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Dow J. Cold Injury. Emerg Med Clin North Am 2024; 42:513-525. [PMID: 38925771 DOI: 10.1016/j.emc.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Cold injury has been documented for centuries and remains a concern for military personnel, winter recreationalists, and urban homeless populations. Treatment advances in the last decades have included thrombolytic and prostaglandin therapies however the mainstay remains early recognition and rapid rewarming. This chapter focuses on frostbite, with a brief overview of other cold related conditions.
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Affiliation(s)
- Jennifer Dow
- Department of Emergency Medicine, Alaska Regional Hospital, Anchorage, AK, USA; National Park Service, Alaska Region.
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Gruber E, Oberhammer R, Brugger H, Bresadola E, Avogadri M, Kompatscher J, Kaufmann M. Prolonged critical avalanche burial for nearly 23 h with severe hypothermia and severe frostbite with good recovery: a case report. Scand J Trauma Resusc Emerg Med 2024; 32:11. [PMID: 38347576 PMCID: PMC10863192 DOI: 10.1186/s13049-024-01184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Accidental hypothermia with severe frostbite is a rare combination of injuries with a high risk for long-term sequelae. There are widely accepted recommendations for the management of avalanche victims and for frostbite treatment, but no recommendation exists for the treatment of frostbite in severe hypothermic patients, specifically for the management of hypothermic avalanche victims presenting with frostbite. CASE PRESENTATION We present a case of a previously healthy, 53-year-old male skier who was critically buried by an avalanche at 2300 m of altitude at an ambient temperature of - 8 °C for nearly 23 h. The victim was found with the right hand out of the snow and an air connection to outside. He was somnolent with Glasgow Coma Scale 11 (Eye 4, Verbal 2, Motor 5) and spontaneously breathing, in a severely hypothermic state with an initial core temperature of 23.1 °C and signs of cold injuries in all four extremities. After rescue and active external forced air rewarming in the intensive care unit, the clinical signs of first-degree frostbite on both feet and the left hand vanished, while third- to fourth-degree frostbite injuries became apparent on all fingers of the right hand. After reaching a core body temperature of approximately 36 °C, aggressive frostbite treatment was started with peripheral arterial catheter-directed thrombolysis with alteplase, intravenous iloprost, ibuprofen, dexamethasone and regional sympathicolysis with a right-sided continuous axillary block. After ten months, the patient had no tissue loss but needed neuropathic pain treatment with pregabalin. CONCLUSION The combination of severe accidental hypothermia and severe frostbite is rare and challenging, as drug metabolism is unpredictable in a hypothermic patient and no recommendations for combined treatment exist. There is general agreement to give hypothermia treatment the priority and to begin frostbite treatment as early as possible after full rewarming of the patient. More evidence is needed to identify the optimal dosage and time point to initiate treatment of frostbite in severely hypothermic patients. This should be taken into consideration by future treatment recommendations.
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Affiliation(s)
- Elisabeth Gruber
- Department of Emergency Medicine, Anaesthesia and Intensive Care, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, Via Lorenz Boehler 5, 39100, Bolzano-Bozen, Italy.
- HELI HEMS Service South Tyrol, Via Lorenz Boehler 3, 39100, Bolzano-Bozen, Italy.
| | - Rosmarie Oberhammer
- HELI HEMS Service South Tyrol, Via Lorenz Boehler 3, 39100, Bolzano-Bozen, Italy
- Department of Anaesthesia and Intensive Care, Emergency Medicine and Pain Therapy, Hospital of Brunico (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, Via Ospedale 11, 39031, Brunico-Bruneck, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, 39100, Bolzano-Bozen, Italy
| | - Elisa Bresadola
- Department of Emergency Medicine, Anaesthesia and Intensive Care, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, Via Lorenz Boehler 5, 39100, Bolzano-Bozen, Italy
- Aiut Alpin Dolomites Helicopter Emergency Medical Service, Pontives 24, 39040, Laion- Lajen, Italy
| | - Matteo Avogadri
- Aiut Alpin Dolomites Helicopter Emergency Medical Service, Pontives 24, 39040, Laion- Lajen, Italy
| | - Julia Kompatscher
- Department of Emergency Medicine, Anaesthesia and Intensive Care, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, Via Lorenz Boehler 5, 39100, Bolzano-Bozen, Italy
- HELI HEMS Service South Tyrol, Via Lorenz Boehler 3, 39100, Bolzano-Bozen, Italy
| | - Marc Kaufmann
- Department of Emergency Medicine, Anaesthesia and Intensive Care, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, Via Lorenz Boehler 5, 39100, Bolzano-Bozen, Italy
- HELI HEMS Service South Tyrol, Via Lorenz Boehler 3, 39100, Bolzano-Bozen, Italy
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Mekjavic IB, Norheim AJ, Friedl KE. Human performance and medical treatment during cold weather operations - synthesis of a symposium. Int J Circumpolar Health 2023; 82:2246666. [PMID: 37594504 PMCID: PMC10444010 DOI: 10.1080/22423982.2023.2246666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023] Open
Abstract
In October 2022, the Human Factors and Medicine (HFM) panel of the NATO Science and Technology Organization convened a review of progress in military biomedical research for cold weather operations. This paper represents a summary of the research presentations and future directions. The importance of realistic training was an overarching theme. Many reported studies took advantage of cold weather training exercises to monitor soldiers' health and performance; these are valuable data, using winter exercises as a platform to gain further knowledge regarding human performance in the cold and represent an excellent extension of controlled laboratory studies. Topics also included prevention of Cold Weather Injuries (CWI); effects of cold weather stressors on cognitive function; field treatment of freezing cold injuries (FCI); and new consideration to injury and trauma care in the cold. Future work programmes re-emphasise development of cold weather training and establishment of consensus diagnostic criteria and treatments for FCI and non-FCI. CWI prevention should take advantage of biomathematical models that predict risk of CWI and provide guidance regarding optimal clothing and equipment and move from group averages to personalised predictions. The publication of selected presentations from the symposium in this special issue increases attention to military cold weather research.
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Affiliation(s)
- Igor B. Mekjavic
- Department of Automatics, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, SLOVENIA
| | - Arne Johan Norheim
- National Research Center in Complementary and Alternative Medicine, Institute of Community Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Karl E. Friedl
- US Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA, USA
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