UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
Effective Date: August, 2002 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed October, 2003 April, 2005 Dec. 2007 May 2009
PURPOSE: To provide guidelines for the assessment and treatment of frostbite in
patients at UWMF Clinics.
Frostbite occurs when skin tissue and blood vessels are damaged from exposure to
temperatures below 32 degrees Fahrenheit. It most commonly affects the toes, fingers,
earlobes, chin, cheeks and nose, body parts that are often left uncovered in cold
temperatures. Frostbite can occur gradually or rapidly.
Frostbite has three stages of progression:
Frostnip- Usually affects the face, ears, or fingertips. Individuals experience a pins and
needles sensation with the skin turning very white and soft. No blistering occurs. This
stage produces no permanent damage and may be reversed by soaking in warm water or
breathing warm breath on the affected area.
Superficial or Second Degree Frostbite- In this stage, blistering may occur. The skin
feels numb, waxy and frozen.
Deep or Third Degree Frostbite - This is the most serious stage of frostbite. In this
stage, blood vessels, muscles, tendons, nerves and bone may be frozen. This stage can
lead to permanent damage, blood clots and gangrene, in severe cases. No feeling is
experienced in the affected area and there is usually no blistering. Serious infection and
loss of limbs frequently occurs after frostbite reaches this stage. However, even with deep
frostbite, some frozen limbs may be saved if medical attention is obtained as soon as
Superficial or Second degree frostbite Deep or Third degree frostbite
POLICY: The clinical staff will utilize the following guidelines to assess and treat
frostbite in UWMF patients.
SUPPLIES: Warm water, towels, Pen or pencil, Provider’s order, Patient’s record
PPE (gloves, gown, goggles, mask)
Emergency equipment, pillows, tetanus record and vaccine (if indicated).
1. Wash hands and gather equipment including putting on PPE
(personal protective equipment).
2. Introduce yourself and identify the patient.
3. Explain procedure to the patient.
4. Provide good light and provide privacy by closing curtains or door.
5. Get patient out of wet clothing as soon as possible and remove all constrictive jewelry
6. Initial frostbite assessment:
Including history of exposure -
* skin swelling
* loss of limb function and absence of pain (See Neuro Assessment Policy
section - Assessing the Patient’s Motor Function – if needed)
* drastic skin color changes
* memory loss (See Neuro Assessment Policy section - Assessing the
Patient’s Level of Consciousness – if needed)
6. If the patient has one or more of the of the above items CALL 911 and begin
a re-warming process.
*Narcotics may be given at this time due to pain
Apply warm (100F - 38C) towels for 15- 30 minutes or
Immerse the area in circulating lukewarm water for twenty minutes.
Offer the patient warm coffee or tea, if alert.
Keep the affected area raised.
Leave the blisters intact and cover with a sterile cloth to prevent rupturing.
Apply dry, sterile dressings between frostbitten fingers or toes to keep them
Check on the patient’s tetanus status.
NOTE: DO NOT
Use dry heat (sunlamp, heating pad, etc.) to thaw the injured area.
Thaw the injury in melted ice.
Massage/Rub the area.
7. Document in the patient's chart the care give and the patient's response to the
Ronnie Peterson, R.N., M.S., Clinical Staff Educator
LaVay Morrison, RN, BSN, Clinical Staff Educator
1. Basic Skills and Procedures: Perry & Potter, 4
Ed., 1998, Mosby, St. Louis.
2. Clinical Nursing Skills & Techniques, 5
Ed. Perry & Potter, 2002, Mosby, St. Louis.
3. Frostbite; http://www.emedicinehealth.com/frostbite/page7_em.htm
5. Lippincott Williams & Wilkins. Procedure Checklists Fundaments of Nursing of
Nursing: The Art and Science of Nursing Care, 4
ed. Lillis, LeMone and LeBon.
Medical Director Date