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For further information, see CMDT Part 37-07: Frostbite

Key Features

Essentials of Diagnosis

  • Injury is due to freezing and formation of ice crystals within tissues

General Considerations

  • Localized hypothermia, vasoconstriction, and slowed metabolism occur as temperature falls below 25°C, although oxygen demand may increase if activity continues

  • Once tissue is frozen it becomes pain free

  • Most tissue destruction follows the reperfusion of the frozen tissues, with damaged endothelial cells and progressive microvascular thrombosis resulting in further tissue damage

Clinical Findings

Symptoms and Signs

Mild cases

  • Only the skin and subcutaneous tissues are involved

  • The symptoms are numbness, prickling, itching, and pallor

Severe cases

  • With increasing severity, deep frostbite involves deeper structures

  • There may be paresthesia and stiffness

  • Thawing causes tenderness and burning pain

  • Skin is white or yellow, loses its elasticity, and becomes immobile

  • Edema, hemorrhagic blisters, necrosis, and gangrene may appear

Diagnosis

Imaging Studies

  • MRI with magnetic resonance angiography and technetium scintigraphy can assess the degree of involvement and distinguish viable from nonviable tissue

Treatment

Medications

  • Administration of an intra-arterial thrombolytic administration within 24 hours of exposure has resulted in improved tissue perfusion and has reduced amputation

  • The rate of tissue salvage decreases with every hour of delay from rewarming to thrombolytic therapy

  • Anti-infective measures

    • Tetanus prophylaxis status must be verified and updated as needed; frostbite increases susceptibility

    • Infection risk may be reduced by aseptic wound care and protection of skin blebs from physical contact

    • Wounds should be kept open and allowed to dry before applying dressings

    • Nonadherent sterile gauze and fluffy dressing should be loosely applied to wounds and cushions used for all areas of pressure

    • Antibiotics should not be administered empirically

    • Systemic antibiotics are reserved for deep infections not responding to local wound care

Therapeutic Procedures

  • Treat associated systemic hypothermia (see Hypothermia)

  • Monitor fluids and electrolytes

  • Superficial frostbite (frostnip) of extremities

    • In the field, apply firm steady pressure with warm hand (without rubbing)

    • Place fingers in the armpits

    • Remove footwear, dry the feet, rewarm, cover with adequate dry socks or other protective footwear

  • Frostbite

    • If there is a possibility of refreezing, frostbitten part should not be thawed, even if it means prolonged walking on frozen feet; refreezing increases tissue necrosis

Rewarming

  • Rapid thawing at temperatures slightly above body heat may significantly decrease tissue necrosis and reverse the tissue crystallization

  • Immerse the frozen extremity for several minutes in a moving-water bath heated to 40–42°C until the distal tip of the part being thawed flushes (water feels warm but not hot to the normal hand)

  • Dry heat (eg, stove or ...

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