Frostbite

Definition

Frostbite is damage to skin and tissues from prolonged exposure to below-freezing temperatures. Frostbite severity is based on the depth of tissue injury. The most severe frostbite can lead to permanent damage and/or amputation.

The most common parts of the body to become frostbitten include your fingers, toes, ears, nose, chin, or cheeks.

Frostbitten Skin
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Causes

Exposure to below-freezing temperatures can cause the body tissue to freeze. Ice crystals form within the frozen body part. Blood cannot flow through the frozen tissue. This causes the frozen tissue to be deprived of blood and oxygen. The combination of freezing and oxygen deprivation causes tissue damage or tissue death. Rewarming may also ultimately lead to tissue death.

Risk Factors

Factors that may increase your chance of getting frostbite include:

  • Exposure to below-freezing temperatures without adequate covering
  • Low body temperature, a condition known as hypothermia
  • Being very young or very old
  • Homelessness
  • Fatigue
  • History of previous cold weather injury
  • High-altitude cold exposure
  • Working in below-freezing conditions
  • Participating in winter sports or high-altitude sports
  • Wearing wet clothing
  • Suffering from a condition that affects your mental status such as:
  • Inability to move
  • Using drugs that cause your blood vessels to become constricted
  • Medical conditions, such as:

Symptoms

Early stages of frostbite may cause:

  • Weakness or clumsiness with extremities, such as with your hands or feet
  • Numbness, stinging, burning, or tingling sensation
  • 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

Later stages of frostbite may cause:

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

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Diagnosis is usually based on symptoms and the findings of the physical exam.

Treatment

Rapid rewarming in a warm (100°F to 110°F [37.8°C to 43.4°C]) water bath is the treatment of choice. Slow rewarming may cause more tissue damage.

If you are stranded with frostbite and unable to get medical help:

  • Try to get to a warm location. Wrap yourself in blankets.
  • Do not put snow or hot water on the injured area.
  • Do not rub affected areas.
  • Tuck your hands into your armpits to try to rewarm them.
  • If it's available, use warm water (at about 105°F [40°C]) to rewarm your frostbitten area.
  • Avoid refreezing the affected area. This can result in more severe injury.
  • Walking on frozen feet and toes can cause damage. It may be more important to find shelter.
  • Drink warm liquids.
  • Avoid alcohol and sedatives.
  • Cover the injured area with a clean cloth until you can get medical help.
  • Rewarming can be intensely painful. To relieve pain, take an over-the-counter pain medication such as acetaminophen or ibuprofen.

If you're able to get medical assistance, treatment may include moving you to a warm place and wrapping you in blankets. The injured body part may be soaked in warm (not hot) water.

Other treatments may include:

  • Opening and emptying blisters
  • Antibiotics
  • Prescription pain medication
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation
  • Aloe vera gel or other ointments to relieve inflammation and promote healing
  • Drugs to prevent blood clots in the first 24 hours
  • Vasodilators after 24 hours if needed due to lack of improvement
  • Elevation of the injured body part above your heart
  • A tetanus booster shot
  • Hyperbaric oxygen therapy —this is a special chamber that uses oxygen under greater pressure than normal to help with blood flow and tissue repair
  • Amputation of all or part of the affected body part in severe cases

Prevention

To help reduce the chance of frostbite, take these steps:

  • Dress properly when going outside in cold weather:
    • Cover your head, face, hands, and feet adequately.
    • Wear layers of clothing.
    • Wear materials that provide good insulation, such as wool, polyester, or polypropylene. It should keep moisture away from the skin.
    • Wear a waterproof outer layer and stay dry.
  • Avoid drinking alcohol when you will be in cold weather.
  • Stay hydrated by drinking water.
  • Recognize signs of early frostbite, such as numbness, paleness, and difficulty grasping objects with your hands.
  • Treat early frostbite promptly with the body heat of a companion by using their abdomen or armpit for warmth.

Revision Information

  • American Academy of Orthopaedic Surgeons

    http://orthoinfo.org

  • Family Doctor—American Academy of Family Physicians

    http://familydoctor.org

  • Environment Canada

    http://www.ec.gc.ca

  • Health Canada

    http://www.hc-sc.gc.ca

  • Frostbite. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 15, 2011. Accessed September 25, 2014.

  • Frostbite. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/parent/firstaid%5Fsafe/emergencies/frostbite.html. Updated April 2011. Accessed September 25, 2014.

  • Winter weather: frostbite. Centers for Disease Control and Prevention website. Available at: http://emergency.cdc.gov/disasters/winter/staysafe/frostbite.asp. Updated December 3, 2012. Accessed September 25,2014.

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