Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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More on Frostbite

In the last post, I wrote about frostbite management. Since the time that the information for that post was made available to me, there have been some interesting developments in the science and clinical management recommendations for frostbite injury.

There was a very interesting case report about frostbite published by Robert Sheridan, MD and colleagues entitled "Case 41-2009: A 16-Year-Old Boy with Hypothermia and Frostbite" in the New England Journal of Medicine (N Engl J Med 2009;361:2654-62). This is the medical tale of a boy who became intoxicated with alcohol and then was found unconscious in a snowbank with his limbs buried in the snow and a layer of ice surrounding one of his feet. In addition to his foot, his hands were frozen. When these limbs and the victim were rewarmed, blood-filled blisters formed on the frostbitten extremities. This was indicative of severe frostbite.

The patient had his frozen tissues rapidly rewarmed by immersion in water heated to 40 degrees Centigrade (104 degrees Fahrenheit). Appropriately, the tissues were not rubbed or massaged, to avoid additional injury. After the limbs were rewarmed and were soft to the touch, there was an obvious loss of circulation. Therefore, the patient was administered a drug (nitroglycerin) directly into the affected arteries supplying his hands to cause the arteries to dilate, followed by a thrombolytic ("clot buster") drug (tissue plasminogen activator, or t-PA). The t-PA was given using an ultrasound-generating catheter, which was felt to augment the beneficial effect. Because the t-PA was now in the general circulation, it was hoped that it would benefit the patient's foot as well.

It was the impression of the clinicians that this therapy was beneficial and contributed significantly to a lessening of the tissue loss that would otherwise have been experienced by this patient. This is a promising therapy. According to my colleagues who are specialists in wilderness medicine and in particular, frostbite, we will hear much more about this approach in the future.
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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.