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Frostbite

Cold exposure - arms or legs

Frostbite is damage to the skin and underlying tissues caused by extreme cold. Frostbite is the most common freezing injury.

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Frostbite - hands
Frostbite

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Causes

Frostbite occurs when the skin and body tissues are exposed to cold temperature for a long period of time.

You are more likely to develop frostbite if you:

Symptoms

Symptoms of frostbite may include:

Very severe frostbite may cause:

Frostbite may affect any part of the body. The hands, feet, nose, and ears are the places most prone to the problem.

First Aid

A person with frostbite on the arms or legs may also have hypothermia (lowered body temperature). Check for hypothermia and treat those symptoms first.

Take the following steps if you think someone might have frostbite:

  1. Shelter the person from the cold and move them to a warmer place. Remove any tight jewelry and wet clothes. Look for signs of hypothermia (lowered body temperature) and treat that condition first.
  2. If you can get quick medical help, it is best to wrap the damaged areas in sterile dressings. Remember to separate affected fingers and toes. Transport the person to an emergency department for further care.
  3. If medical help is not nearby, you may give the person rewarming first aid. Soak the affected areas in warm (never hot) water -- for 20 to 30 minutes. For ears, nose, and cheeks, apply a warm cloth repeatedly. The recommended water temperature is 104°F to 108°F (40°C to 42.2°C). Keep circulating the water to aid the warming process. Severe burning pain, swelling, and color changes may occur during warming. Warming is complete when the skin is soft and feeling returns.
  4. Apply dry, sterile dressings to the frostbitten areas. Put dressings between frostbitten fingers or toes to keep them separated.
  5. Move thawed areas as little as possible.
  6. Refreezing of thawed extremities can cause more severe damage. Prevent refreezing by wrapping the thawed areas and keeping the person warm. If protection from refreezing cannot be guaranteed, it may be better to delay the initial rewarming process until a warm, safe location is reached.
  7. If the frostbite is severe, give the person warm drinks to replace lost fluids.

Do Not

In case of frostbite, DO NOT:

When to Contact a Medical Professional

Call your health care provider if:

Prevention

Be aware of factors that can contribute to frostbite. These include extreme:

Wear clothing that protects you well against the cold. Protect exposed areas. In cold weather, wear mittens (not gloves); wind-proof, water-resistant, layered clothing; 2 pairs of socks; and a hat or scarf that covers the ears (to avoid heat loss through the scalp).

If you expect to be exposed to the cold for a long period of time, do not drink alcohol or smoke. Make sure to get enough food and rest.

If caught in a severe snowstorm, find shelter early or increase physical activity to maintain body warmth.

Related Information

Hypothermia
Paleness
Numbness and tingling

References

Sawka MN, O'Connor FG. Disorders due to heat and cold. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 109.

Zafren K, Danzl DF. Accidental hypothermia. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 132.

Zafren K, Danzl DF. Frostbite and nonfreezing cold injuries. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 131.

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Review Date: 10/16/2017  

Reviewed By: Jesse Borke, MD, FACEP, FAAEM, Attending Physician at FDR Medical Services/Millard Fillmore Suburban Hospital, Buffalo, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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