Bedside Fluorescence Microangiography for Frostbite Diagnosis in the Emergency Department
Introduction: Frostbite leads to progressive ischemia eventually causing tissue necrosis if not quickly reversed. Patients with frostbite tend to present to the emergency department (ED) for assessment and treatment. Acute management includes rewarming, pain management, and (when indicated) thrombol...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2022-10-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/1g90h9fj |
| _version_ | 1828283604949532672 |
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| author | Sarah M. Raleigh Margot Samson Rachel Nygaard Fredrick Endorf Joseph Walter Thomas Masters |
| author_facet | Sarah M. Raleigh Margot Samson Rachel Nygaard Fredrick Endorf Joseph Walter Thomas Masters |
| author_sort | Sarah M. Raleigh |
| collection | DOAJ |
| description | Introduction: Frostbite leads to progressive ischemia eventually causing tissue necrosis if not quickly reversed. Patients with frostbite tend to present to the emergency department (ED) for assessment and treatment. Acute management includes rewarming, pain management, and (when indicated) thrombolytic therapy. Thrombolytic therapy in severe frostbite injury may decrease rates of amputation and improve patient outcomes. Fluorescence microangiography (FMA) has been used to distinguish between perfused and non-perfused tissue. The purpose of this study was to evaluate the potential role of FMA in the acute care of patients with frostbite, specifically its role as a tool to identify perfusion deficit following severe frostbite injury, and to explore its role in time to tissue plasminogen activator (tPA). Methods: This retrospective analysis included all patients from December 2020–March 2021 who received FMA in a single ED as part of their initial frostbite evaluation. In total, 42 patients presented to the ED with concern for frostbite and were evaluated using FMA. Results: Mean time from arrival in the ED to FMA was 46.3 minutes. Of the 42 patients, 14 had clinically significant perfusion deficits noted on FMA and received tPA. Mean time to tPA (measured from ED arrival to administration of tPA) for these patients was 117.4 minutes. This is significantly faster than average historical times at our institution of 240–300 minutes. Conclusion: Bedside FMA provides objective information regarding perfusion deficits and allows for faster decision-making and improved times to tPA. Fluorescence microangiography shows promise for quick and efficient evaluation of perfusion deficits in frostbite-injured patients. This could lead to faster tPA administration and potentially greater rates of tissue salvage after severe frostbite injury. |
| first_indexed | 2024-04-13T08:46:28Z |
| format | Article |
| id | doaj.art-4f55cd1df84b4e97a3bc7e08a912e7de |
| institution | Directory Open Access Journal |
| issn | 1936-9018 |
| language | English |
| last_indexed | 2024-04-13T08:46:28Z |
| publishDate | 2022-10-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-4f55cd1df84b4e97a3bc7e08a912e7de2022-12-22T02:53:38ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-90182022-10-0123610.5811/westjem.2022.8.55020wjem-23-872Bedside Fluorescence Microangiography for Frostbite Diagnosis in the Emergency DepartmentSarah M. Raleigh0Margot Samson1Rachel Nygaard2Fredrick Endorf3Joseph Walter4Thomas Masters5Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, MinnesotaHennepin County Medical Center, Department of Emergency Medicine, Minneapolis, MinnesotaHennepin County Medical Center, Department of Surgery, Minneapolis, MinnesotaHennepin County Medical Center, Department of Surgery, Minneapolis, MinnesotaHennepin County Medical Center, Department of Hyperbaric Medicine, Minneapolis, MinnesotaHennepin County Medical Center, Department of Emergency Medicine, Minneapolis, MinnesotaIntroduction: Frostbite leads to progressive ischemia eventually causing tissue necrosis if not quickly reversed. Patients with frostbite tend to present to the emergency department (ED) for assessment and treatment. Acute management includes rewarming, pain management, and (when indicated) thrombolytic therapy. Thrombolytic therapy in severe frostbite injury may decrease rates of amputation and improve patient outcomes. Fluorescence microangiography (FMA) has been used to distinguish between perfused and non-perfused tissue. The purpose of this study was to evaluate the potential role of FMA in the acute care of patients with frostbite, specifically its role as a tool to identify perfusion deficit following severe frostbite injury, and to explore its role in time to tissue plasminogen activator (tPA). Methods: This retrospective analysis included all patients from December 2020–March 2021 who received FMA in a single ED as part of their initial frostbite evaluation. In total, 42 patients presented to the ED with concern for frostbite and were evaluated using FMA. Results: Mean time from arrival in the ED to FMA was 46.3 minutes. Of the 42 patients, 14 had clinically significant perfusion deficits noted on FMA and received tPA. Mean time to tPA (measured from ED arrival to administration of tPA) for these patients was 117.4 minutes. This is significantly faster than average historical times at our institution of 240–300 minutes. Conclusion: Bedside FMA provides objective information regarding perfusion deficits and allows for faster decision-making and improved times to tPA. Fluorescence microangiography shows promise for quick and efficient evaluation of perfusion deficits in frostbite-injured patients. This could lead to faster tPA administration and potentially greater rates of tissue salvage after severe frostbite injury.https://escholarship.org/uc/item/1g90h9fj |
| spellingShingle | Sarah M. Raleigh Margot Samson Rachel Nygaard Fredrick Endorf Joseph Walter Thomas Masters Bedside Fluorescence Microangiography for Frostbite Diagnosis in the Emergency Department Western Journal of Emergency Medicine |
| title | Bedside Fluorescence Microangiography for Frostbite Diagnosis in the Emergency Department |
| title_full | Bedside Fluorescence Microangiography for Frostbite Diagnosis in the Emergency Department |
| title_fullStr | Bedside Fluorescence Microangiography for Frostbite Diagnosis in the Emergency Department |
| title_full_unstemmed | Bedside Fluorescence Microangiography for Frostbite Diagnosis in the Emergency Department |
| title_short | Bedside Fluorescence Microangiography for Frostbite Diagnosis in the Emergency Department |
| title_sort | bedside fluorescence microangiography for frostbite diagnosis in the emergency department |
| url | https://escholarship.org/uc/item/1g90h9fj |
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