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Overview of Cold Injury

By Daniel F. Danzl, MD, Professor and Chair, Department of Emergency Medicine, University of Louisville School of Medicine

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Exposure to cold may cause decreased body temperature (hypothermia) and focal soft-tissue injury.

Treatment is rewarming and selective, usually delayed, surgical treatment for injured tissues.

Susceptibility to all cold injury is increased by exhaustion, undernutrition, dehydration, hypoxia, impaired cardiovascular function, and contact with moisture or metal.


Prevention is crucial. Several layers of warm clothing and protection against moisture and wind are important even when the weather does not seem to threaten cold injury. Clothing that remains insulating when wet (eg, made of wool or polypropylene) should be worn. Gloves and socks should be kept as dry as possible; insulated boots that do not impede circulation should be worn in very cold weather. A warm head covering is also important.

Consuming ample fluids and food helps sustain metabolic heat production.

Paying attention to when body parts become cold or numb and immediately warming them may prevent cold injury.

General reference

  • Zafren K, Geisbrecht GG, Danzl DF, et al: Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update. Wilderness Environ Med, S66-S85, 2014.