Wilderness Medical Society snowmass 2005 Page 226
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multiple fluid-filled and hemorrhagic blisters form. The portion of the extremity beyond
the hemorrhagic blisters is extremely damaged and may eventually become mummified
over time. Suspend the frostbitten area in the container of water without allowing contact
with the sides. Check water temperature often. Avoid excessive heat. During thawing,
pain is usually severe and analgesics, including narcotics, are indicated. When rewarming
is accomplished, dry the affected parts gently, and place sterile gauze between digits.
Elevate the injured part. Give ibuprofen every 6 hours to inhibit thromboxane production.
Maintain adequate hydration. Provide definitive medical care as soon as possible.
Immersion foot: Injury includes cold, swollen, waxy feet, mottled with dark burgundy to
blue splotches. Skin is sodden and friable. In the later stage, feet become red and hot, and
blisters often form. Infection and gangrene frequently result. Field treatment includes 1)
maintenance of dry, warm feet, 2) oral hydration, 3) ibuprofen every 6 hours to inhibit
thromboxane production, and 4) immediate evacuation to definitive care (note: walking
may be difficult for the patient).
III. CONTROVERSIES
A. Should deep frostbite be thawed in the field? There is evidence that the longer tissue
stays frozen, the worse the injury. Frozen extremities in an otherwise uninjured patient
are difficult to keep frozen, and spontaneous thawing usually occurs during evacuation.
Field therapy, which can render an ambulatory patient non-ambulatory, must be balanced
against the time required for evacuation.
B. Should a patient self-evacuate on frozen toes/feet prior to thawing if worse freezing is
unlikely or field thawing can not be easily accomplished? The longer the extremity is
frozen, the greater the tissue damage, although even more significant damage occurs with
a thaw followed by freezing. The decision to walk out on frozen feet should not be made
if there is any reasonable ability to thaw and provide further protection from freezing.
Thawed toes may not be so painful as to preclude self-evacuation. Deep frostbite of the
entire foot may become so painful and debilitating upon thawing that self-evacuation
becomes impossible. As the field diagnosis before thawing may be difficult to accurately
access, frozen extremities should generally be thawed and protected from further freezing
as soon as possible, realizing that the victim might not be able to self-evacuate.
