According to the CDC, frostbite is an injury to the body that is caused by freezing. Frostbite can cause a loss of feeling and color in affected areas, and 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.
Listen in as Jay Meyer, MD explains the importance of recognizing frostbite and covering up when going into freezing temperatures.
Selected Podcast
Recognizing and Preventing Frostbite
Featured Speaker:
Jay Meyer, MD, Nebraska Emergency Medicine
Dr. Jay Meyer is a board certified emergency medicine doctor at Bryan Medical Center. Transcription:
Recognizing and Preventing Frostbite
Melanie Cole (Host): According the CDC, frostbite is an injury to the body that is caused by freezing. Frostbite can cause a loss of feeling and color in affected areas, and it most often affects the nose, ears, cheeks, chin, fingers or toes. Frostbite can permanently damage parts of the body, and in severe cases can lead to amputation. My guest day is Dr. J. Meyer. He’s an emergency medicine doctor at Bryan Medical Center. Welcome to the show, Dr. Meyer. Tell us: what is frostbite, what causes it, and how quickly can people get this?
Dr. J. Meyer (Guest): Hey, thank you very much. You summed it up pretty well. So, both of us know it can get awful cold, be pretty painful, and frostbite can occur. Now first of all, let me just come up with a couple of general housekeeping issues here. As an emergency room doctor, there’s a couple things you want to do besides not freeze yourself in the winter: don’t hang up Christmas lights on a ladder if you’re not so inclined and never put your hand in a running snow blower.
Melanie: Those are great bits of advice.
Dr. Meyer: That’s a couple of things we see every year in addition to frostbite. So, moving along. So, the frostbite--now remember, this is local versus hypothermia which is more of a systemic decrease in body temperature that everybody worries about. The frostbite is something that’s going to happen, like you said, on the extremities. It’s a local injury, and it’s basically, like you said, it is frozen skin, frozen human skin, and even deeper down to tissue, muscle, tendons, depending on how bad it gets. It’s a continuum. It can be easily reversible, a little painful, all the way to major tissue damage, and, like you said, amputation at the very worst. So, the way I think about it and, like you said, it’s almost universally on the extremities--that’s the nose, ears, face, hands, feet--basically because they’re further away from the core of the body, they’re very often exposed and the body wants to try to maintain its core temperature of 98.6. In the summertime, you may sweat to maintain that, and in the wintertime, your body has to bring the blood flow from the cold extremities back to the core. When that happens, if your hands and feet are cold, they’re going to start getting less blood flow, they’re going to get even colder, and that’s when some of the tissue damage can occur. And, the way to think about it is, it’s not like an ice cube or a popsicle that you can just freeze and then thaw and then freeze again. You’re talking about human cells that have a big job to do. Very complex. There are proteins that can get denatured. Enzymes that get destroyed. Biochemical processes just don’t work when they’re frozen. So, it’s pretty complex, and that’s where some of the damage is going to occur when it gets just too cold to function and/or literally frozen.
Melanie: What are some of the signs and symptoms? What should people look for in those extremities to say, “Oh, you know what? This is getting dangerous now.”
Dr. Meyer: Well, very fortunately, most of us have our wits about us enough to know that it’s just cold and it’s uncomfortable, and we want to get out of there. But, again, it is a continuum from just a little bit of damage to further damage. What we need to think about is, a lot of this does not become apparent until quite a bit later in the course of re-warming, even hours to days. So, what you see initially can be much more pronounced as things actually re-warm, and the damaged cells try to repair, and the inflammatory mediators are released. If you think about it, if you ever touched a hot stove and you got maybe just a little teeny white spot on your fingertip, and couple hours later you got a big blister, and a couple days later you got a big mark and it looks worse. Anyway, it’s similar. So, what we’re normally going to see for the signs and symptoms--people go out, maybe forget to wear gloves or you don’t wear a mask and you get pale and cold in your fingers or your nose, and that’s frost nip. There’s no real damage done there. It’s pale, it’s painful, it’s not permanent. You go inside, you're-warm, you’re fine. When you’re talking about actually frozen skin or frostbite, there’s first to fourth degree. Your first degree, maybe you’re out too long. You’re going to see some--it’s partial skin freezing, superficial. You can get red, you can get some edema or that’s just swelling. Usually, no blisters with first degree, just kind of painful. And sometimes, the skin can peel off or slough maybe five to 10 days later. Now, if you stay out even longer than that, and/or you can't get in, then you get the second degree, that’s going to start being some more full thickness. You can get red, you can get swelling. In a few hours you can get, generally, clear blisters, and these are full of inflammatory mediators. And, sometimes, six to 24 hours later, more blisters, maybe some skin slough in there as well. Third degree, you’re getting worse. You’re going to see some red skin, some swelling, and then it’s deep enough that you often get blood-filled blisters, skin sloughing, and sometimes it can even be numb there because it’s gone so deep that the nerves are even affected. So, actually you feel like you just got a big block of wood for an extremity. If you’re out there to get bad enough to get fourth degree, you’ve basically got an icicle for a limb, and it’s not going to do well. That’s going to be a lot of permanent damage. But, fortunately, most of us are going to get out before that.
