Emergency War Surgery NATO Handbook: Part I: Types of Wounds
and Injuries: Chapter IV: Cold Injury
First Aid
United States Department of Defense
Peer Review Status: Internally Peer
Reviewed
The emergency treatment of cold injury is as follows:
- All casualties with involvement of the lower extremities
should be treated as litter cases if feasible.
- Carefully assess concomitant injury or complicating systemic
problems.
- All constricting items of clothing, such as boots, gloves, and
socks, should be removed, but only when adequate protection from
further cold exposure is available. Boots and clothing frozen on
the body should be thawed by immersion in warm water before
removal. Vigorous manipulation of frozen parts or attempts at
range of motion or massage should be avoided. If the hands are
affected, rings should be removed from the fingers early after
presentation.
- If the injured parts are still frozen when first seen, they
should be rewarmed rapidly by immersion in water at 100° to
104°F (375° to 40°C) with added antiseptic soap,
such as pHisoHex, and with agitation of the bath water to hasten
the warming. A whirlpool apparatus is most satisfactory for
this.
- General body warmth must be maintained. Sleep and rest should
be encouraged.
- A booster dose of tetanus toxoid should be given to those
previously immunized. No evidence exists that prophylactic use of
antibiotics is valuable either in promoting healing or in
preventing superficial or deep infection. In fact, the use of
prophylactic antibiotics may result in the emergence of a
resistant strain of organisms.
- Large vesicles or bullae should be protected and kept intact
if possible. Once ruptured, it is usually desirable to debride the
vesicle. Ointment dressings have no place in the usual management
of cold injury. Protective dry dressings are desirable during
transportation, and sterile cotton should be used between the toes
to prevent maceration.
- Smoking is prohibited.
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