FROSTBITE
Avoid partial rewarming then refreezing (begin rewarming only when no further risk of cold exposure)
TREATMENT
Rewarm limb in 42 degrees circulaitng water for 10-30 min (until pliable and erythematous)
Provide analgesia
Debride clear vesicles/Aspirate haemorrhagic vesicles
ADT
Penicillin prophylaxis
Allow to demarcate (takes weeks/months) then surgical debridement/amputation
?Sympathectomy - medical (intraarterial reserpine), surgical
?Epidural
ASSESSMENT OF SEVERITY
DEGREE
FEATURES
First
Anaesthesia/Erythema
Second
Vesicles
Third
Haemorrhagic vesicles
Fourth
Subcutaneous/Bone/Muscle involvement
DISPOSAL
Admit severe cases otherwise discharge
Aloe vera
Ibuprofen 400mg bd PO
Dress
Elevate
Physiotherapy referral/Whirlpool hydrotherapy
PROGNOSIS
Good
Rapid response
Oedema < 3 hrs
Poor
Violet hue post warming
Haemorrhagic blebs
No oedema formation
Mummified/Black
LATE COMPLICATIONS
Chronic paraesthesia/Altered temperature sensation
Increased sweating
Nail changes/Skin pigmentation
SCC/Epidermal carcinoma
Premature physeal fusion
Rhabdomyolysis