In the peri-injury period, the primary care goal is rapid rewarming. However, this should only be initiated if the warming can be rapidly and completely done as partial rewarming with subsequent re-exposure to cold exacerbates tissue injury.
The current standard of care is immersion in a warm water bath at 40 to 42 degrees C until sensation returns. If possible, the bath should be circulating water to provide a constant temperature.
After warming, clear blisters should be gently unroofed to prevent local thromboxane-mediated injury. Hemorrhagic blisters are generally left undisturbed.
On no account should any major debridement be done in the peri-injury period, even in the setting of what appears to be frank gangrene.
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