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Frostbite

• Overview
• Symptoms
• Treatment
• Prevention

Alternative Names:

Cold exposure - extremities

First Aid:

1. Shelter the victim from the cold and move the victim to a warmer place. Remove any constricting jewelry and wet clothing. Look for signs of hypothermia (lowered body temperature) and treat accordingly.

2. If immediate medical help is available, it is usually best to wrap the affected areas in sterile dressings (remember to separate affected fingers and toes) and transport the victim to an emergency department for further care.

3. If immediate care is not available, re-warming first aid may be given. Immerse the affected areas in warm (never HOT) water -- or repeatedly apply warm cloths to affected ears, nose, or cheeks -- for 20 to 30 minutes. The recommended water temperature is 104 to 108 degrees Fahrenheit. Keep circulating the water to aid the warming process. Severe burning pain, swelling , and color changes may occur during warming. Warming is complete when the skin is soft and sensation returns.

4. Apply dry, sterile dressing to the frostbitten areas. Put dressings between frostbitten fingers or toes to keep them separated.

5. Move thawed areas as little as possible.

6. Re-freezing of thawed extremities can cause more severe damage. Prevent re-freezing by wrapping the thawed areas and keeping the victim warm. If re-freezing cannot be guaranteed, it may be better to delay the initial re-warming process until a warm, safe location is reached.

7. If the frostbite is extensive, give warm drinks to the victim in order to replace lost fluids.

Do Not:

• DO NOT thaw out a frostbitten area if it cannot be kept thawed. Refreezing may make tissue damage even worse.
• DO NOT use direct dry heat (such as a radiator, campfire, heating pad, or hair dryer) to thaw the frostbitten areas. Direct heat can burn the tissues that are already damaged.
• DO NOT rub or massage the affected area.
• DO NOT disturb blisters on frostbitten skin.
• DO NOT smoke or drink alcoholic beverages during recovery as both can interfere with blood circulation.

Call immediately for emergency medical assistance if:

• There has been severe frostbite, or if normal feeling and color do not return promptly after home treatment for mild frostbite.
• Frostbite has occurred recently and new symptoms develop, such as fever , malaise , discoloration, or drainage from the affected body part.

References:

Ulrich AS. Hypothermia and localized cold injuries. Emerg Med Clin North Am . 2004; 22(2): 281-98.

Petrone P. Surgical management and strategies in the treatment of hypothermia and cold injury.  Emerg Med Clin North Am . 2003; 21(4): 1165-78.

Morton PM. Wilderness survival. Emerg Med Clin North Am . 204; 22(2): 475-509, ix-x.

• Review Date: 3/21/2006
• Reviewed By: Eric Perez, MD, Department of Emergency Medicine, St. Luke's-RooseveltHospital Center, New York, NY. Review provided by VeriMed HealthcareNetwork.

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