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FROSTBITE: EPIDEMIOLOGY, PATHOPHYSIOLOGY AND TREATMENT (LECTURE)

CHRIS IMRAY, SEAN HUDSON, MARTIN RHODES LEICESTER UNIVERSITY, LEICESTER, UK
This lecture aims to describe epidemiology, pathophysiology and latest approaches in treatment of a frostbite. The prevalence of frostbite has risen over past years. The feet and the hands account for 90% of injuries reported. The pathophysiological processes have been studied extensively. Skin sensation is lost around 10–15°C. As skin cools further (0°C), freezing occurs and frostbite starts to develop. Very low ambient temperatures, wind and moisture accelerate this rate. Depending on the method of rewarming, hyperaemia, ischaemia, cyanosis, or total circulatory failure develops. Symptoms and signs of frostbite include a cold numbness with accompanying sensory loss. Thawing and reperfusion is often intensely painful. With thawing, frozen tissue may appear mottled blue, yellowish- white or waxy. A predictive classification system based on the topography of the lesion(s) and early technetium99 bone scanning helps to predict the likely outcome as early as two days. Treatment includes warm drinks, removal of boots and clothes, Aspirin (150–300 mg), Ibuprofen (400 mg), rewarming of limbs, blisters care, aloe vera, antibiotics and thrombolytic therapy. Fasciotomy should be performed if a compartment syndrome develops, but amputation should be delayed for up to three months, and certainly until the level of demarcation is clear. Improved imaging assessment using MRA, and technetium scintigraphy, further research into the use of adjunctive therapies (use of thrombolytic agents and vasodilators) are further advancement in the treatment of frostbite. .
Keywords: 
frostbite, cold injury, frostnip, rewarming, mountain medicine, wilderness medicine, field care, thrombolytic therapy, aloe vera, hypothermia.