Winter weather signals the beginning of winter sports, including ice-skating, skiing, snow shoeing and hiking. Without proper preparation for exposure to cold weather, frostbite can occur. Smokers, those who have been drinking, the elderly and those who are mentally challenged are at greatest risk for frostbite. Exhaustion, dehydration, malnutrition or peripheral vascular disease may inhibit the ability to respond to the cold. According to the Centers for Disease Control and Prevention, the cheeks, fingers, toes, chin and nose are typically affected.
Superficial Frostbite
Superficial frostbite is characterized by redness and swelling of the affected area. Skin that is swollen may be numb. More extensive superficial frostbite is recognized by blisters that contain clear or milky fluid, which develop within 24 hours of exposure as well as swelling, numbness and redness, according to the CDC. The skin may feel thick and waxy, be white or grayish-yellow in color. Some blisters may have a bloody fluid behind them. Recommended treatment for superficial frostbite is to immerse the affected part in warm water that is 104 to 108 degrees F and apply aloe vera and dressings as needed, according to the "5-Minute Clinical Consult" textbook. The use of ibuprofen for pain and to decrease the inflammatory response can be helpful. The CDC warns against rubbing the affected area with snow or using a heating pad, stove, fireplace or radiator for rewarming.
Deep Frostbite
Deep frostbite is characterized by a deeper degree of injury and blisters that are blood-filled, states the "5-Minute Clinical Consult." Extension of the injury can go as deep as the muscle and bone and involves complete tissue necrosis and possible gangrene. According to the "5-Minute Clinical Consult" textbook, the use of special imaging to determine the extent of the injury is unreliable during vascular instability, which can last up to two to three weeks. The injuries result from ice crystallization in the small capillaries within the tissue and can extend deep into the tissues. These areas become necrotic and require surgical cleaning or possible amputation, notes the "5-Minute Clinical Consult."
Infection
Infection occurs as tissue dies and pathogens invade the dying tissue. Streptococcus, staphylococcus and pseudomonas are common pathogens that cause infection. Frostbite is considered a tetanus-prone injury and requires a tetanus booster shot. In severe frostbite, preventive antibiotics may be given, according to the "5-Minute Clinical Consult."
References
- "5-Minute Clinical Consult 2010"; Frank J. Domino, M.D., Editor; 2009
- Centers for Disease Control and Prevention: Winter Weather: Frostbite
