Monday Medical: Fending off frostbite | SteamboatToday.com

Monday Medical: Fending off frostbite


Susan Cunningham
For Steamboat Pilot & Today

As you head out into the elements this winter, don’t forget to protect yourself from the cold.

“Frostbite is a significant issue in our community, and particularly hits cold weather enthusiasts, people who work in the cold and people who may find themselves stranded outdoors in the winter,” said Dr. David Cionni, an emergency medicine physician at UCHealth Yampa Valley Medical Center.

To better understand this cold weather injury — and how to prevent it — check out Cionni’s tips below.

Frostbite can come on quickly

“Frostbite can happen within minutes to hours, depending on circumstances and risk factors,” Cionni said.

Icy temperatures play a key role.

“The risk skyrockets with very low temperatures,” Cionni said. “Sometimes, you’ll see people skiing on those 20 below (zero) days. As they’re moving downhill, any exposed skin is at risk for frostbite in a matter of minutes.”

But it’s not all about temperature: contact with wind or water quickly increases heat loss, predisposing you to frostbite.

Exhaustion, dehydration, malnutrition and illnesses, such as diabetes, can increase your risk. So does consuming alcohol, which dilates blood vessels close to the skin, resulting in further heat loss, while also impairing your judgment, making it tough to realize there’s a problem.

Frostbite can be serious

“A lot of people, when they’re recreating here, realize it’s a potential issue and think, ‘I’ll just get a little burn, and then it’ll go away,’” Cionni said. “But frostbite can cause lifelong issues with your digits. So, it’s important to pay attention to.”

Superficial frostbite impacts the surface layers of tissue; deep frostbite can impact ligaments, tendons and even bones. The grade of frostbite can be determined by a medical professional.

Damage happens in freezing and rewarming

When your tissues get very cold, ice crystals form first outside of your cells, and then inside your cells. “The cell membranes rupture because the ice crystals are sharp, and then the cells die,” Cionni said.

Damage also happens when tissue is warmed back up, due to the intense inflammatory process.

Prevention and symptoms

Clothes that are too tight, permeable to wind or that don’t breathe or wick away moisture can quickly cause issues. “If clothes don’t wick, or get wet and stay wet, it can really predispose you to frostbite,” Cionni said.

Hands, feet, fingers, toes, ears, cheeks and the nose are the most at risk. “They’re at the end of the blood flow and oftentimes, they’re less protected,” Cionni said.

Tissue that is hard, cold, white or numb, and clumsy movements, are all signs of frostbite. After 24 hours, people may also develop significant blisters with fluid that is clear or dark and bloody.

“People should pay attention to numbness and tingling, and if skin looks or feels abnormal,” Cionni said. “Skin that is white, gray, yellow, hard, waxy or blisters is a sign that that you’re in trouble.”

If you’re worried that you might be dealing with frostbite you should get warm quickly. “Stopping the process is critical,” Cionni said.

But don’t warm tissue if there’s a chance it will get cold again, as that causes more damage. Also avoid walking on frostbitten feet, using frostbitten hands or rubbing areas of frostbitten skin, all of which can cause further damage.

Seek medical help

If you think there’s a chance you’re experiencing frostbite, see a medical professional immediately. At the hospital, doctors will quickly warm the tissue in very hot water, while trying to not damage surrounding tissue.

“Thawing usually happens quickly, within 30 minutes,” Cionni said. “It’s an extremely painful process, and it’s typically done in the emergency department, so we can give pain medication.”

Advanced medication may also be administered for people at high risk of amputation.

“Our emergency department routinely uses an interface with the UCHealth Burn and Frostbite Center that allows us to share images of tissue damage in real time. This interaction provides additional evaluation and the opportunity to provide a clot-busting medicine if recommended,” Cionni said. “They’ve had pretty incredible digit and limb salvage based on the use of this medicine.”

Don’t forget that the best medicine is still prevention.

“If you’re getting frostbite, you’re also at risk for other cold-related processes, like hypothermia, which can further cloud your judgment,” Cionni said. “Always be prepared for the cold and work to prevent frostbite before it takes hold.”

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at cunninghamsbc@gmail.com.


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