- General: White, waxy, mottled appearance, loss of sensation.
- First-degree: Erythema, edema, waxy, hard white plaques.
- Second-degree: Formation of clear blisters within 24 hr.
- Third-degree: Formation of blood-filled blisters.
- Fourth-degree: Full-thickness (muscle, tendons, and bones).
- Thawing: Red, warm, edema, burning, stinging, painful.
- Remove Pt from cold environment.
- Remove wet clothing, and protect Pt from further heat loss or hypothermia.
- Anticipate and manage hypothermia per protocol.
- Avoid excessive or rough handling of Pt or affected area.
- Do not massage frostbitten area.
- Leave blisters intact.
- Remove jewelry and keep affected area slightly elevated.
- For first-degree injury-position Pt with affected area against warm body surface (e.g., placing frostbitten fingers into the axilla).
- Encourage warm, nonalcoholic beverage unless AMS or trauma present.
- Monitor ECG and manage dysrhythmias per hypothermia protocol.
- Obtain IV access in a nonfrostbitten extremity.
- Consider Morphine 1-4 mg IV or Fentanyl 25-50 mcg IV for pain.
Rapid Thawing Procedure
Caution: Avoid thawing procedures if refreezing is likely.
- Submerse affected area in warm water (38°-42°C/102°-108°F) for 10-30 min (may use warm wet packs).
- Carefully separate digits with cotton or gauze.
- Elevate extremity slightly to minimize swelling.
- Manage pain as needed.