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With the cold winter months upon us, many of us will find ourselves taking part in outdoor activities. Whether it is skiing, snowboarding, ice-skating or simply shoveling snow if we do not take some simple precautions and use some common sense these outdoor activities can often lead to frostbite.

FROSTBITE
Frostbite occurs when the body is exposed to temperatures below the freezing point of skin and the tissues freeze and is often associated with hypothermia. The extremities are most commonly affected including the nose, cheeks, ears, fingers and toes. The people most at risk for frostbite include those who spend a significant amount of time outdoors, those under the influence of alcohol, the elderly without adequate heating and shelter and those that are exhausted or dehydrated.

When you are exposed to cold temperatures, your body will constrict blood vessels to the extremities in order to send more blood to the major organs.  When your brain detects that you are in danger of hypothermia (body temperature below 98.6 degrees) the body with maintain this blood vessel constriction. Ice will begin to develop outside your body’s cells, which cause the cells to lose water in their interior resulting in cell destruction.

In people who experience superficial frostbite, symptoms include burning, numbness, tingling, itching and cold sensations. The affected areas appear white and frozen but they feel normal when touched. In deep frostbite, sensation is either decreased or completely lost initially. Swelling and blood blisters develop. The skin appears white or yellowish with a waxy texture and will turn purple upon rewarming. When touched the skin feels hard and may turn blackened and appear dead (gangrene). As the areas are rewarmed and blood flow increases there is usually intense pain that turns into a dull continuous ache that lasts for 2-3 days. Following this initial 2-3 days, the ache will turn into a throbbing sensation that may last for weeks to months. It is only after this that the full extent of tissue damage can be determined.

If you are concerned that you may have suffered frostbite, seek medical attention immediately. The doctor must be able to see and feel the affected body part and even then may not be able to determine the full extent of damage.  Initially you want to move to a warm area to prevent further heat loss and elevate the affected body part to avoid swelling. Avoid walking on frostbitten feet as this may lead to further damage. Be aware that most people will also be suffering from hypothermia and this must be addressed immediately as this could be life threatening. Remove all wet clothing and anything that could restrict blood flow. Give warm, nonalcoholic, non-caffeinated fluids to drink. Rewarm the affected area quickly but only if there is no chance of refreezing. Remember the amount of damage is determined by how long the freezing lasts.

Treatment by healthcare professionals will include rapid warming in a heated water bath, pain medication to control the intense pain, IV fluids to control dehydration and possible removal of dead tissue including amputation.  Remember, the process of treating frostbite and determining the extent of damage may take months and the patient will often experience numbness, throbbing sensations, tingling, occasional electric shock sensations, cold sensitivity, sensory loss and chronic pain during this period and possibly for years. Good outcome indicators include intact sensation, normal skin color, blisters with clear fluid and the skin becoming pink when thawed. Blisters with dark fluid, skin that turns dark blue when thawed and skin that is firm touch all indicate significant frostbite and damage.

While outside, taking these simple steps will reduce your chances of developing frostbite:

• Avoid alcohol as this will impair your judgment and ability to remove yourself from the cold conditions
• Be aware that tobacco users and those with conditions that affect the blood vessels (like diabetes) already have decreased blood flow to their extremities
• Dress for the weather. Layers are best and mittens are better than gloves as they keep the fingers close together and allow them to warm each other
• Wear 2 layers of socks with the inner layer made of a synthetic fiber to pull moisture away from the skin
• Wear waterproof shoes/boots
• Cover all extremities at all times
• Always travel in pairs 
• Avoid how much time you spend outdoors

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