Highlights & Basics
- Frostbite severity is determined by the depth of the freezing and subsequent injury. Grading scales are sometimes used to guide therapy.
- Diagnosis is clinical, but technetium-99m or magnetic resonance scanning can give an early indication of prognosis.
- The mainstay of treatment is rapid initial rewarming of the injured tissue.
- Being a thermal injury, wound management is similar to the management of burns and involves debridement of white blisters (in hospital), regular aloe vera application, and regular hydrotherapy. Early therapy with a nonsteroidal anti-inflammatory drug is advised.
- Iloprost and thrombolytic therapy have been shown to be of benefit in severe frostbite where there is a risk of amputation, particularly if given within 24 hours of injury.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Grade II frostbite injury of the foot
Grade IV frostbite injury inappropriately thawed using boiling water
(A) Technetium-99m scans of the hands of a patient with frostbite. The terminal digits have reduced signal (especially in the left hand), suggesting that substantial tissue necrosis has occurred. (B) Clinical picture after a 5-day iloprost infusion showing the close correlation between the initial technetium-99m scans and the subsequent clinical appearance
Immersion foot (trench foot)
Typical frostbite injuries in the hands and feet of a climber with mildly hemorrhagic bullae presenting 3 days after exposure. The bullae were aseptically aspirated and a 5-day iloporost infusion resulted in a complete recovery
A typical frostbite affecting the hallux and third left toes showing the initial injury at presentation at base camp on Everest (A), at 6 weeks (B), and at 10 weeks (C). Note the delayed surgical amputation of the hallux after definitive demarcation and the recovery of the third digit after appropriate management
Citations
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Rabold MB. Frostbite and other localized cold-related injuries. In: Tintinalli JE, Kelen GD, Stapczynski JS, et al. Tintinalli's emergency medicine: a comprehensive study guide. 6th ed. New York, NY: McGraw-Hill; 2004.
Roche-Nagle G, Murphy D, Collins A, et al. Frostbite: management options. Eur J Emerg Med. 2008 Jun;15(3):173-5.[Abstract]
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