Deep frostbite: Clinical characteristics and outcomes in northeastern China.

OBJECTIVE: To investigate the clinical characteristics and treatment outcomes in patients with severe frostbite in a single institution in northeastern China. METHODS: The clinical records of patients with severe frostbite of the extremities who were hospitalized at the authors' institution between January 2009 and April 2019 were retrospectively reviewed. Demographic data, predisposing factors, clinical presentation, duration of signs and symptoms, number of surgical interventions, and length of hospital stay were extracted and analyzed. RESULTS: A total of 156 consecutive inpatients were treated for severe frostbite with the mean age was 43.7 ± 14.15 years. Hands were the most common site involved (38.5%). The most prevalent predisposing factor for frostbite included alcohol abuse (41.67%), smoking habits (37.18%) and psychiatric illness (14.11%). Mean duration of signs and symptoms was 3.6 days. Most of patients (37.8%) sustained frostbite injury in January. All patients survived, and the mean length of hospital stay was 45.6 days (range, 29-62). Amputations of limbs were performed in 40.4% of patients. CONCLUSION: The incidence of deep frostbite in Jilin province correlates with the environmental temperature and is often associated with alcohol abuse, smoking and other psychosocial factors. Delayed presentation would increase the risk of amputation. These findings should guide clinical decisions about the treatment of individual patients with deep frostbite.

Frostbite in the Norwegian Armed Forces. / Frostskader i Forsvaret.

BAKGRUNN: Det finnes lite forskning på forekomst av frostskader, både sivilt og militært. Prognosen og tidsforløpet ved slike skader har ikke tidligere vært undersøkt i større kohorter. MATERIALE OG METODE: Deltagerne var personer registrert i Forsvarets helseregister med kulde- og frostskade i tidsrommet 1.1.2010-31.12.2014. Data om diagnostikk, forløp og behandling ble innhentet fra i alt 460 personer ved hjelp av et spørreskjema. Svarprosenten på undersøkelsen var 66. RESULTATER: 397 av 460 personer (86,3 %) som var registrert med frostskade i Forsvarets helseregister bekreftet at de hadde hatt en kulde- og frostskade. 123 av 397 personene som svarte (30,1 %) anga at de hadde hatt blemmer, noe som gir mistanke om at de hadde pådratt seg annengrads frostskade. 225 av 397 (56,7 %) anga at de hadde hatt frostskade, men ikke blemmer. De aller fleste fikk frostskaden under feltøvelse/vinterøvelse (81,1 %), og ⅔ av de som pådro seg skader var vernepliktige. Langt de fleste hadde skader på fingre/hender eller tær/føtter (96,0 %). To av tre (69,8 %) hadde fortsatt plager fra sin frostskade mer enn to år etter skadetidspunktet. FORTOLKNING: Mange i militæret pådrar seg frostskader under tjenestegjøring. En femdel anga kroniske helseplager som påvirker arbeidsevnen. Kunnskap om forekomsten av frostskader hos militært mannskap er viktig for Forsvarets videre skadeforebyggende arbeid.

[Frostbites: cold-freezing injuries due to a biting cold]. / Les gelures, des lésions locales liées à un froid mordant.

Frostbites are cold-freezing injuries of the extremities due to the exposure to temperatures below 0°C. The risk, in the absence of treatment, is the amputation of frostbitten areas which become gangrenous. Victims of frostbite must be treated and evacuated urgently. Nurses play an active role in the secondary long-term treatment.

Frostbite: management update / Actualización en el manejo de las congelaciones

The popularity of winter sports is leading to an increase in the number of subjects exposed to environmental pathologies such as frostbite. This is the reason why the patient's profile is changing from the classical descriptions of adults with preexisting conditions, basically those with cognitive impairment that prevented them from a proper protection against cold or as an occupational illness in working routines related with low temperature exposures. Nowadays these disorders occur mainly in healthy athletic young patients who expose themselves voluntarily to the cold environment, both for professional or amateur aims. Frostbite can occur as a single pathology or can take part in a more complex clinical picture that includes more serious conditions, as hypothermia or trauma. In addition to this fact, it is not uncommon that frostbite appears in exhausted and dehydrated subjects. The likelihood of such injuries taking place in remote areas further complicates its management, primarily because of the delay in diagnosis and definitive treatment. Sequelae after frostbite are common and potentially limiting for the posterior sports career. In recent years, efforts have been made to establish algorithms intended for rescue and expedition doctors to manage mountain medical care based on scientific evidence. Current recommendations include prompt identification and immediate medical care, followed by early hospital treatment if necessary and specific long-term rehabilitation programmes. This review attempts to describe current knowledge of the physiopathology and the clinical aspects of frostbite, in addition to new management perspectives, from in-situ emergency care through to hospital treatment

