Frostbite is diagnosed when skin is exposed to temperature below freezing point. The first sign is frostnip when the exposed skin is white and the surrounding area is reddish or normal in colour. The next sign is second-degree frostbite where blisters form including thickness and oedema of the surrounding skin tissue. Third-degree frostbite is when the skin tissue becomes black and falls off.
The GP is able to manage frostnips and second-degree frostbites. Other severe forms are referred to specialist care.
Frostbite occur in feet, hands, ears, nose and cheeks. Very rarely does it occur in the eyes and genital area.
It is important to know that certain behaviours can put people at risk of frostbite in winter periods such as alcohol consumption and illegal drug use. Alcohol is known to dilate blood vessels, this causes heat loss from the skin. There are prescribed medication that can affect your behaviour so much so that it also inhibits your ability to react appropriately during cold temperatures.
There are 3 processes that your GP will assess if you have frostbite
- The presence of ice crystals; this causes local damage to the tissues
- Arteries that become narrow due to cold; this causes less blood flow to the tissues, cell death and blood to become thicker and coagulate more
- Release of toxins and enzymes that create a vicious circle of blood coagulation, less oxygen to the tissue and cell death
If there are blisters and whitish fluids come out this is a good sign and is seen in second-degree frostbites. If however blisters are filled with reddish coloured fluid this can be a sign of third-degree frostbite.
Other things that a GP should be aware of in those who are exposed to cold weather are
- Loss of coordination
- Inability to complete sentences
- Uncontrollable shivers
- Decreased level of consciousness
- Heart rate that is slower than normal
- Breathing rate that is lower than usual
- Temperature that is less than 35 degrees Celsius
- Problems with eye sight or corneal discolouration
Management of frostbite is as followed
- Warm the body and site of frostbite for a minimum of 30 minutes. Preferably in a bath that is about 40-42 degrees Celsius.
- Provide warm fluids
- Avoid smoking or alcohol consumption
- Give painkillers in the form of ibuprofen or paracetamol because the process of warming up can be painful.
- Consider tetanus vaccinations
- The use of local antibiotic creams can be used
- In the event that the eye is affected
- Oxybuprocaine eye drops for local pain relief
- Chloramphenicol eye gel/drops as an antibacterial
The GP will refer to specialist care in the event of
- Second or third-degree frostbites
- When management is not effective
- Frostbites of the eye that does not improve after 3 days despite treatment
- Hypothermia (body temperature less than 35 degrees Celsius)
Frostbite can happen when skin is exposed to cold temperatures. It is important to protect exposed skin with clothing. Skin that has previously have frostbite are more likely to become affected by cold and hot temperature. It is important to wear sun protection at all times if exposed to outdoor sun. It is advised not to wear tight clothing in cold weather conditions. The most effective treatment for frostbite is warm baths.