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recent trauma or surgery, bleeding diathesis, neurological impairment, etc) Access to a critical care unit Intra-arterial administeration is preferred Co-administeration of papaverine may be needed to reduce vasospasm Heparin should be used as an adjunctive treatment to minimize new clot formation Iloprost Prostacyclin analogue with vasodilatory properties, reduces capillary permability, supresses platelet aggregation, promotes fibrinolysis [29] Note that it is not available in the US Research Cauch et al: reduced amputation among 407 patients that were at risk [30] Case reports have also suggested benefit Administered as an IV infusion Advantages over TPA Does not require radiological intervention, can be administered on a monitored ward, used more than 24 hours after injury, not contraindicated after trauma Surgical Treatment Options Fasciotomy Acute Compartment Syndrome can develop with rewarming and the subsequent edema Important to monitor for signs and symptoms Note that this can be challenging in the context of frosbite Amputation Ideally, surgical amputation should be avoided until autoamputation/demarcation awaited

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