FROSTBITE

Frostbite usually occurs in extreme cold conditions like high altitudes, snowy areas where temperatures reach sub zero. Distal extremities (foot) and exposed skin are most often affected. It occurs due to formation of ice crystals within or between the tissues leading to freezing and then death of tissues.

Symptoms and Signs:

Frostbite in Hand

The affected area is hard, numb, cold and white. When warmed the area becomes blotchy red, swollen and painful (as seen in the pic). Within 4-6 hrs blister formation starts. Blisters with clear fluid indicate superficial injury while those with blood indicate deep injury. Gangrene may also develop. Wet gangrene which is soft, gray and edematous, suggests infection while dry gangrene is less likely to be infected. All degrees of frostbite may cause long term neuropathic symptoms.


Thrombosis may occur around the frostbitten tissues compromising blood supply leading to further injuries.

Diagnosis:

Diagnosis is usually on the basis of history and clinical findngs.

Treatment:

Frostbite Healing

• Rewarming in warm water
• Supportive measures
• Local wound care
• Sometimes delayed surgery is also needed

What should be done at home before visiting hospital:

• The frostbitten area should be rewarmed by totally immersing in warm water preferably around 40-42 degrees.
• Avoid exposure of the frostbitten area to cold
• Seek physicians advice as early as possible.

What should not be done:

• Do not rewarm the frostbitten area over dry heat as the area is numb and may result in burns.
• Avoid large movements in the area as the crystal formed may harm the tissues.

Medications:

Anti-inflammatory drugs like Ibuprofen, Diclofenac may be helpful. Phenoxybenzamine an alpha blocker might reduce vasospasm.

Adequate nutrition is requuired for sustained metabolic heat production.