What is the treatment for frostbite?

Treatment of Frostbite

Frostbite should be treated with rapid rewarming in warm water at 37-40°C (99-104°F) for 20-30 minutes, followed by protective dressing application, pain management with ibuprofen, and avoidance of refreezing the affected area. 1

Initial Assessment and Rewarming Protocol

Assessment

• Identify severity of frostbite:
  • Superficial: numbness, pale/white skin, firm but pliable texture
  • Deep: hard waxy appearance, complete sensation loss, dark discoloration 1
• Always assess for concurrent hypothermia, which takes priority over frostbite treatment 1
• Remove all jewelry and constricting items from affected areas 1

Rewarming Procedure

1. Immerse affected area in warm water at 37-40°C (99-104°F) for 20-30 minutes 1

   • If thermometer unavailable, water should feel slightly warmer than body temperature when tested on wrist 1
   • Animal studies support rapid rewarming in water baths between 37-42°C 2
   • Optimal rewarming temperature is 37-39°C, with 45°C potentially harmful 3

2. Important cautions:

   • Never rewarm if there is any risk of refreezing, as freeze-thaw cycles dramatically worsen tissue damage 1
   • Avoid dry heat sources (heating pads, fires, radiators) and chemical warmers as they can cause burns 1
   • Avoid rubbing or massaging the area as this causes further tissue damage 1

Post-Rewarming Care

Wound Management

• Apply bulky, clean, dry dressings to protect the area 1
• Place gauze between toes/fingers if affected 1
• Wrap circumferential dressings loosely to accommodate swelling 1
• Do not debride blisters as they provide natural protection 1
  • Clear fluid-filled blisters indicate less severe injury
  • Blood-filled blisters indicate more severe injury 1
• Keep the area clean and dry to prevent infection 1
• Avoid walking on frozen feet/toes if possible 1

Pain and Inflammation Management

• Administer ibuprofen to reduce inflammation and pain 1
• Be prepared for significant pain as sensation returns during and after rewarming 1

Advanced Treatment Options

For severe frostbite cases with perfusion deficits, additional interventions may be necessary:

• Thrombolytic therapy may be beneficial if administered early (≤12 hours from rewarming) 4
  • Early use of thrombolytics has shown positive impact on tissue salvage 5
  • However, some studies show controversial results regarding efficacy 6

When to Seek Medical Attention

Immediate medical attention is required for:

• Moderate to severe frostbite injuries
• Signs of infection
• Blisters or skin discoloration
• Persistent numbness or tingling
• Any concerns about depth or severity of injury 1

Common Pitfalls to Avoid

1. Refreezing after thawing: This is the most damaging mistake and must be prevented at all costs 1, 7
2. Using inappropriate rewarming temperatures: Too hot water can cause burns, too cool water is ineffective 3
3. Delaying treatment: Prompt rewarming improves outcomes 5
4. Ignoring concurrent hypothermia: Core rewarming must take priority over frostbite treatment in moderate to severe hypothermia 1
5. Rubbing or massaging frozen tissue: This causes mechanical damage to ice crystal-filled tissues 1

Without proper treatment, late complications may include tissue mummification, dry gangrene, autoamputation, and secondary infections 1.