Ask The Doc - Frostbite

Thursday, January 15, 2015

Question: What should I do if I think I have frostbite?

By Dr. Nicholas Meyer, Medical Director, Columbia St. Mary’s Regional Burn Center

Last winter was historically cold and, as a result, many people suffered from cold exposure. Across the Midwest, far more people than usual sustained frostbite and this winter is proving to be another cold one. Everyone should be aware of the potential for frostbite, how to recognize it and what steps to take to minimize injury.

Frostbite is a form of cold exposure involving local tissue damage. With mild injury, the tissues are stressed, turning red and painful and swollen, but they eventually recover. With more severe injury, the tissues actually freeze and ice crystals form, blocking blood flow and destroying cells. The skin turns black and dry and the affected part shrivels up and eventually falls off. Fingers, toes, parts of ears and nose are most often affected. The injury can be very painful both at onset and long after. Recovering from frostbite can be a prolonged process, lasting many months and often resulting in temporary or permanent disability.

As one might expect, the colder the temperature, the less time of exposure will result in frostbite injury. Areas of the body that “stick out” are most at risk of damage (fingers, toes, ears, nose). Below zero degrees Fahrenheit, a person can experience tissue loss in less than five minutes when bare skin is exposed to the elements – windy and wet conditions increase the chance of injury. The elderly and very young are most at risk.

Avoiding frostbite is easy enough: dress warmly. This means gloves, hats and something to cover your face and ears. It’s also a good idea to keep extra gloves and boots (and even those heat packs) in your car in case of a breakdown. Contrary to some beliefs, lotions and ointments do not protect the skin from frostbite and may even be harmful.

Initial Treatment
The primary symptom of frostbite is pain followed by numbness with the skin becoming white and waxy. If you experience this, you need to rewarm the affected area immediately. This is best achieved by immersion in warm water no more than 102 degrees Fahrenheit (test with an unaffected extremity if there is no thermometer available) or by placing the affected area next to warm skin in the armpit. It’s important not to rewarm with a blow dryer, heating pad or fireplace as these unregulated temperatures can inadvertently cause burns to the numb tissues.

Rewarming will be painful, but the skin should gradually become pink and normal sensation should return to the area. Do not rub frostbitten areas or walk on frostbitten feet as this may further traumatize the tissues. Repeated cold injury and rewarming is harmful and dangerous, so postpone rewarming until you’re able to ensure refreezing will not occur. If the area stays numb or painful after rewarming, or if it changes color or blisters develop, this is a sign deep injury has occurred and you should seek urgent medical treatment to preserve as much tissue as possible.

Medical Intervention
If you believe you’ve suffered frostbite, it’s strongly recommended you go to the closest hospital or medical facility to get assessed. At that point proper treatment can be initiated and it can be determined if you need to be transferred to a higher level of care. Burn centers have traditionally been referral centers for frostbite, especially the most severe cases, as much of the treatment is similar to burn injury.

Columbia St. Mary’s Regional Burn Center specializes in the treatment of frostbite injuries. The center provides pain control and proper wound treatments to facilitate recovery. For more severe injury, our highly trained staff can utilize high tech anti-clogging agents as well as hyperbaric oxygen therapy to reestablish blood flow and help repair and preserve damaged tissue. For severe frostbite with deep tissue injury, hospital stays can last several weeks and even include surgical reconstruction and rehabilitation.

Dr. Nicholas Meyer is Medical Director of Columbia St. Mary’s Regional Burn Center. For more information, please call 414-291-1163. 

This article appeared in the January 15 issue of The Ozaukee News Graphic.



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