Frostbite is tissue damage caused by freezing temperatures and constitutes an important cause of morbidity in cold climate zones and high altitude. The direct effects of sub-zero temperatures lead to tissue freezing, electrolyte shifts and pH alterations, microvascular damage, and eventually to cell death. Upon rewarming, inflammatory reperfusion injury and thrombosis may lead to further tissue damage. Several studies and various case reports show that many patients suffer from long-term sequelae such as vasomotor disturbances (associated with susceptibility to refreezing), and neuropathic and nociceptive pain, as well as damage to skeletal structures. There are still many uncertainties regarding the pathophysiology of these sequelae. It has been shown that the transient receptor potential channel (TRP) family plays a role in cold allodynia. Botulinum Toxin type A (BTX-A) injections have been reported to be beneficial in vasomotor and neuropathic disturbances secondary to frostbite. Epidural sympathetic block has been used for short-term treatment of frostbite induced chronic pain. Furthermore, amitriptyline, gabapentinoids, and duloxetine may have some benefits. Frostbite arthritis clinically resembles regular osteoarthritis. In children there is a risk of epiphyseal cartilage damage leading to bone deformities. Despite some promising therapeutic concepts, the scarcity of data on frostbite long-term sequelae in the literature indicates the need of more in-depth studies of this pathology in all its aspects.

Cardiopulmonary resuscitation (CPR) is considered an aerosol-generating procedure. Consequently, COVID-19 resuscitation guidelines recommend the use of personal protective equipment (PPE) during resuscitation. In this simulation of randomised crossover trials, we investigated the influence of PPE on the quality of chest compressions (CCs). Thirty-four emergency medical service BLS-providers performed two 20 min CPR sequences (five 2 min cycles alternated by 2 min of rest) on manikins, once with and once without PPE, in a randomised order. The PPE was composed of a filtering facepiece 3 FFP3 mask, safety glasses, gloves and a long-sleeved gown. The primary outcome was defined as the difference between compression depth with and without PPE; secondary outcomes were defined as differences in CC rate, release and the number of effective CCs. The participants graded fatigue and performance, while generalised estimating equations (GEE) were used to analyse data. There was no significant difference in CC quality between sequences without and with PPE regarding depth (mean depth 54 ± 5 vs. 54 ± 6 mm respectively), rate (mean rate 119 ± 9 and 118 ± 6 compressions per minute), release (mean release 2 ± 2 vs. 2 ± 2 mm) and the number of effective CCs (43 ± 18 vs. 45 ± 17). The participants appraised higher fatigue when equipped with PPE in comparison to when equipped without PPE (p < 0.001), and lower performance was appraised when equipped with PPE in comparison to when equipped without PPE (p = 0.031). There is no negative effect of wearing PPE on the quality of CCs during CPR in comparison to not wearing PPE.

Background: Frostbite is a localized cold injury resulting from tissue freezing, primarily affecting the extremities. Although rare in the general population, it is more frequent among individuals exposed to extreme cold, such as soldiers and mountaineers. Severe cases can result in permanent disability and tissue loss. Objective: To provide a narrative overview of current evidence-based recommendations for the prevention and treatment of frostbite, based primarily on recent guideline updates from the Wilderness Medical Society (2024) and the American Burn Association (2024).Methods: This narrative review summarizes and compares recommendations from two major clinical guideline publications, supplemented by supporting literature. No systematic literature search or meta-analysis was conducted. Results: Immediate management focuses on protecting the patient from further cold exposure, treating hypothermia, and rapidly rewarming affected areas in a warm water bath (37–39°C), followed by sterile wound care, possible blister management, splinting (immobilisation) and rapid hospital transport. Ibuprofen is recommended early for its anti-inflammatory and antiplatelet effects. In hospital settings, treatment includes rapid rewarming (if not yet applied), sterile wound care, analgesia, hydration, and tetanus prophylaxis. Thrombolytic therapy with rt-PA within 24 hours of rewarming may reduce amputation rates in deep frostbite. Iloprost is recommended as first-line therapy for grade 3–4 injuries, particularly when thrombolysis is contraindicated. Antibiotics are reserved for confirmed infection. Conclusions: Frostbite results from prolonged cold exposure, causing ice crystal formation, microvascular injury, inflammation, and ischemia. Early recognition and rapid, controlled rewarming, pain management, and immobilization are essential. Hospital care includes severity assessment, pharmacologic therapy (ibuprofen, thrombolytics, iloprost, anticoagulants), selective blister management, and supportive measures. Timely intervention reduces tissue loss, prevents progression to necrosis, and improves functional outcomes.