Treatment of Frostbite (Cold-Induced Burns)
The optimal first-line treatment for frostbite is rapid rewarming by immersing the affected area in warm water at 37-40°C (98.6-104°F) for 20-30 minutes, but only if there is no risk of refreezing. 1, 2
Initial Assessment and Management
- Remove all jewelry and constricting items from the affected area immediately, as tissue will swell during the rewarming process 1, 2
- Assess for concurrent hypothermia - if present, prioritize core rewarming before treating frostbite, as rewarming extremities first can worsen core temperature 1, 3
- Protect frostbitten tissue from further injury and avoid walking on frozen feet whenever possible 1, 4
- Do not attempt field rewarming if there is any chance the tissue might refreeze or if medical care is nearby, as refreezing causes additional severe tissue damage 1, 2
Rewarming Protocol
- For severe or deep frostbite, use warm water immersion at 37-40°C (98.6-104°F) for 20-30 minutes 1, 2
- If a thermometer is unavailable, test water temperature against your wrist - it should feel slightly warmer than body temperature 1
- Never use hot water or direct heat as this can worsen tissue damage 1, 2
- For minor or superficial frostbite (frostnip), simple rewarming using skin-to-skin contact such as a warm hand may be sufficient 1
- Air rewarming can be used as an alternative when warm water immersion is not possible 1
- Avoid using chemical warmers directly on frostbitten tissue as they can reach temperatures that cause burns 1
Post-Rewarming Care
- Apply bulky, clean, dry dressings to the affected areas and between digits to prevent maceration 1, 5
- Wrap circumferentially but loosely to allow for expansion as swelling increases 1
- Administer NSAIDs (particularly ibuprofen) to decrease production of prostaglandins and thromboxanes that can cause vasoconstriction and further tissue damage 1, 6
- Leave intact blisters undisturbed as intact skin is an essential barrier against infection 1, 7
- Elevate the affected extremity to minimize edema 1
When to Seek Advanced Medical Care
- All frostbite patients should seek prompt medical attention, as advanced treatments like thrombolytic therapy are most effective when administered early 1, 2
- Deep frostbite may require specialized care at a burn center 1
- Frostbite affecting large areas of the body should be treated similarly to thermal burns 8
Common Pitfalls to Avoid
- Never rub or massage the affected area as this can cause further tissue damage 4
- Avoid using ice or ice water for treatment - unlike thermal burns, cold injuries require warming, not cooling 5, 6
- Do not pop blisters as this increases infection risk 1, 7
- Recognize that frostbite and thermal burns have different underlying mechanisms - frostbite primarily damages microcirculation while thermal burns primarily damage cutaneous tissues 9