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Frostbite

Frostbite occurs when body tissues freeze, forming ice crystals within them and damaging the smaller blood vessels in the area. As tissue debris accumulates, it increasingly blocks circulation; this causes more injury to surrounding tissues, eventually killing them by depriving them of oxygen. In less severe conditions, the cold may produce chilblains, in which the exposed parts become red, painful, and swollen. Subsequent exposure to cold causes recurrent symptoms. The tissues most likely to be affected by both frostbite and chilblains are the skin and muscles of the hands and feet, because the body diverts blood flow from these areas to provide heat to the vital internal organs. The ears, nose, and cheeks are also vulnerable.

Diagnostic Studies And Procedures

Just before frostbite takes hold, the skin may be slightly flushed. As the condition develops, the area becomes cold, white, smooth, shiny, and numb. The person may not be aware of impending danger because she may feel no sensation of pain, but companions may notice the pale, glossy skin, as well as signs of mental confusion.

Medical Treatments

Emergency first aid

Cover the person with blankets anchor loose layers of clothing, and seek shelter. As soon as possible, call for an emergency medical team and ambulance. If the skin is still soft, rewarm the frozen area by immersing it in warm not hot water, 105°F to HO°F. If the skin is hard or if no water is at hand, warm the frostbitten part with your own body for example, cover ears with your warm hands Stop warming procedures as soon as the area becomes flushed, and help the patient change into warm, dry clothing, if available. (Caution: If the area may become frostbitten again, use skin to skin warming, not water. It’s dangerous to “thaw” an area that may refreeze.) There are several things you should not do. Do not rub the frozen area; this can cause further tissue damage. Do not apply a heating device of any kind.Do not permit the victim to place the affected area close to a hot stove or an open fire. Do not break any blisters that form. Do not allow the person to walk on recently thawed feet, but see that the feet remain elevated. Give warm drinks, but DO NOT permit alcohol consumption.

Emergency hospital treatment

Medical care begins with evaluating the patient’s overall condition and taking steps to restore damaged blood vessels and repair damaged tissues. After the initial warming procedure is completed, the affected area is kept warm, clean, and exposed to air. Treatment may include administering antibiotics and a tetanus shot to prevent infection, and giving aspirin or ibuprofen to alleviate pain and decrease the danger of blood clot formation. Intravenous fluids and drugs may be given as well. In some cases, reserpine may be injected directly into an artery. This drug, used to treat high blood pressure, dilates blood vessels and helps prevent thickening of the blood. Physical therapy takes place as soon as possible to speed rehabilitation of affected muscles and to restore joint movement. Surgery, if considered, is generally postponed until the extent of irreversible tissue damage is clear. The exception would be a severe case of gangrene; with this condition, prompt amputation is essential.

Alternative Therapies

Long term management for physical and psychological recovery may employ several alternative therapies.

Hydrotherapy

Warm baths, including underwater exercise and whirlpool baths, are a major aspect of treatment and rehabilitation .

Nutrition Therapy

A high protein diet may be devised to increase the nutrients necessary for rebuilding tissues damaged by frostbite.

Tai Chi

The gentle range of motion exercises of this ancient discipline can easily be integrated into a program of physical therapy following frostbite.

Self Treatment

If you must spend time outside during very cold weather, follow these precautions to avoid frostbite.

Listen to weather forecasts and be guided not only by the temperature, but also by wind-chill and humidity factors, which can increase the danger of frostbite significantly.

Wear protective clothing, including thermal underwear, a loose shirt, loose trousers, wind and moisture repellent outer garments, wool socks, fleece lined boots, wool gloves under water repellent gloves, close fitting ear coverings, and a face mask. A hat is very important-30 percent of body heat escapes through an uncovered head.

Limit your exposure time.

Maintain general circulation by moving about, but avoid overexertion.

Try to stay out of the wind.

Provide occasional additional warmth for your fingers by crossing your arms and placing your hands in your armpits .

Know the early symptoms of frostbite. If you experience any of them, seek shelter promptly and, if possible, change into dry, warm clothes.

Do not rub any part of your body with snow this only hastens freezing. Also, do not drink an alcoholic beverage before going out in the cold or while exposed to the cold.

Other Causes of Cold Injuries

Conditions that increase vulnerability to cold injuries include anemia, alcoholism, atherosclerosis, coronary artery disease, heart failure, and such circulatory disorders as Raynaud’s disease.

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