6-43
c. Low molecular weight Dextran (1 L of 6% solution IV, followed by 500 ml/day for 5 days) or heparin
management (15 units/kg IV stat, then a total of 70 units/kg in the first 24 hours) helps to prevent
sludging of blood.
d. Vasodilator phenoxybenzamine hydrochloride (Dibenzyline) 10 mg bid po. Increase dose 10 mg
each day to max of 60-80mg qd.
e. Surgically debride dead tissue* (see Procedure: Wound Debridement)
- Manage pain with appropriate medications: Aspirin, NSAIDs or narcotics if indicated (deep, long standing
injury may require morphine sedation). - All medications have more benefit if given before thawing.
*NOTES: Debriding frostbitten tissue too early is the most common error in frostbite management. Debriding
too early results in retraction, infections, graft failures and removal of viable tissue. Wait to debride mummified
tissue for 4 to 8 weeks unless fever and coagulopathies mandate earlier intervention. There is a 2 mm
liquefaction line between viable tissue and distal mummifying tissue. Late surgical debridement of indurated
tissue should only be to this line.
Patient Education
General: Use personal protective measures to prevent cold injury.
Diet: Eat 5% to 10% more calories. Include more fat in the diet.
Medications: Give NSAIDs with food. Monitor respiratory status if morphine is used.
Wound Care: Manage wounds with warm water baths bid, pat dry and bandage with a loose, dry dressing.
Follow-up Actions
Evacuation/Consultant Criteria: Minor frostbite can be managed quite successfully in the field, but deep
frostbite will require evacuation. Consult a general surgeon as needed for management.
Cold Illnesses and Injuries: Hypothermia
Murray Hamlet, DVMIntroduction: Hypothermia is a reduction in body temperature below the normal range. Risk factors for
hypothermia include trauma, wind and wetness, physical and mental exhaustion, poor clothing and cold,
particularly during rapid changes in weather. Freezing temperatures are not necessary to cause hypothermia.
Water immersion can produce extremely rapid cooling. Use core temperature taken via rectum or esophagus.
Simply feeling between the shoulder blades to determine if the victim is cold is a field expedient diagnostic
test.
Subjective: Symptoms (see Table 6-1, Classification of Level of Hypothermia)
Mild hypothermia (core temperature between 90° and 95°F): Poor coordination, stumbling and shivering.
Moderate hypothermia (81° - 90°F): Muscle and joint stiffness, poor coordination, slurred speech, extreme
disorientation and confusion.
Severe hypothermia (below 81°F): Asleep or unconscious. Below 77°F: Spontaneous ventricular fibrillation.
Objective: Signs (Use rectal thermometer to take core temperature. Do not place in stool.)
Using Basic Tools: Mild: Lethargic, diminished fine motor control, shuffling, stumbling gait, shivering;
Moderate: Lack of shivering, slow to react, disoriented, makes major errors in judgment, loses
consciousness; Severe: Heart and respiration rates slow, difficult to perceive a pulse, muscles become too
stiff to move, cardiac arrhythmias often develop. If unconscious, the victim may have spontaneous ventricular
fibrillation or cardiac arrest if handled roughly. Below 77°F spontaneous cardiac arrest is likely. There are
often no obvious vital signs and the victim may appear clinically dead, but in fact is not.