Melanie: Dr. Meyers, as a parent, we often tell our children, put a hat on because of their ears but they don’t want to put a hat on. Do you have any advice for parents on what they can tell their children of the importance of keeping their ears covered?
Dr. Meyer: The ears, like we talked about earlier--any of the extremities--ears are going to be almost number one along with the nose because just the vascular supply is very--it’s the end of it. And it’s a very exposed area and it’s a very thin area, so especially if there’s any wind, yeah, the ears are going to be affected. And, the one thing you can tell them depending on if they’re old enough to understand is that most people have heard that exposed head and neck account for about 80 percent of the heat loss. So, if you can do a mask or hat and even a scarf, that’s going to help protect them a lot from feeling cold all over to protect that 80 percent of that heat loss.
Melanie: People wear masks, maybe they’re going to wear their hat and scarf in this cold weather. What about your eyes, Dr. Meyer? Are they at risk for problems in this cold?
Dr. Meyer: It’s interesting you say that. Yes, the corneas can freeze as well but, typically, where you see that is people who ski, and that’s why you notice people always wear the eye protection when they’re skiing, those ski mask things that contain eye protection. And, that’s not so that snow doesn’t blow in their eyes, but yeah, the corneas can actually suffer the same type of frostbite as other parts of the body.
Melanie: Now, how should someone treat it? If they do notice their ears or their fingertips or their cheeks or any of these areas are starting to get those symptoms that you described, what then should they do? Should they use warming tools or hot water? Give us some of your best tips.
Dr. Meyer: The number one thing to do, obviously, but sometimes not so obvious, is to get of the cold. Once you do that, you got to take off all the wet, cold clothes because, as you know, anything moist or any type of moisture just adds to that amount of cold in the form of frostbite so you got to get cold, wet and constrictive clothes off because if you got clothes that are too tight and they constrict, well then how’s the blood flow going to get out there to warm you? So, get out, take off the clothes, anything constrictive cold and/or wet, and yeah, warm water immersion has been pretty much the cornerstone of treating cold and/or frostbitten extremities. Now, you might want to throw your hand in front of the fire which feels real good, but they’ve shown that the dry heat tends to dry off the skin more at a time when sometimes it could be predisposed to sloughing off a little bit. So, if it’s minor and you sit in front of the fire and get some hot cocoa, well, that feels good. But if you got a real frostbitten extremity, then you’re supposed to do the warm water immersion therapy. But, the main thing is get out of the elements. Get out of the wet clothes, put on some nice warm dry ones.
Melanie: When do you think it’s important to tell them to see a doctor?
Dr. Meyer: Most of these things are going to be able to be dealt with at home from a regular person’s standpoint; that is, someone who is thinking properly and has the ability to get out of the elements. But if you get to the point where you get some second degree frostbite where you actually start getting some blisters, then I would recommend seeing someone because those can predispose to infection and the jury’s out on whether you pop them or not--which we call debreeding--and then put some aloe or other lotions on there. You got to make sure your tetanus is up to date at that point. You need to be monitored to make sure these things aren’t getting infected. If it gets to the blister stage, I would suggest seeking treatment.
Melanie: So, wrap it up for us, and give us your best advice about preventing frostbite in the first place, and what you tell people every day as an emergency room physician about this danger.
Dr. Meyer: Well, what I tell my wife and my family every time this time of the year that we’re moving to Arizona. So, if you can get South, that’s going to be the number one thing. But, if you got to stay here for whatever reason, the number one cause of frostbite or frost nip is just inadequate clothing. So, you got to dress, like I said, not constrictive, something that’s going to stay dry, and do it in layers, so it’s nice, loose, fluffy, and just keeps you warm, keeps you dry. And, like I said, the head and neck are 80 percent of the heat loss so always make sure you get those warm gloves, wool socks and stay dry, and then just listen to your body. It’s almost universal, in the United States, it’s people who either have drug problems, alcohol problems, or psychiatric problems that get this. So, most of us, if you just listen to your body and know you’re getting too cold, get in, get dry, get warm, and that’ll keep you safe. But, one other thing, people who actually have other diseases--diabetes, peripheral vascular disease, there’s some medications as well that are going to make you a little more prone to getting some frostbite.
