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Frostbite, Emergency Medicine

Joseph M. Weber Reviewed 06/2017
 


Basics

Description

  • Tissue damage caused by cold temperature exposure

  • Mechanism:

    • Tissue damage results from:

      • Direct cell damage: Intracellular ice crystal formation

      • Indirect cell damage: Extracellular ice c...

Diagnosis

Signs and Symptoms

  • Extremities (fingers, toes) and head (ears, nose) most commonly affected.

  • After rewarming frostbite can be classified; however, initial classification often fails to provide...

Treatment

Pre-Hospital

  • Protect and immobilize frostbitten area during transport

  • Remove restrictive or wet garments

  • Avoid dry rewarming of the frostbitten limb if there is a likelihood of refreezing injur...

Follow-Up

Disposition

Admission Criteria

  • All but the most superficial cases should be admitted.

  • Lower admission threshold where risk of refreezing exists.

  • Immersion (trench) foot patients may be discharge...

Pearls and Pitfalls

Pitfalls: 
  • Allowing freeze, thaw, refreeze cycle to occur

  • Failure to keep warm water bath between 40°C and 42°C during rewarming

  • Failure to address hypothermia or other systemic illne...

Additional Reading

  • Gross  EA, Moore  JC. Using thrombolytics in frostbite injury. J Emerg Trauma Shock.  2012;5(3):267–271.

  • McIntosh  SE, Hamonko  M, Freer  L, et al. Wilderness Medical Society pr...

Codes

ICD9

  • 991.0 Frostbite of face

  • 991.1 Frostbite of hand

  • 991.3 Frostbite of other and unspecified sites

  • 991.2 Frostbite of foot

ICD10

  • T33.09XA Superficial frostbite of other part of head, init encntr

  • T33.9...

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