La popularidad de los deportes de montaña conlleva que cada vez haya más individuos expuestos a patologías ambientales como son las congelaciones. De esta forma, el perfil de los pacientes está variando respecto a las descripciones clásicas, donde se consideraban lesiones propias del adulto con patología de base, principalmente alteraciones cognitivas que le impedían protegerse adecuadamente del frío, o bien como una enfermedad laboral en profesiones relacionadas con la exposición a las bajas temperaturas. Actualmente esta patología se presenta más frecuentemente en jóvenes sanos y deportistas que se exponen voluntariamente al ambiente frío para la práctica deportiva. Las congelaciones pueden presentarse como una patología aislada o formando parte de un cuadro clínico más complejo, que puede incluir la hipotermia o patología traumática. Añadido a este hecho, es frecuente que se presenten en individuos debilitados por la fatiga y la desnutrición. La posibilidad de que esta patología tenga lugar en entornos remotos añade complejidad a su manejo y empeora el pronóstico debido al retraso del tratamiento definitivo. Las secuelas tras las congelaciones son frecuentes y potencialmente limitantes para la práctica deportiva posterior. En los últimos años se han hecho esfuerzos para basar los algoritmos de actuación de las patologías de montaña en la evidencia científica, destinados tanto al público deportivo como al personal sanitario. En síntesis, estos versan en la identificación y tratamiento inicial tempranos seguidos de tratamientos hospitalarios administrados de forma precoz en caso de ser necesarios y programas de rehabilitación específicos y prolongados. La presente revisión trata de describir las recomendaciones actuales, desde la identificación y clasificación de las congelaciones hasta los nuevos avances en el manejo sobre el terreno, médico inicial y hospitalario de las mismas

Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite: 2014 update.

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the original guidelines published in Wilderness & Environmental Medicine 2011;22(2):156-166.

Critical care for frostbite.

Frostbite, a preventable cold-weather injury, occurs when the skin temperature cools to below 0°C with the formation of extracellular ice crystals. On rewarming, an inflammatory response develops, contributing to ischemia and tissue loss. The severity of injury depends on the temperature, duration of exposure, and amount and depth of frozen tissue. Environmental, individual, behavioral, and physiologic factors increase susceptibility to cold. Rapid rewarming and watchful waiting remains the mainstay of treatment. Prevention can be accomplished through increasing public awareness of the adverse effects of cold exposure, and recognizing and mitigating the risks associated with the development of frostbite.

Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite.

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens for each modality according to methodology stipulated by the American College of Chest Physicians.

Cold injury in the United States military population: current trends and comparison with past conflicts.

OBJECTIVE: The war in Afghanistan represents the first large-scale conflict involving military troops in a cold, mountainous climate since the Korean War. An analysis was conducted to identify the extent of cold weather injuries, especially frostbite, in the deployed military population. DESIGN: A retrospective analysis of military databases was conducted with tabulation of all cases of cold-weather injuries in Operations Enduring Freedom and Iraqi Freedom. Casualties reviewed occurred between 2001 and 2009. SETTING: The 81st Medical Group at Keesler AFB. PARTICIPANTS: A total of 18,214 patients reported in the Joint Theater Trauma Registry (JTTR). RESULTS: Overall, 19 cases of cold-weather injury were identified in the Afghanistan Conflict. Two cases of frostbite were identified with only 1 likely requiring surgical intervention. No cases were identified in Iraq. CONCLUSION: The 19 cold-weather injuries represent a dramatic decrease from the 6300 cases of cold-weather injury reported in the last major cold-weather conflict, the Korean War. This decrease results from the shorter and weather-dependent engagements, cold-weather education, and improved equipment of United States and allied personnel.

Cold damage to the extremities: frostbite and non-freezing cold injuries.

