Cold Injury

Cold injury is damage to the peripheral tissues due to the direct effects. The milder form is known as “frost nip”, where the skin will become white and numb. This is fully reversible on warming. The more severe form is known as “frost bite”, where the affected area becomes white on freezing, but on rewarming will become blue/purple and may progress to be black and thickened. This area will eventually separate away and in most patients this will reveal healthy tissues beneath.

Treatment of Cold Injury

The patient should be removed from the cold environment and rewarmed. Rewarming should not be attempted until it is sustainable and when the patient will not be re-exposed to the same cold conditions. In milder cases, passive rewarming may be appropriate, but in more severe cases active rewarming using circulating warm water should be considered. Rewarming can be extremely painful and adequate analgesia will be required.

It is worth considering the use of nonsteroidal anti-inflammatory drugs to inhibit prostaglandin actions.