I wrote about hypothermia a few years ago hoping that people would heed all my good advice and never have to worry about treating frostbite. However on occasion, someone will insist on walking the dog without wearing gloves and end up with a bit of a case of frostbite. Since we are gearing up for actual temperatures of -24 hear in Iowa Sunday and Monday, I thought this would be a prudent time to talk about frostbite here on the blog.
Risk Factors
Some people are more at risk than others for frostbite. Obviously little babies and elders are at greater risk. Those with peripheral diabetic neuropathies or cardiovascular diseases which impair circulation should also take extra caution. Being on beta blockers increases your risk of frostbite, also. Also any agent , prescription or otherwise, which thins your blood makes you more susceptible to frostbite, especially alcohol. Dehydration and poor nutrition may also predispose one to frostbite. The presence of precipitation and high winds, along with the cold can also increase your risk. Being dumb and going outside without gloves on when it is a windy -6, will also do the trick.
Frostbite causes injury during both the freezing and thawing process. Freezing temperatures decreases blood flow and causes ice crystals to form in the interstitial fluid.
These crystals may rub together and cause tissue damage or leech fluid from the cells causing dehydration. As the skin thaws the inflammation process is triggered which results in vasoconstriction and more blood clots which may further reduce circulation to the affected area.
Symptoms of Frostbite Include:
1. Pain or prickly sensations.
2. Numbness
3. Pale-looking skin that feels cold, and possibly hard, to the touch.
4. Skin may appear swollen. Steve’s finger almost swelled out of his wedding ring even though he had a fairly mild case. .
Three Categories of Frostbite
Superficial frostbite or frostnip – This is a mild case of frostbite, so mild in fact that it is not considered true frostbite. Skin may go white, be painful and feel cold to the touch but it is still pliable and springs back after having been touched.
Partial thickness frostbite is more serious. Generally speaking the skin feels harder and may retain an indentation after it has been touched. In this case the injured party is likely to feel more pain and a prickling sensation verging on numbness. You might also want to assess this person for symptoms of hypothermia and treated for mild-moderate hypothermia.
Full thickness frostbite occurs when the skin is frozen solid. Touching the skin is not likely to leave an ident. It will feel “wooden” to the person assessing the damage and numb to the injured person. Unless you are in a wilderness situation, do NOT try to handle this on your own. The injured party is almost positively going to be suffering from hypothermia at this point, as well.
Treating Frostbite
Treat frostnip and partial thickness frostbite by submerging the skin in 40-42 degree C water or if water isn’t available skin-to-skin contact. Do not rub the skin or place the frozen skin near a heater. Both of these measures can cause further damage. You also want to be sure not to do something that will further damage already damaged skin like cayenne or some other rubefacient like mustard, on the skin to thaw it out. If you want to warm someone up and increase circulation do that by giving them a warming, stimulation infusion, to drink. Sage and yarrow are nice for this or even tea made from pine needles if that is all you can find.
The skin is properly thawed when the color returns to the skin. The injured party will experience some pain as this happens. In more severe cases the skin may take on a red, mottled look which is referred to as flushing. This is not by itself, a cause for concern.
Once the skin is thawed, you should treat frostnip like you might a superficial burn. Lavender, chamomile and calendula, or yarrow infusions made into a compress or a soak, might be helpful. Balm of Gilead is an often mentioned traditional preparation for frostbite. Aloe has been indicated as being helpful, as well.
Partial thickness frostbite blisters sometimes form blisters known as “blebs”. It is good to try to keep these from rupturing. Steve had a very mild case with just a few small blisters. We are using a salve I make with a blend of St. John’s Wort, yarrow and comfrey which seems to be helping but if they do rupture I will probably switch to poultices or soaks because I don’t like to use ointments on open wounds.
I really hope no one ever has to deal with this, but it should go without saying that you should only attempt to treat full thickness frostbite, if you have no way of getting to a hospital. Submerging the frozen body parts in water that is between 40-42 degrees Celsius is still the preferred treatment but you need to be prepared for the fact that this is going to be intensely painful for the injured party and that the skin may take on a black dead look almost immediately upon thawing. Compounding this problem is the fact that the person is likely to have severe hypothermia, as well. It really isn’t something to try to tackle on your own, seek immediate medical attention as soon as possible.
I hope that none of you have any need of any of this information over the next few days. Be safe. If you must be outside, read up on hypothermia and take appropriate precautions. Travel with a winter safety kit and keep your cell phone charged at all times.
Center, University of Maryland Medical. Medical Reference – Complementary Medicine. 16 11 2011.
Tilton, Buck. Wilderness First Responder: Second Edition. Connecticut: FalconGuide, 2004.
