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When Should You Worry About Frostbite?

With winter season in full swing, when should you worry about frostbite? And what steps should you take to avoid it or treat it?

By
Sanaz Majd, MD,
January 11, 2018
Episode #256

image of hands with frostbite from movie Frozen

Despite living in sunny Southern California as an adult, I actually spent most of my childhood in Gaithersburg, Maryland, a state with four seasons and a seemingly never-ending winter reminiscent of Arendelle (from the Disney cartoon "Frozen," of course). I have to say, I do not miss driving in the deep snow, slipping on ice and not-very-graciously landing on my butt (I cannot count the number of times that has happened), or feeling as though my limbs are frozen to the core despite thinking I was sporting the appropriate winter attire (most of the time).

It’s no fun living in a constant winter flurry…unless of course you’re Queen Elsa. If you’ve lived anywhere aside from the West Coast generally, you may be wondering what frostbite even really is. How can you tell if you have it? And how can you treat it? Note that the correct answer is NOT to apply direct heat. This knowledge is vital.

What is Frostbite?

It’s important to distinguish “frostnip” from “frostbite.” In the former, any symptoms experienced are reversed with rewarming, and without permanent damage to the tissue. In true frostbite, however, the extreme cold temperature causes cell death and induces an inflammatory response during the rewarming process, and hence causes injury to the tissue via these two processes. Even further injury is caused if the tissue is refrozen once again after the thawing process has already begun. It’s vital to avoid this when treating frostbites.

Most frostbites occur on the tips of the fingers, toes, nose, chin, cheeks, and ears. Subzero temperatures can cause injury to our bodies within minutes to hours of exposure. The injury can vary in severity. Unnervingly, frozen people may not initially experience any symptoms at all. In fact, the frozen area may feel numb. No discomfort. The skin at the site of the freezing can feel hard initially, and appear pale and white with surrounding redness around it.

But when the thawing process begins, in addition to feeling a cold sensation at the affected site, it can cause tingling, numbness, or weakness in the same area. It can also begin to form a blister, which is a blood- or fluid-filled little pocket on the skin. The skin is usually red diffusely over the affected area, but after days to weeks it can turn black if the frostbite is severe. This represents the deadened tissue called an “eschar,” and may fall off on its own. If severe, however, amputation may be necessary to remove the deadened tissue.

How to Treat Frostbite

The three golden rules of a suspected frostbite treatment includes the following:

  1. Move into a warmer environment as soon as possible.
  2. If the clothing is wet, remove it.
  3. Gradually warm the frostbitten region (note: gradually, not suddenly). Do this preferably by submerging the area into warm water (not hot). The other option is placing the affected area against a warmer area of the body, such as placing your frostbitten finger under the armpits

What NOT to Do With Frostbite

Now that we are unable to obliterate visions of Mary Katherine Gallagher (from "Saturday Night Live") jamming her fingers deep up into her armpits (and subsequently smelling them), let’s talk about what we shouldn’t do with a suspected frostbite:

  • As hinted above, do not submerge the frostbite into hot water, which can further injure the tissue. Even though it may intuitively feel as though hot water would be appropriate…it’s NOT. Use warm water.
  • Do not further injure the frostbitten tissue. So if it’s the finger, don’t use that finger. If it’s the toe, do not walk on that foot. This can also further injure the tissue.
  • Do not attempt rewarming over a stove or fire. The tissue is quite fragile and vulnerable—it is more easily susceptible to a burn than normal, healthy tissue.
  • Do not warm the tissue if there’s a chance for it to be frozen once again. As stated above, the damage becomes more extensive if the frostbite is thawed and then re-frozen once again. So if you’re stuck hiking in the snow, for instance, you may want to rethink rewarming your toes when you know you’ll have to use those toes to return back to civilization in the snow.
  • Do not rub the frostbitten area. Rubbing also causes further damage to the now very delicate tissue.
  • Do not use an ice pack directly over your skin. If you use ice as a form of treatment for muscle aches and pains, do not apply it without a form of barrier in between the ice and your skin. Use a towel or cloth, and apply for no longer than 15 minutes at a time.

So, fellow ice creatures, the next time you head out in search of your long lost sister with icy powers (with an ice harvester and talking snowman tagging along) do not forget the ski mask, hat, mittens, and clothing layers.

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Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.

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