The treatment of cold injuries to the periphery has advanced substantially in the last 10 years and optimal outcomes are only likely to be achieved if a multidisciplinary team uses the full range of diagnostic and treatment modalities that are now available. The internet and satellite phones with digital images allow immediate access by patients from remote geographical locations to hospital based specialists who can assess cold injuries and advise on early field care. The severity of frostbite injuries can now be assessed with triple phase bone scanning, allowing early prediction of likely subsequent tissue loss. Early hyperbaric oxygen therapy appears to improve outcome and the use of intravenous drugs such as synthetic prostaglandin analogues infusions and tissue plasminogen activator have been shown to reduce amputation rates. In non-freezing cold injuries the early administration of analgesia, the avoidance of secondary exposure, and the use of infrared thermography to assess the injuries are among newer approaches being introduced.

[Frostbites amongst service men, participants of contreterroristic operations on North Caucasus (1994-1996, 1999-2001)].

In clause the analysis of the rendering medical help military is reflected in article with frostbites in military conflict on North Caucasus (1994-1996, 1999-2001). Efficient rendering medical help military with frostbites possible only under simultaneous observance united principle on terminological glances and provision to receivership approach to organizations of the rendering medical help damaged military. It is generalised and analysed own experience of the rendering medical help military with frostbites during military conflict on territory of the Chechen Republic (2003-2005).

Retrospective study of 70 cases of severe frostbite lesions: a proposed new classification scheme.

OBJECTIVE: Previous frostbite classifications were mainly based on retrospective diagnosis and, most of the time, could not be used to predict the final outcome of the lesions and especially the probability of an amputation and its level. The aim of this study was to suggest a new classification at day 0 based mainly on the topography of the lesions and on early bone scan results, which are more convenient and accurate in predicting the final outcome of frostbites. METHODS: The retrospective study of the clinical histories of 70 patients hospitalized at Chamonix Hospital (Mont-Blanc Massif) from 1985 to 1999 for severe frostbite injuries of the extremities has allowed us to classify the aspects of the initial lesions on day 0 and to compare them with final outcomes. RESULTS: A strong correlation was found between the extent of the lesion and the outcome of each finger or toe. When the initial lesion was on the distal phalanx, the probability of bone amputation was around 1% for the digit, 31% for the middle phalanx, 67% for the proximal phalanx, 98% for the metacarpal/metatarsal, and 100% for the carpal/tarsal. CONCLUSIONS: Based on these clinical results and on the results of bone scans (previously validated), a new classification of frostbite severity at day 0 is proposed. Four degrees of severity are defined: first degree, leading to recovery; second degree, leading to soft tissue amputation; third degree, leading to bone amputation, and fourth degree, leading to large amputation with systemic effects.

[Frostbite injuries]. / Lokale frostskader.

Frostbite injuries occur mainly in toes, fingers, ears, nose and cheek. Typically an initial vasoconstriction in the skin will protect from drop in core temperature. Ice crystal development occurs when tissue temperature drops to -2 degrees C, leading to increased osmolality of the extracellular fluid and intracellular dehydration. An additional insult occurs with thawing due to reperfusion of the tissue and thereby release of inflammatory mediators. Symptoms of frostbite injury are: White-cyanotic discoloration, pain and numbness followed by hypoaesthesia. General hypothermia should be prevented and treated before managing the local frostbite injuries. Direct contact with warm skin without rubbing should be used in superficial injuries. More severe and deeper injuries should not be thawed until definite treatment could be given in a hospital. Re-freezing and mechanical influence on the injured parts must be avoided. Thawing should preferably be done in stirred water of 40-42 degrees C with mild soap. Antibiotics may be indicated when the skin barrier is broken. Surgical debridement should be postponed until a clear demarcation occurs.

Schedule for rating disabilities: cold injuries--VA. Final rule.

This document amends the Department of Veterans Affairs (VA) Schedule for Rating Disabilities by revising the provisions governing evaluations for cold injury residuals. The intended effect of this amendment is to provide evaluation criteria based on current medical knowledge about the long-term effects of cold injury that can be applied to any part of the body affect by cold injury.

Frostbite: an overview with case presentations.

Much of the interest in frostbite has arisen from various military experiences including the Korean war, World War II, and Napolean's battles in Russia and Poland. Historically frostbite has been not only a military problem, but also a problem in high-altitude climbers and the more recently investigated homeless population. However, the physician should not disregard frostbite as only victimizing the poor and indigent. Anyone who is exposed to harsh winter conditions over a long period of time can suffer from frostbite. Many milder cases of frostbite presented to Cook County Hospital in Chicago were simply due to prolonged winter exposure when a motorist's care broke down. The authors present a review of the variants, pathophysiology, classifications, predisposing factors, and treatment of frostbite. Five cases of frostbite will also be presented from Cook County Hospital in Chicago, IL.