10/13 Wilderness Medicine Wednesday

In the spirit of the first snowfall this year today's post is going to be about frostbite!

​By Coach Nick
Happy Wednesday everyone! I hope you are all having a good week and enjoying the first snow of the year! In the spirit of some cold weather moving in we are going to be talking about frostbite today.
As most of you probably know, frostbite is a condition that develops at the far extreme of cold injuries. Frostbite itself is the actual freezing of the skin tissue on our bodies. It is most likely to develop in areas with less blood flow such as our fingers, toes, and exposed parts of the face like our cheeks or nose. The most severe form of frostbite occurs when the skin is fully frozen and the cells fully freeze and burst, unfortunately there is no coming back from this form of frostbite. Fortunately, there are several degrees of frostbite that occur before this point that are recognizable and treatable. The differing degrees of frostbite are: superficial, partial thickness, and full thickness which I will discuss independently in more detail below.
Superficial frostbite is the most common and one that a lot of us who enjoy winter activities may be familiar with. As localized areas of the body are getting extremely cold the body will begin to restrict blood flow to the area in a process known as vasoconstriction. This is why it becomes harder to move your fingers and toes when they get really cold. The easiest way to recognize superficial frostbite is that the area will be cold, numb, and pale but the skin will still appear soft. At this point the tissue is not frozen but it is still damaged and if not treated will progress to more severe forms of frostbite. The industry standard is to re-warm the area within 6 hours. The best way to safely rewarm the tissue is through skin to skin contact in warm areas of the body like the groin or the armpits, this can be done with the patient themselves or other members of the group. Keep in mind that the patient is also at risk of hypothermia at this point so it may be best for another member of the group to help rather than place a patient’s cold hands in their armpits. It’s important not to rub the area or apply any sort of aggressive measure in reheating as this can cause further damage to the cells (this is true for all stages of frostbite). Also, do not use anything hot (water, flame, etc) to rewarm as the patient will not be able to feel when they are being burned which can cause a new set of problems.
The next form of frostbite is partial thickness which is when we need to start becoming a little more worried. This stage of frostbite is defined by the actual formation of ice crystals in the tissue. The skin will appear largely similar to superficial frostbite with the addition of the formation of fluid or blood filled blisters. The patient will also experience pretty intense pain when thawing the area. The good news is that the treatment for partial thickness frostbite is largely the same as superficial frostbite. The only exception is that it’s critical to cover any blisters that may form and DO NOT try to puncture and drain them. At this stage of frostbite the patient needs to be evacuated. Also, once this point is reached the skin is pretty damaged and the patient is at extreme risk of developing frostbite again and much more quickly so you should take extra measures to prevent it during evacuation.
The final stage of frostbite, and one you hopefully never see or experience, is full thickness frostbite. This condition is characterized by the full freezing of the skin, tissue, tendons, and nerves. The tissue will be numb, white, and hard to the touch which indicates that the area is fully frozen and the tissue is destroyed. The major difference here is that we should never attempt to re-warm the tissue in the field as the patient needs higher level medical attention to properly re-warm. When the tissue at this point is re-warmed too quickly the area will release dangerous quantities of proteins that can cause fever and renal failure which we obviously don’t want in the field. Also, at this point when the tissue is re-warmed it becomes useless and unable to be used. In the field, while it would be extremely painful, a patient can still walk on fully frostbitten feet, if they are re-warmed the patient will not be able to walk and will need to be carried. Obviously at this point evacuation is critical, the faster the patient can be evacuated the better chance they have of saving the tissue.
As you can see there are some common themes in treating frostbite. We always need to keep in mind that the patient at an elevated risk of hypothermia so we need to take measures to treat that at the same time. It’s important not to get sucked into just treating the frostbite and forgetting about other potential problems. In an effort to be proactive make sure to be constantly checking yourself and other members of your group to recognize frostbite before it develops. Wet clothing and exposed skin are the biggest risk factors for frostbite, addressing these issues will prevent frostbite entirely in most cases.
As always, I hope none of you ever have to experience this but if the situation does arise I hope this post was helpful! 

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