Melanie: Thank you so much. It’s really important information to hear. Thanks for being with us today, Dr. Meyer. You’re listening to Bryan Health Radio. For more information, you can go to bryanhealth.org. That’s www.bryanhealth.org. This is Melanie Cole. Thanks so much for listening.
Recognizing and Preventing Frostbite
Melanie Cole (Host): According the CDC, frostbite is an injury to the body that is caused by freezing. Frostbite can cause a loss of feeling and color in affected areas, and it most often affects the nose, ears, cheeks, chin, fingers or toes. Frostbite can permanently damage parts of the body, and in severe cases can lead to amputation. My guest day is Dr. J. Meyer. He’s an emergency medicine doctor at Bryan Medical Center. Welcome to the show, Dr. Meyer. Tell us: what is frostbite, what causes it, and how quickly can people get this?
Dr. J. Meyer (Guest): Hey, thank you very much. You summed it up pretty well. So, both of us know it can get awful cold, be pretty painful, and frostbite can occur. Now first of all, let me just come up with a couple of general housekeeping issues here. As an emergency room doctor, there’s a couple things you want to do besides not freeze yourself in the winter: don’t hang up Christmas lights on a ladder if you’re not so inclined and never put your hand in a running snow blower.
Melanie: Those are great bits of advice.
Dr. Meyer: That’s a couple of things we see every year in addition to frostbite. So, moving along. So, the frostbite--now remember, this is local versus hypothermia which is more of a systemic decrease in body temperature that everybody worries about. The frostbite is something that’s going to happen, like you said, on the extremities. It’s a local injury, and it’s basically, like you said, it is frozen skin, frozen human skin, and even deeper down to tissue, muscle, tendons, depending on how bad it gets. It’s a continuum. It can be easily reversible, a little painful, all the way to major tissue damage, and, like you said, amputation at the very worst. So, the way I think about it and, like you said, it’s almost universally on the extremities--that’s the nose, ears, face, hands, feet--basically because they’re further away from the core of the body, they’re very often exposed and the body wants to try to maintain its core temperature of 98.6. In the summertime, you may sweat to maintain that, and in the wintertime, your body has to bring the blood flow from the cold extremities back to the core. When that happens, if your hands and feet are cold, they’re going to start getting less blood flow, they’re going to get even colder, and that’s when some of the tissue damage can occur. And, the way to think about it is, it’s not like an ice cube or a popsicle that you can just freeze and then thaw and then freeze again. You’re talking about human cells that have a big job to do. Very complex. There are proteins that can get denatured. Enzymes that get destroyed. Biochemical processes just don’t work when they’re frozen. So, it’s pretty complex, and that’s where some of the damage is going to occur when it gets just too cold to function and/or literally frozen.
Melanie: What are some of the signs and symptoms? What should people look for in those extremities to say, “Oh, you know what? This is getting dangerous now.”
Dr. Meyer: Well, very fortunately, most of us have our wits about us enough to know that it’s just cold and it’s uncomfortable, and we want to get out of there. But, again, it is a continuum from just a little bit of damage to further damage. What we need to think about is, a lot of this does not become apparent until quite a bit later in the course of re-warming, even hours to days. So, what you see initially can be much more pronounced as things actually re-warm, and the damaged cells try to repair, and the inflammatory mediators are released. If you think about it, if you ever touched a hot stove and you got maybe just a little teeny white spot on your fingertip, and couple hours later you got a big blister, and a couple days later you got a big mark and it looks worse. Anyway, it’s similar. So, what we’re normally going to see for the signs and symptoms--people go out, maybe forget to wear gloves or you don’t wear a mask and you get pale and cold in your fingers or your nose, and that’s frost nip. There’s no real damage done there. It’s pale, it’s painful, it’s not permanent. You go inside, you're-warm, you’re fine. When you’re talking about actually frozen skin or frostbite, there’s first to fourth degree. Your first degree, maybe you’re out too long. You’re going to see some--it’s partial skin freezing, superficial. You can get red, you can get some edema or that’s just swelling. Usually, no blisters with first degree, just kind of painful. And sometimes, the skin can peel off or slough maybe five to 10 days later. Now, if you stay out even longer than that, and/or you can't get in, then you get the second degree, that’s going to start being some more full thickness. You can get red, you can get swelling. In a few hours you can get, generally, clear blisters, and these are full of inflammatory mediators. And, sometimes, six to 24 hours later, more blisters, maybe some skin slough in there as well. Third degree, you’re getting worse. You’re going to see some red skin, some swelling, and then it’s deep enough that you often get blood-filled blisters, skin sloughing, and sometimes it can even be numb there because it’s gone so deep that the nerves are even affected. So, actually you feel like you just got a big block of wood for an extremity. If you’re out there to get bad enough to get fourth degree, you’ve basically got an icicle for a limb, and it’s not going to do well. That’s going to be a lot of permanent damage. But, fortunately, most of us are going to get out before that.
