Sunday, December 26, 2010

might be useful this winter! - Frostbite

I made a big mistake of not paying attention to the local weather forecast this weekend, and I had my car stuck in the snow.I got my fingers and toes frozen! red! numb! and tender!It took a while before I got the color back in my fingers. Prolonged exposure of this kind would lead to whats called Frostbite!

Lets see what we can do! First thing is ..DONT PANIC!. and call for help....if you can!The do's & dont's according to the 2010 First Aid guidelines from American Heart Association(most of the evidence is from around 1950s) are..

1.remove wet clothing and dry and cover the victim to prevent hypothermia.
2.Do not try to rewarm the frostbite if there is any chance that it might refreeze(i.e..if you cannot avoid being continuously exposed to the cold temperature, as repeated change of temperature will worsen tissue injury due to on & off formation of ice crystals) or if you are close to a medical facility.
3.Minor or superficial frostbite (frostnip) can be treated with simple, rapid rewarming using skin-to-skin contact such as a warm hand.
4. Severe or deep frostbite should be rewarmed within 24 hours of injury and this is best accomplished by immersing the frostbitten part in warm (37° to 40°C or approximately body temperature) water for 20 to 30 minutes. THIS IS THE MOST IMPORTANT STEP IN THE MANAGEMENT/FIRST AID.
5. Do not use heating devices, stoves etc to treat frost bite..mainly because the area is numb...and there is a risk of burns.

The mechanism of injury - Exposure to low temperatures leads to ice-crystal formation, which results in damage to capillaries leading to progressive ischemia and infarction. Generation of oxygen free radicals, production of prostaglandins and thromboxane A2, release of proteolytic enzymes, and generalized inflammation are the underlying mechanical effects of these injuries. There have been studies on use of therapies aimed at reducing the production of these metabolites. (J Trauma 1983). Another study(Ann Emer Med 1987)compared use of aspirin, aloe vera, methyl prednisone and methimazole against no medications.....and showed may be a marginal benefit with these agents in reducing dermal ischemia. There may also be a role for t-PA /heparin for management of severe fostbite(after rewarming within 24 hours).J Trauma 2005. Ibuprofen(or any NSAID) can be used initially on presentation, due to their anti inflammatory properties as per this recent article from Canada. (hard to disregard as...they are probably experts in snow related issues!!)


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