The name of the article I chose was “Interventions for frostbite injury” by Lorentenz et al and was published to the Cochrane database of systematic reviews in December of 2020. The article is based on a systematic review to assess the benefits and harms of different management options for frostbite injuries. Within regard to intervention the study looked at forms of intervention such as pharmacological therapy, topical treatments, and rewarming techniques. For primary outcomes it looked at incidence of amputations and rate of serious adverse events such as any medical occurrence that resulted in death, life threatening, or led to significant disability. For secondary outcomes things such as acute pain, chronic pain, ability to perform ADLs, quality of life, and duration of absence due to sickness were measured. The search identified a total of 1801 references however after eliminating duplicates it was brought down to 1047 studies and exclusion of irrelevant references left only one randomized clinical trial. 

     The one included randomized clinical trial was a study that had a total of 47 participants, 44 of these were men and 3 of them were women, and all were within a mean age of 33 years. 45 of the people acquired their frostbite lesions during sport activities at altitudes over 2000 meters. All the participants underwent rapid rewarming, received 250 mg of aspirin, 400 mg of IV buflomedil and were then randomized into three different groups. Group 1 received an additional IV buflomedil 400mg for one hour per day. Group 2 received IV prostacyclin, iloprost, 0.5 ng/kg/min to 2 ng/kg/min for six hours per day. Group 3 received IV iloprost 2 ng/kg/min for six hours per day plus fibrinolysis 100 mg rtPA for the first day only. Treatment was evaluated after 8 days and patients were followed 3 months after regularly. The study found that amputations were less common in Group 2 (0/16) than Group 1 (9/15) and similarly with Group 3 (3/16). The trial concludes that iloprost and iloprost plus rtPA may result in a large reduction in the rate of amputations compared to buflomedil alone. However, some things that need to be considered include the fact that this conclusion is only based on one study. Not only that but this study has a small sample of participants at 47 and 44 of those are men. The fact that 44 of them are means that it is not proven that this study applies to women as well due to their only being 3 in the study. Another thing that needs to be considered is that 45 of the participants got their injuries at high altitudes while play sports, this likely means that those 45 participants are physically active beyond that of the average person. In addition, all the participants were given a 400mg IV dose of buflomedil before being assigned to their groups, so it is uncertain if this affected the results of the study. Overall, this article is of very low evidence and should not be applied to clinical practice, instead more studies with larger sample sizes that include a more equal number when it comes to gender should be conducted to determine if the findings of this study hold true.