Baby, it’s cold outside!

It’s been really cold here in the Intermountain West for the last week or so.  In my line of work, that means that it’s frostbite season.  The phone calls for advice and clinic visits for care have gone into high gear after this past weekend. The other morning I had a colleague call me to help with the care of a family friend who was out skiing this weekend and came home with some really pale, cold toes.

Here are some simple frostbite education tips for anyone, as well as a link to a talk I’ve given on frostbite.

How do I prevent frostbite?

Frostbite is definitely in the category of things it’s better to prevent than to treat.  A few simple interventions can help you not end up with cold injury.  First, use warm clothing to maintain your core temperature (this is where the great coat comes in!), wear a hat to prevent thermal loss from your head, and make sure that you have good gloves and sturdy, dry footwear that will keep your feet protected.  Any clothing that you wear in cold conditions should not be constrictive.  And don’t forget that dressing in layers of technical fabrics provides you with additional insulation.  In addition to clothing interventions, make sure that you stay hydrated.   Monitoring hydration status can be a challenge in cold conditions, but it’s no less important than when you’re out in extreme heat.  “Cold checks” are another important technique for preventing frostbite, or for catching cold injury early when it can still be reversed.  If you have numbness or pain in your fingers, hand, toes, foot, or nose, it’s time to go in and warm up.  Finally, exposure in any temperature less than -15⁰C (that’s 5⁰F), even if the air is still, puts you at risk for frostbite.  If you can avoid being out in those temperatures, you should.  If you must be out, dress wisely for the conditions and try to get back indoors as quickly as you can.

How do I know if I have frostbite?  And what should I do about it?

It’s entirely possible to have a lesser cold injury like frostnip, which is easily treated with simple rewarming.  Frostnip usually happens on exposed areas like the nose, ears, and cheeks. Frost forms on the skin, but it quickly reverses with warming the skin and getting out of the cold.  Frostnip is fully reversible, but it serves as an important marker of conditions that are appropriate for development of frostbite.

Frostbite can present as either superficial or deep frostbite.  If you have superficial frostbite, the injured tissue remains a bit hard after it is rewarmed and often becomes swollen.  Superficial frostbite can even present with some small blisters with clear fluid, and these blisters are surrounded by redness and swelling.  The good news about superficial frostbite is that it results in very little tissue loss and it heals quickly with little need for medical intervention.

Deep frostbite is more concerning and has greater consequences.  Deep frostbite may present with purple, bruised-looking tissue, and the injury can extend down to bone quite easily in fingers and toes.  With deep frostbite we anticipate significant tissue loss, and this is the type of frostbite that often results in amputations for management of the injury.  If you see fingers or toes that have a deep purple color after being rewarmed, those need professional evaluation.

For initial management of frostbite, the Wilderness Medical Society released guidelines in 2011 that focus on being more than 2 hours away from definitive medical care.  A few key principles apply whether you are in the backcountry or in the lodge at Alta or shoveling snow in Salt Lake!

Initial Frostbite Management

  • Treat hypothermia (cold body temperature) first
  • Remove any jewelry on an affected extremity
  • Rapidly rewarm the affected extremity in a warm water bath that is 37-39⁰C for 30 minutes
  • Air dry the extremity- do not rub, and don’t pop any blisters (save them for the professionals)
  • Protect an injured area from refreezing and from additional trauma
  • Hydrate, hydrate, hydrate
  • Carefully pad the affected area to protect it and seek medical attention

For more information on frostbite, check my SlideShare.  Note:  If you may be offended by pictures of cold-injured fingers and toes, you may want to pass on the PowerPoint.

Edited to add:  An interview I did with Dr. Vivian Lee.  Happy listening!