Frostbite

 Is a damage to tissue and blood vessels as a result of prolonged exposure to cold

 Is a cold related injury that results in tissue damage due to cold temperature exposure.
 The extent of damage to the skin and surrounding tissues ranges from first degree
(redness and cold to touch) to fourth degree (full thickness deep tissue destruction).
 Figers, toes, nose and ears are often affected
ASSESSMENT:
 Environmental temperature
 Duration of exposure
 Humidity
 Wet or dry conditions
 First aid and rewarming efforts
 Ambulation attempts before and after rewarming
 Previous frostbite injury

Causes:
 Tissue damage occurs when ice crystals form within the cells or outside the cells

Causing intracellular dehydration hypoxia

through osmosis

Tissue damage may not be vasospasm

evident until after reperfusion
when swelling leads to thrombus
formation, inflammatory ischemia
leukocyte infiltration and then
necrosis
Tissue necrosis
The extent of the damage may
evolved over week to months

PEOPLE AT RISK:
 Work outdoors: athletes, mountain climbers
 Homeless
 Intoxicated
 Low GCS
 DM
 Peripheral vascular disease
 Raynauds phenomena
 Previous history of frostbite
STAGES OF FROSTBITE
Stages of frostbite
Frostnip or mild frostbite:
 The skin is irritated, reddened, cold, or numb-feeling and is easily treated with first aid
measures.
Superficial frostbite:
 This involves only the skin and no tissue damage. Initially, skin appears white, pale, or
waxy and then becomes mottled, purple, or blue as the skin thaws. There may be a
stinging, numb, or burning sensation. Hyperemia, swelling, and pain occur within 3 hours
of rewarming and will resolve within 2 to 3 days. Small fluid-filled blisters may develop
24 to 36 hours after thawing of the skin.
Deep frostbite:
 This affects all layers of the skin, muscle, nerve, or bone. Initially, the area will feel
numb, and then as rewarming occurs will develop a severe pain or burning sensation. The
tissue feels hard or woody to touch. Edema develops within 3 hours and can last 5 days.
Large clear fluid-filled blisters
 Form within 6 to 24 hours. Small blood-filled blisters form after 24 hours. Skin will
appear black as the tissue becomes necrotic and dies in 9 to 15 days. It may require
surgery to remove necrotic tissue or amputation.

DEGREE OF FROSTBITE
 First degree:
o Involves hyperemia and edema formation of the involved area
 Second degree
o Large fluid-filled blisters with partial thickness skin necrosis
 Third degree
o Involves the formation of small blister that contain dark fluid and affected body
part that is cool, numb, blue or red and does not blanch
o Full thickness and subcutaneous tissue necrosis require debridement
 Fourth degree
o No blisters or edema noted and the part is numb, cold,a nd bloodless
o Full thickness necrosis extends into muscle and bone and gangrene develops,
which may require amputation of the affected part
INTERVENTIONS
 Rewarm the affected part rapidly and continuously with a warm water bath to thraw the
frozen part (how toweld may be used if a warming tub is not available)
 Handle the part gently and immobilize and elevate the part above the heart.
 Avoid using dry heat and never rub or massage the part, which may result in further
tissue damage
 Rewarming process may be painful, analgesics may be necessary
 Avoid compression of the injured tissues and apply only loose and nonadherent sterile
dressings
 Monitor for signs of compartment syndrome
 Tetanus toxoid propylaxis is necessary and topical. And systemic antibiotics may be
prescribed
 Debridement of necrotic tissue may be necessary; amputation may be necessary in
those in whom gangrene develops.
What tests tell you Lab tests:
• In minor cases, no lab tests are indicated.
• For severe frostbite, a CBC, electrolytes, BUN, creatinine, glucose, and a urinalysis for
evidence of myoglobinuria might be considered.

Imaging:
• Tc99 bone scanning is helpful in determining tissue and bone viability and assists in making
amputation decisions within 2 to 7 days after cold injury.
• Angiography is helpful in assessing tissue before and after thrombolysis.

TREATMENT
 will be based on the age of the injury
 may require rewarming the affected part,
 analgesia,
 administration of fluids to enhance blood flow and tissue perfusion,
 blister debridement or aspiration,
 tetanus and antibacterial prophylaxis,
 application of topical medications.

Rewarming helps to reduce the amount of tissue loss.

Adjunctive and controversial measures include thrombolytic therapy with tissue plasminogen
activator (TPA) within 24 hours of thawing for deep frostbite and hyperbaric oxygen.

What to do
• Remove constrictive clothing or jewelry.
• If injury is less than 24 hours old, rewarm the affected part in warm water (104° F) for 10 to 30
minutes or apply warm wet packs. Avoid dry heat. Stop rewarming when the part is warm, red,
and pliable.
• Remove clear or milky-filled blisters and apply aloe vera topical cream.
• Do not remove blood-filled blisters. This exposes deeper underlying structures to dehydration
and infection.
• Place sterile gauze or cotton between the affected fingers or toes to prevent maceration.
• Wrap affected part in a loose bandage or sterile sheet.
• Splint and elevate the affected part.
• Administer analgesics for pain control, antibiotics to treat infection, and tetanus prophylaxis if
vaccination status is not current or unknown
 Reassess for soft tissue injury, dehydration, mental status changes, or respiratory difficulty.
• Hypovolemia and hypokalemia may need correction.
• Instruct the patient that the full extent of tissue damage may not be evident for 1 to 3 months.

• Instruct the patient to avoid tobacco, alcohol, and caffeine due to their vasoconstrictive effects, thus reducing the
blood supply to the affected part.