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.
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.
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 be avoided.
During the re-warming process, the pain may be extreme and oral or intravenous analgesics may be required.
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.