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Mild frostbite usually appears as a shallow, blanched wheal on the nose, ears, fingers, or toes. After rewarming, the area is slightly reddened for several hours and then resumes a normal appearance. If the frostbite is more severe, deeper tissues are affected and the area appears waxy and feels doughlike to the touch. With rewarming, the area becomes edematous and the patient feels itching, burning, and deep pain. Later on, mild edema may remain and the skin becomes mottled, cyanotic, or red without blistering. Over the following weeks the pain and edema should subside, but the skin may peel and the patient may experience increased sensitivity to cold in that area until healing is complete.
Blistering occurs in deeper frostbite. The vesicles may contain pink or clear fluid that has leaked from damaged cells and tissues. Eventually the vesicles contract and dry out, leaving an eschar that sloughs off and exposes new skin underneath if there has been adequate circulation to the part.
Severe frostbite damages all layers of soft tissue down to connective tissue and bone. The frostbitten area is hard and wooden and appears lifeless. There is no sensation of pain and the patient cannot voluntarily move the frozen part. With rewarming there are aching pain, burning, and blistering. If there is no pain or other sensation after rewarming, the tissue may be dead and amputation may be indicated.
Emergency medical care, if the patient cannot be brought to the hospital and rewarming must be done in the field, includes rapid rewarming in water baths not exceeding 40.6°C (105°F). Hot water can cause further tissue destruction. Tetanus prophylaxis is administered as necessary. If severely frostbitten tissue swells to the point of totally restricting circulation, a fasciotomy may be required to allow adequate blood supply. Vesicles are left intact but frostbitten fingers and toes should be separated with cotton balls and a loose dressing applied. If the patient will be taken outside for transport to a medical facility, rewarming should be started at the hospital.
frostbiteTissue damage or destruction induced by temperatures below 0ºC, which is divided into superficial–frostnip and deep forms; in deep frostbite, subcutaneous tissue, muscle, and bone are involved Clinical Numbness, prickling, itching, if severe paresthesia, stiffness, bullae formation, necrosis, gangrene Treatment-immediate Rewarm in water 40-42ºC/104ºF-107.6ºF, never warmer Treatment-post emergent Debride blister, topical aloe vera gel, tetanus prophylaxis, analgesia, NSAIDs, penicillin, hydrotherapy, physical therapy
frostbiteFreezing of bodily tissues, especially the tips of the extremities. Expanding ice crystals damage the tissues and the local blood supply is cut off. The result is local tissue death (GANGRENE).
Patient discussion about frostbite
Q. What are the visual distinctions between thermal burns and frostbite? Is it possible to definitively distinguish the two from each other in all cases, or do they present identically in many cases? In other words, are frostbite injuries-for all intents and purposes, actual burns and if they are not, in what ways do they differ?
In late stage frostbite, the ice crystals in the cells melt and the ruptured cells pour out their contents, then blisters may form. Since the affected area has basically lost circulation, gangrene sets in rather quickly and the tissue turns black and dry.
Deep (full thickness) heat related burns are surrounded by areas of erythema (reddened skin) and skin with less degrees of burning. Also, eschar is obviously charred skin tissue forming a scab like structure, and looks nothing like gangrene. The wound bed in a burn leaks plasma constantly. Blistering is pretty immediate with heat related burns of a sufficient degree.