Skiing with no gloves. How do you handle these cold injuries? — Management of Pediatric Hypothermia

A 17-year-old boy comes into your ED complaining of numbness and hardening of his fingers. He is a previously healthy foreign exchange student who is staying with a host family. The symptoms started yesterday after he went snow skiing for the first time. He says he wore gloves, but he was having a hard time holding the ski poles, so he took them off midway through the day. On examination, the fingertips on both of his hands are firm to the touch, have a dark discoloration, and are without sensation. The firmness and discoloration extend only to the distal interphalangeal joint in most of the fingers, but to the proximal interphalangeal joint in the middle finger of his left hand. The thumb on his right hand has a sizeable blister. As you step out of the room, you contemplate the next steps.

How do you classify the severity of his cold injuries? Does his thumb need debridement? Should you consult a hand surgeon and/or the burn center? What is the long-term prognosis for his injuries?

Come back on Jan 14th to see if you got it right!

Last Updated on January 26, 2023

3 thoughts on “Skiing with no gloves. How do you handle these cold injuries? — Management of Pediatric Hypothermia

  1. This would be considered severe frostbite based on blistering, firmness of tissue, loss of sensation and discoloration. This patient will need debridement, antibiotics (blister and possible secondary infection), possible tpa dependent on severity to help restore blood flow to distal tips . Hyperbaric oxygen therapy may help in promoting wound healing, lastly amputation to prevent further necrosis of tissue and to prevent a more severe infection. I would consult surgery and let them advise on further treatment plan..

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