Frost Bite (Freezing Injury): Symptoms, Causes, Diagnosis & Treatment

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Frost Bite (Freezing Injury): Symptoms, Causes, Diagnosis & Treatment

Frostbite is the most common type of freezing injury. It is defined as the freezing and crystallizing of fluids in the interstitial and cellular spaces. This is a consequence of prolonged exposure to freezing temperatures.

Frostbite may occur when the skin is exposed to extreme cold, at times combined with high winds, resulting in vasoconstriction. The associated decrease in blood flow does not deliver sufficient heat to the tissue. This makes it unable to prevent the formation of ice crystals. The anatomic sites most susceptible to frostbite include hands, feet, and exposed tissues (eg, ears, nose, and lips).

The goal of the frostbite treatment is to salvage as much tissue as possible, to achieve the maximal return of function, and to prevent complications. This may involve both medical and surgical measures, depending on what is appropriate.

Most frostbite victims are male. This disparity may be a result of increased outdoor activity among males as opposed to genetic predisposition. However, it has also been noted that women are at a greater risk of developing hypothermia than men.

Self-diagnosis:

  • A part of the person’s body or skin turns white, hard or black.
  • The person experiences a lack of feeling in the area.
  • The person shows signs of hypothermia.
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How Does Frostbite Affect Your Body?

Heat conduction and radiation from deeper tissue circulation prevent freezing and ice crystallization. This happens until the skin temperature drops below 0°C. Once the temperature of the tissue drops below 0°C, the cutaneous sensation is lost and the frostbite injury cascade is initiated.

What Are The Causes of Frostbite?

The most common cause for frostbite is exposure to cold-weather conditions. But it can also be caused by direct contact with ice, frozen metal or very cold liquids.

Conditions that lead to frostbite include:

  • Wearing clothing that isn’t suitable for the prevailing conditions. This can include clothing that does not protect against cold, windy or wet weather, or is too tight.
  • Staying out in the cold and wind for too long increases the risk as air temperature falls below 5° F (minus 15° C), even with low wind speeds. In the wind chill of minus 16.6° F (minus 27° C), frostbite can occur on exposed skin in less than 30 minutes.
  • Touching materials such as ice, cold packs or frozen metal.
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What Are The Risk Factors of Frostbite?

Common risk factors of frostbite are as follows:

  • Inadequate shelter
  • Inadequate or constrictive clothing
  • Winter season
  • Wind chill factor
  • High altitude
  • Prolonged exposure to cold
  • Prolonged exposure to moisture (wet skin cools faster because of heat loss from evaporation and from direct heat conduction to water)
  • Immobilization
  • Malnutrition and exhaustion
  • Previous cold injury (increases the risk 2-fold)
  • Acclimatization to tropical climates
  • Improper behavioral response to cold ambient temperature
  • Extremes of age
  • Homelessness
  • Altered mental status (eg, from head trauma, ethanol or illicit drug abuse, or psychiatric illness)
  • Exposure to drugs with vasoconstrictive effects (eg, nicotine)
  • The tendency of hands to become white in the cold
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What Are The Symptoms of Frostbite?

Symptoms during early stages of frostbite include:

  • Weakness or clumsiness with extremities, such as with the hands or feet
  • Numbness, stinging, burning, or tingling sensations
  • Areas of white skin blended with, or next to healthy-looking skin
  • Coldness or firmness of tissue
  • Pain, especially during the thawing process
  • Inflammation may occur during the thawing process

Symptoms during later stages of frostbite include:

  • Waxy appearance of the skin
  • Blisters that may be filled with clear or bloody fluid
  • Color ranging from white to blue, depending on the severity
  • Joint pain

How is Frostbite Diagnosed?

The diagnosis of frostbite is usually made on the basis of the signs and symptoms, the appearance of the skin, and a review of recent activities that included exposure to cold.

The doctor may conduct tests, such as an X-ray, a bone scan or an MRI to determine the severity of the frostbite. The doctor will also check whether there is bone or muscle damage.

How to Prevent And Control Frostbite?

The primary defense against frostbite is to get out of the cold. If this is not possible, preplanning and using appropriate clothing are mandatory.

