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Frostbite
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Other Cold Injuries
If the freezing continues, the skin may become frozen and hard (a second degree injury). However, the deep tissues of the affected part are spared and remain soft and normal. This type of injury generally blisters 1-2 days after freezing. The blisters may become hard and blackened. However, they usually look worse than they are. Most of these injuries heal over 3-4 weeks. Again, the affected area may remain sensitive to heat and cold permanently. Should blistering occur, the injury should be seen by a healthcare practitioner.
If further freezing continues, a deep frostbite occurs (a third or fourth degree injury). When this occurs, all of the muscles, tendons, blood vessels, and nerves of the affected extremity are frozen. The extremity is hardened, feels woody, and use of the involved part is lost temporarily, and in severe cases, even permanently. The involved area is deep purple or red with blisters; usually these blisters are filled with blood. It is this type of severe frostbite that results in lost fingers and toes. However, it can take several months to determine how much damage has actually occurred in the freezing process. For this reason, surgery to remove tissue that is not capable of surviving is frequently delayed.
Who is most likely to get a cold injury and what can be done to prevent it?
Anybody can develop a cold-related injury, but the young and the elderly are especially prone to this type of injury. In the young, the small size of their extremities makes them more likely to freeze. In the elderly, poor circulation may contribute. In both of these groups, mobility may be limited and the cold injury occurs before the person is able to move indoors. Certain drugs, such as alcohol and other drugs or medications that depress the ability to feel accurately, make it more likely that the individual will develop a cold injury. These drugs make it less likely that a person will recognize that he or she is in danger of becoming frostbitten. Alcohol also causes the skin to flush, allowing warm blood to become cooled at the surface of the skin. Additionally, any underlying illnesses which are characterized by poor circulation, such as diabetes, hypothyroidism (low thyroid), and arteriosclerosis, can make it more likely that one will develop a cold injury.
The best way to prevent a cold injury is to dress warmly and move indoors once your fingers or toes begin to feel cold. Always keep your hands and feet dry and your ears covered. Several drugs have been tried to help prevent frostbite. One of the most commonly used drugs is nifedipine (PROCARDIA). Nifedipine increases circulation to the extremities by dilating the blood vessels. While it makes sense that it would help prevent frostbite, all of the evidence is anecdotal. No studies have been conducted to determine whether or not nifedipine prevents frostbite. Beta-blockers (LOPRESSOR, TENORMIN, INDERAL, and others), which are often used to treat high blood pressure and heart disease, reduce the circulation to the hands and feet. These medications are more likely to contribute to the problem of frostbite.
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