Frostbite T34.90XA 991

Frostbite Treatment

• In the acute phase of frostbite (less than 24 hours after injury), the initial treatment includes rewarming of the entire body prior to transportation of the patient to the hospital. Rapid warming of the extremity is then recommended. 
• A frozen foot should be placed in a circulating water bath at 104 degrees F (40.0 degrees C) for 15 to 30 minutes.
• Analgesics may be necessary during the rewarming phase.
• Consider an early phase Tc-99n scintiscan, intravenous or intra-arterial tissue plasminogen activator (0.15mg/kg bolus and continuing at 0.15mg/kg/hr up to 100mg in 4-6hours), therapeutic heparin for 3-5 days followed by warfarin and ibuprofen. (Twomey JA, J Trauma 2005;59:1350-1355)
• Additional treatment includes appropriate splinting, tetanus prophylaxis, analgesia, and antibiotics.  A rewarmed body part is very susceptible to further injury; therefore, it should be protected from any additional pressure or chance of refreezing. 
• Because severe swelling may occur with the rewarming of extremities, the patient must be monitored for signs or symptoms of compartment syndrome.
• Surgery shoulde be delayed (@90 days) to assess areas of revitilization vs mummification.
• No rewarming should be done if there is risk of repeat freezing. Freeze/thaw cycles cause increased damage. Do not rub frostbitten areas.
• Frostbite Prevention: the most reliable method to reduce the risk of frostbite is to reduce thermal heat loss.  Wear protective socks and shoes.  Moisture reducing socks.