39. Frostbite. Definition, types, degrees, manifestations, basics of treatment.

FROST INJURIES

Written by Rhiana Devadasan

Frost injuries = a spectrum of injuries that occurs upon exposure to cold, resulting from the human body's inability to adapt to low temperatures.

TYPES:

Depending on if injury is local or general:

• PERIPHERAL COLD INJURIES (localized injury to a body part)
• SYSTEMIC HYPOTHERMIA (systemic injury due to generalized cooling of the entire body)
• Combination of both

Specific types:

• Frost nip
• Superficial cooling of tissues
• Causes no cellular degeneration
• Chilblains
• Superficial ulcers that occur on the skin
• Occurs in individuals who have a predisposition and who are regularly exposed to the cold.
• Frostbite
• Non-superficial cooling of tissue
• Sufficient enough to cause tissue damage and kill cells.
• Hypothermia
• Point at which the internal body temperature falls below 35°C
• Trench foot
• Caused by the individual repeatedly exposing their feet to cold (non- freezing) water.

STAGES of Manifestation

1. First degree – Simply freezes the surface level of skin

• The skin will turn white and yellow and will cause itching and some pain
• OR it may become numb.

1. Second degree – At this point if freezing continues the skin may completely freeze and harden

• The deep tissues will still remain unaffected
• Blister around 2 days after thawing
• Normally results in full recovery, but might on occasion result in permanent lack of sensitivity to hot and cold in those areas.

1. Third and Fourth degree – At this degree the frostbite will freeze more deeply and start to affect muscles, tendons, blood vessels and nerves

• Skin will feel hard and waxy and use of the area will be temporarily lost. Depending on the severity and duration, this may be permanently.
• Deep frostbite will cause the area to develop purple or black blisters and this will often result in nerve and cell damage.
• Often the extremities will require amputation if it leads to an infection of gangrene, or might even fall off on their own.

TREATMENT

1. Restore cardiopulmonary function.
2. If the patient is still not breathing, endotracheal intubation should be undertaken immediately to maintain the airway.
3. Frozen skin may require cricothyroidotomy.
4. External cardiac compressions must be continued in pulseless patients with compressible chest walls.
5. A central venous access line should be established to obtain blood for laboratory studies and to administer warmed fluids for volume expansion.
6. Treatment of all hypothermic patients must include volume expansion and rewarming.