處理凍瘡. 點滴不需要加溫. 回溫仍以直接泡溫水最有效. 浸泡在 37-39 °C 熱水, 最好有迴旋的水流, 維持恆溫. 回溫的時候請病患動一動肢體, 治療的過程避免凍傷部位觸碰到外界 (例如恆溫水浴槽)造成受傷 (凍傷的部位組織脆弱容易受損), 水溫更高會讓回溫過程更痛. 而且不一定能更迅速回溫. 不建議乾式回溫(吹風機等等).
當肢體呈現紅色或紫色而且柔軟通常代表回溫完成. 回溫過程一般需要 15-30 分鐘. 回溫過程會很痛. 應給予適當的止痛(例如類嗎啡 OPIOIDS).
Rewarming — Rewarming is most effectively accomplished by immersing the affected area in water heated to 37 to 39°C (98.6 to 102.2°F), ideally in a whirlpool so a steady temperature can be maintained [50]. Gentle active motion of the extremity while rewarming may help. Care should also be taken to avoid trauma to the injured area against the container walls during treatment. Higher temperatures do not warm the injured area appreciably faster and cause the warming process to be much more painful. Dry heat is difficult to regulate and is not recommended.
Thawing 解凍 is usually complete when the tissue is red or purple and soft to the touch. This usually takes 15 to 30 minutes. Rewarming of frostbitten tissue may be painful. Appropriate analgesia, generally opioids, should be administered.
Thawing 解凍 is usually complete when the tissue is red or purple and soft to the touch. This usually takes 15 to 30 minutes. Rewarming of frostbitten tissue may be painful. Appropriate analgesia, generally opioids, should be administered.
教科書建議, 如果有起水泡, 應該每六小時塗抹蘆薈膠. ALOE VERA.
凍傷長這樣
下面這段新版的相同. 解凍過程最常見的錯誤是因為疼痛而中止解凍過程. 不完全解凍. 解凍過程外傷(用冰塊或手按摩或磨擦造成)以及使用高溫和長時間回溫對於保存活組織是有害的. 應避免. 直接乾式回溫或使用加熱器可能導致次發性燙傷. 應避免.
舊版的 MEDSCAPE 回溫的溫度寫 40-42 度C. 新版的已經修改了. 住院的時候以 37-39 度C 的循環水回溫. 通常需 15-30 分鐘直到組織完全解凍. 可在回溫的水裡面添加殺菌劑 (優碘,氯己定). 回溫不要太慢. 也不要過度加熱, 建議病患一邊回溫一邊活動肢體, 持續監測水溫是否恆溫. 解凍過程可能需 20-40 分鐘, 深部組織可能需 1 小時才能解凍.
回溫，治療凍傷最有效的方式是回溫，在循環的 40-42度C 水溫中，於 15-30 分鐘內讓病患凍傷部位回溫，不要讓水溫超過 43.3度C，回溫時間不要太長，不要加熱過度，解凍常需要 20-40 分鐘，深度凍傷可能需 1 小時達成回溫，最常見的錯誤是，因為疼痛而太早結束回溫，物理性傷害（按摩、使用手或冰雪摩擦），回溫使用的溫度過高，回溫時間過久，這些都會加重組織傷害，應該避免，使用火或者加熱器乾式回溫，可能讓失溫的組織缺乏溫度感覺下，造成二度燙傷，應該避免。
部分解凍和再次凍傷會造成更大傷害，應該避免，如果傷患解凍過的部位又再次凍傷，回溫應該先避免，直到能保證回溫過程順暢
下面是舊的資料... 僅供參考.
