II. Risk Factors

  1. Peripheral Vascular Disease
  2. Peripheral Neuropathy (e.g. Diabetic Neuropathy)
  3. Prolonged cold or moisture exposure
  4. High wind (high wind chill)
  5. High altitude
  6. Inadequate clothing
  7. Malnutrition
  8. Extremes of age
  9. Vasoconstrictive agents (e.g. nicotine)
  10. Altered Mental Status

III. Pathophysiology: Changes by skin Temperature

  1. Room Temperature
    1. Normal skin perfusion >200 ml/min
  2. Skin Temperature 59 F (15 C)
    1. Skin perfusion 20-50 ml/min
    2. Vasoconstriction interrupted by periods of vasodilation lasting 5-10 minutes each, recurring every 15-20 minutes
  3. Skin Temperature 50 F (10 C)
    1. Skin sensation lost (Neuropraxia)
  4. Skin Temperature 32 F (0 C)
    1. Minimal skin perfusion
    2. Skin Temperature drops each minute by 0.9 F (0.5 C)

IV. Signs

  1. Distribution - high risk areas
    1. Extremities (hands, feet)
    2. Face (ears, nose)
    3. Genitalia (penis)
  2. Superficial Frostbite
    1. White color
    2. Frozen exterior
    3. Blisters developing into eschar
  3. Deep Frostbite
    1. Woody-feel to skin
    2. No Blisters
    3. Mummification or amputation

V. Management

  1. Rapid rewarming in warm bath
  2. Do not rub skin
  3. Narcotic pain medication
  4. Elevate involved area
  5. Oxygen or hyperbaric oxygen
  6. Tetanus prophylaxis
  7. Penicillin G
  8. Daily Hydrotherapy
  9. Do not rewarm if chance of refreezing

VI. Sequelae

  1. Excessive sweating
  2. Cool extremities
  3. Numbness
  4. Abnormal color
  5. Nail Disorder
  6. Skin Pigment Changes
  7. More susceptible to second injury

VII. Prevention

  1. Never ignore numbness in a cold extremity

VIII. Images

  1. Presentation Graphic
    1. erEnvironFrostbite.jpg

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Ontology: Frostbite (C0016736)

Definition (MEDLINEPLUS)

Frostbite is an injury to the body that is caused by freezing. It most often affects the nose, ears, cheeks, chin, fingers, or toes. Frostbite can permanently damage the body, and severe cases can lead to amputation.

Signs of frostbite include

  • A white or grayish-yellow skin area
  • Skin that feels unusually firm or waxy
  • Numbness

If you have symptoms of frostbite, seek medical care. But if immediate medical care isn't available, here are steps to take:

  • Get into a warm room as soon as possible.
  • Unless absolutely necessary, do not walk on frostbitten feet or toes. Walking increases the damage.
  • Put the affected area in warm - not hot - water.
  • You can also warm the affected area using body heat. For example, use your armpit to warm frostbitten fingers.
  • Don't rub the frostbitten area with snow or massage it at all. This can cause more damage.
  • Don't use a heating pad, heat lamp, or the heat of a stove, fireplace, or radiator for warming. Since frostbite makes an area numb, you could burn it.

Centers for Disease Control and Prevention

Definition (NCI) Damage to tissues as the result of low environmental temperatures. (MeSH)
Definition (MSH) Damage to tissues as the result of low environmental temperatures.
Concepts Injury or Poisoning (T037)
MSH D005627
ICD10 T33-T35.9 , T33-T34
SnomedCT 157717008, 213637003, 370977006, 38045000
English Frostbites, Frostbite, frostbite (diagnosis), frostbite, Frostbite [Disease/Finding], frostbites, Frostbite (T33-T34), Frostbite (event), Congelation injury, Frostbite (disorder), Frostbite - disorder, Congelation injury, NOS, Frostbite, NOS
Japanese 凍傷, トウショウ
Swedish Frostskada
Czech omrzlina, Omrzlina
Finnish Paleltumavamma
Polish Odmrożenie
Hungarian Fagyás
Norwegian Frostskader, Kuldeskader, Forfrysninger
Portuguese Ulceração por Frio, Queimadura por Frio, Congelação, Congelamento das Extremidades
Spanish congelamiento (trastorno), congelamiento, Congelación, Congelación de Extremidades
Dutch bevriezing, Bevriezing
French Gelure, Gelures
German Erfrierung
Italian Congelamento