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Frost Bite

Intro

A doctor must be able to see and feel the affected area. A simple telephone call is probably not sufficient in all but the mildest cases of cold injury to hands and feet. You need to see a doctor for care.

At the time of initial evaluation, it is very difficult to categorize the injury as superficial or deep, and even more difficult to ascertain the amount of tissue damage. Therefore, all people should be seen by a doctor, who will supervise the rewarming process, attempt to classify the injury, and further guide the treatment process. Someone with frostbite will need evaluation for, and possible treatment of, hypothermia and dehydration.

Self-Care at Home
  • First, call for help.
  • Keep the affected part elevated in order to reduce swelling
  • Move to a warm area to prevent further heat loss.
  • Note that many people with frostbite may be experiencing hypothermia . Saving their lives is more important than preserving a finger or foot.
  • Remove all constrictive jewelry and clothes because they may further block blood flow.
  • Give the person warm, nonalcoholic, noncaffeinated fluids to drink.
  • Apply a dry, sterile bandage, place cotton between any involved fingers or toes (to prevent rubbing), and take the person to a medical facility as soon as possible.
  • Never rewarm an affected area if there is any chance it may freeze again. This thaw-refreeze cycle is very harmful and leads to disastrous results.
  • Also, avoid a gradual thaw either in the field or in the transport vehicle. The most effective method is to rewarm the area quickly. Therefore, keep the injured part away from sources of heat until you arrive at a treatment facility where proper rewarming can take place.
  • Do not rub the frozen area with snow (or anything else, for that matter). The friction created by this technique will only cause further tissue damage.
  • Above all, keep in mind that the final amount of tissue destruction is proportional to the time it remains frozen, not to the absolute temperature to which it was exposed. Therefore, rapid transport to a hospital is very important.
Follow-up

Symptoms follow a predictable pathway. Numbness initially is followed by a throbbing sensation that begins with rewarming and may last weeks to months. This is then typically replaced by a lingering feeling of tingling with occasional electric-shock sensations. Cold sensitivity, sensory loss, chronic pain, and a variety of other symptoms may last for years.

The treatment of frostbite is done over a period of weeks to months. Definitive therapy, possibly in the form of surgery, may not be performed for up to 6 months after the initial injury. Therefore, establish a working relationship between you and your doctor that will continue throughout the healing process.

Prevention

The first step in preventing frostbite is knowing whether you are at increased risk for the injury.

  • Most cases of frostbite are seen in alcoholics, people with psychiatric illness, car accidents or car breakdowns in bad weather, and recreational drug misuse.
  • All of these conditions share the problem of cold exposure and either the unwillingness or inability of a person to remove himself or herself from this threat.
  • Tobacco smokers and people with diseases of the blood vessels also are at increased risk because they have an already decreased amount of blood flow to their arms and legs.
  • Homelessness, fatigue, dehydration, improper clothing, and high altitude are additional risk factors.

Although people don't always know or acknowledge these dangers, many of the dangers can be reduced or prevented.

  • Dress for the weather.
  • Layers are best, and mittens are better than gloves (keeps your warm fingers together while warming each other).
  • Wear 2 pairs of socks, with the inner layer made of synthetic fiber, such as polypropylene, to wick water away from the skin and the outer layer made of wool for increased insulation.
  • Shoes should be waterproof.
  • Cover your head, face, nose, and ears at all times.
  • Clothes should fit loosely to avoid a decrease in blood flow to the arms and legs.
  • Always travel with a friend in case help is needed.
  • Avoid smoking and alcohol.

People with diabetes and anyone with vessel disease should take extra precautions, as should the very young, very old, and unconditioned.

Be especially wary of wet and windy conditions. The "feels like" temperature (windchill) is actually much lower than the stated air temperature.

Outlook

A common saying among surgeons who have treated people with frostbite is "frostbite in January, amputate in July." It often takes months before the final separation between healthy and dead tissue may be determined. If surgery is performed too early, the risks of removing tissue that may eventually recover or leaving behind tissue that may eventually die are great. Some radiographic techniques currently are being investigated that may be able to make this division much sooner, thus permitting earlier definitive treatment.

Beyond this waiting period, 65% of people will suffer long-term symptoms because of their frostbite. Common symptoms include pain or abnormal sensations in the extremity, heat or cold sensitivity, excessive sweating, and arthritis .

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