Melanie: Dr. Meyers, as a parent, we often tell our children, put a hat on because of their ears but they don’t want to put a hat on. Do you have any advice for parents on what they can tell their children of the importance of keeping their ears covered?
Dr. Meyer: The ears, like we talked about earlier--any of the extremities--ears are going to be almost number one along with the nose because just the vascular supply is very--it’s the end of it. And it’s a very exposed area and it’s a very thin area, so especially if there’s any wind, yeah, the ears are going to be affected. And, the one thing you can tell them depending on if they’re old enough to understand is that most people have heard that exposed head and neck account for about 80 percent of the heat loss. So, if you can do a mask or hat and even a scarf, that’s going to help protect them a lot from feeling cold all over to protect that 80 percent of that heat loss.
Melanie: People wear masks, maybe they’re going to wear their hat and scarf in this cold weather. What about your eyes, Dr. Meyer? Are they at risk for problems in this cold?
Dr. Meyer: It’s interesting you say that. Yes, the corneas can freeze as well but, typically, where you see that is people who ski, and that’s why you notice people always wear the eye protection when they’re skiing, those ski mask things that contain eye protection. And, that’s not so that snow doesn’t blow in their eyes, but yeah, the corneas can actually suffer the same type of frostbite as other parts of the body.
Melanie: Now, how should someone treat it? If they do notice their ears or their fingertips or their cheeks or any of these areas are starting to get those symptoms that you described, what then should they do? Should they use warming tools or hot water? Give us some of your best tips.
Dr. Meyer: The number one thing to do, obviously, but sometimes not so obvious, is to get of the cold. Once you do that, you got to take off all the wet, cold clothes because, as you know, anything moist or any type of moisture just adds to that amount of cold in the form of frostbite so you got to get cold, wet and constrictive clothes off because if you got clothes that are too tight and they constrict, well then how’s the blood flow going to get out there to warm you? So, get out, take off the clothes, anything constrictive cold and/or wet, and yeah, warm water immersion has been pretty much the cornerstone of treating cold and/or frostbitten extremities. Now, you might want to throw your hand in front of the fire which feels real good, but they’ve shown that the dry heat tends to dry off the skin more at a time when sometimes it could be predisposed to sloughing off a little bit. So, if it’s minor and you sit in front of the fire and get some hot cocoa, well, that feels good. But if you got a real frostbitten extremity, then you’re supposed to do the warm water immersion therapy. But, the main thing is get out of the elements. Get out of the wet clothes, put on some nice warm dry ones.
Melanie: When do you think it’s important to tell them to see a doctor?
Dr. Meyer: Most of these things are going to be able to be dealt with at home from a regular person’s standpoint; that is, someone who is thinking properly and has the ability to get out of the elements. But if you get to the point where you get some second degree frostbite where you actually start getting some blisters, then I would recommend seeing someone because those can predispose to infection and the jury’s out on whether you pop them or not--which we call debreeding--and then put some aloe or other lotions on there. You got to make sure your tetanus is up to date at that point. You need to be monitored to make sure these things aren’t getting infected. If it gets to the blister stage, I would suggest seeking treatment.
Melanie: So, wrap it up for us, and give us your best advice about preventing frostbite in the first place, and what you tell people every day as an emergency room physician about this danger.
Dr. Meyer: Well, what I tell my wife and my family every time this time of the year that we’re moving to Arizona. So, if you can get South, that’s going to be the number one thing. But, if you got to stay here for whatever reason, the number one cause of frostbite or frost nip is just inadequate clothing. So, you got to dress, like I said, not constrictive, something that’s going to stay dry, and do it in layers, so it’s nice, loose, fluffy, and just keeps you warm, keeps you dry. And, like I said, the head and neck are 80 percent of the heat loss so always make sure you get those warm gloves, wool socks and stay dry, and then just listen to your body. It’s almost universal, in the United States, it’s people who either have drug problems, alcohol problems, or psychiatric problems that get this. So, most of us, if you just listen to your body and know you’re getting too cold, get in, get dry, get warm, and that’ll keep you safe. But, one other thing, people who actually have other diseases--diabetes, peripheral vascular disease, there’s some medications as well that are going to make you a little more prone to getting some frostbite.
Melanie: Thank you so much. It’s really important information to hear. Thanks for being with us today, Dr. Meyer. You’re listening to Bryan Health Radio. For more information, you can go to bryanhealth.org. That’s www.bryanhealth.org. This is Melanie Cole. Thanks so much for listening.