Frostbite occurs when skin and tissue freezes due to exposure to cold temperature. Symptoms include numbness, dull pain, skin discoloration and a "pins and needles" sensation. There are three stages of frostbite---frostnip, superficial frostbite and severe frostbite. Frostbite may be reversed; however, severe and deep injuries may be permanent. Severe complications such as nerve damage and limb amputation are possible depending on injury and treatment. People with nerve damage, diabetics, alcoholics and those with mental illness are prone to frostbite injuries.
Initial Treatment Considerations
Initial treatment of frostbite involves preventing the affected area from partially thawing or additional trauma. If the area begins to defrost and then refreezes, more severe nerve and tissue damage occurs. Mayoclinic.com warns the frostbitten skin should never be rubbed or covered with snow. A person should cover his face, ears or nose with gloves hands or place hands in arm pits to decrease exposure to freezing temperatures.
Rewarming Effects
Removal of all wet clothes is required. A person should gradually place affected areas into warm water; water temperature should measure between 104 and 107 .6 degrees Fahrenheit, reports MayoClinic.com. Immersing affected areas into the water should take between 15 and 30 minutes. Patients should be aware treatment may cause severe pain, but treatment must continue to ensure the tissue is completely unfrozen.
After the initial warming, warm clothes or a blanket should loosely wrap the injured area. Frostbite victims should avoid using electric heating pads, stoves, fireplaces or other direct heating devices because they can burn the skin. Walking on injured extremities, such as feet and toes should be avoided to decrease additional trauma. Skin should be closely monitored during the thawing process. Skin color and increased sensation should occur. If skin does not change color and numbness persists, more severe injury occurred and a person should seek immediate medical attention.
MayoClinic.com warns victims not to thaw skin if any risk of refreezing is present. Merck Manual suggests cleaning and drying the skin followed by wrapping skin in sterile or clean bandages, if delaying thawing. Administration of pain medications is recommended, and the remainder of the body should be kept warm.
Long-term Care
The extent of injuries associated with frostbite are not apparent for several days. Gangrene, or death and necrosis of tissue, occurs several days after the injury. The skin appears black and leather-like when tissue death is present. Antibiotics are often prescribed if an infection may be present. Cleansing of skin and removal of dead tissue occurs when patients use whirlpool baths for hydrotherapy. The area is often covered with clean wound dressings and elevated to promote healing. Severe cases of tissue damage require amputation. Physical and occupational therapy may be required for a patient to adjust to the loss of a limb.
Prevention
A person should dress in several layers of clothing, instead of one single layer when going outdoors in extreme low temperatures. A hat should fully cover the ears and mittens are advised instead of gloves, advises MayoClinic.com. People should carry emergency supplies such as additional clothing and blankets when traveling through cold weather conditions.
Diagnosis
A confirmation of frostbite involves a thorough clinical evaluation and assessment. An immediate diagnosis is often not available because initial symptoms of frostbite are similar to nonfreezing cold injuries, according to the Merck Manual. Medical professionals will continue to watch skin for signs of gangrene and appearance of additional systems.
