From the Guidelines
The primary treatment for frostbite is rapid rewarming of the affected area in warm water at a temperature of 37° C to 40° C (99–104° F) for 20 to 30 minutes, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The goal of treatment is to minimize tissue damage by restoring blood flow and preventing further injury. Here's a step-by-step approach:
- Move to a warm environment immediately.
- Remove wet or constrictive clothing and jewelry, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
- Immerse the frostbitten area in warm water at a temperature of 37° C to 40° C (99–104° F) for 20 to 30 minutes.
- Take over-the-counter pain medication like ibuprofen (400-600 mg every 6 hours) to manage pain and reduce inflammation, as ibuprofen is recommended by many experts and included in many treatment guidelines, although direct clinical evidence is lacking 1.
- Apply loose, dry, sterile dressings to the affected areas.
- Elevate the affected limb to reduce swelling.
- Avoid walking on frostbitten feet or toes.
- Do not rub or massage the area, as this can cause further tissue damage.
- Avoid re-exposing the area to cold temperatures.
- Seek medical attention as soon as possible, especially for severe cases, as advanced treatment for frostbite such as thrombolytic medication can be administered only in a health care setting and is most effective when given soon after injury 1. In severe cases, medical professionals may use thrombolytic therapy (such as tissue plasminogen activator) to improve blood flow and prevent tissue loss. Antibiotics may be prescribed if there's a risk of infection. Rapid rewarming helps prevent the formation of ice crystals within cells, which can cause cellular damage. Pain medication and elevation help manage discomfort and swelling, while sterile dressings protect the vulnerable skin from further harm.
From the Research
Treatment Overview
The treatment for frostbite, a cold-induced tissue injury, involves several steps to prevent further tissue loss and promote recovery.
- Rapid rewarming of the affected area in warm water (between 38-42°C) is the first line of treatment 2, 3, 4, 5, 6.
- Protection from refreezing is crucial to prevent further tissue damage 2.
- Therapy with aspirin or ibuprofen may be helpful, but evidence is limited 2.
- Thrombolytic treatment within the first 24 hours after rewarming may be beneficial in some cases of severe frostbite 2, 3, 6.
- Prostacyclin therapy is also promising for the treatment of frostbite 2, 4.
Thrombolytic Treatment
Thrombolytic treatment, such as intra-arterial tissue plasminogen activator, has been studied as a potential treatment for severe frostbite.
- A study found that thrombolytic treatment within the first 24 hours after rewarming may be beneficial in some cases of severe frostbite 2.
- However, another study did not show statistically significant results on amputation levels and could not support the hypothesis of efficacy of thrombolytic therapy 3.
- A protocol that includes thrombolytic treatment has been shown to result in significant tissue salvage, with over 80.7% of previously ischemic tissue becoming viable and not requiring amputation 6.
Institutional Protocols
Institutional protocols for the treatment of severe frostbite injury have been developed and studied.
- A 6-year retrospective analysis of an institutional protocol found that it resulted in significant tissue salvage and improved efficiency in treatment delivery 6.
- The protocol included diagnosis, medical treatment, wound care, therapy, and surgery, and was found to be effective in promoting recovery and preventing tissue loss 6.