By: Nicole Mosley, ATC
As the cold winter months quickly advance on Hampton Roads, understanding the signs and symptoms of frostbite is essential. Frostbite can occur quickly when the cold, moist air in our area is combined with windy conditions. As the body attempts to keep the core temperature warm, blood is “pulled” from the extremities and superficial tissue. It typically starts in the hands, feet, nose and ears; if untreated, will progress into the arms and legs. Re-warming of cold injured tissues should occur gradually.
Frostbite is the result of the body’s tissues at the cellular level actually freezing. There are three stages to frostbite: frostnip, mild frostbite, and severe frostbite. Frostnip involves only the outermost layers of skin cooling below 50°F. It can occur from exposure to cold, windy conditions, and from touching extremely cold surfaces such as metal. Repeated bouts of frostnip could lead to frostbite. The most common symptom of frostnip is the loss of sensation in cold extremities. Treatment options for frostnip involve rubbing your hands together, shielding them from the wind, or placing them close to your body which would delay the onset of frostbite.
Mild frostbite is the freezing of the skin and adjacent subcutaneous tissues below 28°F. The water in the body between cells freezes first, and as mild frostbite progresses the cells will begin to freeze. Mild frostbite can be shown with any of the following signs and symptoms: dry skin, waxy skin, swelling, redness of the skin, tingling or burning sensation, white, blue or gray patches, cold and firm feeling to the touch, and limited movement. Re-warming mildly frostbitten tissues is completed using one’s own body or placing under warm running water. Hot water, rapid re-warming, and massage should be avoided.
When the freezing progresses into muscle, tendon, and bone, severe frostbite is occurring. The signs and symptoms for severe frostbite are: hard and cold skin, waxy skin, white, gray, black or purple skin color, blisters, burning or shooting pain, progressive tissue death, along with damage to muscles, peripheral nerves and joints. Severely frostbitten skin requires immediate medical attention. The tissues need to be completely immersed in warm water for 15-30 minutes, and the process will likely be painful. As with mild frostbite, severe frostbite treatment should not involve massage or return to the cold environment that resulted in the frostbite injury.
With the appropriate precautions, frostbite injuries are preventable. “Tips for Working Out Outside in the Winter” is a great resource to stay safe and warm while enjoying the outdoors.
- Cappaert T, Stone J, Castellani J, et al. National Athletic Trainers’ Association Position Statement: Environmental Cold Injuries. Dec 2008; 43(6): 640-658.
- Rivlin M, King M, Kruse R, et al. Frostbite in an Adolescent Football Player: A Case Report. 2013, 48(6): 000-000.
- Waxenberg R & Satlof E. NATA offers information and guidelines for exercising safely in cold weather. Website: http://www.nata.org/NR120208.
- Baker N & Mehlman J. Transient Heat Transfer and Frostbite. Website: http://people.cst.cmich.edu/yelam1k/asee/ASEE_North_Central_Section/Events_files/Full%20Papers/Baker_2.pdf .