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Frostbite is a cold-induced injury that occurs when tissues freeze, leading to ice crystal formation, cellular damage, and impaired microcirculation. The most severe cases can result in tissue necrosis and amputation. Individuals at highest risk include those exposed to prolonged cold, such as military personnel, outdoor workers, mountaineers, and unhoused populations. Rapid rewarming and supportive care remain the mainstays of treatment, but adjunctive therapies like hyperbaric oxygen therapy (HBOT) are gaining interest. HBOT may improve outcomes by enhancing oxygen delivery to hypoxic tissues, reducing edema, and limiting ischemia-reperfusion injury, which are key components in frostbite pathophysiology. Although high-quality evidence is limited to animal models, case reports, and small retrospective studies, the biological plausibility and promising clinical observations support its cautious use in select cases. Indications for HBOT in frostbite include deep tissue involvement, absent Doppler signals in affected digits, and early signs of tissue hypoxia not responsive to standard care. Contraindications include untreated pneumothorax, certain types of ear or sinus barotrauma, and inability to tolerate the chamber environment. In this setting, complications may include barotrauma, oxygen toxicity, and confinement anxiety. This activity for healthcare professionals is designed to enhance learners' competence in administering HBOT for frostbite and evaluating candidates for suitability. Participants will deepen their understanding of HBOT's action mechanism in treating frostbite, as well as its indications, contraindications, and potential complications. Proper equipment, preparation, and technique will also be highlighted. Improved skills will empower clinicians to collaborate within interprofessional teams caring for affected individuals. Objectives: Evaluate patients with frostbite injury for suitability to undergo hyperbaric oxygen therapy. Apply best practices when administering hyperbaric oxygen therapy to individuals with frostbite injury. Improve communication strategies to educate patients with frostbite injury on the benefits, risks, and process of hyperbaric oxygen therapy, ensuring informed decision-making in their treatment plan.

Evaluate patients with frostbite injury for suitability to undergo hyperbaric oxygen therapy. Apply best practices when administering hyperbaric oxygen therapy to individuals with frostbite injury. Improve communication strategies to educate patients with frostbite injury on the benefits, risks, and process of hyperbaric oxygen therapy, ensuring informed decision-making in their treatment plan. Coordinate with the interprofessional team to improve care coordination and communication to advance hyperbaric treatment of frostbite injury and optimize patient outcomes. Access free multiple choice questions on this topic.

Although evidence for treating frostbite with hyperbaric oxygen therapy (HBOT) is limited, primarily based on case reports and inadequate animal studies, a plausible mechanism of action supports its potential effectiveness. Early initiation of HBOT following rewarming may offer additional benefits. However, animal studies typically involve rapid freezing of tissues, leading to deeper and nearly immediate tissue destruction.[1][2][3] This model differs from the slower, progressive freezing observed in human clinical cases of frostbite.

The most common complications of HBOT involve barotrauma of the ears and, less frequently, the sinuses. Oxygen toxicity, though extremely rare, has been reported without recurrence or sequelae. Another rare complication is barotrauma to parenchymal lung tissue from blebs or emphysematous bullae, leading to pneumothorax, but this condition is also rarely reported after HBOT. A review of 782 patients undergoing 11,376 HBOT found that 17% experienced ear pain or discomfort, with barotrauma confirmed in only 3.8%. No cases of barotrauma to teeth or sinuses were identified. Four patients experienced oxygen seizures, but none had recurrences or sequelae. Other complications include possible worsening of existing cataracts and a temporary increase in myopia, which resolves within weeks after treatment. Patients with confinement anxiety (claustrophobia) may require anxiolytic therapy.

Adjuvant therapy with HBOT for frostbite appears reasonable, well-tolerated, and safe. However, supporting evidence remains limited to level 4 studies, primarily case series with only historical outcomes for comparison. Nurses and clinicians involved in wound care should be reminded about HBOT as a potential intervention. Optimal outcomes typically require an interprofessional team involving hyperbaric medicine, nursing, wound care, plastic surgery, and trauma surgery.