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The ultimate guide to frostbites

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Frostbite is an injury that happens when your body parts are exposed to the cold. Due to extreme cold, skin and underlying tissues freeze and cause frostbite. The common parts that are affected by frostbite are fingers, feet and toes. It is important to have protective clothing when you go out in extreme cold conditions such as a snow filled hill or area.

What is frostbite?

Frostbite is an injury caused by temperature below freezing point. The extreme cold affects the skin and underlying tissues. Even though fingers, feet and toes are the most commonly affected parts but frostbite can also cause problems for your nose, ears and cheeks.

Frost bite

Frost bite

What causes frostbite?

In general conditions, blood takes oxygen to different parts of your body so that the body tissues stay healthy and in work efficiently. If different organs are receiving blood and oxygen, then they work in a normal and healthy condition. When you expose your body to extreme cold, then your body goes into a protective mode and as a response it reduces the size of the blood vessels or constrict them so that less amount of blood and oxygen go to the extreme tissues and organs. The diverted blood and oxygen goes to your vital organs so that they work fine and keep your body alive. If it continues for some time, due to the lack of blood and oxygen, damage to the cells and tissues at the extreme distance may happen.

What happens in the areas that are affected by frostbite? In such areas of your body which are affected by frostbite, ice crystals form. These crystals may damage your cells and blood vessels. Blood clots also form in the blood vessels which are already narrowed. That reduces the possibility of blood and oxygen reaching the affected tissues.

The possibility of frostbite increases with the increasing duration for which you expose yourself to extreme cold condition. It can be highly risky in areas which have a cold temperature along with wind causing wind chill. High altitude is another risk factor because in such areas, the temperature is very low.

Is it common?

It is not very common in general, but it is often seen in cases of people who work or stay in cold temperature.

It is common in

  • Soldiers
  • Homeless people
  • People who work in the outdoors during cold
  • Winter outdoor sports enthusiast such as climbers and skiers

Frostbite can attack anyone exposed to very low temperature below freezing. If you are not wearing adequate clothing while being exposed to cold temperature, you may suffer from frostbite. Higher risk of frostbite is present in cases of people suffering from certain health problems like narrowing of the arteries, peripheral vascular disease and diabetes. The possibility of frostbite will increase in your case if you are using medicines that constrict your blood vessels. Beta-blockers are such a medicine. If you are a smoker, you have a higher risk of frostbite because the chemicals present in cigarettes may reduce the size of your blood vessels. People suffering from Raynaud’s phenomenon or the condition in which the small blood vessels of your fingers constrict, are also in a higher risk of frostbite.

Different degrees of frostbite

Frostbite injuries have been classified according to the degree of injury. The degree of frostbite means how deep the injury caused by frostbite goes.

Human skin has two layers- the outer layer which is called epidermis and the dermis. The dermis is present inside epidermis. Under dermis, you will see a layer of fat and then the muscles and tendons.

First-degree frostbite

In this frostbite type, only the epidermis is affected

Second-degree frostbite

It affects the epidermis and some part of the dermis

Third degree frostbite

This frostbite affects your epidermis, dermis and the fatty tissues below the dermis

Fourth degree frostbite

It affects the skin, the tissues under the skin, muscles, bone and tendons

Sometimes doctors also categorize frostbite as superficial frostbite or deep frostbite. Superficial frostbite means first degree or second degree frostbite. Deep frostbite means third degree or fourth degree frostbite. In superficial frostbite, there is a possibility of very little tissue loss but on the other hand in deep frostbite tissue loss is greater.


What are the symptoms of frostbite?

In case of frostbite, the patients feel cold and firmness in the areas affected by frostbite. They have the sensation in their fingers and toes. Burning, stinging and numbness may also be experienced by the patients. Some people may suffer from pain, burning, probing or electric current like sensation when the affected part is warmed.

In case of first-degree frostbite, the area attacked looks white and the patient may feel numbness in the area. Reddening of the area may also happen. There area may become hard and stiff. It is possible to recover the skin fully if the treatment is given quickly. It is also called as frost nip.

The affected area may look red and then become blue in the case of second-degree frostbite. The area will feel frozen and hard. Swelling of the affected area may happen. Blisters are also seen on the skin. They are filled with milky or clear fluid.

In case of third degree frostbite, the affected skin will become white or blue. It may be blotchy sometimes. Blisters are seen on the skin, which are filled with blood. Thick black scabs may form after some time. The skin becomes hard and cold.

In case of fourth degree frostbite, damage is done to the skin and underlying tissues. Muscles, bones and tendons are also damaged. Initially the skin becomes a deep red and then turns black.

Initial treatment for frostbite

First aid treatment

Some basic first aid treatments can help in treating frostbite injuries

  • Get away from the cold
  • Change wet clothing and get the patient to wear something dry
  • Let the affected area air dry. Do not rub the area to avoid further damage to the tissues.
  • Remove rings and other materials from the fingers because they may tighten and it may be difficult to get them off.
  • Wrap the affected area in a blanket
  • Do not walk on frostbitten feet because it may result in chipping of the tissues or fracture
  • At any cost avoid refreezing
  • Keep the patient rehydrated. The patient should take enough water so as to make up for the water loss
  • Treat hypothermia and any injuries present on the body

Rewarming treatment

You need to start rewarming as soon as possible. In case of any possibility of refreezing, it is better to keep the affected part frozen until safe. Repeat rewarming is possible using heated water. The water should be kept at 37 to 39°C. It may take 30 minutes. Never massage the affected area because it can result in further injury. Rewarming can be repeated twice in a day.

Treatment with medicines

Pain killers are very much needed for treatment of the pain associated with frostbites. Anti-inflammatory painkillers are necessary during rewarming because it can be very painful. Morphine may also be used during rewarming. In some cases, you may need clot busting medicines to treat deep frostbite by improving the blood supply to those affected areas.

Doctors may prescribe antibiotic medicines, if there is any infraction in the frostbite affected areas. Fluids via a drip may also be prescribed to ensure enough supply of fluid in the body. Drainage of some of the blisters may also be necessary, which should be done by a surgeon.