Frostbite

Symptoms

DEFINITION

• Frostbite is a cold injury to the skin.
• Symptoms of mild frostbite (frostnip) are cold, tingling and painful skin.
• True frostbite causes white, hard, completely numb skin; can be serious, and always requires medical attention after re-warming.
• Common sites are toes, fingers, tip of the nose, outer ear or cheeks.

General

• Frostbite and hypothermia are two distinct and independent medical problems.
• Frostbite results from a cold injury to the skin. The body's core temperature can be normal. In frostbite, the nerves, blood vessels and skin cells of a part of the body are temporarily frozen. The ears, nose, penis, fingers, and toes are most commonly affected.
• In contrast, hypothermia signifies a marked decrease in the body's core temperature, and frostbite may not be present. Hypothermia is defined as a body temperature < 95° F (35° C) rectally, and can be fatal without intervention.

Frostbite Severity - Frostbite can be classified like burns:

• Frostnip (mild frostbite): Cold, tingling and painful skin
• 1st Degree: White and waxy (hard) while frozen; mild erythema and swelling after re-warming
• 2nd Degree: Same as 1st degree plus blisters after 24 hours
• 3rd Degree: Hemorrhagic blisters progressing to skin necrosis

Factors Contributing to Frostbite

• Alcohol, mental illness: Impairs judgement and reduces normal self-protective actions.
• Medical conditions: A number of medical conditions predispose to frostbite. Patients with diabetes, congestive heart failure, peripheral vascular condition, Raynaud's disease, and previous frostbite are all at greater risk.
• Type of contact: The frostbite is much worse if the skin and clothing are also wet at the time of cold exposure. Touching bare hands to cold metal and volatile products (like gasoline) stored outside during freezing weather can cause immediate frostbite.
• Duration of contact: The longer the cold exposure the greater both the heat loss and the likelihood of frostbite. The wind velocity on a cold day (windchill index) also determines how quickly frostbite occurs.

Frostbite Prevention - General

• Change wet gloves or socks immediately
• Set limits on the time spent outdoors when the wind-chill temperature falls below zero.
• Know the earliest warnings of frostbite. Pain, tingling, numbness are signals from your body that you are not dressed adequately for the weather and that you need to go indoors.

Frostbite Prevention - Clothing

• Clothing: Dress in layers for cold weather. The first layer should be long underwear preferably made of polypropylene or polyester (wicks moisture away from skin). The middle layer(s) should be fleece or wool. The outer layer serves as a windbreaker and also needs to be waterproof. The layers should be loose, not tight.
• Hand Protection: Mittens are warmer than gloves. You may wish to wear a thin glove under the mitten.
• Footwear: Avoid tight shoes that might interfere with circulation. Wear 1-2 pairs of socks made from wool or a wool blend. You may also wish to wear a thin liner sock made from polyester or polypropylene (wick away moisture) under the wool socks.
• Headwear: Wear a hat, because over 50% of heat loss occurs from the head.

FIRST AID Advice for Frostbite:

Rewarm the frostbitten area rapidly with wet heat.

• Move into a warm room.
• For frostbite of an extremity (e.g., fingers, toes): Place the frostbitten part in very warm water. A bathtub or sink is often the quickest approach. The water should be very warm (104 to 108 F, or 40 to 42 C), but not hot enough to burn. Immersion in this warm water should continue until a pink flush signals the return of circulation to the frostbitten part (usually 30 minutes).
• For frostbite of the face (e.g., ears, nose): Apply warm wet washcloths to frostbitten area of the face. Continue doing this until a pink flush signals the return of circulation to the frostbitten area (usually 30 minutes).

Note: Do not rewarm a frostbitten area if there is a chance of refreezing.

FIRST AID Advice for Frostbite During Transport to a Medical Facility:

• Wrap frostbitten area in warm blanket or clean dressing.
• Protect frostbitten area from injury.
• Avoid walking on frozen feet if possible (Reason: may cause further tissue injury).

FIRST AID Advice for Hypothermia:

• Remove wet clothing.
• Wrap in warm blankets (or clothing, sleeping bag, even newspaper).
• Move into a warm space (e.g., home, building, car, tent).

Should I Call?

WHEN TO CALL YOUR DOCTOR

Care at Home

HOME CARE ADVICE FOR MILD FROSTBITE

1. Frostbite Treatment - Rewarming - Rewarm the area rapidly with wet heat:  
   • Move into a warm room.
   • For Frostbite of an Extremity (e.g., fingers, toes): Place the frostbitten part in very warm water. A bathtub or sink is often the quickest approach. The water should be very warm (104 to 108 F, or 40 to 42 C), but not hot enough to burn. Immersion in this warm water should continue until a pink flush signals the return of circulation to the frostbitten part (usually 30 minutes). At this point, the numbness should disappear.
   • For Frostbite of the Face (e.g., ears, nose): Apply warm wet washcloths frostbitten area of the face. Continue doing this until a pink flush signals the return of circulation to the frostbitten area (usually 30 minutes).
   • With more severe frostbite, the last 10 minutes of rewarming is usually quite painful.
   • If not using a tub, keep the rest of your body warm by covering yourself with plenty of blankets.
2. Frostbite Treatment - Common Mistakes:
   • A common error is to apply snow to the frostbitten area or to massage it. Both can cause damage to thawing tissues.
   • Do not re-warm with dry heat, such as a heat lamp or electric heater, because frostbitten skin cannot sense burning.
   • Do not re-warm if there is a high likelihood of refreezing in the next couple hours. Freezing-warming-freezing causes more damage than freezing-warming.
3. Drink Warm Liquids: Drink warm liquids (e.g., hot chocolate).
4. Pain Medicines:
   • For pain relief, take acetaminophen, ibuprofen or naproxen.
   • Acetaminophen (e.g., Tylenol):
     • Take 650 mg by mouth every 4-6 hours. Each Regular Strength Tylenol pill has 325 mg of acetaminophen.
     • Another choice is to take 1,000 mg every 8 hours. Each Extra Strength Tylenol pill has 500 mg of acetaminophen.
     • The most you should take each day is 3,000 mg.

   • Ibuprofen (e.g., Motrin, Advil):

     • Take 400 mg by mouth every 6 hours

     • Another choice is to take or 600 mg by mouth every 8 hours.

     • Use the lowest amount that makes your pain feel better.

   • Naproxen (e.g., Aleve)

     • Take 250-500 mg by mouth every 12 hours.

     • Use the lowest amount that makes your pain feel better.

   • Extra Notes

     • Acetaminophen is thought to be safer than ibuprofen or naproxen in people over 65 years old. Acetaminophen is in many OTC and prescription medicines. It might be in more than one medicine that you are taking. You need to be careful and not take an overdose. An overdose can hurt the liver.

     • Before taking any medicine, read all the instructions on the package.

5. Aloe Vera Ointment: Apply aloe vera ointment to the area of frostbite twice daily for 5 days.
6. Tetanus Booster for Frostbite: If your last tetanus shot was given more than 10 years ago, then you need a booster.
7. Call Your Doctor If:
   • Color and sensation do not return to normal after 1 hour of re-warming
   • Frostbitten part develops blisters
   • You become worse.

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Photo Example

Frostbite of the Ear

Source: LMS Inc.

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