Frostbite

Introduction:

When a person’s skin is exposed to an extremely cold atmosphere, the skin starts showing signs of tissue damage, this tissue damage due to cold exposure is known as frostbite. Frostbite is also called a cold injury. Frostbite can be usually seen under circumstances where the temperature is below zero degrees Celsius. Protecting the skin against exposure to cold temperatures with appropriate clothing such as warm clothes can help avoid frostbite.

Prolonged exposure has to be avoided always. Patients who experience frostbite are at higher risk of ischemic injury (an injury caused by restricted oxygen and blood supply) of tissues and necrosis (tissue death due to injury or failed blood supply). When the body experiences an intense amount of cold, the process of vasoconstriction (narrowing of blood vessels) starts. Then, the skin tissues are deprived of heat and adequate blood supply, eventually, ice crystals start forming in the tissues. That is why it is also cold as cold burns on skin.

What Is a Frostbite?

Frostbite is a condition in which skin tissue death is caused by exposure to extremely cold temperatures. A person who does not have adequate means to protect the skin against such a low temperature may suffer frostbite. Whenever the skin of a person stays exposed for a prolonged time to an extremely cold temperature generally below zero degrees Celsius, eventually suffers frostbite. The skin tissues need sufficient blood and oxygen supply to keep themselves alive. When this supply cycle is disrupted due to vasoconstriction that is the narrowing of blood vessels, and the blood supply is slowed down or restricted, then the tissue starts losing its viability. When tissue death occurs, frostbite takes place. The heat along with the oxygen and blood does not reach the tissues and thus, ice crystals start forming at the place of the tissues. The body parts that are more susceptible to frostbite are the face, lips, hands, feet, and ears. Frostbite cases can be seen mostly in winter and among homeless people as they cannot protect themselves from extreme cold weather. Frostbite can be dangerous if not treated as soon as it appears.

In What Stages Does the Frostbite Occur?

Frostbite occurs in different stages explained and different classifications are also given in the following:

• Frostnip: The skin gets sore, and cold and the person can feel a certain amount of pain.

• Surface or Superficial Frostbite: In this stage, the pins and needles sensation occurs and slight changes in the color of the skin can also be seen. If this stage is treated then a fluid-filled blister can appear for two to three days on the skin.

• Deep Frostbite: This is the severe stage of frostbite. It affects all the layers of the skin, the color changes to a whitish tone or bluish-gray tone. The person loses the sensation and eventually the frostbitten area turns black as the tissue dies completely.

The following classification is given according to grades:

• Grade I: There is no risk of cyanosis (bluish discoloration of the skin due to lack of oxygen) and amputation (surgical removal of the extremity) is not needed.

• Grade II: Cyanosis can be seen at the end of the extremities and amputation of the soft tissue may need to be done.

• Grade III: Cyanosis starts spreading and is in an intermediate state, amputation of the affected digits of the affected extremity may need to be done.

• Grade IV: The entire tissue dies and turns black, amputation of the entire affected area has to be done in this stage.

The following classification is based on degrees of frostbite:

• First Degree: Central pallor (skin loses its original color and shows whitish tone), numbness, surrounding erythema (surface of the skin turns red) or edema (swelling caused by fluid saturation), desquamation (loss of skin tissue in the form of scaling, peeling or shedding), dysesthesia (an abnormal sensation felt after a touch usually happens due to peripheral nerve damage.)

• Second Degree: Skin blistering with surrounding edema or erythema.

• Third Degree: Tissue loss concerning the entire thickness of skin, hemorrhagic (bleeding) blisters

• Fourth Degree: Tissue loss affects deeper structures, resulting in the loss of the involved part.

How Is Frostbite Diagnosed?

A healthcare provider will diagnose frostbite after a thorough physical exam and potential imaging tests. During the exam, the healthcare provider will look for skin discoloration or other skin symptoms like blisters or mottling (marks or smears of color). The provider will ask the patient questions about the cold exposure. Depending on the severity of the symptoms, the healthcare authority may take an imaging test such as an X-ray to look under the skin for tissue damage. Tools like the frostbite calculator can be used by people prone to frostbite.

What Is the Treatment and Management of the Frostbite?

• Further injury by covering the exposed areas has to be avoided. The care of patients with frostbite initiates with rewarming in the affected area if there is no uncertainty of refreezing, as thawing or refreezing can worsen injuries. Patients should be avoided from the cold wind.

• The wet clothing should be removed and replaced with dry clothing. Vigorous rubbing has to be avoided as this can cause further damage.

• Patients with full-thickness injuries with evidence of ischemia and no restoration of tissue perfusion after rewarming may be candidates for thrombolytic (tPA) therapy (the use of medications to destroy blood clots or prevent new blood clots from forming.). Thrombolytic therapy (tPA) may lessen the need for digital amputation (the surgical removal of a portion of a finger). Combination therapy with tPA (Thrombolytic therapy is a strong clot-dissolving medication, intravenously given, that liquefies the blood clot and reconstitutes the blood flow and oxygen to the brain.) and IV (intravenous) heparin may also lower the necessity for digital amputation. A potent vasodilator holds the potential treatment to avert ischemia in frostbite.

Conclusion:

Frostbite can lead to death if not treated at a proper time with appropriate means. It may form small blood clots in the blood vessels leading to disrupted blood flow to the organs. Cardiac collapse can also occur which can be fatal. Sepsis (an extreme stage of infection) can be seen in various cases of frostbite, which has the potential to kill the patient. If slurred speech, loss of coordination, and intense shivering occur then the patient should seek emergency help. Time is an important factor while treating frostbite along with an appropriate treatment. Frostbite can lead to many functional changes in the organs of the body later in the life of a person. Thus, it is important to prevent this condition.