From the Guidelines
Frostbite treatment involves rapid rewarming with lukewarm water immersion at a temperature of 37° C to 40° C for 20 to 30 minutes.
Key Considerations
- The rewarming process should be done with caution to avoid refreezing, as this can cause further tissue damage 1, 2.
- If a thermometer is not available, water temperature can be tested against one’s wrist, where it should feel slightly warmer than body temperature 1.
- Air rewarming can be used as an alternative rewarming method when warm water immersion is not possible 1.
- Chemical warmers should not be placed directly on frostbitten tissue because they can reach temperatures that can cause burns 2.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may not be effective in frostbite treatment, as their effectiveness has not been well established in human studies 2.
- Advanced treatment for frostbite, such as thrombolytic medication, can be administered only in a healthcare setting and is most effective when given soon after injury 3.
- Frostbite involving deeper tissue depths may require care at a burn center 3.
Rewarming Techniques
- Lukewarm water immersion at 37° C to 40° C for 20 to 30 minutes is the recommended rewarming technique 1, 4, 2.
- Skin-to-skin contact, such as a warm hand, can be used for minor or superficial frostbite (frostnip) 2.
From the Research
Treatment for Frostbite
The treatment for frostbite, a cold-induced tissue injury, typically involves rapid rewarming of the affected area, followed by tissue care and surgical debridement of necrotic tissue 5, 6, 7, 8.
- Rapid rewarming is considered the mainstay of treatment, as it helps to minimize tissue loss and prevent further damage 5, 7, 8.
- Medical treatment may include the use of various drugs such as ibuprofen, aspirin, warfarin, tissue plasminogen activator, and prostacyclin to prevent tissue necrosis and improve outcomes 6.
- Thrombolytic therapy, such as iloprost and iloprost plus recombinant tissue plasminogen activator (rtPA), may also be effective in reducing the rate of amputations in people with severe frostbite 5.
- Wound care, therapy, and surgery may be necessary to promote tissue salvage and prevent long-term complications 9.
- Diagnostic tools such as Tc bone scans, magnetic resonance imaging arthrogram, or angiography may be used to determine the extent of tissue loss and guide treatment decisions 6.
Treatment Protocols
Institutional protocols for the treatment of severe frostbite injury have been developed, which include diagnosis, medical treatment, wound care, therapy, and surgery 9.
- These protocols aim to promote tissue salvage and prevent long-term complications, with reported success rates of over 80% of previously ischemic tissue becoming viable and not requiring amputation 9.
- Efficient treatment protocols can also improve center efficiency, reducing the time from rapid rewarming to delivery of thrombolytics to under six hours 9.
Prevention
Prevention of frostbite can be accomplished through increasing public awareness of the adverse effects of cold exposure and recognizing and mitigating the risks associated with the development of frostbite 7.