How to Properly Treat Frostbite?
Frostbite, or congelation, is defined as an acute condition involving damage to the skin and subcutaneous tissues due to local cold, particularly at subzero temperatures. Treatment requires quality care. By choosing the right therapy, we can prevent complications that might otherwise threaten the patient with amputation of the affected part. The healing process is lengthy and requires patience from both the patient and the attending physician.
Mechanism of Frostbite Formation
When the body is exposed to prolonged cold, particularly low temperatures, there is a real risk of frostbite. However, frostbite can also occur at above-freezing temperatures — the main risk factors here are strong winds and excessive humidity.
The body undergoes vasoconstriction, where the affected area is not sufficiently supplied by the bloodstream. The body tries to maintain thermal stability for the long term, reducing blood flow demands in the extremities to protect vital organ function. This primarily affects the tip of the nose, ear, cheekbone area, chin, fingers, and toes. Fingers are most frequently affected as these peripheral areas lose heat very quickly. The rule of thumb is that wherever there is a thin layer of fat and the skin closely adheres to tendons, these are high-risk areas.
Classification
The extent of tissue damage depends on the duration of cold exposure, the overall condition of the affected individual, and the time span between occurrence and receiving first aid and subsequent treatment, particularly warming the affected area.
We distinguish between 4 degrees of frostbite:
- 1st degree – grayish-white discoloration, loss of sensation, redness, swelling, and pain after warming
- 2nd degree – pasty skin, increasing swelling, blister formation
- 3rd degree – bleeding into the skin, formation of blue-black discoloration, necrosis, coldness, reduced mobility of fingers
- 4th degree – irreversible tissue destruction, black-brown discoloration, mummification, demarcation from healthy surroundings
The Risk of Hypothermia
Prolonged cold exposure can lead to hypothermia and a reduction in body temperature below the level necessary for physiological functioning. Hypothermia reduces blood circulation in the circulatory system. If this situation arises, we wrap the affected individual in a blanket and give high-energy foods — such as chocolate.
First Aid
Properly administered first aid in the field is crucial. The affected area must be warmed with body heat. However, rubbing is contraindicated! If professional medical help is far off, do not attempt to warm the affected areas. More severe consequences could arise. This is a serious associated complication of the victim's overall condition.
Subsequent Treatment
In a medical facility, we continue to gently rewarm the area in warm water (around 40 °C). Warm infusion solutions are continually administered through an intravenous entry. The overall goal is to improve the body's circulatory function. We must wait for the demarcation of tissue damage, which will eventually reveal the full extent of the injury. Another treatment objective is to prevent infection.
For second to fourth-degree frostbite, we treat them as chronic wounds during healing. Modern technologies, such as moist healing, are recommended. Dressings are regularly changed based on the wound's characteristics. Before treatment, painkillers should be administered as per the doctor's prescription. Antiseptic dressings with healing ointments or silver-containing preparations that do not adhere to the wound bed are used. We continuously fight against infection and potential septic states. In some cases, amputation of the affected body part may be necessary for vital indications.
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Sources:
1. Learn first aid for someone who has hypothermia. British Red Cross, 2021. Available at: www.redcross.org.uk/first-aid/learn-first-aid/hypothermia
2. Frostbite. Wound Treatment, 2021. Available at: www.lecbarany.cz/odbornik/diagnozy/omrzliny
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