A New Proposal for Management of Severe Frostbite in the Austere Environment.

Details

Serval ID
serval:BIB_1CC347005EC1
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Title
A New Proposal for Management of Severe Frostbite in the Austere Environment.
Journal
Wilderness & environmental medicine
Author(s)
Cauchy E., Davis C.B., Pasquier M., Meyer E.F., Hackett P.H.
ISSN
1545-1534 (Electronic)
ISSN-L
1080-6032
Publication state
Published
Issued date
03/2016
Peer-reviewed
Oui
Volume
27
Number
1
Pages
92-99
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Despite advances in outdoor clothing and medical management of frostbite, individuals still experience catastrophic amputations. This is a particular risk for those in austere environments, due to resource limitations and delayed definitive treatment. The emerging best therapies for severe frostbite are thrombolytics and iloprost. However, they must be started within 24 hours after rewarming for recombinant tissue plasminogen activator (rt-PA) and within 48 hours for iloprost. Evacuation of individuals experiencing frostbite from remote environments within 24 to 48 hours is often impossible. To date, use of these agents has been confined to hospitals, thus depriving most individuals in the austere environment of the best treatment. We propose that thrombolytics and iloprost be considered for field treatment to maximize chances for recovery and reduce amputations. Given the small but potentially serious risk of complications, rt-PA should only be used for grade 4 frostbite where amputation is inevitable, and within 24 hours of rewarming. Prostacyclin has less risk and can be used for grades 2 to 4 frostbite within 48 hours of rewarming. Until more field experience is reported with these agents, their use should probably be restricted to experienced physicians. Other modalities, such as local nerve blocks and improving oxygenation at high altitude may also be considered. We submit that it remains possible to improve frostbite outcomes despite delayed evacuation using resource-limited treatment strategies. We present 2 cases of frostbite treated with rt-PA at K2 basecamp to illustrate feasibility and important considerations.

Keywords
Extreme Environments, Fibrinolytic Agents/therapeutic use, Frostbite/drug therapy, Frostbite/therapy, Humans, Hyperbaric Oxygenation/utilization, Nerve Block/utilization, Peripheral Nerves/drug effects, Prostaglandins I/therapeutic use, Thrombolytic Therapy/methods
Pubmed
Open Access
Yes
Create date
10/03/2016 18:21
Last modification date
20/08/2019 12:53
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