If hypothermia present, must rewarm to a core temperature of at least 35°C before treating<unk> 
Remove all wet or constrictive clothing
Thawing
Do NOT attempt until the risk of refreezing is eliminated
Refreezing will cause even more severe damage
Rapid rewarming is the core of therapy and should be initiated as soon as possible
Extremities
Place in water with temperature of 37 to 39°C (98.6 to 102.2°F)
Approximately 20-30min, until extremity is pliable and erythematous
OR consider 38-40°C in whirlpool bath with antibacterial soap
Face
Apply moistened compresses soaked in warm water
Analgesia
Rewarming is very painful
Provide parenteral opioids
Local wound care
Apply topical aloe vera cream q6hr (interrupts arachidonic acid cascade)
Affected digits should be separated with cotton and wrapped with sterile, dry gauze
Elevate involved extremities
Blister removal is controversial
Consider drainage of nonhemorrhagic bullae that interfere with movement
Never debride hemorrhagic bullae
Compartment Syndrome is a known complication; maintain a high suspicion
Systemic care
Ibuprofen may be helpful in interrupting arachidonic cascade
tPA or IV Iloprost (not available in US), followed by several days of heparin, reduces digit amputation rate for 3rd and 4th degree<unk> 
Hyperbaric oxygen therapy is of theoretical benefit but no randomized trials have been performed
Tetanus
Reported complication of<unk> ; provide prophylaxis
Antibiotics
Controversial
Penicillin G 500,000 units IV Q6 hours for 48-72 hours
Topical bacitracin may be as good or better than IV penicillin
Silver sulfadiazine cream not consistently beneficial
May interact with aloe vera cream
Surgery
May be required if wet gangrene or infection occurs
Usually not performed until full demarcation occurs (3-4wk)
Do NOT attempt until the risk of refreezing is eliminated
Refreezing will cause even more severe damage
Rapid rewarming is the core of therapy and should be initiated as soon as possible
Extremities
Place in water with temperature of 37 to 39°C (98.6 to 102.2°F)
Approximately 20-30min, until extremity is pliable and erythematous
OR consider 38-40°C in whirlpool bath with antibacterial soap
Face
Apply moistened compresses soaked in warm water
Refreezing will cause even more severe damage
Extremities
Place in water with temperature of 37 to 39°C (98.6 to 102.2°F)
Approximately 20-30min, until extremity is pliable and erythematous
OR consider 38-40°C in whirlpool bath with antibacterial soap
Face
Apply moistened compresses soaked in warm water
Place in water with temperature of 37 to 39°C (98.6 to 102.2°F)
Approximately 20-30min, until extremity is pliable and erythematous
OR consider 38-40°C in whirlpool bath with antibacterial soap
Apply moistened compresses soaked in warm water
Rewarming is very painful
Provide parenteral opioids
Apply topical aloe vera cream q6hr (interrupts arachidonic acid cascade)
Affected digits should be separated with cotton and wrapped with sterile, dry gauze
Elevate involved extremities
Blister removal is controversial
Consider drainage of nonhemorrhagic bullae that interfere with movement
Never debride hemorrhagic bullae
Compartment Syndrome is a known complication; maintain a high suspicion
Consider drainage of nonhemorrhagic bullae that interfere with movement
Never debride hemorrhagic bullae
Ibuprofen may be helpful in interrupting arachidonic cascade
tPA or IV Iloprost (not available in US), followed by several days of heparin, reduces digit amputation rate for 3rd and 4th degree<unk> 
Hyperbaric oxygen therapy is of theoretical benefit but no randomized trials have been performed
Reported complication of<unk> ; provide prophylaxis
Controversial
Penicillin G 500,000 units IV Q6 hours for 48-72 hours
Topical bacitracin may be as good or better than IV penicillin
Silver sulfadiazine cream not consistently beneficial
May interact with aloe vera cream
May interact with aloe vera cream
May be required if wet gangrene or infection occurs
Usually not performed until full demarcation occurs (3-4wk)
Frostbite
Generalized
Le Fort fractures
Hypothermia
Shark bite
Freezing
Nasal fracture
Nailbed laceration