Page 129 - 2022 Ranger Medic Handbook

Frostbite & Frostnip
DEFINITION:
Frostnip: superficial freezing of the skin, a precursor to frostbite, that produces reversible skin changes that usually re-
solve with warming. FROSTBITE: occurs when tissue freezes and crystals form in the extracellular space between cells.
S/Sx: Edema; tenderness; loss of sensation (often loss of previous painful sensation); inability to move or flex affected
areas; blisters (clear-fluid blisters indicate less severe/hemorrhagic blisters indicate a deeper, more severe injury); skin
color may be pale, yellowish, or waxy-looking; frozen area will feel solid or wooden and may have a lifeless appearance.
MANAGEMENT:
1. Prevent additional freezing and/or progression of injury.
2. DO NOT attempt rewarming or thawing if there is a chance that refreezing will occur.
3. Treat per Pain Management Protocol prior to attempting rewarming. FROSTNIP:
a. Administer passive re warming with warming devices such as warm blankets, insulated ready-heat, or HPMK. SECTION 3
b. Manage mild to moderate pain as per Pain Management Protocol.
c. After rewarming, assess every 6 hours for tissue damage or signs of infection. Give NSAIDs prn × 5 days.
Frostbite:
1. Administer passive rewarming with warming devices as above OR if available, preferred is rapid rewarming in 104–
108F (40°C) water.
2. Gain IV access.
3. Administer warmed crystalloid fluids (1,000–1,500mL) to reduce blood viscosity and capillary sludging.
4. For pain, treat with narcotics or for severe pain as per Pain Management Protocol.
5. Clean and dress any blisters that have burst while avoiding bursting any intact blisters.
6. Splint fingers/toes and separate digits with nonadherent gauze.
7. Elevate extremities to reduce edema.
8. Initiate NSAID regimen until evacuated.
DISPOSITION: Urgent evacuation if risk of refreezing or rewarming is not an option. Priority evacuation for frostbite.
Frostnip generally will not require evacuation if resolved (any indication of infection or tissue damage should be evacu-
ated as routine.
SPECIAL CONSIDERATIONS:
1. Ensure complete differential diagnosis from hypothermia (hypothermia may occur in conjunction with frostbite and
should be managed first).
2. Do not allow patient any type of tobacco product.
3. Do not rub or massage injured tissue in the re-warming process.
4. Troops are more susceptible to cold at high altitudes or windy conditions below 32F.

2022 RANGER MEDIC HANDBOOK 115