Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series
Autor: | Mira MacLennan, Alexander Poole, Josianne Gauthier |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Adult
Male medicine.medical_specialty Emergency Medical Services Alcohol Drinking Vasodilator Agents Medical care Severity of Illness Index Amputation Surgical Time-to-Treatment Fingers Fibrinolytic Agents Risk Factors Yukon Territory medicine Humans Clinical significance Iloprost General hospital Retrospective Studies Frostbite business.industry Heparin Research Clinical course General Medicine Emergency department medicine.disease Surgery Outcome and Process Assessment Health Care Tissue Plasminogen Activator Female business medicine.drug Sports |
Zdroj: | CMAJ Open |
ISSN: | 2291-0026 |
Popis: | 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. |
Databáze: | OpenAIRE |
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