- Ken Zafren, MD, FAAEM, FACEP, FAWM
Ken Zafren, MD, FAAEM, FACEP, FAWM
- Clinical Associate Professor of Emergency Medicine
- Stanford University Medical Center
- Emergency Programs Medical Director, State of Alaska
- C Crawford Mechem, MD, FACEP
C Crawford Mechem, MD, FACEP
- Professor of Emergency Medicine
- Perelman School of Medicine, University of Pennsylvania
Frostbite results from the freezing of tissue. It is a disease of morbidity, not mortality. It is most frequently encountered in mountaineers and other cold weather enthusiasts, soldiers, those who work in the cold, the homeless, and individuals stranded outdoors in the winter [1-3]. Among patients with severe frostbite, timely diagnosis and treatment is essential to maximize limb and digit salvage.
This topic review will discuss the classification, presentation, diagnosis, and management of frostbite. Severe hypothermia, high altitude illness, and other related illnesses are discussed separately. (See "Accidental hypothermia in adults" and "High altitude illness: Physiology, risk factors, and general prevention" and "Acute mountain sickness and high altitude cerebral edema" and "High altitude pulmonary edema" and "High altitude disease: Unique pediatric considerations".)
Frostbite is a severe, localized cold-induced injury due to freezing of tissue. Immersion foot (also referred to as trench foot) is a nonfreezing cold injury (NFCI) that may also cause tissue loss and long-term sequelae. Milder forms of injury include frostnip and pernio:
●Frostnip refers to cold-induced, localized paresthesias that resolve with rewarming. There is no permanent tissue damage.
●Pernio, or chilblains, is characterized by localized inflammatory lesions that can result from acute or repetitive exposure to damp cold above the freezing point. Lesions are edematous, often reddish or purple, and may be very painful or pruritic (picture 1). Pernio is most common in young women, but both sexes and all age ranges may be affected .
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- Kemper TC, de Jong VM, Anema HA, et al. Frostbite of both first digits of the foot treated with delayed hyperbaric oxygen:a case report and review of literature. Undersea Hyperb Med 2014; 41:65.
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- Thomas JR, Oakley HN. Nonfreezing cold injury. In: Medial Aspects of Harsh Environments, Pandolf KB, Burr RE. (Eds), Office of the Surgeon General, Falls Church 2001. p.467.
- Ervasti O, Hassi J, Rintamäki H, et al. Sequelae of moderate finger frostbite as assessed by subjective sensations, clinical signs, and thermophysiological responses. Int J Circumpolar Health 2000; 59:137.
- Castellani JW, Young AJ, Ducharme MB, et al. American College of Sports Medicine position stand: prevention of cold injuries during exercise. Med Sci Sports Exerc 2006; 38:2012.
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- Lehmuskallio E. Cold protecting ointments and frostbite. A questionnaire study of 830 conscripts in Finland. Acta Derm Venereol 1999; 79:67.
- Lehmuskallio E, Rintamäki H, Anttonen H. Thermal effects of emollients on facial skin in the cold. Acta Derm Venereol 2000; 80:203.
- RISK FACTORS
- CLINICAL MANIFESTATIONS
- IMAGING STUDIES
- Prehospital care
- Hospital-based management
- - Rewarming
- - Thrombolysis for severe injury presenting within 24 hours
- - Prostacyclin therapy for severe injury presenting within 48 hours
- - Wound care
- - Infection prophylaxis
- - Surgical consultation
- Unproven therapies: Hyperbaric oxygen, pentoxifylline, heparin without thrombolysis, and others
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS