Introduction

It's crucial for a medical professional to visually and physically examine the affected area. In most cases of cold injury to hands and feet, a mere phone call isn't sufficient. Seeking immediate medical attention is essential.

During the initial assessment, distinguishing between superficial and deep injuries and estimating the extent of tissue damage is challenging. Therefore, it's advisable for everyone to consult a healthcare provider who can oversee the rewarming process, assess the injury, and guide the treatment. Individuals with frostbite may require evaluation and possible treatment for hypothermia and dehydration.

Self-Care at Home

• First and foremost, call for assistance.
• Elevate the affected part to reduce swelling.
• Move to a warm environment to prevent further heat loss.
• Keep in mind that many individuals with frostbite might also be experiencing hypothermia. Saving their lives takes precedence over preserving a finger or foot.
• Remove any constrictive jewelry and clothing that could impede blood flow.
• Offer the person warm, non-alcoholic, non-caffeinated fluids to drink.
• Apply a dry, sterile bandage, place cotton between any affected fingers or toes to prevent rubbing, and transport the individual to a medical facility as soon as possible.
• Never attempt to rewarm the affected area if there is a chance it may refreeze. This thaw-refreeze cycle can be extremely harmful and lead to severe consequences.
• Avoid gradual thawing in the field or during transport. The most effective method is rapid rewarming. Keep the injured area away from heat sources until you reach a treatment facility where proper rewarming can occur.
• Do not rub the frozen area with snow or anything else, as friction can cause additional tissue damage.
• Remember that the final extent of tissue damage is proportional to the duration of freezing, not the absolute temperature of exposure. Rapid transportation to a hospital is critical.

Follow-up

Frostbite symptoms follow a predictable pattern. Initial numbness is followed by a throbbing sensation that typically begins during rewarming and may persist for weeks to months. This is often replaced by a lingering tingling sensation with occasional electric-shock-like sensations. Cold sensitivity, sensory loss, chronic pain, and various other symptoms may endure for years.

Frostbite treatment occurs over weeks to months. Definitive therapy, possibly in the form of surgery, may not be performed until up to 6 months after the initial injury. Therefore, it's important to establish an ongoing relationship with your healthcare provider throughout the healing process.

Prevention

The first step in preventing frostbite is recognizing whether you are at an increased risk for this condition.

• Frostbite is most commonly seen in individuals with alcoholism, psychiatric conditions, car accidents or breakdowns in severe weather, and recreational drug misuse.
• All of these situations involve prolonged exposure to cold and the individual's unwillingness or inability to remove themselves from this threat.
• Tobacco smokers and individuals with vascular diseases are also at greater risk due to reduced blood flow to their extremities.
• Additional risk factors include homelessness, fatigue, dehydration, inappropriate clothing, and high altitudes.

While not everyone may be aware of or acknowledge these dangers, many of them can be mitigated or prevented.

• Dress appropriately for the weather.
• Layer your clothing, and opt for mittens over gloves as they keep your warm fingers together, helping to retain heat.
• Wear two pairs of socks, with the inner layer made of synthetic fiber (e.g., polypropylene) to wick moisture away from the skin and the outer layer made of wool for better insulation.
• Use waterproof footwear.
• Keep your head, face, nose, and ears covered at all times.
• Choose loose-fitting clothing to avoid constriction of blood flow to your limbs.
• Always travel with a companion in case assistance is needed.
• Avoid smoking and alcohol consumption.

People with diabetes, those with vascular diseases, as well as the very young, elderly, and those who are not physically conditioned should take extra precautions.

Be especially cautious in wet and windy conditions, as the "feels like" temperature (windchill) can be much lower than the stated air temperature.

Outlook

A common saying among surgeons who have treated individuals with frostbite is "frostbite in January, amputate in July." It often takes months to determine the final demarcation between healthy and dead tissue. Performing surgery too early carries the risk of removing tissue that might eventually recover or leaving behind tissue that could eventually die. Some radiographic techniques are currently under investigation, which may enable earlier and more definitive treatment.

Beyond this waiting period, 65% of people with frostbite will experience long-term symptoms. Common symptoms include pain or abnormal sensations in the affected extremity, heat or cold sensitivity, excessive sweating, and arthritis.