Frostbite and Frostsnip

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Homepage: EMNote.org ■ • 🚩Membership: https://tinyurl.com/joinemnote • 🚩ACLS Lecture: https://tinyurl.com/emnoteacls • • Frostbite • Frostbite: Pathophysiology • Frostbite: Tissue injury resulting from freezing temperatures • Primary affected areas: Extremities (fingers, toes, nose, ears, cheeks, chin) • Mechanism: Decreased blood flow and tissue freezing in cold temperatures • Epidemiology • High-risk populations: • Residents of cold climates • Homeless individuals • Winter sports enthusiasts • Patients with circulatory disorders (diabetes, peripheral vascular disease, Raynaud's) • Smokers and alcohol consumers • Clinical Stages • 1. Frostnip • Reversible • Symptoms: Redness/pallor, coldness, tingling, mild pain • 2. Superficial Frostbite • Symptoms: Warmth sensation, pins-and-needles, stinging, swelling • Post-rewarming: Bruising, clear fluid-filled blisters • 3. Deep Frostbite • Symptoms: Numbness, white/grayish-yellow skin, hardness • Complications: Blood-filled blisters, tissue necrosis • Diagnosis • Primary: Clinical assessment (history and physical examination) • Key factors: Duration and temperature of exposure, contributing conditions • Physical signs: Skin color changes, blisters, sensory alterations • Imaging (severe cases): Technetium-99 scans, MRI, bone scans for tissue damage assessment • Treatment: Immediate Actions • Remove patient from cold environment • Remove wet/constricting clothing • Avoid rubbing/massaging affected areas • Treatment: Medical Management • Rapid rewarming: 15-30 minutes in 37-39°C water • Pain management: Analgesics (preference for ibuprofen over aspirin) • Wound care: Blister management, aloe vera application, protective dressings • Severe cases: Consider thrombolytic therapy (tPA) within 24 hours • Surgical intervention: Debridement or amputation for extensive necrosis/gangrene • Prognosis and Long-Term Management • Potential complications: • Cold sensitivity • Chronic pain • Joint stiffness • Sensory deficits • Management strategies: • Cold exposure prevention • Ongoing pain management • Physical/occupational therapy • Psychological support • Prevention Strategies • Limit outdoor exposure in extreme cold • Wear appropriate, layered clothing • Maintain dryness • Ensure proper hydration and nutrition • Avoid alcohol and drugs • Recognize early symptoms • Prepare for cold weather emergencies • Key Takeaways • Frostbite: Potentially severe cold-related injury • Early recognition and intervention crucial for tissue salvage • Treatment focuses on rapid rewarming and tissue preservation • Long-term management often necessary • Prevention remains the most effective strategy

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