Nipping Frostbite

Photo Credit: Jaanus Silla (Flickr/Creative Commons)

By Dr. Fasiha Hasham
TMO Columnist

With the winter season in full swing, exposure to abnormally cold temperatures can result in serious injuries – particularly frostbite.

Frostbite occurs when ice crystals form in body fluids, usually blood, causing your tissues to freeze. In many instances, the freezing is superficial, involving mostly the nose, ears, toes and fingers. However, if the right precautions are not taken, it can lead to death.

Frostbite occurs more rapidly on a wet, windy day than on a dry, calm one on which the air temperature may actually be lower. Wind and humidity accelerates the freezing. Other factors that intensify the effects of cold include:

• ALCOHOL: Consuming alcohol may produce a sensation of warmth, but it causes a rush of blood to the surface i.e. skin, which allows more heat to escape from the body. Alcohol also dulls the senses, making the person oblivious to the cold.
• SMOKING: Smoking interferes with normal blood circulation and thereby promotes frostbites of the extremities.
• AGE: Older people often feel the effect of cold less intensely than young people. Thus, they may not realize they are in danger. Also, aging reduces the shiver response, which protects against freezing.
• FATIGUE: Being overly tired dulls sensation and the ability to move briskly.

Signs of frostbite include:

• Slight flushing of the skin followed by blanching or grayish- yellow coloration. Later, the skin takes on a glossy appearance.
• Numbness or the sensation of intense cold in the affected part.
• Possible stinging sensation or pain that subsides as tissue freezes.
• In superficial frostbite, the surface skin will feel hard and the underlying tissue will be soft.

Here’s what the American Red Cross recommends as steps to treat frostbite:

1. Cover the frozen part by providing extra clothing or blankets. Prevent further injury by covering all exposed parts, especially the nose, ears, face and hands.
2. Bring the victim indoors or to a sheltered area as quickly as possible.
3. If possible, give the victim something warm to drink.
4. Warm the frozen parts as quickly as possible. In the past, gradual thawing was recommended, but studies show that rapid warming is preferable. The best method is to immerse the affected part in warm water 102 to 105 degrees; it should feel pleasantly warm, but not burning hot.
5. If warm water is not available, warp the affected part gently in a warm towel or blanket.
6. Discontinue warming as soon as the part becomes flushed or reddish. Have the victim gently exercise the affected part, but do not massage or rub it. Rubbing can cause further tissue damage.
7. Cleanse the affected area with a mild soap, rinse, and pat dry. Avoid any blisters that may form.
8. If the toes or fingers have been frostbitten, keep them separated with dry sterile gauze or strips of clean cotton cloth.
9. If the feet have been frostbitten, do not allow the victim to walk after thawing until they have been checked by the doctor. If the victim must walk, do not try to thaw the feet first.
10. Keep the frostbitten part elevated after thawing and during transportation to medical help.

And, here’s what you can do to protect yourself from frostbite:

• Dress for the weather. When it is cold and windy, make sure that the face, ears, hands and feet are adequately protected. Wear several layers of clothing to provide proper insulation. Undergarments and socks should be made cotton, silk, cotton-lined wool, all of which retain heat but allows body moisture to escape.
• Going hatless allows a significant amount of body heat to escape. Wear a hat and scarf.
• Even traveling by car, take clothing appropriate for weather outdoors in case the car breaks down.
• A frostbitten should not be rubbed with snow or even with hands. Snow will worsen the freezing and rubbing will increase the tissue damage.
• Never give a freezing victim alcohol.
• After rewarming, do not apply additional heat such as a warming pad or hot water bottle. Do not allow the victim to sit next to a stove or radiator. Instead, cover the person lightly with a blanket, with the frostbitten area elevated and protected from pressure of clothes.

Editor’s Note: Dr. Fasiha Hasham obtained her medical degree from Sindh Medical College and completed a residency at Jinnah Post Graduate Medical Centre in Pakistan before moving to the United States. Her specialties include Internal Medicine and Gynecology and Obstetrics. She is married with four children and lives in Farmington Hills, Michigan. The views expressed here are her own.