Contact frostbite

13 Aug


Your next patient is 42 yo handyman who was attempting to change the filter in a home air conditioning unit when he noticed a Freon leak.

In order to stop the leakage, he covered the opening with his left hand, and now comes in complaining of a ‘burn’ on his index finger.  Now what?




Contact frostbite is common in young workers and typically involves the hands


often involves burns by refrigerant liquids and gases (e.g. Freon)


uncommon among burn injuries, (e.g. 17 out of 1670 burn patients [~1%] at one burn center over 4 years.)


fingers are more susceptible to cold exposure due to smaller vascular structures and thinner tissue 


appearance of the superficial tissue is often an unreliable indicator of the viability of the underlying tissue.  

injury may be more severe than that caused by a thermal burn because refrigerant liquids and gases rapidly and deeply penetrate through the skin.


Unlike typical frostbite which takes hours to days, the damage occurs within seconds.


recommendation is to remove the coolant material as fast as possible and transfer to a burn center 


more superficial damage treated similar to other burns (e.g. debridement, splinting, topical wound care, etc).


Submitted by C. Stokes. 


References: Sever C, et al. Unusual hand frostbite caused by refrigerant liquids and gases. Turkish Journal of Trauma & Emergency Surgery. 2010;16 (5):433-438; picture


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