Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- cold or numbness of affected extremity
- pain during rewarming
- purplish skin discoloration
- white or yellowish, waxy skin discolouration
- superficial skin vesiculation
- deep purple blisters
- tissue necrosis and mummification (dry gangrene)
Risk factors
- cold exposure
- previous frostbite
- vascular insufficiency
- high altitude
- hypoxia
- alcohol
- tobacco
- dehydration
- extremity trauma
- constrictive clothing or equipment
Diagnostic investigations
Investigations to consider
- technetium-99m pertechnetate scintigraphy
- magnetic resonance angiography of affected extremity
- plain radiography
Treatment algorithm
Contributors
Authors
Elizabeth A. Kaufman, MD, CAQ-SM
Attending Physician
Department of Orthopedics, Sports Medicine
Scripps Clinic
Attending Physician
Rady Children’s Hospital San Diego
Department of Orthopedics, Sports Medicine
San Diego
CA
Disclosures
EAK declares that she has no competing interests.
Christopher Imray, PhD, FRCS, FRCP, FRGS
Consultant Vascular and Renal Transplant Surgeon
University Hospital Coventry and Warwickshire NHS Trust
Professor Coventry University, Warwick Medical School, Exeter University
Coventry
UK
Disclosures
CI has been asked to provide expert testimony on frostbite. He has delivered lectures, and produced educational material on frostbite.
Acknowledgements
Professor Christopher Imray and Dr Elizabeth A. Kaufman would like to gratefully acknowledge Professor Paul S. Auerbach and Dr Claire Turchi, previous contributors to this topic. PSA and CT declare that they have no competing interests.
Peer reviewers
Luanne Freer, MD, FACEP, FAWM
Medical Director
Yellowstone National Park
WY
Founder/Director
Everest Base Camp Medical Clinic
Nepal
Disclosures
LF declares that she has no competing interests.
Grant S. Lipman, MD
Clinical Assistant Professor of Surgery and Emergency Medicine
Associate Director Wilderness Medicine Fellowship
Assistant Research Director
Stanford University School of Medicine
Palo Alto
CA
Disclosures
GSL declares that he has no competing interests.
Peter Hackett, MD
Director
Institute for Altitude Medicine
Telluride
CO
Disclosures
PH declares that he has no competing interests.
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