Frostbite is caused by two different means: cell death at the time of exposure and further cell deterioration and death because of a lack of oxygen.
◦ In the first, ice crystals form in the space outside of the cells. Water is lost from the cell’s interior, and dehydration promotes the destruction of the cell.
◦ In the second, the damaged lining of the blood vessels is the main culprit. As blood flow returns to the extremities upon rewarming, it finds that the blood vessels themselves are injured, also by the cold. The vessel walls become permeable and blood leaks out into the tissues. Blood flow is impeded and turbulent and small clots form in the smallest vessels of the extremities. Because of these blood flow problems, complicated interactions occur, leading to inflammation that causes further tissue damage. This injury is the primary determinant of the amount of tissue damage that occurs in the end.
◦ It is rare for the inside of the cells themselves to be frozen. This phenomenon is only seen in very rapid freezing injuries, such as those produced by frozen metals.
Minor frostbite can be treated at home with basic first-aid measures. For all other 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 your injury.
Unless absolutely necessary, the person should not walk on frostbitten toes or feet. Do not rewarm the skin until you can keep it warm. Warming and then re-exposing the frostbittenarea to cold air can cause worse damage. Gently warm the area in warm water (not hot) or with wet heat until the skin appears red and warm.
- Rewarming of the skin. If it hasn’t been done already, your 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. You may be encouraged to gently move the affected area as it rewarms.
- Oral pain medicine. Because the rewarming process can be painful, your doctor will likely give you a drug to ease the pain.
- Protecting the injury. Once your skin thaws, your doctor may loosely wrap the area with sterile sheets, towels or dressings to protect the skin. Or he or she may protect your fingers or toes as they thaw by gently separating them from each other. And you may need to elevate the affected area to reduce swelling.
- Removal of damaged tissue (debridement). To heal properly, frostbitten skin needs to be free of damaged, dead or infected tissue. To better distinguish between healthy and dead tissue, your doctor may wait 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. You may be encouraged to gently move the affected area.
- Infection-fighting drugs. If your skin or blisters appear infected, your doctor may prescribe oral antibiotics.
- Clot-busting drugs. You 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. But these drugs can cause serious bleeding and are typically used only in the most serious situations and within 24 hours of exposure.
- Wound care. A variety of wound care techniques may be used, depending on the extent of 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. But more study is needed.
To care for your skin after frostbite:
- Take all medications — antibiotics or pain medicine — as prescribed by your doctor. For milder cases of frostbite, take over-the-counter ibuprofen (Advil, Motrin IB, others) to reduce pain and inflammation.
- For superficial frostbite that has been rewarmed, some people find it soothing to apply aloe vera gel or lotion to the affected area several times a day.
- Avoid further exposure to cold and wind.
- Remove rings or other tight items. Try to do this before the affected area swells.
- Don’t walk on frostbitten feet.
- Don’t apply direct heat or rub the area.
- Don’t break blisters that may develop. Blisters act like a bandage. Allow blisters to break on their own.
What is the best way to treat frostbite? First-aid care Check for hypothermia. … Protect your skin from further exposure. … Get out of the cold. … Gently rewarm frostbitten areas. … If there’s any chance the affected areas will freeze again, don’t thaw them. … Take pain medicine. … Don’t walk on frostbitten feet or toes if possible. … Know what to expect as skin thaws.
Frostbite can be prevented. Here are tips to help you stay safe and warm.
- Limit time you’re outdoors in cold, wet or windy weather. Pay attention to weather forecasts and wind chill readings. In very cold, windy weather, exposed skin can develop frostbite in a matter of minutes.
- Dress in several layers of loose, warm clothing. Air trapped between the layers of clothing acts as insulation against the cold. Wear windproof and waterproof outer garments to protect against wind, snow and rain. Choose undergarments that wick moisture away from your skin. Change out of wet clothing — particularly gloves, hats and socks — as soon as possible.
- Wear a hat or headband that fully covers your ears. Heavy woolen or windproof materials make the best headwear for cold protection.
- Wear mittens rather than gloves. Mittens provide better protection. Or try a thin pair of glove liners made of a wicking material (such as polypropylene) under a pair of heavier gloves or mittens.
- Wear socks and sock liners that fit well, wick moisture and provide insulation.You might also try hand and foot warmers. Be sure the foot warmers don’t make your boots too tight, restricting blood flow.
- Watch for signs of frostbite. Early signs of frostbite include red or pale skin, prickling, and numbness. Seek warm shelter if you notice signs of frostbite.
- Plan to protect yourself. When traveling in cold weather, carry emergency supplies and warm clothing in case you become stranded. If you’ll be in remote territory, tell others your route and expected return date.
- Don’t drink alcohol if you plan to be outdoors in cold weather. Alcoholic beverages cause your body to lose heat faster.
- Eat well-balanced meals and stay hydrated. Doing this even before you go out in the cold will help you stay warm.
- Keep moving. Exercise can get the blood flowing and help you stay warm, but don’t do it to the point of exhaustion.
So What Is Frostbite? Frostbite refers to the freezing of body tissue that results when the blood vessels contract, reducing blood flow and oxygen to the affected body parts. Normal sensation is lost, and color changes also occur in these tissues. Frostbite is most likely to affect body parts that are farther away from the body core and, therefore, have less blood flow. These include your feet, toes, hands, fingers, nose, and ears! There are three degrees of cold injury: frostnip, superficial frostbite, and deep frostbite. Although children, older people, and those with circulatory problems are at greater risk for frostbite, most cases occur in adults between 30 and 49. If you develop frostbite, you may not realize at first that anything is wrong, because the affected area may be numb. With prompt medical attention, most people recover fully from frostbite.
Quotes About Frostbite
There’s nothing worse than waiting and not knowing what’ll happen to you. Your own imagination can be crueler than any captor.
Know how to treat frostbite until you can get indoors.
by Marilyn vos Savant