Summary
Definition
History and exam
Key diagnostic factors
- cold or numbness of affected extremity
- pain during rewarming
- purplish skin discoloration
- white or yellow skin plaque
- superficial skin vesiculation
- deep purple blisters
- tissue necrosis and mummification (dry gangrene)
Other diagnostic factors
- erythema
- joint dislocation
- fractures
Risk factors
- cold exposure
- previous frostbite
- vascular insufficiency
- high altitude
- hypoxia
- alcohol
- tobacco
- dehydration
- extremity trauma
- constrictive clothing or equipment
Diagnostic investigations
1st investigations to order
- clinical diagnosis
Investigations to consider
- technetium-99m pertechnetate scintigraphy
- magnetic resonance angiogram of affected extremity
- plain radiography
Emerging tests
- thermography and duplex imaging
Treatment algorithm
all patients
Contributors
Authors
Elizabeth A. Kaufman, MD, CAQ-SM
Attending Physician
Scripps Green Hospital
Urgent Care Center
Scripps Clinic
La Jolla
CA
Disclosures
EAK declares that she has no competing interests.
Christopher Imray, PhD, FRCS, FRCP, FRGS
Director of Research, Development and Innovation
University Hospital Coventry and Warwickshire NHS Trust
Warwick Medical School
Coventry
UK
Disclosures
CI has been paid for medico-legal work as a medical expert and receives royalties of approximately £150 per annum for the Oxford Handbook of Wilderness and Environmental Medicine. CI has spoken pro bono at lectures and other educational events.
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.
Differentials
- Cutaneous burns
- Frostnip
- Raynaud phenomenon
More DifferentialsGuidelines
- Heat illness and cold injury: medical management part 2 guidance
- Wilderness Medical Society clinical practice guidelines for the prevention and treatment of frostbite: 2019 update
More Guidelines
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