What is the treatment for frostbite?

Treatment of Frostbite

For frostbite, immediately remove the person from cold exposure, remove wet clothing and jewelry, protect the frozen tissue from further injury, and if severe frostbite is present and you can maintain a warm environment without risk of refreezing, rapidly rewarm by immersing the affected part in warm water at 37-40°C (98.6-104°F) for 20-30 minutes. 1, 2

Immediate Field Management

Priority Assessment

• If the person has moderate to severe hypothermia, rewarm the core first before treating the frostbite, as rewarming extremities first can cause core temperature to drop dangerously 1, 2, 3
• Remove all jewelry, rings, watches, and tight clothing from affected extremities immediately to prevent constriction as swelling develops 1, 2

Critical Decision: To Rewarm or Not

• Do not attempt rewarming if there is any chance the tissue might refreeze or if you are close to a medical facility (within transport distance), as repeated freeze-thaw cycles cause worse tissue damage than delayed rewarming 1, 2, 4
• Protect frostbitten hands and feet from use—do not walk on frozen feet or use frozen hands for climbing whenever avoidable, as the frozen tissue cannot sense ongoing mechanical damage 1, 2, 3

Rewarming Protocol (When Appropriate)

For Severe/Deep Frostbite

• Rapidly rewarm by immersing the affected part in warm water at 37-40°C (98.6-104°F) for 20-30 minutes 1, 2
• If no thermometer is available, test water against your wrist—it should feel slightly warmer than body temperature but not hot 2
• Never use water above 40°C as this causes additional tissue damage 2
• Air rewarming can be used as an alternative when warm water immersion is not possible 2

For Minor/Superficial Frostbite (Frostnip)

• Simple skin-to-skin contact rewarming with a warm hand is sufficient 1, 2

What NOT to Use

• Never place chemical warmers directly on frostbitten tissue—they can reach temperatures that cause burns 1, 2

Post-Rewarming Care

Wound Management

• Apply bulky, clean, dry gauze or sterile cotton dressings to affected areas and between all fingers and toes 1, 2
• Wrap circumferential dressings loosely to allow for swelling without constricting blood flow 1, 2
• The bulky dressings serve multiple purposes: they insulate tissue, absorb moisture, prevent infection, distribute pressure evenly, and allow expansion as edema develops 1
• Do not debride or rupture blisters 2

Pain and Tissue Protection

• Administer ibuprofen to prevent further tissue damage and treat pain 1, 2
• Ibuprofen decreases production of prostaglandins and thromboxanes that cause vasoconstriction and dermal ischemia, though direct clinical evidence is limited 1

Post-Thaw Precautions

• Frozen and thawed tissues are extremely vulnerable to further injury, infection, pressure sores, and necrosis—maintain protective environment 1, 3
• Keep affected areas elevated if possible to reduce swelling 5

When to Activate Emergency Services

• All frostbite cases should seek prompt medical attention 2
• Deep frostbite involving deeper tissue depths may require specialized care at a burn center 1, 2
• Advanced treatments available in hospital settings include thrombolytic therapy (most effective within 24 hours), prostacyclin therapy, and imaging to determine tissue viability 6, 5

Common Pitfalls to Avoid

• Do not delay vascular consultation waiting for "demarcation"—hours matter for tissue salvage in severe cases 4
• Do not assume the extent of tissue loss based on initial appearance—hard eschar may form with healthy tissue beneath, and final tissue loss is often less than initial appearances suggest 6
• Estimating severity is challenging in the first aid setting, so err on the side of seeking advanced care 3