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Year |
2001 |
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Question Number |
26 |
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Category |
Select |
Question
Initial management of severe frostbite of the finger should consist of
1 – rubbing the hands together over a heat source and the application of compressive bandages.
2 – rapid rewarming of the frozen extremity in a 104oF to 111.2oF (40oC to 44oC) bath.
3 – allowing the extremity to thaw at room temperature and providing warm liquids by mouth to raise the patient’s core temperature.
4 – plunging the extremity into cold water baths of increasing temperatures.
5 – intra-arterial infusion of warmed, saline-diluted blood products.
Figures
Answer (click for answer)
ANSWER: 2
DISCUSSION: Frostbite is a recurring theme on the OITE. A frozen extremity needs to be rapidly rewarmed to limit damage to the tissues from crystallization of water into ice and to reestablish liquid blood flow to the capillaries. This is best accomplished by immersion in a hot water bath between 104?F to 111.2?F, or 40?C to 44?C (correct answer 2); this should also be accompanied by general body rewarming in a warm room and admission to the hospital. Frostbite requires emergent treatment. Rubbing the hands over a heat source as a medical treatment would be advisable only for whinos on a street-corner who have no health insurance (wrong answer 1). Slow rewarming of the extremity by thawing at room temperature or by plunging into ice baths of slowly progressive warmer temperatures would allow ongoing cell death to occur (wrong answers 3 and 4). Intra-arterial infusion of warmed blood products sounds like a nice idea, but the frostbitten extremity has ice clogging the small vessels (or at the very least vasoconstricted arterioles from autoregulatory mechanisms), so the warmed blood products would not reach the frozen tissues (wrong answer 5).
Reference: Washburn B: Frostbite: What it is, how to prevent it and emergency treatment. N Eng J Med 1962;266:974-989.
Pedowitz WJ: Soft tissue disorders of the foot, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Harcourt Health Science, 1999, pp 1373-1397.