From: Frostbite: a practical approach to hospital management
Questions/indications to be considered | |
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Treatment screen (four ‘yes’ answers required to proceed to angiography) | Are the patient's gas exchange and haemodynamics stable? |
Is flow absent after rewarming (no capillary refill or Doppler signals)? | |
Was the cold exposure time less than 24 h? | |
Is the warm ischaemia time less than 24 h? | |
Treatment protocol | Perform angiography with intra-arterial vasodilators |
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 | |
Repeat angiography after 24 h | |
Indications for stopping the infusion of the rTPA | When restored flow has been confirmed by angiography or clinical examination |
If major bleeding complication occurs | |
After 72-h treatment | |
Post lysis anticoagulation | One month of subcutaneous low-molecular weight heparin at prophylactic dose |