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Frostbite Medication

  • Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Feb 26, 2016
 

Medication Summary

The goal of medical management is to rewarm the injury as quickly as possible, provide pain control during rewarming, reduce reperfusion injury, prevent frostbite complications, and decrease long-term sequelae.

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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort and may have sedating properties, which are beneficial for patients who have sustained trauma or injuries.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have analgesic and antipyretic activities. Their mechanism of action is not known, but these agents may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil and platelet aggregation, and various cell-membrane functions.

Ibuprofen (Ibuprin, Advil, Motrin, Caldolor)

 

Ibuprofen inhibits inflammatory reactions and pain by blocking synthesis of thromboxane and prostaglandins to reduce reperfusion injury. It prevents platelet aggregation. Ibuprofen is preferable to aspirin, which irreversibly blocks synthesis of the prostaglandins needed for normal cell function and integrity, because it is not associated with Reye syndrome.

Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)

 

Naproxen is a member of the propionic acid group of NSAIDs. It is available in low-dose form as an over-the-counter (OTC) medication. It is highly protein-bound, is metabolized in the liver, and is eliminated primarily in the urine. Naproxen may reversibly inhibit platelet function.

Sulindac (Clinoril)

 

Sulindac decreases COX activity and, in turn, inhibits prostaglandin synthesis. This results in decreased formation of inflammatory mediators.

Celecoxib (Celebrex)

 

Celecoxib primarily inhibits COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID gastrointestinal (GI) toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited; thus, GI toxicity may be decreased. Seek the lowest dose of celecoxib for each patient.

Meloxicam (Mobic)

 

Meloxicam decreases COX activity, and this, in turn, inhibits prostaglandin synthesis. These effects decrease the formation of inflammatory mediators.

Flurbiprofen

 

Flurbiprofen may inhibit COX, thereby, in turn, inhibiting prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities.

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Opioid Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort and may have sedating properties, which are beneficial for patients who have sustained trauma or injuries. These agents are used for pain control during rewarming

Morphine (Duramorph, MS Contin, Oramorph, Avinza)

 

Morphine is the drug of choice for strong analgesia because of its reliable and predictable effects, good safety profile, and ease of reversibility with naloxone. Morphine sulfate administered intravenously (IV) may be dosed in a number of ways and is commonly titrated until the desired effect is obtained.

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Topical Skin Products

Class Summary

Topical agents are applied to debrided clear blisters and intact hemorrhagic blisters to minimize thromboxane synthesis.

Aloe vera

 

Aloe vera inhibits the arachidonic cascade, especially thromboxane synthesis.

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Antibiotics

Class Summary

Antibiotics are used for wound infection prophylaxis. Their use is controversial and not recommended by some experts unless signs of infection develop. If antibiotic prophylaxis is employed, it should be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Penicillin G (Pfizerpen)

 

Penicillin G interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

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Immune Globulins

Class Summary

Immunizing agents are used to treat any person with a wound that might be contaminated with tetanus spores. Patients who may not have been immunized against Clostridium tetani products should receive tetanus immune globulin.

Tetanus immune globulin (TIG) (Hyper Tet, HyperTET S/D, TIG)

 

Tetanus immune globulin is used for passive immunization of any person not been previously vaccinated for tetanus who has a wound that may be contaminated with tetanus spores

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Vaccines, Inactivated, Bacterial

Class Summary

Toxoids are used for tetanus immunization in patients at risk of frostbite-associated tetanus. Booster injection in previously immunized individuals is recommended to prevent this potentially lethal syndrome. In a patient who was never fully immunized, these should be supplemented with tetanus immune globulin 250 U intramuscularly (IM).

Diphtheria and tetanus toxoids (Decavac)

 

Tetanus and diphtheria toxoids are used to induce active immunity against tetanus in selected patients. They are the immunizing agents of choice for most adults and children older than 7 years. Booster doses must be administered to maintain tetanus immunity throughout life. Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen-containing product.

In children and adults, tetanus and diphtheria toxoids may be administered into the deltoid or the midlateral thigh muscles. In infants, the preferred site of administration is the mid thigh laterally.

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Contributor Information and Disclosures
Author

C Crawford Mechem, MD, MS, FACEP Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department

C Crawford Mechem, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

David Cheng, MD Associate Professor of Emergency Medicine, Education Director, Associate Emergency Medicine Residency Director, Case Medical Center

David Cheng, MD is a member of the following medical societies: American College of Emergency Physicians, International Society for Mountain Medicine, Council of Emergency Medicine Residency Directors, American Heart Association, National Association of EMS Physicians, Society for Academic Emergency Medicine, Society of Critical Care Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Ramy Yakobi, MD, MBA Medical Director, Department of Emergency Medicine, Beth Israel Medical Center

Ramy Yakobi, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Tonya M Thompson, MD, MA Assistant Professor, Departments of Pediatrics and Emergency Medicine, Associate Fellowship Director, Pediatric Emergency Medicine Fellowship, Associate Medical Director, The PULSE Simulation Center, Arkansas Children's Hospital, University of Arkansas for Medical Sciences College of Medicine

Tonya M Thompson, MD, MA is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Womens Association, Phi Beta Kappa, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

H Scott Bjerke, MD, FACS Clinical Associate Professor, Department of Surgery, University of Missouri-Kansas City School of Medicine; Medical Director of Trauma Services, Research Medical Center; Clinical Associate Professor, Department of Surgery, Indiana University School of Medicine

H Scott Bjerke, MD, FACS is a member of the following medical societies: American Association for the History of Medicine, American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Midwest Surgical Association, National Association of EMS Physicians, Pan-Pacific Surgical Association, Royal Society of Medicine, Southwestern Surgical Congress, andWilderness Medical Society

Disclosure: Nothing to disclose.

Burt Cagir, MD, FACS Assistant Professor of Surgery, State University of New York, Upstate Medical Center; Consulting Staff, Director of Surgical Research, Robert Packer Hospital; Associate Program Director, Department of Surgery, Guthrie Clinic

Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, and Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

John Geibel, MD, DSc, MA Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Other

Dawn Hackshaw, MD Consulting Staff, Northwest Pediatrics, Inc

Disclosure: Nothing to disclose.

David L Morris, MD, PhD Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

Disclosure: RFA Medical None Director; MRC Biotec None Director

Harold K Simon, MD, MBA Professor of Pediatrics and Emergency Medicine, Associate Division Director of Pediatric Emergency Medicine, Director of Research, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston

Harold K Simon, MD, MBA is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, American Pediatric Society, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Amit Tevar, MD Staff Physician, Department of Surgery, Methodist Hospital of Indianapolis and University of Indiana

Amit Tevar, MD is a member of the following medical societies: Indiana State Medical Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose

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Frostbite of the foot. Photo courtesy of Kevin P. Kilgore, MD, Department of Emergency Medicine, Regions Hospital.
Frostbite of the ear. Photo courtesy of Kevin P. Kilgore, MD, Department of Emergency Medicine, Regions Hospital.
Frostbite of the hand.
 
 
 
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