Asynchrony PEM: Frostbite (Baby, It's Cold Outside!)

Welcome to the first installment of Asynchrony PEM (Pediatric EM), brought to you by the PEM faculty and fellows of Warren Alpert Medical School/Brown University's Pediatric Emergency Medicine fellowship.
Each week we'll be curating content from the #FOAMpeds and #FOAMed world into modules organized by topic and relevant to the pediatric population. Follow @AsynchronyEM and @BrownEMRes on Twitter for new releases!
Baby, It's Cold Outside!

Baby, It's Cold Outside!

This week: Frostbite. We'll review classification and treatment, with a special focus on pediatric patients. We'll also talk about non-freezing cold injuries such as trench foot and chilblains. And if you haven't heard of popsicle panniculitis before, you'll be an expert by the time we're done!

Theme song! "Baby, it's Cold Outside" (Lady Gaga and Tony Bennett)

Enough chillin', let's get to work!

1) EP Monthly has a review of Frostbite: How to Classify and Treat it. These points are similar in the pediatric and adult populations; read on for some pediatric-specific points. 


2) has an outline type review of Frostbite that discusses some management not mentioned in EP monthly as well as complications specific to pediatrics.


3) Who better to get treatment guidelines for Frostbite and Nonfreezing Cold Injuries than from doctors in Alaska!! The State of Alaska: Cold Injury Guidelines. Starting on page 29 it reviews frostbite and Nonfreezing Cold injuries including Trench foot and Chilblains (and the rest of the pdf is very useful -- you can save it for reference on any cold-related injury.) Much of this relates to both adults and kids, but they make pediatric exceptions clear.

Example tidbit: "Children’s cartilage is more susceptible to cold injury than that of adults. This is especially true in the carpal and tarsal bones and is due to the epiphyseal growth plates being still open. Injury may occur in a child at any age at which the cartilage still persists. Orthopedic consultation is mandatory in children with frostbite that might affect a joint." (see 'complications' in the Orthobullets post as well.)


4) Popsicle Panniculitis: Yes this is a real diagnosis! Sean Fox has a nice quick review of its presentation and management on Pediatric EM Morsels.

Still don't believe this is a real thing? Check out this Case of Popsicle Panniculitis

This case might make you think twice about the popsicles we hand out in our ED, right?


Cold, short and sweet like a Hoodsie cup (and less likely to give you panniculitis!) -- we're done! See you next week with another curated PEM topic. 

(Any other #FOAMed resources that you would recommend on frostbite? Let us know in the comment section.)


Frances Turcotte Benedict, MD MPH (@fturcotteMD) is an Assistant Professor, Department of Emergency Medicine and Pediatrics at Alpert Medical School of Brown University. Her interests in medicine include injury prevention with a focus on youth violence prevention, medical education and simulation.