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  • • Frostbite involves freezing of tissues

    • Ice crystals form between cells and grow at expense of extracellular fluid

    • Cellular dehydration and ischemia due to vasoconstriction and increased viscosity are mechanisms of tissue injury

    • Caused by cold exposure; effects can be amplified by moisture or wind

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Symptoms and Signs

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  • • Frostbitten parts are numb, painless, and white or waxy in appearance

    • Superficial frostbite is compressible with pressure (unfrozen deep tissues)

    • Deep frostbite is woody (frozen deep tissues)

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  • • Evaluate for endocarditis

    • Evaluate for secondary LV dysfunction

    • After rewarming, frostbitten area becomes mottled blue or purple and painful and tender

    • Blisters appear that may take weeks to heal

    • Affected part becomes edematous and painful

    • Must evaluate for other associated injuries as suggested by history

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  • • Nuclear medicine scans may be useful to delineate tissue viability

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  • • Frostbitten part should be rewarmed in a water bath at 40-42.2 °C for 20-30 min

    • Thawing should not be attempted until the victim can be kept permanently warm and at rest

    • After thawing, patient should be kept recumbent and with thawed part exposed to air

    • Blisters should be left intact

    • Skin gently debrided by immersion in whirlpool for 20 min twice daily

    • Vasodilating agents and sympathectomy are NOT helpful

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Surgery

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Indications

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  • • Constricting eschar

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Contraindications

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  • • Expectant management is the rule

    • Tissue usually sloughs spontaneously

    • Amputation rarely indicated before 2 months

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Prognosis

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  • • Excellent if appropriate treatment is provided

    • Recovered patients will have increased susceptibility to future frostbite

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References

Farstad M et al. Recovering from accidental hypothermia by extracorporeal circulation: a retrospective study. Eur J Cardiothorac Surg. 2001;20:58.  [PubMed: 11423275]

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