Pediatric emergency medicine trisk 1957 1957
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (102.81 KB, 1 trang )
FROSTBITE INJURY
CLINICAL PEARLS AND PITFALLS
Care should be taken not to rub or apply pressure to the affected areas.
Rewarming is painful and analgesics should be provided.
Clinical Recognition
Frostbite is injury or destruction of the skin and its underlying tissue that can
occur in temperatures below the freezing point of water. Damage is caused by
tissue freezing, hypoxia, and inflammatory response with microvascular thrombus
formation mediated by the release of bradykinin, prostaglandin F2α, thromboxane
β2, and histamine. Children are at greater risk for frostbite injuries due to their
high body surface area-to-mass ratios and less subcutaneous fat. The most typical
body parts affected include the fingers, toes, ears, and nose. Emergency
physicians should be suspicious when adolescents present with geometrical burn
injuries and unexplained circumstances and be aware of the “salt and ice
challenge,” which involves putting salt on the skin and then applying ice cubes on
top of the salt with the goal to resist the pain from the resultant frostbite for as
long as possible.
The clinical presentation of frostbite can range from superficial areas of pallor
and edema to more severe hemorrhagic blisters and necrosis. Severe injury can
lead to amputations, chronic pain, and premature fusion of the epiphyseal
cartilage that can affect growth.
The treatment goals are to minimize dermal ischemia and promote timely
healing. Treatment can be described in three phases. The initial prethaw period,
usually performed by prehospital personnel, involves getting the patient out of the
cold environment and then removing wet clothing. Soft padding should be
applied to protect the affected area; care must be taken not to rub any of these
tissues as this may cause further damage. The second phase, the actual rewarming
process, will take place over the next 15 to 30 minutes with the affected area
being immersed in water that is preheated to 40° to 42°C. Because rewarming is
quite painful, IV analgesics will likely be required. The third phase, the postthaw
period, involves careful wound management and application of loose, sterile
dressings. Digits are typically separated with cotton, and extremities are splinted.
A follow-up with a wound care specialist is highly recommended.
Tetanus prophylaxis is warranted. Prophylactic antibiotic use is controversial;
however, coverage for staphylococci, streptococci, and pseudomonas should be
