Bundle up: frigid winter temperatures increase frostbite risk

As frigid temperatures set in across the United States, concerns of frostbite are starting to rise.
There are a number of variables involved in one’s risk of suffering frostbite. It not only depends on the ambient air temperature but the general condition of the person. The very young and very old are more susceptible, along with people with certain diseases, such as diabetes or thyroid disease. Wet conditions and alcohol consumption will make things worse. Length of exposure has an impact as well.

The way to avoid frostbite when the weather is cold is to stay inside, but that’s not always feasible. If you know it’s going to be cold, bundle up; dress in layers; protect exposed areas, especially the hands, feet and face; and limit your time outside.

If you’re out in the cold and notice the following symptoms, seek medical attention right away:
  • Pain
  • Numbness
  • Red, white or grayish-yellow skin
  • Firm or waxy skin
  • Joint or muscle stiffness
  • Blistering

In the past, we would use the staging of burn injuries to classify frostbite injuries. Frostbite that causes redness of the skin is first degree. If it causes blistering, we would say that’s second degree. If it eventually causes gangrene, we’d say that’s third degree. 

As we learned more about the disease, we realized the frostbite injury is in the lining of the capillaries, the small blood vessels that go to the fingers and toes. Doctors can’t tell by looking at you if you’re going to have a vascular injury that interrupts the blood flow, causing tissue to die. 

When a patient comes to the emergency room with frostbite symptoms, we check for a pulse in the fingers and toes, followed by an imaging study to check blood flow. If there’s no blood flow, the patient may be a candidate for tPA treatment, a technique used to break up clots in the capillaries and get the blood flowing again. This has been shown to decrease the likelihood of amputation.

Time is of the essence. Treatment needs to start within 24 hours of the injury, otherwise you’ll get irreversible tissue damage. It works if we get the right patient at the right time. 

If you’re concerned you may have frostbite, go to the emergency room. 

Dr. Larry M. Jones is the director of the Burn Center and clinical professor of surgery at The Ohio State University Wexner Medical Center.

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