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Frostbite
(Advice provided by Dr David Hillebrandt, Dr Paul Richards, and Mr Chris Imray
to Jagged Globe and Adventure Works).
Introduction
If the fluid in cells freezes it swells and chemicals are produced and these two
processes permanently damage the tissues. This is frostbite. It can vary in the
depth and extent of damage.
If only superficial skin is damaged and it is rewarmed soon after injury it may
recover completely. This is frostnip.
Frostbite commonly occurs on the extremities such as fingers, toes, ears, penis
and nose. It can occur anywhere.
It obviously requires a cold, but not necessarily freezing, environment and
wind-chill can add to the potential for damage. It is more likely at altitude
(less oxygen for the tissues) and in a hypothermic or injured person. It is more
likely if circulation is restricted by tight fitting clothes, boots or
jewellery.
Clients with pre-existing conditions which may predispose to poor circulation
(Diabetics, Raynaud's sufferers etc) are more likely to suffer from frostbite.
Certain drugs that effect peripheral circulation may also predispose (b Blockers
or nicotine in cigarettes).
Prevention
Prevention is the key to "treatment". Awareness and experience is the key to
prevention.
Diagnosis
Diagnosis is made from an awareness of the risk. Frostbite may be initially
painful but may not be so. If a cold extremity becomes numb frostbite is the
likely cause. The skin may become white and blanched in appearance and tissues
feel "woody" to the patient. If a large area becomes frostbitten it may become
purple due to blood sludging.
Field Treatment
Frostnip rapidly warmed should result in no long term damage.
For Frostbite:
- 1. Protect from further cold injury. Remove jewellery, put on dry
gloves/mitts/socks if possible, and adjust boots.
- 2. Do not deliberately thaw part until it can be rapidly rewarmed in a water
bath in a situation from which evacuation can be arranged without further
pressure on damaged tissue (normally base camp).
- 3. As soon as available give Aspirin 75mg daily to facilitate circulation.
Ibuprofen 200-400mg should be given 8 hourly to inhibit potentially damaging toxins
unless contraindicated.
- 4. If above 4000m and oxygen is available give it.
- 5. On arrival at a secure base the patient should first be treated for potential
hypothermia by slow rewarming with insulation in a warm environment.
- 6. The patient should be kept well hydrated with warm fluid drinks.
- 7. The frostbitten part should be rapidly rewarmed by immersion in warm water.
This should be at 40-42oC (baby bath temperature). The "bath" should contain a
large enough volume of water to minimise cooling by the cold body part and to
facilitate easy top-ups with warm water to maintain the temperature. The damaged
part should not be in contact with the side of the "bath". Antiseptic can be
added to the water if available. Full thawing may take an hour or more.
- 8. Thawing may be very painful and strong painkillers may be needed by
injection.
- 9. Once thawed the frostbitten part must not be used. A patient with frostbitten
toes or feet will have to be carried. A patient with frostbitten fingers or
hands will be unable to use a walking stick, ice axe or crutch and will need
help with dressing, eating and going to the toilet.
- 10. The damaged part should be loosely bandaged with dry protective non adherent
dressings and well padded, especially between digits. Try to avoid bursting
blisters but if inevitable do so with sterile needle or blade.
Use Aloe
Vera cream topically once to twice daily to reduce the toxic effect of local
prostaglandin release.
- 11. Take daily digital photos and photos of all procedures for medical records
and to facilitate E mail transmission if advice is needed.
- 12. If there is any suspicion of infection start antibiotics.
- 13. Check patient is up to date with tetanus cover.
Definitive treatment
World class centres for the treatment of frostbite are Chamonix and Anchorage.
Dr Emmanuel Cauchy and his team from Chamonix hospital have lectured to the
holders of the UK Diploma in Mountain Medicine and a liaison system has been set
up so that digital photos and digital bone scan images can be transmitted and
discussed.
Modern definitive treatment is based on the validated predictive data from Bone
Scans taken soon after injury. Intravenous lloprost (synthetic prostaglandin
analogue), and intra-arterial tPA (clot
busting drug) appear to improve outcome.
Prof. Chris Imray is a UK based vascular surgeon with access to all necessary
facilities. He is an active climber and holds the Diploma in Mountain Medicine.
He has volunteered to act as the UK liaison surgeon. We would suggest that any
cases are discussed with either him or with Dr David Hillebrandt or with Dr Paul
Richards, the Jagged Globe doctors, prior to decisions being made about any
surgery or repatriation.
Golden Rules for Frostbite
Do not:
Rub, beat or cover with snow.
Warm with external heat source such as stove or fire.
Allow refreezing once thawed.
Rewarm a frostbitten part unless hypothermia is being treated
Submit to early amputation
Do
Rewarm rapidly in a safe environment (preferably hospital) and within 48 hours
of injury
Give analgesia
Avoid infection
Delay surgery
Contacts:
Prof. Chris Imray, Consultant General and Vascular Surgeon,
Coventry and Warwickshire County Vascular Unit,
University Hospitals Coventry & Warwickshire,
Clifford Bridge Road, Coventry, CV2 2DX.
Tel: 0247 696 4000
E Mail: chrisimray@aol.com
Dr. David Hillebrandt, Medical Advisor
to Jagged Globe & Adventureworks, Derriton House,
Derriton, Holsworthy, Devon. EX22 6JX
Tel: 01409 253814 home 01409 253692
work
E mail: dh@hillebrandt.org.uk
Dr Paul Richards, Medical Advisor
to Jagged Globe & Adventureworks,
The Surgery & Travel Clinic, 64 London Road,
Wickford, Essex. SS12 0AN. Tel: 01268
568240 Mobile: 0771 510 4796.
E mail: pritchi@aol.com
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