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Non-freezing cold injury versus frostbite — RCPSC EM MCQ

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ModerateEnvironmental emergenciesNon-freezing cold injury versus frostbiteRCPSC EM

CTAS 3: A 44-year-old unhoused man presents after a night in wet boots at 2°C. Feet are pale, numb and swollen with burning pain after rewarming. Skin is mottled but pliable, without hard frozen tissue or haemorrhagic blisters. Pulses are dopplerable. What is the most likely diagnosis?

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Correct answer: D — Trench foot

Prolonged cold wet exposure above freezing with painful swollen pliable feet suggests non-freezing cold injury. Frostbite implies tissue freezing and usually hard, waxy tissue before rewarming.

Reference: Wilderness Medical Society cold injury guidance; Canadian EM practice