Prevention methods include:

  • Keeping hands and feet dry
  • Using mittens instead of gloves
  • Clothing in multiple layers
  • Avoiding perspiration by using adequately ventilated clothing
  • Avoiding tight clothing
  • Increasing fluid and calorie intake in cold weather
  • Avoiding alcohol and tobacco
  • Maintaining current tetanus immunization
  • Keeping toenails and fingernails trimmed

Treatment of Frostbite

  • Minor frostbite – It can be treated at home with basic first-aid measures.
  • Severe frostbite – After appropriate first aid and assessment for hypothermia, treatment may involve rewarming, medications, wound care, surgery, and various therapies, depending on the severity of the injury.

Common treatment methods include:

  • Rewarming of the skin – If it hasn’t been done already, the doctor will rewarm the area using a warm-water bath for 15 to 30 minutes. The skin may turn soft and look red or purple. One may be encouraged to gently move the affected area as it re-warms.
  • Oral pain medicine – Since the rewarming process can be painful, the doctor will likely prescribe a drug to ease the pain.
  • Protecting the injury – Once the skin thaws, the doctor may loosely wrap the area with sterile sheets, towels or dressings to protect the skin. Alternatively, he or she may protect the fingers or toes as they thaw, by gently separating them from each other. You may need to elevate the affected area to reduce swelling.
  • Removal of damaged tissue (debridement) – To heal properly, the frostbitten skin needs to be free of damaged, dead or infected tissue. To better distinguish between healthy and dead tissue, the doctor may wait for one to three months before removing damaged tissue.
  • Whirlpool therapy or physical therapy – Soaking in a whirlpool bath (hydrotherapy) can aid healing by keeping skin clean and naturally removing dead tissue. One may be encouraged to gently move the affected area.
  • Infection-fighting drugs – If the skin or blisters appear infected, the doctor may prescribe oral antibiotics.
  • Clot-busting drugs – One may receive an intravenous injection (IV) of a drug that helps restore blood flow (thrombolytic), such as tissue plasminogen activator (TPA). Studies of people with severe frostbite show that TPA lowers the risk of amputation. However, these drugs can cause serious bleeding and are typically used only in the most serious situations. This is done within 24 hours of exposure.
  • Wound care – A variety of wound care techniques may be used, depending on the extent of the injury.
  • Surgery – People who have experienced severe frostbite may in time need surgery or amputation to remove dead or decaying tissue.
  • Hyperbaric oxygen therapy – Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room. Some patients showed improved symptoms after this therapy. However, more study is needed.
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Frostbite – Lifestyle Tips

  • Do not use dry heat to thaw frostbitten areas. Moist heat is better because it allows thorough thawing.
  • Do not allow the injury to thaw then refreeze. Therefore, hospital rewarming is favored over field rewarming.
  • In remote areas, use a buddy system to help prevent cold injury, and have a system for rapid evacuation, if needed.
  • At high altitudes, moderate activities must be undertaken to minimize the work of breathing and associated heat loss through the respiratory tree. Use of supplemental oxygen has been found to reduce the incidence of frostbite among mountain climbers.

What Are The Recommended Exercises For a Person With Frostbite?

Any type of physical exercise would be helpful, as it would keep the body warm.

Frostbite And Pregnancy – Things to Know

No clinical data is available regarding this.

Common Complications Related to Frostbite

Common complications of frostbite include:

  • Increased sensitivity to cold
  • Increased risk of developing frostbite again
  • Long-term numbness in the affected area
  • Excessive sweating (hyperhidrosis)
  • Changes in skin color
  • Changes in or loss of nails
  • Joint stiffness (frostbite arthritis)
  • Growth defects in children, if frostbite damages a bone’s growth plate
  • Infection
  • Tetanus
  • Gangrene — decay and death of tissue resulting from an interruption of blood flow to the affected area; can result in amputation
  • Hypothermia

Other FAQs About Frostbite

Q. How long does it take to recover from frostbite?

A. The recovery time for a frostbite injury depends on the extent of tissue injury and whether or not there are any subsequent complications, such as an infection. It may take 1 to 3 months before it is possible to determine the extent of tissue damage and to clearly delineate which tissue is still viable.

Q. Can you die from frostbite?

A. Yes, one can certainly die from frostbite. However, this is exceptionally rare. Usually, when people die from frostbite, it is from some complication down the road. This may be due to gangrene, decay, or death of tissue. These complications occur when the tissue does not receive enough blood or becomes infected.

Q. At what temperature can you get frostbite?

A. A temperature of 0 degrees Fahrenheit and a wind speed of 15 mph creates a wind chill temperature of -19 degrees Fahrenheit. Under these conditions, frostbite can occur under just 30 minutes.

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