What are the Wilderness Medical Society guidelines on treatment of frostbite in the emergency department (ED)?

Updated: Oct 13, 2020
  • Author: Bobak Zonnoor , MD; Chief Editor: Dirk M Elston, MD  more...
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The following is a summary of initial hospital management:

  • Treat hypothermia or serious trauma
  • Rapidly rewarm affected body part in water (maintain 37-39°C [98.6-102.2°F]) until the area is soft (pliable) to the touch
  • Administer ibuprofen at 12 mg/kg/day divided twice daily
  • Administer pain medication (eg, opiates) as needed
  • Administer tetanus prophylaxis
  • Institute air drying (ie, do not rub at any point)
  • Debride with selective drainage by needle aspiration of clear blisters, leaving hemorrhagic blisters intact
  • Apply aloe vera cream or gel every 6 hours with dressing changes
  • Use dry, bulky dressings
  • Elevate affected body part, if possible
  • Ensure systemic hydration
  • Thrombolytic therapy: This should be considered for deep frostbite at distal interphalangeal joints or proximal if fewer than 24 hours have elapsed since thawing. Angiography should be used for prethrombolytic intervention and for monitoring progress. If angiography is not available, consider using intravenous thrombolysis.
  • Iloprost therapy: This should be considered for deep frostbite on or proximal to the proximal interphalangeal joint within 48 hour of the injury; this is particularly pertinent if angiography is not available or if there are contraindications to thrombolysis.
  • Clinical examination (plus angiography or technetium TC-99 bone scan if necessary): This is performed to help determine surgical margins. An experienced surgeon should perform an evaluation for possible intervention.

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