Frostbite

1 What is Frostbite?

Frostbite is an injury that is caused by exposure of the skin and underlying tissues to cold for a long period of time.

The skin firstly becomes very cold and red, then numb, hard and pale. Frstbite usually occurs on the fingers, toes, nose, ears, cheecks and chin.

Most people may not realize that they have frostbite unless someone points it out. This is because the skin becomes numb.

Frostbite occurs in three stages.

Frostnip

This is the first stage of frostbite.  The skin becomes pale or red and may feel very cold. With further exposure to cold, a person might have a prickling or numb sensation and pain and tingling can be felt as the skin starts warms. At this stage the skin doesn't get damaged permantly.

Superficial frostbite

Reddened skin turns white or pale. The skin may remain soft although some ice crystals may form in the tissue. Rewarming the skin can lead to mottled, blue or purple skin, a stinging, burning sensation and swelling. Blisters can appear 24-36 hours after rewarming the skin.

Severe (deep) frostbite

At this stage all the layers of the skin and underlying tissues are affected. Numbness, loss of cold sensation, pain and discomfort in the affected area are among the symptoms. Joints and muscles are unable to function at this stage. Large blisters may form 24 to 48 hours after rewrming the affected tissue. Later on , the area becomes black and hard due to the death of tissue.

2 Symptoms

The signs and symptoms of frostbite depend on the severity.

They include:

  • Cold skin and a prickling feeling
  • Numbness
  • Red, white, bluish-white or grayish-yellow discoloration of the skin
  • Hard or waxy-looking skin
  • Clumsiness due to joint and muscle stiffness
  • In severe cases blistering can occur after rewarming the affected area                                                      
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3 Causes

Frostbite is caused when the skin and underlying tissues freeze.

This is due to exposure to cold weather. However, it can also be caused by direct contact with ice, freezing metals or very cold liquids.

Wearing clothing that doesn't suit the weather or staying put in the cold for long periods of time especilaly when the temperature is below 5 F (minus 15 C) can cause frostbite.

4 Making a Diagnosis

Making a diagnosis of frostbite is done by performing several tests.

Apart from a medical history and physical exam, doctors may also conduct imaging tests like X-ray, bone scan or magnetic resonance imahing (MRI) to determine the severity of the frostbite.

These tests can also be used to check if nones or muscles are damaged. 

5 Treatment

There are two types of treatments for  frostbite depending on the severity. Mild cases require first-aid care while severe cases require medical treatment.

First-aid care involves the following

  • Upon suspicion of hypothermia it is important to move the person indoors to prevent further exposure. Once the person is indoors, remove all wet clothes.
  • Gently rewarm the frostbitten areas by saoking the hands and feet in warm water of not more than 108 F (37-42 C) for 15 to 30 minutes. If there is no thermometer to measure the temperature of the water , an uninjured hand can be placed in the water. It should feel warm and not hot. Avoid rewarming frostbitten areas with direct heat, such as a stove, heat lamp, fireplace or heating pad as these can cause burns.
  • Wrap the affected areas to  prevent them from refreezing.
  • Administer pain medication like Ibuprofen (Advil, Motrin IB) if the person complains of pain.
  • Check if there are any signs of blood flow returning to the affected area. If blood flow returns to normal the skin will turn red and the person will have a tingling and burning sensation. However, if numbness persists it is important to seek emergency medical attention.

Medical treatment involves the following

  • Rewarming the affected skin in a warm-water bath for 15 to 30 minutes. Moving the affected area as it rewarms is encouraged.
  • Taking pain medication since the rewarming process can be painful.
  • Protecting the injured area once it thaws. This can be done by loosely wrapping the area with sterile sheets, towels or dressings. A brace is recommended in cases were the bone or muscle is also affected. Rising the affected area can help to prevent swelling.
  • Removing damaged tissue ( debridement) in order for frostebitten skin to heal properly. Doctors can wait one to three months before removing the damaged tissue since distinguishing healthy and dead tissue can be challenging.
  • Using whirpool therapy, in which a whirpool bath (Hydrotherapy) is used to help keep skin clean and remove dead tissue naturally.
  • Giving antibiotics  id the skin or blister appear infected.
  • Using vaccum-assisted closure therapy for complex wounds. This technique promotes healing.
  • Surgery or amputation is severe cases to remove dead tissue.
  • Using hyperbaric oxygen therapy.                                                                                      

6 Prevention

Frostbite can be prevented by following these tips

  • Limiting the time spent outdoors especially in cold, wet or windy weather.
  • Dressing in several layers of loose, warm clothing.
  • Wearing a hat or headband that can fully cover the ears.
  • Wearing mittens instead of gloves since mittens provide better protection.
  • Wearing socks and sock liners that fit well, wick moisture and provide insulation.
  • Keep watching for early signs of frostbite like red or pale skin, prickling and numbness.
  • Avoiding drinking alcoholic beverages  outdoors because alcohol causes the body to lose heat faster.
  • Eating a well-balanced meal and staying hydrated.
  • Keep moving since exercise helps to keep blood flowing and thus can help to keep you warm.                                                                                                                

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with frostbite.

The following can be done after frostbite:

  • Taking medicatons like antibiotics and painkillers
  • Applying aloe vera gel or lotion to the affected area several times to reduce inflammation.
  • Avoiding further exposure to cold.
  • Avoiding walking on frostbitten feet.
  • Avoiding direct heat or rub to the afected area.
  • Allowing blisters to break on their own.

8 Risk and Complications

Factors that increase the risk of frostbite include:

  • Medical nconditions that affect a person's ability to feel or respond to cold. They include; dehydration, exhaustion, diabetes and poor blood flow to the limbs.
  • Alcohol and drug abuse.
  • Smoking
  • Fear, pain or mental illnesss which may inhibit good judgement or the ability to respond to cold.
  • A history of frostbite
  • Children and older adults who have a hard time retaining body heat
  • Being at high altitude, hich reduces the oxygen supply to the skin.

Complications of frostbite include:

  • Increased sensitivity to cold
  • Increased risk of having frostbite in the future
  • Long-term numbness in the frostbitten area
  • Frostbite arthritis
  • Growth defects in chidren if the bones growth plate is affected
  • Infections
  • Tetanus
  • Decay and death of tissues due to inturrupted blood flow to the area (Gangrene). This can lead to amputation.

Sever cases of fostbite can lead to hypothermia. This causes the heart and other systems to not function properly which can lead to cardiovascular and respiratory syatem failure. If this is not treated, it can lead to death.

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