{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T22:15:35Z","timestamp":1774476935605,"version":"3.50.1"},"reference-count":22,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2018,9,1]],"date-time":"2018-09-01T00:00:00Z","timestamp":1535760000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:p> Severe frostbite occurs frequently at extreme altitude in the Himalayas, often resulting in amputations. Recent advances in treatment of frostbite injuries with either intravenous or intra-arterial tissue plasminogen activator, or with iloprost, have improved outcomes in frostbite injuries, but only if the patient has access to these within 24 to 48 h postinjury, and ideally even sooner. Frostbitten Himalayan climbers are seldom able to reach medical care in this time frame. We wished to see if delayed iloprost use (up to 72 h) would help reduce tissue loss in grade 3 to 4 frostbite. In a series of 5 consecutive climbers with severe frostbite in whom we used iloprost, 4 of whom received treatment between 48 and 72 h from injury, 2 had excellent results with minimal tissue loss, and 2 had good results with tissue loss less than expected. The 1 patient with a poor outcome likely experienced a freeze-thaw-refreeze injury. This small series suggests that iloprost can be beneficial for severe frostbite, even after the standard 48-h window and perhaps for up to 72 h. <\/jats:p>","DOI":"10.1016\/j.wem.2018.03.003","type":"journal-article","created":{"date-parts":[[2018,6,8]],"date-time":"2018-06-08T05:05:32Z","timestamp":1528434332000},"page":"366-374","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":22,"title":["Case Report: Severe Frostbite in Extreme Altitude Climbers\u2014The Kathmandu Iloprost Experience"],"prefix":"10.1177","volume":"29","author":[{"given":"Prativa","family":"Pandey","sequence":"first","affiliation":[{"name":"CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal (Drs P Pandey, Pradhan, and K Pandey)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravi","family":"Vadlamudi","sequence":"additional","affiliation":[{"name":"Packard Health, Ann Arbor, MI (Dr Vadlamudi)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rashila","family":"Pradhan","sequence":"additional","affiliation":[{"name":"CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal (Drs P Pandey, Pradhan, and K Pandey)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kishore R.","family":"Pandey","sequence":"additional","affiliation":[{"name":"CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal (Drs P Pandey, Pradhan, and K Pandey)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Medicine and Physiology, University of Fribourg, Fribourg, Switzerland (Dr Kumar)"},{"name":"Department of Primary Care & Public Health Sciences, King\u2019s College London, London, UK (Dr Kumar)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Hackett","sequence":"additional","affiliation":[{"name":"Altitude Research Center, University of Colorado School of Medicine, Aurora, CO"},{"name":"Institute for Altitude Medicine, Telluride, CO (Dr Hackett)"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,9,1]]},"reference":[{"key":"bibr1-j.wem.2018.03.003","unstructured":"Vadlamudi R, Murphy HA, Pandey P. 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