Since it is difficult to determine the extent of frostbite on initial examination, it is best to be conservative when contemplating admission. It has been the standard of care in the past to admit all but the most isolated and superficial frostbite cases. It is important to consider the associated social factors as well. The homeless or elderly, especially when unable to care for themselves adequately, should never be discharged into subfreezing temperatures. If the frostbite is extensive and the hospital and staff are not equipped to treat the degree of severity, transfer to a tertiary hospital should be considered after initial rewarming and treatment. Patients who are discharged from the emergency department should be treated with topical aloe vera (Dermaide Aloe Cream) and oral ibuprofen and encouraged not to smoke. Close surgical follow-up should be arranged.
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