thermometer cold canstockphoto22282395A 26-year-old woman presented to an urban Detroit emergency department complaining of bilateral foot pain after walking outside in the snow for 30 minutes without shoes or socks. She was unable to ambulate secondary to the pain and swelling. Physical examination revealed bilateral pallor, doughy texture, and coolness to the touch. There was generalized tenderness to palpation throughout the digits. The overlying skin was edematous, although without signs of breakdown.

Background on Frostbite

Frostbite is a commonly encountered chief complaint during the winter months. It affects many groups of people including mountain climbers, “weekend warriors”, intoxicated individuals, those with underlying psychiatric impairment, and the homeless population. Frostbite is treated with warm water immersion in a circulating bath at water temperatures between 37 and 39 degrees C. 1 There are multiple commercial whirlpools available for reheating, however they cost thousands of dollars and are unfortunately unavailable at our institution.

Trick of the Trade: DIY Circulating Water Bath

We therefore created a whirlpool using a plastic tub, a sink with a faucet and a portable thermometer (Figure 1). The patient was placed on the standard gurney and placed adjacent to the sink. The tub was placed into the sink and filled with water until the monitored temperature was 37-39 degrees C using the hot and cold levers. Once the temperature was stable, the patient placed both of her feet into the warm water to begin re-warming. With the tub placed in the sink, there was continuous movement of water with the overflow going down into the sink drain. This effectively creates an immersion circulating water bath. This technique could be used for any body part that is easily placed into a sink and can be done with supplies readily available in most departments.


circulating water bath for frostbite

Figure 1. Easily create a water bath using a plastic tub placed into a sink and a thermometer to monitor the water temperature.

This period of re-warming takes approximately 10-30 minutes and should continue until the tissues are more pliable and distal erythema returns. 2 Our patient’s feet were rewarmed in our make-shift circulating bath. Her pain improved, the tissues became more pliable, and gradually the distal erythema returned to her toes. She was admitted to the hospital for a period of observation and pain control and was ultimately discharged following an uncomplicated course.

Take Home Points

  • The treatment of frostbite includes warm water immersion at water temperatures between 37 and 39 degrees C.
  • You can create a make-shift circulating bath using supplies that are readily available in most emergency departments: a plastic tub, a sink with a faucet, and a portable thermometer.
  • Other important considerations for frostbite treatment include prevention of tissue refreezing 1–3  and adequate pain control during rewarming.


(c) Can Stock Photo

McIntosh S, Opacic M, Freer L, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite: 2014 update. Wilderness Environ Med. 2014;25(4 Suppl):S43-54. [PubMed]
Zafren K, Giesbrecht G. Cold Injuries Guidelines. State of Alaska. 2014. Published 2014.
Zafren K, Danzl DF. Frostbite. In: Rosen’s Emergency Medicine – Concepts and Clinical Practice. 8th ed. Saunders; 2013:1877-1882.
Ciara Barclay-Buchanan, MD

Ciara Barclay-Buchanan, MD

Associate Residency Director, Emergency Medicine
Assistant Professor
University of Wisconsin School of Medicine and Public Health
Ciara Barclay-Buchanan, MD

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Steven Irving, MD

Steven Irving, MD

PGY-2 Emergency Medicine Resident
Sinai-Grace Hospital/Detroit Medical Center/Tenet Health Systems
Steven Irving, MD

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