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frostbite
Classification:
- much like burns
- 1st degree: skin irritation
- 2nd degree: blisters, reversible damage
- 3rd degree: all layers of skin affected; irreversible damage
Etiology:
- exposure to temperatures below freezing point of skin
Pathology:
- tissue freezes
- nose, cheeks, ears, fingers, toes extremities) are most commonly affected
- ice crystals form in the extracelluar space resulting in dehydration of cells
- vascular injury results in extravasation of blood, vascular occlusion & ischemia
- interior of cells rarely freezes
Clinical manifestations:
- paresthesias, numbness
- blistering & edema
- pain & purpura may occur on rewarming
- dull pain may become throbbing in 2-3 days follwowing rewarming
- pain may last for weeks
Management:
- remove from exposure to cold
- treatment of associated hypothermia (if present) takes priority
- elevate involved area to reduce edema
- remove restrictive, wet clothing
- warm fluids (no alchohol, caffeine)
- immerse affected area in water bath heated to 40-42 C (104-107.6 F) until thaw complete
- opiates as needed to diminish pain
- treat associated dehydration (if present)
- debride clear blisters; leave bloody blisters intact to preserve viable blood vessels
- hospitalize 1-2 days (most patients)
- surgery consult if need for amputation contemplated
Related
chilblain
hypothermia
General
cold injury
superficial injury/trauma
References
- Stoppler MC
eMedicine
http://www.emedicinehealth.com/frostbite/article_em.htm