FROSTBITE
Frostbite is trauma from exposure to freezing
temperatures and actual freezing of the tissue fluids in the cell and
intercellular spaces. It results in cellular and vascular damage. Body parts
most frequently affected by frostbite include the feet, hands, nose, and ears.
Frostbite ranges from first degree (redness and erythema) to fourth degree
(full-depth tissue destruction).
A frozen extremity may
be hard, cold, and insensitive to touch and may appear white or mottled
blue-white. The extent of injury from exposure to cold is not always initially
known. The history of the patient should include environmental temperature,
duration of exposure, humidity, and the presence of wet conditions.
The goal of management is to restore normal body
temperature. Constrictive clothing and jewelry that could impair circulation
are removed. If the lower extremities are involved, the patient should not be
allowed to ambulate.
Controlled yet rapid
rewarming is instituted. The extremity is usually placed in a 37° to 40°C (98.6° to 104°F) circulating bath for
30- to 40-minute spans. This treatment is repeated until cir-culation is
effectively restored. Early rewarming appears to de-crease the amount of
ultimate tissue loss. During rewarming, an analgesic for pain is administered
as prescribed, because the re-warming process may be very painful. To avoid
further mechanical injury, the body part is not handled. Massage is
contraindicated.
Once rewarmed, the part
is protected from further injury and is elevated to help control swelling.
Sterile gauze or cotton is placed between affected fingers or toes to prevent
maceration. A foot cradle may be used to prevent contact with bedclothes if the
feet are involved. Blebs, which develop 1 hour to a few days after rewarming,
are left intact and not ruptured, especially if they are hemorrhagic.
A physical assessment is
conducted with rewarming to observe for concomitant injury, such as soft tissue
injury, dehydration, alcohol coma, or fat embolism. Problems such as dehydration,
hyperkalemia, and hypovolemia, which occur frequently in people with frostbite,
are corrected. Risk for infection is also great; there-fore, strict aseptic
technique is used during dressing changes, and tetanus prophylaxis is
administered as indicated. Antiinflammatory medication is also prescribed.
Additional measures that may be carried out when
appropri-ate include the following:
·
Whirlpool bath for the
affected extremity to aid circulation, debride necrotic tissue, and help
prevent infection
·
Escharotomy (incision through
the eschar) to prevent fur-ther tissue damage, allow for normal circulation,
and permit joint motion
·
Fasciotomy to treat
compartment syndrome
After rewarming, hourly active motion of the affected
digits is encouraged to promote maximal restoration of function and to prevent
contractures. Refreezing is avoided. The patient is also encouraged to avoid
tobacco, alcohol, and caffeine because of their vasoconstrictive effects, which
further reduce the already de-ficient blood supply to injured tissues.
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