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more articles by Allen, Richard , MD  |  author's bio

Risk of Frostbite

Risk of Frostbite

Prevention and treatment of frostbite

By Ric Allen, M.D., F.A.C.E.P.

When cold, wet weather comes, as it does each year, with it comes an increased risk for frostbite.

Frostbite can be treacherous because it often occurs when we're enjoying outdoor activities like hunting, downhill skiing, ice-skating, or hiking. When we choose to ignore the signals that our bodies are getting too cold, we put ourselves at risk for damage to exposed skin and extremities. Faces, fingers, toes, ears, and noses are the most common areas for frostbite.

Types of cold weather injury

There are four basic types of cold weather injury. Pernio, commonly known as chilblain, occurs when skin is repeatedly exposed in cold, dry weather conditions. Joggers and people whose work puts them outside in cold weather often develop patches of itchy, red skin on their faces and other areas of unprotected skin. These red patches may blister, which can lead to scarring as the skin heals. The best way to prevent pernio is to cover your skin when outside.

Frostnip, which most of us experience at one time or another, occurs when the skin and extremities begin to have a burning or numb sensation and the skin appears white. These symptoms indicate that the temperature of the skin is very low and is in danger of freezing. Treat frostnip by going inside, removing restrictive clothing (which cuts off circulation), and allowing your skin to regain heat naturally. As you rewarm, you will experience a tingling sensation and your skin may look redder that usual for a while. Avoid consuming alcohol until all of your symptoms are gone.

Another common cold-weather injury, known as immersion foot, occurs when the feet are wet and cold for a long period of time. You can get immersion foot from walking around in wet shoes or boots in cold weather. Hunters and children playing outside in the cold are at special risk for this condition. People with immersion foot find that even after they have dried their feet, they remain clammy and pale, and are very sensitive to the touch. Though the feet are not frozen, immersion foot can cause quite a bit of tissue damage. The feet should be gradually and carefully rewarmed; do not vigorously rub them as this can increase tissue damage.

Frostbite, the most serious of the cold weather injuries, occurs when body tissue actually freezes. There are three stages of frostbite which, like burns, are based on the depth of the injury. The first symptoms of frostbite are similar to those of frostnip; a pins-and-needles sensation followed by numbness. When frostbite sets in, the skin first appears waxy, white, and hard, and then becomes red and swollen. You can no longer move the skin around like you can under normal circumstances, and there is no capillary refill when you push hard on the skin with your finger.

If you think you have frostbite, don't rub the area and don't try to warm it slowly. Simply cover the effected tissue and get to an emergency room as quickly as possible. There, the medical staff will rewarm the tissue by immersing it in warm water (104-108 degrees Fahrenheit). The rewarming process causes significant pain, and in the hospital setting we are able to provide analgesia to offset the discomfort. After the tissue has thawed, blisters will form which help to determine the prognosis for healing. With a bad case of frostbite, it can take months to know the extent of the permanent damage. Tissue that has suffered frostbite should be handled gently and with extreme care.

At special risk

Babies and small children are at increased risk for frostbite because they can't make their needs known. People who have impaired mental abilities are at risk, as are those with Alzheimer's disease. Alcohol consumption is often an aggravating factor in cases of frostbite. Smokers and people with high blood pressure, heart or vascular disease, and diabetes should take special precautions.

Avoiding injury

Dress appropriately for the weather in layers of clothing that are not restrictive, and wear a warm hat that protects your ears. Avoid alcohol because it alters your mental status and judgment. Recognize that babies and children are at greater risk than adults, and take special care to protect them.

Dr. Allen is board certified by the American College of Emergency Physicians. He practices emergency medicine in the Emergency Department at Cayuga Medical Center.

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