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Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series
BACKGROUND: We identified the need to modernize frostbite management in our northern centre and implemented a treatment protocol in 2015. Our aim was to describe the clinical course of patients presenting to the hospital since the implementation of the protocol. METHODS: This was a retrospective cas...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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CMA Joule Inc.
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177911/ https://www.ncbi.nlm.nih.gov/pubmed/34021017 http://dx.doi.org/10.9778/cmajo.20200214 |
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author | Poole, Alexander Gauthier, Josianne MacLennan, Mira |
author_facet | Poole, Alexander Gauthier, Josianne MacLennan, Mira |
author_sort | Poole, Alexander |
collection | PubMed |
description | BACKGROUND: We identified the need to modernize frostbite management in our northern centre and implemented a treatment protocol in 2015. Our aim was to describe the clinical course of patients presenting to the hospital since the implementation of the protocol. METHODS: This was a retrospective case series from Whitehorse General Hospital, Whitehorse, Yukon Territory, Canada. We reviewed the charts of patients who presented to the hospital with grade 2–4 frostbite and were treated as per our protocol between Feb. 9, 2015, and Feb. 8, 2020. Patients with grade 2–4 frostbite received iloprost; in addition, those with grade 4 frostbite received alteplase and heparin. We determined the number of digits affected and salvaged, and the time from presentation to the emergency department to treatment initiation. We also examined patients’ demographic characteristics, predisposing events, frostbite severity and adverse drug reactions. RESULTS: In 22 patients treated for grade 2–4 frostbite, 142 digits were affected: 59 with grade 2 frostbite, 25 with grade 3 frostbite and 58 with grade 4 frostbite; of the 142, 113 (79.6%) were salvaged. All 29 digits amputated had grade 4 frostbite. The mean time from presentation to iloprost initiation was reduced from 32.9 hours in 2015 to 3.0 hours in 2020. Sports (10 cases [45%]) and alcohol use (6 [27%]) were the most common precipitating events, with alcohol use tending to result in more severe injury (grade 4 in 5 of 6 cases). Adverse reactions with iloprost (e.g., headache) were common but mild. Adverse reactions with alteplase (e.g., bleeding) were less common but of greater clinical significance. INTERPRETATION: Over the study period, our protocol contributed to improvement in frostbite care at our institution, resulting in a digit salvage rate comparable to other published results. Our 5-year experience shows that advanced medical care of frostbite can be achieved, even at a rural centre. |
format | Online Article Text |
id | pubmed-8177911 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | CMA Joule Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-81779112021-06-05 Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series Poole, Alexander Gauthier, Josianne MacLennan, Mira CMAJ Open Research BACKGROUND: We identified the need to modernize frostbite management in our northern centre and implemented a treatment protocol in 2015. Our aim was to describe the clinical course of patients presenting to the hospital since the implementation of the protocol. METHODS: This was a retrospective case series from Whitehorse General Hospital, Whitehorse, Yukon Territory, Canada. We reviewed the charts of patients who presented to the hospital with grade 2–4 frostbite and were treated as per our protocol between Feb. 9, 2015, and Feb. 8, 2020. Patients with grade 2–4 frostbite received iloprost; in addition, those with grade 4 frostbite received alteplase and heparin. We determined the number of digits affected and salvaged, and the time from presentation to the emergency department to treatment initiation. We also examined patients’ demographic characteristics, predisposing events, frostbite severity and adverse drug reactions. RESULTS: In 22 patients treated for grade 2–4 frostbite, 142 digits were affected: 59 with grade 2 frostbite, 25 with grade 3 frostbite and 58 with grade 4 frostbite; of the 142, 113 (79.6%) were salvaged. All 29 digits amputated had grade 4 frostbite. The mean time from presentation to iloprost initiation was reduced from 32.9 hours in 2015 to 3.0 hours in 2020. Sports (10 cases [45%]) and alcohol use (6 [27%]) were the most common precipitating events, with alcohol use tending to result in more severe injury (grade 4 in 5 of 6 cases). Adverse reactions with iloprost (e.g., headache) were common but mild. Adverse reactions with alteplase (e.g., bleeding) were less common but of greater clinical significance. INTERPRETATION: Over the study period, our protocol contributed to improvement in frostbite care at our institution, resulting in a digit salvage rate comparable to other published results. Our 5-year experience shows that advanced medical care of frostbite can be achieved, even at a rural centre. CMA Joule Inc. 2021-05-21 /pmc/articles/PMC8177911/ /pubmed/34021017 http://dx.doi.org/10.9778/cmajo.20200214 Text en © 2021 CMA Joule Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ |
spellingShingle | Research Poole, Alexander Gauthier, Josianne MacLennan, Mira Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series |
title | Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series |
title_full | Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series |
title_fullStr | Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series |
title_full_unstemmed | Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series |
title_short | Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series |
title_sort | management of severe frostbite with iloprost, alteplase and heparin: a yukon case series |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177911/ https://www.ncbi.nlm.nih.gov/pubmed/34021017 http://dx.doi.org/10.9778/cmajo.20200214 |
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