Degrees of frostbite
The lesion is divided into four degrees, but the depth can be finally determined only after several days and sometimes weeks. In the first degree, the surface layer of the skin suffers: it turns pale, loses sensitivity, after warming it turns red, swells, burning and itching appear, everything goes away without a trace. With the second, bubbles with transparent contents form. The third degree means the death of the entire thickness of the skin with the formation of blisters with bloody contents and the subsequent formation of a scab. With the fourth, muscles, tendons and bones are damaged, the tissues turn black and mummify.
- First degree - pallor and numbness, full recovery
- Second degree - bubbles with transparent contents
- Third degree - death of the entire thickness of the skin, bloody blisters
- Fourth degree - damage to muscles and bones
- The true depth is visible after a few days
- Fingers, toes, nose, ears, cheeks are most often affected
Who risks more
Contrary to popular belief, alcohol does not warm up: it dilates blood vessels in the skin, accelerating heat loss, and dulls the feeling of cold, which is why a person does not notice the danger. It is intoxication that remains the leading factor in severe frostbite. Wind and humidity, tight or wet shoes, rings and tight gloves, smoking and vascular disease, diabetes mellitus with impaired sensitivity, as well as childhood and old age increase the risk. It is also worth remembering that when contacting metal or liquids in the cold, damage develops in a matter of seconds.
- Alcohol and drug intoxication
- Wind and high humidity with slight frost
- Tight, wet shoes and clothes
- Smoking and peripheral vascular disease
- Diabetes mellitus and sensory impairment
- Children and the elderly
- Contact with metal or flammable liquids in the cold
First aid: do's and don'ts
The victim should be brought into a warm room as quickly as possible, and remove wet and tight clothing, shoes, rings and jewelry. The affected areas are gradually warmed in water at a temperature of about 37–40 degrees for 20–30 minutes, until a pink color and sensitivity appear; there is severe pain, and this is normal. You can give warm drinks, but you can’t give alcohol. It is strictly forbidden to rub the skin with snow, wool and alcohol, use hot water, open fire and batteries, or pierce blisters. If there is a risk of re-freezing, it is better not to warm up until evacuation.
- Transfer to heat, remove wet and tight
- Warm in water 37–40 degrees for 20–30 minutes
- Apply a sterile dry bandage, placing the bandage between the fingers
- Give warm drinks, painkillers according to age
- Do not rub with snow, wool or alcohol
- Do not use hot water, fire or batteries
- Do not puncture blisters or reheat if there is a risk of re-freezing.
Medical care and diagnostics
The clinic evaluates the depth of the lesion, the state of blood circulation and the presence of general hypothermia. Bubbles with clear contents are usually kept or carefully emptied according to the doctor’s decision; bloody ones are not opened. Prescribe pain relief, sterile dressings, tetanus prophylaxis in case of skin damage, and, if necessary, drugs that improve blood flow. Vascular Doppler sonography helps assess the blood supply to the limb. In case of deep damage, treatment is carried out in a hospital, and the issue of removing dead tissue is not decided immediately, but after the boundary between living and dead tissue is clearly defined.
- Assessment of the depth of the lesion over time
- Anesthesia and sterile dressings
- Prevention of tetanus when skin integrity is compromised
- Dopplerography of arteries and veins of the extremities
- Medicines that improve blood flow, as prescribed by a doctor
- Delayed debridement after demarcation
Consequences and prevention
After superficial frostbite, the skin is completely restored, but increased sensitivity to cold, tingling and sweating in the affected area can persist for months. After a deep lesion, scars remain, deformation of the nails, chronic pain, and in case of tissue death, loss of fingers. Having experienced frostbite increases the risk of recurrence, so special care is needed in cold weather. Prevention is simple: multi-layers of dry clothing, loose warm shoes, mittens instead of gloves, face protection, regular breaks in the heat and avoiding alcohol in the cold.
- Increased sensitivity to cold after recovery
- Scars and deformation of nails with deep lesions
- Risk of loss of fingers in the fourth degree
- Layers of dry clothing and loose shoes
- Mittens, hat and face protection in windy weather
- Breaks in warmth and avoidance of alcohol in the cold
