COLD INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 410

If the frostbitten extremity has completely thawed, rewarming has no beneficial effects,
but if the completeness of thawing is uncertain, brief rewarming may be helpful.
During rewarming the water temperature should be maintained between 99° and 102°F
(37° and 39°C). Higher temperatures damage the tissues and are more painful. The water
mustnotfeeluncomfortabletoanuninjuredperson'shand.Alargewaterbathpermitsmore
accurate temperature control and warms the frozen extremity more rapidly, often resulting
in less tissue loss, particularly when freezing has been deep and extensive.
The extremity should be stripped of all clothing and any constricting bands, straps, or
other objects that might impair the circulation. The injured foot or hand should be suspen-
ded in the center of the water bath and not permitted to rest against the side or bottom.
During rewarming, hot water must be added to the bath periodically to keep the temper-
ature at the desired level. (A frozen hand or foot is essentially a block of ice and cools the
water.) The injured extremity should be removed from the bath and not returned until the
water has been thoroughly mixed and the temperature measured.
An open flame should not be used to keep the water bath warm. The frostbitten ex-
tremity may come in contact with the heated area and be seriously burned because sensa-
tion in the tissues has been lost.
Warmingusuallyrequiresthirtytosixtyminutes; itshouldbecontinueduntilthetissues
are soft and pliable or no further changes in color are seen.
During rewarming, the frostbitten tissues usually feel quite painful. Strong analgesics
may be needed during or after rewarming.
Following rewarming, the individual must be kept warm and the injured tissues must
be elevated and protected from any kind of trauma or irritation. A framework should sup-
portbedclothestoavoidpressureorrubbingontheinjuredarea.Toavoidinfection,blisters
should not be ruptured.
Theindividualshouldbeevacuatedimmediately.Healingrequiresweekstomonths,de-
pending upon the severity of the injury. Subsequent care in the field should be directed
primarily toward preventing infection. Cleanliness of the frostbitten area is extremely im-
portant. Soaking the extremity in disinfected, lukewarm water to which a germicidal soap
has been added may be helpful. A small amount of dry, sterile cotton or gauze should
be placed between fingers or toes to avoid maceration. Antibiotics should not be given
routinely, but if infection appears to be present, ampicillin or cloxacillin should be admin-
istered until a physician's care is obtained.
Smokingshouldbestrictlyavoidedbecauseitreducesthealreadydeficientbloodsupply
tothedamagedarea.Movementoftheextremitiesshouldbeencouragedbutshouldbelim-
ited to movements that can be carried out without manipulation or assistance from others.
Most individuals with frostbite need continuing reassurance and emotional support.
Surgery has little or no role in the immediate therapy of frostbite. Unfortunately, occa-
sional surgeons with no experience with this injury are so alarmed by the appearance of