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

Détails

ID Serval
serval:BIB_1CC347005EC1
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Etude de cas (case report): rapporte une observation et la commente brièvement.
Collection
Publications
Titre
A New Proposal for Management of Severe Frostbite in the Austere Environment.
Périodique
Wilderness & environmental medicine
Auteur(s)
Cauchy E., Davis C.B., Pasquier M., Meyer E.F., Hackett P.H.
ISSN
1545-1534 (Electronic)
ISSN-L
1080-6032
Statut éditorial
Publié
Date de publication
03/2016
Peer-reviewed
Oui
Volume
27
Numéro
1
Pages
92-99
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
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.

Mots-clé
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
Oui
Création de la notice
10/03/2016 19:21
Dernière modification de la notice
08/05/2019 15:21
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