Steven Doerr, MD
Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- Frostbite and Cold Weather-Related Injuries Facts
- Introduction to frostbite and cold weather-related injuries
- What type of injuries can be caused by cold weather?
- Cold weather-related injuries without tissue freezing
- Trench foot
- Cold weather-related injuries with tissue freezing
- What does frostbite look like (frostbite pictures)?
- What are the signs and symptoms of frostbite?
- How should frostbite and other cold weather-related injuries be treated?
- What is the recovery time for a frostbite injury?
- When should a person seek medical care for a cold weather-related injury?
- Who is most likely to get a cold weather-related injury and what can be done to prevent it?
What does frostbite look like (frostbite pictures)?
The appearance of frostbite may gradually change over time; the extent of the change depends on how severely the tissue is damaged. Figure 1 shows a hand with severe frostbite changes at the tips of the fingers and thumb (dark to black-appearing tissue) that gradually decreases in severity on the digits.
Figure 1. Frostbite on digits and thumb
How should frostbite and other cold weather-related injuries be treated?
The initial treatment for any cold weather-related injury involves removing yourself or others from the precipitating cold environment, if possible, to prevent further heat loss. Move indoors, and remove all wet clothing and constricting clothing (such as socks, boots, and gloves), and replace with dry clothing. Avoid massaging or rubbing the affected area, as this will only aggravate the injury. It is important to note that some of these individuals may also be suffering from hypothermia, a potentially life-threatening condition.
- Gradually re-warm the affected area, and treatment can generally be accomplished at home. Some individuals may benefit from various lotions, while others may require treatment with corticosteroid creams. If open sores develop, they should remain clean and be monitored for signs of infection.
- Individuals with trench foot should have their wet shoes and socks removed, and the feet should be elevated, cleaned and air dried. Depending on the severity of the condition, some individuals may require antibiotics and/or surgical management of infection or wet gangrene (tissue destruction by bacterial infection, usually Clostridium spp) .
Frostnip will generally improve with conservative re-warming measures at home. Frostnip to the hands, for example, can be treated by breathing into cupped hands or placing the hands in the armpit area. Alternatively, the affected area can be submerged in warm water until normal sensation is restored.
- Frostbite requires immediate medical attention. Ideally, treatment should
be instituted in a health-care facility, when possible.
- Prior to transport to a health-care facility, if possible, loosely wrap the
affected area in a dry sterile bandage or a clean blanket to prevent further
trauma. Cotton may be placed between the toes or fingers, if affected, to
prevent any potential damaging effects of rubbing against one another.
- The most effective treatment measure for frostbite is rapid re-warming.
This is accomplished by immersing the affected area into a circulating tub of
warmed water that is between 40 to 42 C (104 to 108 F) for 20 to 40 minutes or
until thawing is complete. Warm wet packs at the same temperature may be used if
a tub is not available.
- It is important NOT to rapidly re-warm and thaw the affected area if there
is a risk that it may refreeze. This leads to more severe tissue damage and must
- During the re-warming process, the pain may be extreme and oral or
intravenous analgesics may be required.
- It is important NOT to rapidly re-warm and thaw the affected area if there is a risk that it may refreeze. This leads to more severe tissue damage and must be avoided.
- After rapid re-warming is complete, the affected area should be dressed and splinted. Further treatment will focus on wound care (debriding clear blisters, applying aloe vera lotion, and monitoring for infection), pain control, and providing a tetanus vaccine booster shot, if needed. Surgical consultation may be obtained for managing wound care, as well as for the longer-term sequelae of serious frostbite injuries that my require amputation of gangrenous tissue.
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