Wilderness and Rescue Medicine 8th Edition

Wilderness and Rescue Medicine 148

Inflammation, pain, and infection are antici- pated problems. Rewarmed tissue is very sus- ceptible to further injury, even from normal use. Refreezing is devastating. Allowing tissue to remain frozen for several hours during a self- evacuation is better than attempting to walk out on painful and swollen rewarmed feet.

Figure A: Ecchymotic frostbitten lesions on ventral aspect of fingers on both hands. Figure B: Swollen right 4th and 5th fingers showing ruptured blister- ing at the base of 5th finger. Subedi BH, Pokharel J, Thapa R, Banskota N, Basnyat B. Frostbite in a sherpa. Wilderness Environ Med. 2010;21(2):127-9. Reprinted with permission from the Wilderness Medical Society. ©2010 Wilderness Medical Society. Field rewarming of deep frostbite is less than ideal but should be considered if evacuation will be dangerous or prolonged. You must have the necessary shelter and equipment and be able to prevent refreezing. Do not rewarm in the field if use of the extremity will be necessary for survival and evacuation. Set up a secure shelter, and be sure your patient is warm, dry, well fed, and hydrated. Premedicate with an anti-inflammatory drug like ibuprofen (800 mg) taken by mouth. This reduces pain and inflammation and helps pre- vent blood clots in the rewarmed tissue. Giving

In deep frostbite the skin and underlying tissues are frozen solid. The area is white or bluish and hard to the touch.

The foot on the right was frozen, rewarmed, and frozen again before hospital admission. The left foot remained frozen until controlled rewarming was performed.