Frostbite occurs usually to individual parts of the body that are exposed to prolonged, freezing temperatures (20F, or -7C) and wet environments. Ears, nose, cheeks, fingers and toes are areas most susceptible. The symptoms of frostbite range from numbness and tingling to evidence of necrosis(death of tissue). Necrosis is related to the mechanical effects of ice crystals, loss of cellular water, and microvascular clotting.

     Frostbite victims can be a result of prolonged cool water immersions,cold metal exposure and wind chill; therefore, it does not have to be freezing outside . Cellular changes and tissue damage begin to occur at 59F or (15C).

     There are two major types of frostbite: 1) superficial or mild or 2) deep injury.

• Signs and symptoms of mild injury are :numbness, tingling of affected area, pain,area is bright red and warm to touch, rapid swelling, blistering of part, superficial eschar (blackening of top layer of tissue= tissue death).
• Signs and symptoms of deep injury are: affected area is a deep purple color, area is cool to the touch, small bleeding blisters present, slow swelling, mummification of deep structures. Often, deep frostbite requires amputation of the affected area unfortunately.

     If you suspect someone has frostbite , immediate warming of affected areas is essential.

     Seek medical attention to assess for tissue damage and possible hypothermia. Emergency management of frostbite is rapid rewarming with warm water at a a constant temperature of 105F-115F (40.5-46C). Never massage affected area to rewarm as this causes maceration of tissues and can cause severe pain.

     Handle area gently to prevent trauma to the injured part.(sensation is decreased). Rewarm water and affected part in 20-30 mins, again maintaining constant temperature. All jewelry and clothing should be removed that may constrict the area. Leave all blisters intact since they provide a natural dressing. Smoking should be strongly discouraged , since it causes blood vessels to constrict.

     Fostbite victims should go to the nearest Emergency Department to determine need for antibiotics, tetanus shot, pain medications and necessary follow-up. Wear hats, gloves, proper socks, footwear in cold weather. If you see someone drunk on the street and it's cold out, call 911. An alcoholic's sensation is impaired and they will not seek warmth and shelter; therefore they will freeze to death.

References
1.Emergency Nursing Core Curriculum: (4th ed.) Philadelphia,1994, WB Saunders Co, pp 160-163.
2. Collier, I.C. and Lewis M.L: Medical-Surgical Nursing Assessment and Management of Clinical Problems, ed. 3, St. Louis, 1992, Mosby-Yearbook Co.