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Cold damage to the extremities: frostbite and non-freezing cold injuries
  1. C Imray1,2,
  2. A Grieve3,
  3. S Dhillon2,
  4. The Caudwell Xtreme Everest Research Group2
  1. 1
    UHCW NHS Trust and Warwick Medical School, Coventry, UK
  2. 2
    Centre for Altitude Space and Extreme Environment Medicine, Institute of Human Health and Performance, University College London, London, UK
  3. 3
    General Practice Vocational Trainee, Defence Postgraduate Medical Deanery, ICT Centre, Birmingham Research Park, Birmingham, UK
  1. Correspondence to Professor C H E Imray, Warwick Medical School, UHCW NHS Trust, Coventry CV2 2DX, UK; chrisimray{at}


The treatment of cold injuries to the periphery has advanced substantially in the last 10 years and optimal outcomes are only likely to be achieved if a multidisciplinary team uses the full range of diagnostic and treatment modalities that are now available. The internet and satellite phones with digital images allow immediate access by patients from remote geographical locations to hospital based specialists who can assess cold injuries and advise on early field care. The severity of frostbite injuries can now be assessed with triple phase bone scanning, allowing early prediction of likely subsequent tissue loss. Early hyperbaric oxygen therapy appears to improve outcome and the use of intravenous drugs such as synthetic prostaglandin analogues infusions and tissue plasminogen activator have been shown to reduce amputation rates. In non-freezing cold injuries the early administration of analgesia, the avoidance of secondary exposure, and the use of infrared thermography to assess the injuries are among newer approaches being introduced.

  • frostbite
  • hypothermia
  • cold
  • non-freezing cold injury

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  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.