Series Editor: Herbert L. Fred, MD

Prepared by Michael T. Dalley, DO, Chief Resident, Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, Muhammad Waseem, MD, Assistant Clinical Professor, Department of Emergency Medicine, Joan and Sanford Weill Medical College of Cornell University, New York City, and John Lafleur, MD, Attending Physician, Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY

A 61-year-old black man awoke with pain and paresthesias in both hands. The night before, he had been exposed to cold weather for an uncertain length of time. Physical examination showed both hands were swollen and red, with large, weeping bullae between the proximal and distal interphalangeal joints on all the digits (Figure).

Points to remember: Frostbite is characterized by hyperemia, edema, and clear blister formation, leading at times to tissue necrosis and amputation. Depending on the exposure, frostbite may develop within seconds to days. Warning signals include cold sensation, pain, and numbness. Treatment involves initial thawing in a warm water bath (40°C-42°C) for 10 to 30 minutes until the skin is pliable. Rewarming, analgesics, and tetanus prophylaxis are important in the initial management. Covering the damaged areas with agents such as aloe vera cream can also be helpful.

Diagnosis: Second-degree frostbite.