Frostbite

Definition

Frostbite is tissue injury caused by freezing of skin and underlying tissues, most often affecting extremities, ears, and nose. Severity ranges from superficial (frostnip) to deep (full-thickness damage).

Degrees

• 1st degree (frostnip): Numbness, erythema, no tissue loss.
• 2nd degree: Blistering with clear fluid.
• 3rd degree: Blood-filled blisters, full-thickness skin loss.
• 4th degree: Muscle, tendon, bone involvement.

Emergency Management

1. Remove from cold environment
2. Remove wet/constricting clothing and jewelry
3. Rapid rewarming in water 98.6 to 102°F (37 to 39°C) for 15 to 30 minutes
4. DO NOT massage or rub. Causes ice crystal tissue damage
5. DO NOT apply dry heat (stove, heater)
6. DO NOT rewarm if refreezing is possible. Worse than continued freezing
7. Analgesia (rewarming is painful)
8. Elevate extremity; separate digits with sterile dressings
9. Tetanus prophylaxis

NCLEX Relevance

Warm water soak; NEVER rub.