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Introduction (continued) The proportion of adults who are current smokers has declined from 42% in 1965 to 21% in 2006
Nonpharmacologic Treatment Clothing/ Prevent constriction Remove constricting items such as jewelry and rings because swelling will occur with thawing Hydration Patients are often clinically dehydrated due to cold diuresis, altitude, extreme activity Oral vs intravenous fluids should be used based on clinical picture Rewarming Fully or partially frozen tissue should be rapidly and actively rewarmed This should occur in a bath if possible, target temperature 37 to 39 C Povidone iodine or chlorhexidine should be added to prevent infection End point of warming is red/purple appearance, tissue becomes pliable Often takes 30 minutes, may take longer [22] Rewarming may be painful, parenteral analgesia is often required Return of sensation is a favorable prognostic sign Blister management Hemorrhagic blisters indicate injury into the reticular dermis Clear blisters suggest a more superficial injury pattern The wilderness medical society advises draining clear blisters, leaving hemorrhagic blisters intact [23] This process should be performed sterile, may require local anesthetic Hypothetically aids in wound care, tissue healing Dressings/ Wound care Goal: protect and prevent further tissue insult Affected limbs should be splinted, elevated, dressed in a loose dressing Padding between fingers/ toes is ideal Topical aloe vera cream/gel should be applied under the dressing Later, protective footwear should be used Nutrition Recovery requires a high-protein, high-calorie, individually tailored diets [24] Pharmacologic Treatment Analgesia Rewarming is painful, pain should be addressed NSAIDS All patients should be started on Ibuprofen for its anti-inflammatory affects in addition to analgesic 400 mg two or three times a day is a practical dose This can be increased up to 2400 mg/day Aspirin should be avoided due to theoretical blockade of some prostaglandins which promote wound healing Antibiotics Should be given if suspected or proven infection Prophylaxis is controversial
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