Frostbite

Frostbite occurs when skin and subcutaneous tissue freezes after exposure to extreme and prolonged freezing condition. Frostbite usually affects ears, nose, cheeks, fingers and toes.

This is an emergency condition and requires immediate medical attention and prompt treatment. It may usually be associated with hypothermia, a life-threatening condition. So knowing the symptoms of hypothermia is very important. This is most commonly seen in winter sports enthusiasts, climbers, homeless people and also common in people who are frequently exposed to cold weather for long time.

Frostbite symptoms:

Several degrees of frostbite are recognized and symptoms may vary accordingly. The degree of injury is directly related to the temperature and duration of freezing.

Frostnip: It is first degree frostbite and involves skin only and doesn’t cause any irreversible damage. It can be managed effectively with complete recovery by rewarming the skin. It is characterized by severe cold sensation progressing to numbness and followed by painful Erythema. It is commonly present on toes, fingers, cheeks, ear and nose.

Superficial frostbite: It’s second degree frostbite and involves the skin and subcutaneous tissues. It is associated with initial pain which gradually subsides to a feeling of warmth sensation. The affected skin is usually painless, pale and waxy. This is a sign of severe involvement. It may be associated with swelling and erythema within 24 to 36 hours after rewarming, lesions may become eroded.

Deep frostbite: It’s a third degree and fourth degree frostbite where the injury extends to deep subcutaneous tissue and may involve muscles, nerves, large blood vessels and sometimes even bone. The affected area becomes white or bluish, painless and totally numb which may result in immobility of joints and limbs and even paralysis.

One or two days after rewarming, large blisters may form. After 5-10 days of blister formation, the fluid inside the blisters is reabsorbed and this leads to formation of hard, black gangrene. A week later, a line of demarcation occurs, and the tissues distal to the line undergo auto-amputation.

Frostbite Treatment and Prevention

Prevention is the key to protecting individuals from the effects of cold weather. Here are the things you need to do.

Remove the person from the cold and take him to a warmer place. Remove wet clothes and any constricting jewelry and cover the person with warm blanket or warm hands so adequate circulation can be maintained. Seek an immediate medical help. Look for the sign of hypothermia and manage accordingly.

If immediate medical help is not available, start with rewarming first aids.

Start with a warm drink. As slow re-warming causes extensive tissue damage so rapid re-warming in a water bath between 40⁰C to 42⁰C degree is the treatment of choice. Re-warming should be done only after the patient has been removed from the area where there is no risk of refreezing. Never expose the patients to more than 42 degree of water bath or any higher temperature to gain rapid re-warming.

Complete bed rest is advised and the damaged part should be elevated, and blisters should be left intact. Don’t rub, massage or shake the affected area, this can be harmful.

The affected area may exposed to air at room temperature which will help relief pain and prevent further tissue damage. If pain is severe analgesics may be given.

Protection from further refreezing is a must. If you cannot guarantee the protection from refreezing, it is better to delay the re-warming process until you are sure there won’t be any exposure to cold.

First degree frostbite can be effectively managed at home following the first aids. If the skin color and feeling sensation doesn’t return to the normal state after immediate re-warming, than it may be the sign of severe frostbite. For more severe degree frostbite you should always seek medical attention. Even with the first degree frostbite you should consult the doctor. It may still be hard to identify the extent of injury and tissue damage at home. Your doctor will identify the degree of tissue damage and treat accordingly.

Other Similar condition due to cold injury are Chilblains and Trench Foot