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    Fighting Frostbite

     

    Fighting Frostbite

    Frostbite is defined as damage to tissues due to exposure to low environmental temperatures. Frostbite occurs when tissue freezes. The severity can be classified as deep or superficial:

    Superficial frostbite involves only the skin or tissue just beneath the skin, which may cause only erythema (redness), transient numbness, pain and blisters.
    Deep frostbite involves the skin, subcutaneous tissue and structures beneath the skin leading to persistent ischemia (lack of oxygen causing cell death), secondary thrombosis, blood clots, gangrene infection and possibly loss of limb.


    Frostbite most often affects exposed large surface areas of skin such as fingers, toes, ears, nose, chin and cheeks.

    Factors that predispose someone to frostbite include:
    Immobility
    Smoking
    Peripheral vascular disease from hardening of arteries
    Previous frostbite


    Factors that increase the likelihood of frostbite include:
    High wind.
    Tight, moist, constrictive clothing
    Direct skin contact with frozen metal


    Most frostbite cases are associated with alcohol consumption, homelessness and car break-down. However, outdoor winter sports enthusiasts participating in mountaineering, snowskiing, snowboarding and cross-country skiing are at particular risk and must also protect themselves.

    Treatment
    Initial treatment consists of two important concepts:
    Rapid re-warming
    Tissue trauma prevention


    Tissue should be rapidly re-warmed at 104-to-108 degrees Fahrenheit (40-to-42 degrees Celsius) until the distal (farthest from point of attachment) part of the frostbitten tissue is flushed. For the purpose of reference, a hot tub is generally set at 102-to-104 degrees Fahrenheit.

    Slow re-warming causes an increased risk of tissue damage and should be avoided if possible. Re-freezing of tissue should also be avoided; therefore careful planning of rewarming is necessary. In addition, mechanical trauma to the affected tissue (ie., massage, weight bearing, or use of the affected hand) should also be avoided. The damaged limb should be elevated. Topical aloe vera lotion and ibuprofen taken orally may help limit tissue damage and increase comfort.

    Blisters that form within two days of re-warming should be left intact. Medical assistance should be sought as soon as possible for complete treatment, which consists of analgesic pain control, wound management, wound debridement, or amputation in severe cases. if the skin is broken. If the skin is broken, a tetanus toxoid booster should be considered.

    In addition to the risk of lost limb function and deformity, frostbite can lead to future cold hypersensitivity of the affected area, premature closure of growth cartilage in children and rarely, squamous cell skin cancer. Therefore, prevention of frostbite before exposure is critically important.

    Prevention
    Planning for cold weather is the cornerstone of prevention:
    Know the weather report, especially the potential for bad weather.
    Layer warm, loose, nonrestrictive clothing. Polypropelene and other synthetic fabrics that wick moisture away from the skin while providing excellent warmth are advisable.
    Wear water-resistant fabrics, such as Gortex, can be very helpful.
    Select appropriate fitting, nonrestricting, water-proof gloves and boots that give your fingers and toes the ability to move - staying warm is also a key to avoiding frostbite.
    Choose face and head coverings that will help protect high-risk areas from the cold.

     






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