Frostbite
Frostbite
17 Safeguards against the Cold
When Tod Schimelpfenig was 18, he and a friend wanted a winter adventure. So they went hiking and mountain climbing in the northern Vermont wilderness.
"We were out trying to be mountaineers and ended up going to the school of hard knocks," Schimelpfenig says now, almost 20 years later.
Schimelpfenig, in fact, took an advanced course in frostbite. The toes of his right foot turned white and hard. "It looked like a frozen steak," he recalls with a laugh.
Of course, he wasn't laughing then. Fortunately, he and his companion found a place to camp for the night and he was able to stay off the frozen foot for a while. But to prevent even more serious injury, he had to make sure the foot didn't thaw and refreeze. So while keeping the rest of his body in a warm sleeping bag, he kept the frostbitten foot outside the bag and frozen. And he had to stay awake all night to do it.
"I walked out 8 miles the next morning and I was fine," he says. "I still have all my toes."
Schimelpfenig, who, ironically, is now safety and training manager for the National Outdoor Leadership School in Lander, Wyoming, and a volunteer emergency medical technician, readily admits he needlessly put himself in a dangerous situation. But less severe forms of frostbite can occur quickly in very cold weather when you're simply shoveling snow or changing a tire.
And there are plenty of instances of outdoorsmen and motorists getting lost, and then stranded, and having to face the cold. So here's what you need to know about frostbite—from treating mild pain on the tip of your nose to preventing it in the first place.
Know the signs. Frostnip is the least severe form of frostbite and typically leaves skin somewhat numb and white.
The cheeks, tip of the nose, and ears are most frequently frostnipped, says Bruce Paton, M.D., a clinical professor of surgery at the University of Colorado at Denver. Peeling and blistering, he adds, are also possible after the affected area is warmed.
Peeling and blistering after warming are more likely with superficial frostbite, a more serious condition. Frostbite is an injury in which the tissues of the body freeze, causing damage to the tissue. The skin is also frozen harder than with frostnip, but not so deeply that all resiliency is lost.
"Frostbite is the body's way of trying to preserve heat by shutting down circulation to an extremity," says Ruth Uphold, M.D., medical director of the emergency department at Medical Center Hospital of Vermont in Burlington. "Unfortunately, as you develop frostbite," she warns, "you might not even know that you have it because of the numbness."
MEDICAL ALERT
Hypothermia: The Cold Inside The human body was designed to operate at an internal temperature of 98.6°F. A 6 1/2-degree drop—hardly noticeable in air temperature—could be enough to kill a human being. "Below 92°, cardiac arrest can occur," says James Sturm, M.D. Hypothermia, simply defined as low body temperature, begins in its mildest stage at about 96°, Dr. Sturm says. Symptoms of hypothermia include shivering, slow pulse, lethargy, and a general decrease in alertness. If body temperature drops low enough, muscles turn rigid and the person may lose consciousness. Falling into an icy pond would bring on hypothermia in less than an hour, but most cases result from prolonged exposure to cold temperatures. Elderly people are at increased risk for hypothermia, because their bodies regulate temperature less effectively. If hypothermia occurs, Dr. Sturm recommends taking the following steps, and getting the person to a doctor as soon as possible. - Move the person to a warmer place.
- Wrap the person with blankets.
- Give the person warm liquids. But don't give any alcohol, Dr. Sturm says. "Alcohol just gives an artificial feeling of warmth."
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Hide from the wind. Obviously, getting out of the elements into a warm place is a good idea. But if that's impossible, at least get out of the wind—windchill factors contribute significantly to frostbite.
Think before warming. Don't use dry, radiant heat, such as a heat lamp or campfire, Dr. Paton says, if your skin appears to be frostbitten. Frostbitten skin is easily burned.
Use yourself. If you can't get inside, take advantage of your own body heat. To warm fingers and hands, for example, place them under your armpits. "Rolling yourself into a ball also makes you more energy efficient," Schimelpfenig says.
Frostbite: Don't Delay Action Severe frostbite demands professional medical attention. Tissue is dying. And that opens the door to some dark possibilities—infection and loss of fingers or toes, and in extreme cases, loss of an arm or leg. With deep frostbite, the skin is cold, hard, white, and numb. When rewarmed, the skin may turn blue or purple. It also may swell, and blisters might form. The idea, of course, is to treat frostbite quickly and effectively so none of that happens. While waiting for medical attention, here's what you should do. Thaw quickly. "The trend now is to thaw severe frostbite as fast as is safely possible, which is very painful," says Ruth Uphold, M.D. Typically this is done in warm water—104° to 108°F. "Water," she says, "conducts heat better than air." Do not allow a frostbitten part to refreeze. "Never," emphasizes Dr. Uphold. "The water crystals are bigger when the part refreezes, which causes even more tissue damage." Use your head to save your foot. It's not advisable to walk on frozen feet, but it's better than allowing a frozen foot to thaw and refreeze, so if you think walking may be your only route to survival, don't take a shoe or boot off a frostbitten foot, says Bruce Paton, M.D. "The foot could blister and swell," he says, "and you wouldn't be able to get the boot back on." |
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Don't rub with snow. "It just causes friction with the skin," Dr. Uphold says. "Plus, you lose more heat when you get extremely wet."
Don't get wet. Heat loss is greatly accelerated by contact with water, says Dr. Paton.
Make Mom proud. "Wear mittens instead of gloves—mittens are warmer—and wear a stocking cap to protect your ears," advises James Sturm, M.D., an emergency medicine physician at St. Paul-Ramsey Medical Center in Minnesota.
Don't drink. "You only think alcohol is warming you from the inside out. Alcohol actually causes more heat loss," says Dr. Uphold.
Don't smoke. Smoking decreases peripheral circulation, Dr. Uphold says, thereby making the extremities more vulnerable.
Hang loose. To protect circulation, wear loose clothing and don't wear any jewelry on your fingers, says Schimelpfenig.
Don't delay. Schimelpfenig learned the hard, cold way. He says, "You can get into a trap saying, 'Well, my feet [or my hands] are kind of cold, but I'm going to get inside in a little while anyway.' Now I make sure I can honestly say my feet and hands are still warm."
Use the "buddy system." You watch a friend's face—specifically the ears, nose, and cheeks—for any noticeable change in color, and he or she does the same for you.
Avoid contact with metal. Just a few moments with your bare hand on a metal wrench can lead to frostbite in severe cold.
Stay in your vehicle. If you get stranded in your vehicle on a subfreezing night, it's best to stay put and not venture out into the unknown, says Schimelpfenig. You could risk developing hypothermia or an abnormal drop in body temperature (see "Hypothermia: The Cold Inside" on page 296). "Many of the people we've found who were stranded and tried to walk for help were dead," he says.
PANEL OF ADVISERS
Bruce Paton, M.D., is a clinical professor of surgery at the University of Colorado at Denver.
Tod Schimelpfenig is safety and training manager for the National Outdoor Leadership School in Lander, Wyoming. He also is a volunteer emergency medical technician.
James Sturm, M.D., is a staff physician in the Emergency Medicine Department of St. Paul-Ramsey Medical Center in Minnesota.
Ruth Uphold, M.D., is medical director of the Emergency Department at Medical Center Hospital of Vermont in Burlington.
