Managing Superficial Thermal Cold Injury (Frostbite) in the Inpatient and Outpatient Setting using Sodium Carboxymethylcellulose Dressing with Ionic Silver* (Na-CMC-Ag) as the Primary Dressing

 

Clinical Problem:  Frostbite is a common and serious injury in Interior Alaska; deep (beyond subcutaneous tissues involving tendons, muscles, nerves and even bone), and superficial injuries (skin and subcutaneous tissues), are usually present on the same body part.  Most patients show complete healing of superficial frostbite with traditional treatment of daily/ twice daily mechanical debridement,  antibiotic ointment, non-stick dressings and gauze.  Similarities in the pathophysiology of thermal burns and ischemia/reperfusion injury prompted the use of Na-CMC-Ag based on significantly less procedure pain, fewer dressing changes with debridement, decreased hospital stays/readmissions, and less overall cost as seen in burn care with advanced dressings.¹

Approach:  Areas of frostbite were debrided as indicated, Na-CMC-Ag dressings were applied and left in place until detachment or removal.  Patient A:  70 YO male frostbite to bilateral hands, knees, and feet, temperature of -40⁰ F.  Na-CMC-Ag dressings applied post injury day (PID) 1.  PID 11, 95-100% resolved.  Patient B: 24 YO male, frostbite bilateral feet, temperature of -25⁰’F. Initial care, traditional protocol.   Hospital admission on PID 5 with debridement and Na-CMC-Ag dressings initiated by CWCN. Discharge PID 6.   PID 25, 100% resolved.  Patient C:  56 YO homeless male with frostbite bilateral feet, temperature of -30⁰ F compounded by burn over frostbite from kerosene heater.  Hospital  admission  PID 1 with traditional protocol.  Debridement and Na-CMC-Ag dressings began on PID 3.  Discharge PID 4, PID 13 superficial frostbite injuries were 60-90% resolved. 

Conclusions:  Pain control using the frostbite care protocol with Na-CMC-Ag dressings was reported as very good or good in these patients.  The ability to discharge the patient from the hospital and no readmissions was viewed as favorable and may have lowered the cost of care.  Maximizing outcomes with attention to available resources and cost, supports standardizing care with evidence based protocols in both the rural and urban areas.