Primary prevention

Primary prevention involves either avoidance of extreme cold (specifically below 0°C) or taking measures to protect the body from the elements. Adequate clothing should be worn during any potential cold exposure. Measures should be taken to keep the body warm and dry (including keeping free of perspiration, especially inside socks or boots). While mittens provide better cold protection for hands than gloves, gloves provide greater dexterity. The choice of gloves or mittens will depend on the requirement for good dexterity; it is more important that the chosen protection can be worn continuously. Adequate perfusion and heat loss reduction are both needed to prevent frostbite.[4]​ Exercise can help increase peripheral vasodilation, but caution is required to avoid exhaustion and collapse. Alcohol and tobacco should be avoided when exposure to freezing cold weather is possible.[4] Other preventative methods include: heated insoles and gloves; wearing protective clothing in layers that are loose and heat-insulating; adequate nutrition and systemic hydration; avoiding constrictive clothing and tight boots; protecting the skin from moisture, wind and cold, minimising the duration of exposure to cold, and performing 'cold checks' for extremity numbness or pain. Recognising frostnip or superficial frostbite enables warming to be commenced as soon as possible.​[4] Emollients are not protective, and may increase the risk of frostbite through a spurious perception of skin warming.[23]

Limited evidence shows that prophylactic ibuprofen (or if not available, aspirin) may be protective.[1][4]​​[9]​​​​[17][18][19]​​​[22]

Secondary prevention

Frozen tissue should be protected from refreezing and damage from jewellery, clothing, rubbing, or trauma from mobilisation.[4] Frozen tissue should be allowed to thaw spontaneously or passively if rapid rewarming is not possible.[4] The patient should be kept adequately hydrated.[4]

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