在台灣，凍傷病患不常見，多數醫師經驗都不多，在國外，凍傷建議給燙傷中心處理，治療目標是盡量搶救最多的組織，能回復最佳功能，避免併發症。在美國，街友住到燙傷中心，有 29％的人是因為凍傷。治療凍傷前，一樣要注意呼吸道、循環，呼吸狀況，凍傷部位不可以再度凍傷，將凍傷的肢體儘速回溫，使用 40-42度C的溫水回溫。水溫不要太高或太低，回溫過程不要中斷，回溫同時也要控制疼痛。（在野外環境，如果回溫後可能再次凍傷，建議不要先回溫，應該儘速送到有醫療設備的安全場所）
不要太早截肢，除非組織已經確定壞死。曾經受傷的部位更容易再次受傷，即使在稍微溫和的環境溫度變化下也可能受傷。所以要小心保護。
住院病患考慮可以先照個相片，24小時之後再一張，之後每兩三天照一張，直到出院。
The goal of frostbite treatment is to salvage as much tissue as possible, to achieve maximal return of function, and to prevent complications.[30]If treating personnel are unfamiliar with the management of frostbite and its sequelae, transfer of the patient to another facility should be considered. In some settings, burn units have particular expertise in managing severe frostbite injuries. In one report, 29% of homeless patients admitted to a burn unit were admitted for frostbite.[31]Therefore, transfer to a facility with a burn unit may be an option.
Be sure to correct the ABCs (A irway, B reathing, and C irculation) and life-threatening conditions before treating frostbite. Make sure that the frostbitten area does not refreeze. Rewarm the frostbitten area as quickly as possible to salvage as much tissue and function as possible. The use of circulating water at 40-42°C is common. Do not allow the water to get too hot or too cold. Avoid premature termination of the rewarming process. Remember to treat pain associated with rewarming.
Avoid early amputation until after the nonviable tissue is clearly demarcated. Inform patients that the injury site is more prone to recurrent damage when exposed to even moderate changes in environmental temperature.
Consider obtaining a photographic record on admission, 24 hours after admission, and serially every 2-3 days until discharge.
The management of frostbite itself may be divided into 3 phases: field management, rewarming, and postrewarming management.[17]
Rewarming
Rapid rewarming is the single most effective therapy for frostbite.[33]Variations on the original work of McCauley et al are used at most centers experienced in the management of the frostbite patient.[21]This includes admission of all frostbite patients to a specialty unit, if possible. Consider obtaining photographic records on admission, at 24 hours, and serially every 2-3 days until discharge.
新版建議已經將回溫的水溫改為 37-39 度C 了. 回溫的時間相同 15-30 分鐘. 解凍過程通常需要 20-40 分鐘. 深部組織解凍可能需 1 小時.
On admission, rapidly rewarm the affected area in circulating water (ie, a whirlpool bath) at 40-42°C. The circulation of water allows a constant temperature to be applied to the affected area. Warming is continued for 15-30 minutes or until thawing is, by clinical assessment, complete (ie, when the distal area of the extremity is flushed, soft, and pliable).
Avoid inadvertent slow rewarming or overheating. Encourage active gentle motion of the frostbitten area during the rewarming. Constantly monitor water temperature to ensure it does not exceed 43.3°C. Thawing takes about 20-40 minutes for superficial injuries and as long as 1 hour for deep injuries.
下面這段新版的相同. 解凍過程最常見的錯誤是因為疼痛而中止解凍過程. 不完全解凍. 解凍過程外傷(用冰塊或手按摩或磨擦造成)以及使用高溫和長時間回溫對於保存活組織是有害的. 應避免. 直接乾式回溫或使用加熱器可能導致次發性燙傷. 應避免.
The most common error in this stage of treatment is premature termination of the rewarming process because of reperfusion pain. Mechanical trauma (massaging or rubbing with ice or by hand) and rewarming at higher temperatures and for longer periods of time are detrimental to preserving viable tissue and should be avoided. Direct dry heating using fire or a heater can lead to burns secondary to loss of temperature sensation and so should be avoided.
Partial thawing and refreezing generate more damage than does prolonged freezing alone, through the release of multiple inflammatory mediators. In patients who experience a refreezing injury of thawed areas, rewarming should be delayed until it can be maintained.
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