Frostbite Disease

BASICS

DESCRIPTION

A localized complication of exposure to cold, resulting in diminished blood flow to the affected part (especially hands, face or feet). Dehydration, enzymatic destruction and ultimately cell death occurs. In severe cases, deep tissue freezing may occur with damage to underlying blood vessels, muscles and nerve tissue.

System(s) affected: Endocrine/Metabolic, Skin/Exocrine
Genetics: N/A
Incidence/Prevalence in USA: Approximately 4,800/year
Predominant age: All ages
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Injured area first appears cold, hard, white and is anesthetic to touch. Progresses to blotchy-red, swollen and painful regions after rewarming.
Loss of cutaneous sensation
Numbness
Throbbing pain
Paresthesia
Excessive sweating
Joint pain
Pallor
Subcutaneous edema
Hyperemia
Blistering
Blue discoloration
Skin necrosis
Gangrene

CAUSES

Prolonged exposure to cold
Refreezing thawed extremities

RISK FACTORS

Impaired cerebral function
Under the effects of alcohol or drug abuse
Underlying psychiatric disturbance
Ambient temperature less than 0°F (-17.8°C)
Smoker
Elderly
Raynaud's phenomenon

DIAGNOSIS

LABORATORY

Hemoconcentration
Decreased hepatic function

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Ice crystallization in the intravascular extracellular space
Atrophy
Fibroblastic proliferation
Skin necrosis

SPECIAL TESTS

ECG - bradycardia, atrial fibrillation, atrial flutter, ventricular fibrillation, diffuse T wave inversion

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Various imaging techniques such as thermography, angiography, digital plethysmography and radioisotope vascular and bone scanning have been used to assess degree of vascular injury. Helps surgeons make decisions - but no technique is entirely reliable during vascular instability which lasts 2-3 weeks.

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient or inpatient, depending on severity

GENERAL MEASURES

Emergency measures for patient without pulse or respiration. Such measures may include CPR and internal warming with warm IV's and warm oxygen (see hypothermia)
Prevent refreezing. May be necessary to keep frostbitten part frozen until patient can be transported to a care facility
Treat for hypothermia
Treat for pain, NSAIDs, and/or narcotics if needed
Cautious rewarming. May immerse frozen body part for several minutes in water no hotter than 40-42°C (104-107°F)
After rewarming, injured parts should be covered with nonadhesive dressings, splinted, and elevated
Application of aloe vera, administration of nonsteroidal anti-inflammatory drugs are considered helpful in removal and inhibition of deleterious prostaglandins (e.g., ibuprofen 400-800 mg orally bid or a systemic anti-inflammatory given as early as possible)
Keep patient dry. If conscious, give warm fluids with high sugar content
Amputation not to be considered until it is definite that tissues are dead. May take about 3 weeks to know if the tissue is permanently injured
Prevention of infection, once treatment begins
Ongoing whirlpool therapy for cleansing and debridement
Prevention of damage to other body parts

SURGICAL MEASURES

N/A

ACTIVITY

As tolerated, protect injured body parts
Initiate physical therapy once healing progresses sufficiently

DIET

As tolerated
Warm oral fluids

PATIENT EDUCATION

Local library
Exposure protection
Early signs and symptoms of frostbite

FOLLOW UP

PREVENTION/AVOIDANCE

Dress in layers with appropriate cold weather gear. Cover exposed areas and extremities appropriately.
Proper preparation for trips to cold climates. Avoid alcohol.

POSSIBLE COMPLICATIONS

Hyperglycemia
Acidosis
Refractory arrhythmias
Tissue loss. Distal parts of an extremity may undergo spontaneous amputation.
Gangrene
Death

EXPECTED COURSE AND PROGNOSIS

Anesthesia and bullae may occur
The affected areas will heal or mummify without surgery. The process may take 6-12 months for healing. Patient may be sensitive to cold and experience burning and tingling.

MISCELLANEOUS

ASSOCIATED CONDITIONS

Alcohol and/or drug abuse

AGE-RELATED FACTORS

Pediatric: Loss of epithelial growth centers
Geriatric:

Associated disease states increase mortality
Periarticular osteoporosis complicates
More prone to hypothermia

Others: N/A

PREGNANCY

Acidosis

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.