Frostbite and Hypothermia
B – Be sure to conduct a physical assessment to observe for concomitant injury such as:
- Soft tissue injury
- Alcohol coma
- Fat embolism
I – In dressing frostbite injuries, it is essential to use strict aseptic technique. Damages from frostbite make the patient susceptible to infection.
T – Tetanus prophylaxis can be given if there is associated trauma
E – Encourage hourly movement of the affected digits to promote maximal restoration of function and to prevent contractures.
The Rewarming Process
Early rewarming of the tissue appears to decrease injury or damage. Before and during the process of rewarming the following should be done:
- Administer an analgesic for pain per doctor’s prescription. The rewarming process may be very painful.
- To avoid further mechanical injury, the affected part should be handled gently. Massage should never be done in this case.
- The rewarmed part should be protected. Blebs or blisters should NOT be ruptured. Blebs develop an hour to few days after the process of rewarming.
- A sterile gauze or cotton should be placed between the fingers or toes of affected extremity. This is done to prevent maceration.
- To help control swelling, elevate the affected extremity or body part.
- In cases where the feet are involved, bed cradles may be used to prevent contact with bedclothes.
Further Management of Frostbite
When appropriate, the following procedures may be carried out in frostbite:
- Whirlpool bath – used to promote circulation in the affected part, debride necrotic tissue, permit normal circulation in the area and to help prevent infection.
- Escharotomy – in this procedure an incision through the eschar is made. This procedure is done to prevent further tissue damage, to allow normal blood circulation and to permit movements or motion in the joints.
- Fasciotomy – this is a surgical procedure where an incision is made in fascia in order to release pressure on the muscles, nerves and blood vessels. Fasciotomy is useful in treating compartment syndrome.
It is also important to instruct the patient not to use tobacco because the vasoconstrictive effects of nicotine further reduces the already deficient blood supply to the damaged tissues.
Image by: nlm.nih.gov