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frostbite

frostbite

[frawst-bahyt, frost-]
frostbite (chilblains), injury to the tissue caused by exposure to cold, usually affecting the extremities of the body, such as the hands, feet, ears, or nose. Extreme cold causes the small blood vessels in the extremities to constrict. The blood circulates more slowly and stagnation results. Eventually the body fluids may freeze. The condition is aggravated by tight clothing, physical inactivity, and dampness. Severe frostbite that is not treated may result in gangrene; amputation of the affected part may be necessary. See first aid.

Freezing of living tissue, when it loses enough heat in below-freezing weather for ice to form. High winds, wet skin, tight clothes, and alcohol use increase the risk of frostbite. Cell damage, tissue dehydration, and oxygen depletion caused by freezing and thawing can lead to blood-cell disruption, clotting in capillaries, and gangrene. The toes, fingers, ears, and nose are usually affected first, becoming cold, hard, white, or bloodless. The lack of pain is dangerous. Core temperature should be brought to near normal before rapid thawing in warm (under 115 °F [46 °C]) water. Toxoid booster injections are recommended. The outlook is best when freezing is short-term, thawing is by rapid rewarming, and large blisters extending to the end of the part develop early. Tissue that is refrozen after thawing must almost always be amputated. Affected parts become more susceptible to recurrence. Frostbite is best prevented by wearing dry, layered, loose clothing and remaining alert. Seealso hypothermia.

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Frostbite (congelatio in medical terminology) is the medical condition whereby damage is caused to skin and other tissues due to extreme cold. At or below 0º C (32°F), blood vessels close to the skin start to narrow (constrict). This helps to preserve core body temperature. In extreme cold or when the body is exposed to cold for long periods, this protective strategy can reduce blood flow in some areas of the body to dangerously low levels. The areas where this occurs will freeze over. The combination of cold temperature and poor blood flow can cause severe tissue injury by freezing the tissue. Frostbite is most likely to happen in body parts farthest from the heart, and those with a lot of surface area exposed to cold. The initial stages of frostbite are sometimes called "frostnip". Mountains or high altitudes with snow are most serious causes of frostbite. If frostbite is not treated immediately then the damage and the frostbite become permanent. Nerve damage will occur due to oxygen deprivation. Frostbitten areas will turn discolored, purplish at first, and soon turn black. After a while nerve damage becomes so great that feeling is lost in the frostbitten areas. Blisters will also occur. If feeling is lost in the damaged area, checking it for cuts and breaks in the skin is vital. Infected open skin can lead to gangrene and amputation may be needed.

Risk factors

Risk factors for frostbite include using beta-blockers and having conditions such as diabetes and peripheral neuropathy.

Treatment

To treat frostbite, move the victim to a warm location and seek medical help. Soak frostbitten areas in warm (not hot) water, or, if in wilderness, warm by contact with the skin of a non-frostbitten person. Continue until the victim has regained sensation and movement in the afflicted region; this often follows great pain as the nerves thaw. Never rub, slap or shake the stricken region as ice crystals in the frostbitten skin will damage surrounding tissue. Follow the treatment with a period of constant warmth: refreezing following thawing worsens the damage.

The use of hyperbaric oxygen therapy as an adjunctive therapy can assist in the salvaging of a greater amount of tissue by increasing the viability of cells bordering necrotic tissue by preventing hypoxia and reducing edema. There have been case reports but few actual research studies to show the effectiveness.

Prevention

Factors that contribute to frostbite include extreme cold, wet clothes, wind chill, and poor circulation. This can be caused by tight clothing or boots, cramped positions, fatigue, certain medications, smoking, alcohol use, or diseases that affect the blood vessels, such as diabetes.

Moreover employees working in chemical laboratories should take precautions to wear gloves and other safety equipment as liquid Nitrogen and other cryogenic liquids can cause frostbite even with brief exposure.

If caught in a severe snowstorm, one should find shelter early or increase physical activity to maintain body warmth.

People susceptible to frostbite should wear woolen socks/gloves/caps in extreme cold. For frostbite in the feet, keeping feet in warm saline water will provide relief. Diabetes can also sometimes lead to frostbite, so diabetics should take precautions as to avoid trips to ice-cold places.

References

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