Symptoms of Frostbite, Initial Response, and First Aid

Symptoms

The clinical symptoms of frostbite reflect the degree of exposure to a cold environment. The most common symptom is decreased sensation in the affected area, and more than 75% of patients report it.

Mild frostbite is a freezing injury to the epidermis without ice crystal formation or tissue loss. Due to vasoconstriction, the skin becomes pale, and discomfort in the affected area is reported. When rewarmed, the symptoms improve, and there is no tissue loss.

Severe pain appears with reperfusion of the tissue, and the dull, persistent pain over 48 to 72 hours changes into a throbbing, aching type of pain. This pain may continue for weeks to months. In addition, the symptoms of frostbite can appear in various forms, including a cold, pale affected area, decreased sensation or numbness, redness and swelling of the skin, and the formation of blisters. The classification of frostbite most widely used today is based on the degree of frostbite and the depth of the damaged tissue.

Initial Response and First Aid for Frostbite

1. Initial response · Move the patient from the cold environment to a warm environment. · Remove wet clothing and wrap the entire body in a warm blanket. · The basic principle of frostbite treatment is to relax blood vessels, improve blood circulation, and relieve freezing between cells. Therefore, any method or treatment that can produce these effects may be used, but the best method is to immediately immerse the frostbitten area in warm water at about 37 to 39˚C for 20 to 40 minutes. · Replenish warm water so that the water does not cool down. · For frostbite of the ears or face, apply warm towels and change them frequently. · Place sterile dry gauze between the toes and fingers to remove moisture and prevent them from sticking together. · Raise the frostbitten area slightly to reduce pain and swelling. · A patient with a swollen leg and blisters should not walk on it, so transport by stretcher.

2. Precautions · If the frostbitten area is immersed in hot water above 40˚C, there is a risk of burns instead. · Do not pop blisters. · Do not rub or massage the frostbitten area. Rubbing can destroy cells with ice crystals. · Do not rub with ice or snow. · Do not apply direct heat such as placing the frostbitten area over a fire or against an electric blanket, hot water bottle, stove, lamp, radiator, or exhaust gas pipe. These methods can generate excessive heat and cause additional tissue damage. · Never give the patient alcohol. Drinking alcohol causes vasodilation and releases body heat, which can instead lead to hypothermia. · Never let the patient smoke. Smoking causes vasoconstriction and interferes with blood circulation.

3. Medication and hospital treatment · Administer analgesics for pain control. · If there is an open wound, administer antibiotics. · Take tetanus preventive measures. · Protect the thawing area. Blisters that occur between 1 hour and several days after body temperature returns should not be popped if possible because they can predispose to infection. · Since frostbitten areas are highly susceptible to infection, strictly maintain sterile technique when changing dressings. · Elevate the frostbitten area to prevent swelling. · Be sure to perform a full-body examination for associated injuries. (soft tissue injury, dehydration, alcoholic coma, fracture) · Restore electrolyte balance. Dehydration and hypovolemia can commonly occur in frostbite patients. · Immerse the frostbitten limb in a whirlpool. This is to help blood circulation and remove dead tissue, and to help prevent infection. · Perform clinical tests (blood tests, urine tests) to monitor complications.

4. Prevention The most important thing in prevention is protecting body parts exposed to the cold outdoor environment. Therefore, you should always keep exposed body parts warm and dry, avoid staying in one position for long periods, and exercise. Wearing multiple layers of warm, dry outer clothing is helpful, and fabrics with windproof function are beneficial. Wet clothes, socks, and shoes should be changed to dry ones. When engaging in cold outdoor activities, it is a good idea to prepare spare socks, gloves, and shoe insoles, and caution should be taken with a hunched posture, tight clothing, standing for long periods, smoking, drinking alcohol, and taking sedatives.

So far, we have explained the symptoms of frostbite, initial response, and first aid. In the next part, we will look at sprains.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal