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Frostbite is a topic covered in the 5-Minute Emergency Consult.

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  • Tissue damage caused by cold temperature exposure
  • Mechanism:
    • Tissue damage results from:
      • Direct cell damage: Intracellular ice crystal formation
      • Indirect cell damage: Extracellular ice crystal formation leads to intracellular dehydration and enzymatic disruption.
      • Reperfusion injury: Occurs upon rewarming. Fluid rich in inflammatory mediators (prostaglandin and thromboxane) extravasates through damaged endothelium promoting vasoconstriction and platelet aggregation.
      • Clear blisters form from extracellular exudation of fluid.
      • Hemorrhagic blisters occur when deeper subdermal vessels are disrupted, indicating more severe tissue injury.
      • The end result is arterial thrombosis, ischemia, and ultimately, necrosis.
    • Devitalized tissue demarcates as the injury evolves over weeks to months, hence the phrase “frostbite in January, amputate in July.”


  • Cold exposure: Duration of exposure, wind chill, humidity, and wet skin and clothing all increase the likelihood of frostbite.
  • Predisposing factors:
    • Extremes of age
    • Altered mental status (intoxication or psychiatric illness)
    • Poor circulatory status

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Rosen, Peter, et al., editors. "Frostbite." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307579/all/Frostbite.
Frostbite. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307579/all/Frostbite. Accessed April 24, 2019.
Frostbite. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307579/all/Frostbite
Frostbite [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307579/all/Frostbite.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Frostbite ID - 307579 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307579/all/Frostbite PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -