Frostbite acute care and approach to tissue preservation

IA: intra-arterial; IV: intravenous; SUBQ: subcutaneous.

* Refer to separate UpToDate topic on hypothermia.

¶ Wound care includes application of a bulky dressing to the affected area, elevation to reduce edema, and daily hydrotherapy to improve range of motion. Splinting may be required to prevent contracture formation. A technetium-99m scintigraphy (ie, bone scan) can be used to predict the long-term viability of affected tissue. Rarely, acute compartment syndrome develops which requires urgent management. Refer to UpToDate content on frostbite for more discussion on wound care and timing of imaging options.

Δ Absolute contraindications to thrombolytic therapy include but are not limited to prior intracranial hemorrhage, known structural cerebral vascular lesion or malignant intracranial neoplasm, ischemic stroke or significant closed-head trauma within 3 months. Refer to UpToDate content for full list of contraindications.

◊ There are no standardized dosing regimens for alteplase in the treatment of severe frostbite injury. Refer to UpToDate content for dosing recommendations.