Table 3 A proposed screening and treatment tool for the use of thrombolysis in cases of frostbite [17]
From: Frostbite: a practical approach to hospital management
| Â | Questions/indications to be considered |
|---|---|
Treatment screen (four ‘yes’ answers required to proceed to angiography) | Are the patient's gas exchange and haemodynamics stable? |
| Â | Is flow absent after rewarming (no capillary refill or Doppler signals)? |
| Â | Was the cold exposure time less than 24 h? |
| Â | Is the warm ischaemia time less than 24 h? |
Treatment protocol | Perform angiography with intra-arterial vasodilators |
| Â | If there is still no flow after angiography with vasodilators, infuse tissue plasminogen activator (rTPA) with systemic heparinization with priority to the hands; other sites receive a systemic dose |
| Â | Repeat angiography after 24 h |
Indications for stopping the infusion of the rTPA | When restored flow has been confirmed by angiography or clinical examination |
| Â | If major bleeding complication occurs |
| Â | After 72-h treatment |
Post lysis anticoagulation | One month of subcutaneous low-molecular weight heparin at prophylactic dose |