New Hampshire American College of Surgeons The website of the NH Chapter of the American College of Surgeons is an ideal site to offer immediate practical information on the care of frostbite and what has worked for our patients. 1) In the Pre-hospital Setting 2) The Emergency Department 3) The First Week (in/out of hospital) 4) Case History and photographs NOTES IV/PO meds and some hydrating and anti coagulant IV fluids to enhance early survival are being used and are being researched extensively. Low Molecular Weight Dextran may have some effect, as heparin might. The damage to the blood vessels may be more extensive than the local thrombosis. Early use of aloevera/silvadene/ ASA/Ibuprofen for their anti inflammatory / antiinfective properties are strongly encouraged. Antibiotics should be saved for an established infection. Early debridement has been traditionally discouraged, because the demarcation process is often misleading until final necrosis and viability are established. This is a six week disease, by normal clinical determination. If one waits for auto amputation, it means the viability is finally established by 6 weeks, and the demarcation is very clear. In the burned tissue paradigm, where the extent of injury is greater than the visible injury, debridement performed early is encouraged. In the Frostbite case, the tissue may be less damaged than is visible. There may be viable tissue under dead skin. Consider technetium 99 scan in first 48 hours, to determine depth of injury. The haemorrhage over the frozen tissue from prehospital chafing may make the area look worse than it is. Refreezing will cause increased damage. The process is about 6 weeks, before clinical determination of final results can occur. (Do not consider amputation, until all viable tissue has been identified by technetium 99 scan or by adequate time.) Determination of the extent of tissue loss is being schematised in ongoing research**. REFERENCES: Wilderness Environ Med 2001 Winter;12(4):248-55** Retrospective study of 70 cases of severe frostbite lesions: a proposed new classification scheme. Cauchy E, Chetaille E, Marchand V, Marsigny B. Department of Mountain Medicine and Trauma, Chamonix Hospital, France. Advanced Trauma Life Support for Doctors, Instructor Course Manual 1997 American College of Surgeons Committee on Trauma ACKNOWLEDGEMENTS I am deeply grateful for the input of many experienced colleagues and M. Allman in the CASE HISTORY. Harry McDade MD was a real source of inspiration to the Physicians of New Hampshire. His knowledge of Frost Bite is sorely missed. I hope this builds on what he taught us. M. Moslow-Benway, the Photographer of 'The Mount Washington' image and of the CASE HISTORY images has given me gracious permission to use these to help educate those, who need the encouragement to care for others with Frost Bite Injuries. This is not a complete thesis on Frost Bite, merely a guide. Mt. Washington Observatory Observatory Tower