In conditions of prolonged cold exposure, your body sends signals to the blood vessels in your arms and legs telling them to constrict narrow.
As this process continues and your extremities the parts farthest from your heart become colder and colder, a condition called the hunting response is initiated. Your blood vessels are dilated widened for a period of time and then constricted again. Periods of dilatation are cycled with times of constriction in order to preserve as much function in your extremities as possible.
Christmas & Frostbite | Anne Taintor
However, when your brain senses that you are in danger of hypothermia when your body temperature drops significantly below When this happens, frostbite has begun. Frostbite is caused by 2 different means: cell death at the time of exposure and further cell deterioration and death because of a lack of oxygen. In the first, ice crystals form in the space outside of the cells. In the second, the damaged lining of the blood vessels is the main culprit. As blood flow returns to the extremities upon rewarming, it finds that the blood vessels themselves are injured, also by the cold.
Holes appear in vessel walls and blood leaks out into the tissues. Flow is impeded and turbulent, and small clots form in the smallest vessels of the extremities. Because of these blood flow problems, complicated interactions occur, and inflammation causes further tissue damage. This injury is the primary determinant of the amount of tissue damage you will have in the end.
It is rare for the inside of the cells themselves to be frozen. This phenomenon is only seen in very rapid freezing injuries, such as those produced by frozen metals. Continued Frostbite Symptoms A variety of frostbite classification systems have been proposed.
In superficial frostbite, you may experience burning, numbness, tingling, itching , or cold sensations in the affected areas. The regions appear white and frozen, but if you press on them, they retain some resistance. In deep frostbite, there is an initial decrease in sensation that is eventually completely lost. Swelling and blood-filled blisters are noted over white or yellowish skin that looks waxy and turns a purplish blue as it rewarms.
The area is hard, has no resistance when pressed on, and may even appear blackened and dead. You will experience significant pain as the areas are rewarmed and blood flow reestablished.
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A dull continuous ache transforms into a throbbing sensation in days. This may last weeks to months until final tissue separation is complete.
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At first the areas may appear deceptively healthy. Most people do not arrive at the doctor with frozen, dead tissue. Only time can reveal the final amount of tissue damage. When to Seek Medical Care A doctor must be able to see and examine the affected area. Exams and Tests The doctor will take a history in order to gather information on the events of the exposure and the medical condition prior to the cold injury. The doctor will take note of the vital signs, including temperature, pulse , blood pressure , and respiratory rate in order to exclude or treat any immediate life threats such as hypothermia or severe infection.
X-rays may be performed, but they probably will be deferred until weeks later when they are more useful to the treatment team. The doctor will collect data in order to classify the injury as superficial or deep and the prognosis as favorable or poor. A good prognosis is heralded by intact sensation, normal skin color, blisters with clear fluid, the ability to deform the skin with pressure, and the skin becoming pink when thawed. Blisters with dark fluid, skin turning dark blue when thawed, and an inability to indent the skin with pressure indicate a poor prognosis.
Keep the affected part elevated in order to reduce swelling Move to a warm area to prevent further heat loss. Note that many people with frostbite may be experiencing hypothermia. Technetium or MR scans are not required for diagnosis, but might be useful for prognostic purposes. The Wilderness Medical Society recommends covering the skin and scalp, taking in adequate nutrition, avoiding constrictive footwear and clothing, and remaining active without causing exhaustion.
Supplemental oxygen might also be of use at high elevations. Repeated exposure to cold water makes people more susceptible to frostbite. Individuals with frostbite or potential frostbite should go to a protected environment and get warm fluids. If there is no risk of re-freezing, the extremity can be exposed and warmed in the groin or underarm of a companion. If the area is allowed to refreeze, there can be worse tissue damage.
If the area cannot be reliably kept warm, the person should be brought to a medical facility without rewarming the area.
Rubbing the affected area can also increase tissue damage. Aspirin and ibuprofen can be given in the field  to prevent clotting and inflammation. Ibuprofen is often preferred to aspirin because aspirin may block a subset of prostaglandins that are important in injury repair. The first priority in people with frostbite should be to assess for hypothermia and other life-threatening complications of cold exposure. Before treating frostbite, the core temperature should be raised above 35C. Oral or intravenous IV fluids should be given.
If the area is still partially or fully frozen, it should be rewarmed in the hospital with a warm bath with povidone iodine or chlorhexidine antiseptic. The faster tissue is thawed, the less tissue damage occurs. Rewarming can be very painful, so pain management is important. People with potential for large amputations and who present within 24 hours of injury can be given TPA with heparin.
Bone scans or CT angiography can be done to assess damage. Blood vessel dilating medications such as iloprost may prevent blood vessel blockage. Various types of surgery might be indicated in frostbite injury, depending on the type and extent of damage. Debridement or amputation of necrotic tissue is usually delayed unless there is gangrene or systemic infection sepsis. Tissue loss and autoamputation are potential consequences of frostbite. Permanent nerve damage including loss of feeling can occur. It can take several weeks to know what parts of the tissue will survive.
The classification system of grades, based on the tissue response to initial rewarming and other factors is designed to predict degree of longterm recovery. Grade 1: if there is no initial lesion on the area, no amputation or lasting effects are expected. Grade 3: if there is a lesion on the intermediate or near body part, autoamputation and loss of function can occur. Grade 4: if there is a lesion very near the body such as the carpals of the hand , the limb can be lost. A number of long term sequelae can occur after frostbite. There is a lack of comprehensive statistics about the epidemiology of frostbite.
In the United States, frostbite is more common in northern states. In Finland, annual incidence was 2. Research suggests that men aged 30—49 are at highest risk, possibly due to occupational or recreational exposures to cold. Frostbite has been described in military history for millennia.
The Greeks encountered and discussed the problem of frostbite as early as BCE. Napoleon's Army was the first documented instance of mass cold injury in the early s. Several notable cases of frostbite include: Captain Lawrence Oates , an English army captain and Antarctic explorer who in died of complications of frostbite;  noted American rock climber Hugh Herr , who in lost both legs below the knee to frostbite after being stranded on Mount Washington New Hampshire in a blizzard;  Beck Weathers , a survivor of the Mount Everest disaster who lost his nose and hands to frostbite;  Scottish mountaineer Jamie Andrew , who in had all four limbs amputated due to sepsis from frostbite sustained climbing the Mont Blanc massif.
Evidence is insufficient to determine whether or not hyperbaric oxygen therapy as an adjunctive treatment can assist in tissue salvage. Medical sympathectomy using intravenous reserpine has also been attempted with limited success. From Wikipedia, the free encyclopedia. Sue made her way to the kitchen and switched on the light.
She felt a small amount of comfort from the light. With her ear up against the stable style backdoor she listed closely. Sue had the feeling that while the voice said it was cold what it really wanted to say was, it was hungry. In a move of equal parts rational thinking and bravery Sue turned the key quickly and swung open the door. As she opened the door a gust of cold wind blew into the kitchen, hitting her in the face. It was biting cold, and no one was there.