for deep frostbite to or proximal to the proximal interphalangeal joint, within 48 h after injury, especially if angiography is not available or with contraindications to thrombolysis. […] Clinical examination (plus angiography or technetium-99 bone scan if necessary) to assist determination of surgical margins. Evaluation by an experienced surgeon for possible intervention. […] Unproven Therapies: Hyperbaric oxygen, Pentoxifylline, Heparin without thrombolysis, Other vasodilators.

• #26 Frostbite: Stages, Symptoms, Pictures, Treatment & Recovery Time

  https://www.emedicinehealth.com/frostbite/article_em.htm

  What Is First Aid Treatment for Frostbite? The first step for a person who may have frostbite is to call for medical help. If you are in an area that has an emergency medical alert system such as 911 while attending to the injured person, have someone call 911 and best explain the condition of the patient. Remove all wet clothing from the affected area, and elevate the area higher than the heart if possible to avoid swelling. Keep the person dry and warm. If they are immobile and unable to walk try to keep the person busy with conversation. […] What Is the Medical Treatment for Frostbite? After initial life-threatening problems are excluded or managed, rewarming is the highest priority in medical care. This is accomplished in the hospital rapidly in a circulating water bath heated to 40 C to 42 C (104 F to 107.6 F) and continued until the thaw is complete (usually 15 to 30 minutes). Narcotic pain medications may be given because this process is very painful. Because dehydration is very common, IV fluids may also be given. After rewarming, post-thaw care is undertaken in order to prevent infection and a continuing lack of oxygen to the area. […] There are a number of experimental therapies for frostbite, many of which aim to further treat the inflammation or decreased blood flow seen in frostbite. As of yet, none of these treatments has proven beneficial.

• #27 Frostbite Injuries to the Hand | Indiana Hand to Shoulder Center

  https://www.indianahandtoshoulder.com/blog/frostbite-injuries-to-the-hand

  Frostbite Treatment involves rapid rewarming by complete immersion of the frostbitten part in water at 40° to 42°C (104°-107°F) for 20 minutes or more. […] Rewarming should never be initiated unless it can be carried to completion with appropriate medical attention. […] Following rewarming, the frostbitten extremity should be placed in a bulky protective dressing and elevated. […] Various adjuvant therapies have been utilized in the treatment of frostbite injuries to supplement rapid rewarming. […] Long-term complications of frostbite include a persistent burning, tingling pain in the injured part, profuse sweating, trophic ulceration, cold sensitivity and vasospasm. […] The best treatment for frostbite is prevention. […] Hand rehabilitation is an important aspect of the patient’s care following frostbite.

• #27 Frostbite Injuries to the Hand | Indiana Hand to Shoulder Center

  https://www.indianahandtoshoulder.com/blog/frostbite-injuries-to-the-hand

  Primary wound management is handled by the surgeon. […] Edema is generally significant following frostbite. […] One treatment method frequently used to help dampen the pain, which is somewhat pronounced during the early phase of therapy, is the use of Transcutaneous Electrical Nerve Simulation (TENS). […] Proper immobilization of the hand in early care of frostbite is vital. […] As soon as the initial pain and edema from the frostbite has begun to lesson, it is imperative to begin active and passive range of motion exercises to the entire upper extremity. […] Management of frostbite can be simple to relatively complex.

• #28 WMS Prevention and Treatment of Frostbite Guideline Summary

  https://www.guidelinecentral.com/guideline/40547/

  Preventive measures to ensure local tissue perfusion include: 1) maintaining adequate core temperature and body hydration; 2) minimizing the effects of known diseases, medications, and substances (including awareness and symptoms of alcohol and drug use) that might decrease perfusion; 3) covering all skin and the scalp to insulate from the cold; 4) minimizing blood flow restriction, such as occurs with constrictive clothing, footwear, or immobility; 5) ensuring adequate nutrition; and 6) using supplemental oxygen in severely hypoxic conditions (eg, 7500 m). […] A decision must be made whether to thaw the tissue. If environmental conditions are such that thawed tissue could refreeze, it is safer to keep the affected part frozen until a thawed state can be maintained. Prostaglandin and thromboxane release associated with the freezethaw cycle causes vasoconstriction, platelet aggregation, thrombosis, and, ultimately, cellular injury. Refreezing thawed tissue further increases release of these mediators, and significant morbidity may result. One must absolutely avoid refreezing if field thawing occurs.

• #29 Frostbite: Answers, treatment and prevention | HealthPartners Blog

  https://www.healthpartners.com/blog/how-long-does-it-take-to-get-frostbite/

  Severe frostbite has longer-term affects and requires immediate medical attention sometimes involving hospitalization. […] If you think you’re experiencing frostbite, take these steps for first aid right away: Protect your skin from the elements. […] Get out of the cold and into a warmer temperature as soon as possible. […] Gradually warm the frostbitten areas. […] Note: Don’t rewarm frostbitten skin with direct heat like a fireplace or heating pad, due to the risk of burns. […] As your skin rewarms and blood flow returns, you may feel a tingling or burning sensation. […] If you begin to notice skin discoloration, continued numbness or other symptoms that are out of the ordinary, make an appointment with a doctor right away or visit your local urgent care. […] Limiting trips outdoors when the temperature is below zero is the best way to prevent frostbite.

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