What is the proper treatment for frostbite?

Frostbite Treatment

For severe or deep frostbite, rapidly rewarm the affected part by immersing it in warm water at 37-40°C (98.6-104°F) for 20-30 minutes, but only if there is no risk of refreezing and after treating any concurrent hypothermia. 1

Initial Field Management

Immediate Priorities

• Remove all jewelry and constricting materials immediately from the affected extremity to prevent further injury as swelling develops 1
• Assess for hypothermia first - if the person has moderate to severe hypothermia, prioritize core rewarming before treating the frostbite, as rewarming extremities first can cause dangerous drops in core temperature 1, 2, 3
• Remove wet clothing and dry and cover the victim to prevent hypothermia 4
• Protect frostbitten tissue from further injury and avoid walking on frozen feet and toes whenever possible 1

Critical Decision Point: To Rewarm or Not

Do not attempt to rewarm frostbite if:

• There is any chance the tissue might refreeze (repeated freeze-thaw cycles cause worse tissue damage than delayed rewarming) 4, 1, 3
• You are close to a medical facility 4, 1

This is the most important pitfall to avoid - refreezing after thawing causes catastrophic additional tissue damage. 3

Rewarming Protocol (When Safe to Proceed)

For Severe or Deep Frostbite

The definitive rewarming method is warm water immersion:

• Immerse the frostbitten part in warm water at 37-40°C (98.6-104°F) for 20-30 minutes 4, 1, 3
• If no thermometer is available, test water against your wrist - it should feel slightly warmer than body temperature 1
• Never use water above 40°C as this causes further tissue damage 1
• Never place chemical warmers directly on frostbitten tissue as they can reach temperatures that cause burns 4, 1

For Minor or Superficial Frostbite (Frostnip)

• Simple, rapid rewarming using skin-to-skin contact such as a warm hand is sufficient 4, 1

Alternative When Water Immersion Not Possible

• Air rewarming can be used as an alternative 1

Post-Rewarming Care

Wound Management

• Apply bulky, clean, dry gauze or sterile cotton dressings to affected areas and between toes and fingers 1
• Wrap circumferential dressings loosely to allow for swelling without placing pressure on underlying tissue 1
• Do not debride blisters in the first aid setting 1

Pain and Tissue Protection

• Administer ibuprofen to prevent further tissue damage and treat pain (note: the American Heart Association states evidence for NSAIDs is not well established in human studies, but newer guidelines recommend it) 4, 1
• Protect thawed tissue from refreezing at all costs - frozen and thawed tissues are extremely vulnerable to further injury and infection 2
• Thawed tissues become susceptible to pressure sores and necrosis 2

When to Seek Advanced Medical Care

• All frostbite patients should seek prompt medical attention, especially for deeper injuries 1
• Deep frostbite may require specialized care at a burn center 1
• Transport the victim to an advanced medical facility as rapidly as possible 4

Key Clinical Pitfalls

• Never rewarm if refreezing is possible - this is worse than delayed rewarming 3
• Never delay vascular consultation waiting for "demarcation" in cases with signs of critical ischemia 3
• Patients with frostbitten hands or feet may be unaware of ongoing damage from continued movement or walking due to complete inability to sense touch 2
• Estimating severity is challenging in the acute setting - tissue loss is often less than initial appearances suggest 2, 5