Prevention and Treatment of Frostbite

Preventive measures to ensure local tissue perfusion include: 1) maintaining adequate core temperature and body hydration; 2) minimizing the effects of known diseases, medications, and substances (including awareness and symptoms of alcohol and drug use) that might decrease perfusion; 3) covering all skin and the scalp to insulate from the cold; 4) minimizing blood flow restriction, such as occurs with constrictive clothing, footwear, or immobility; 5) ensuring adequate nutrition; and 6) using supplemental oxygen in severely hypoxic conditions (eg, >7500 m). (1 – Strong, C)

A decision must be made whether to thaw the tissue. If environmental conditions are such that thawed tissue could refreeze, it is safer to keep the affected part frozen until a thawed state can be maintained. Prostaglandin and thromboxane release associated with the freeze–thaw cycle causes vasoconstriction, platelet aggregation, thrombosis, and, ultimately, cellular injury. Refreezing thawed tissue further increases release of these mediators, and significant morbidity may result. One must absolutely avoid refreezing if field thawing occurs. (1 – Strong, B)