Frostbite and Hypothermia

 Overview

When tissues freeze, frostbite occurs. Exposure of the skin to temperatures below the freezing point this condition develops abnormally. Frostbite is a trauma where exposure to freezing temperatures and actual freezing of the tissue fluids in the cell and intercellular spaces takes place. The result would be a vascular damage. Any part of the body may be affected by this cold injury but certain body parts are more prone to frostbite such as:

  • Feet
  • Hands
  • Nose
  • Ears
Clinical manifestations

The affected part or extremity may be hard, cold, and insensitive to touch and appear white or mottled blue-white. During the early stage of frostbite, when the skin has thawed out, the affected area becomes red and is very painful. In more severe cases, when the tissue has started to freeze, the skin may appear white and numb. For very severe cases, blisters may occur. The tissue may be blackened and die resulting to gangrene. Damage to deeper layers of the skin would result to injury of the tendons, muscles, nerves and bones.

Possible Nursing Diagnosis
  • Hypothermia
  • Risk for infection
  • Altered tissue perfusion
  • Sensory alteration
Emergency Management (F-R-O-S-T-B-I-T-E)

The main goal of emergency management for frostbite is the restoration of normal body temperature.

F – For injuries in the lower extremities, do not allow the patient to walk. Move the person to a warmer place and shelter him or her from cold.

R – Remove all constricting clothing and jewelries. These items may impair circulation.

O – Observe the patient for signs of hypothermia or lowered body temperature and manage the condition accordingly.

S – Sterile dressings should be used to wrap the affected part if immediate medical help is available before rushing the patient to the emergency department for further care. It is important for the nurse to remember to separate the fingers and toes in doing so.

T – The extremity can be rewarmed using controlled and rapid rewarming. Rewarming fist aid may be given in cases where immediate care is unavailable. To do this, the affected area is placed and soaked for 30 to 45 minutes in a 37 to 40 degree Celsius whirlpool until the tips of the injured part flushes. The flush would indicate that the circulatory flow is re-established. To aid the warming process, the water should be kept circulating.

B – Be sure to conduct a physical assessment to observe for concomitant injury such as:

  • Soft tissue injury
  • Dehydration
  • Alcohol coma
  • Fat embolism

I – In dressing frostbite injuries, it is essential to use strict aseptic technique. Damages from frostbite make the patient susceptible to infection.

T – Tetanus prophylaxis can be given if there is associated trauma

E – Encourage hourly movement of the affected digits to promote maximal restoration of function and to prevent contractures.

The Rewarming Process

Early rewarming of the tissue appears to decrease injury or damage. Before and during the process of rewarming the following should be done:

  • Administer an analgesic for pain per doctor’s prescription. The rewarming process may be very painful.
  • To avoid further mechanical injury, the affected part should be handled gently. Massage should never be done in this case.
  • The rewarmed part should be protected. Blebs or blisters should NOT be ruptured. Blebs develop an hour to few days after the process of rewarming.
  • A sterile gauze or cotton should be placed between the fingers or toes of affected extremity. This is done to prevent maceration.
  • To help control swelling, elevate the affected extremity or body part.
  • In cases where the feet are involved, bed cradles may be used to prevent contact with bedclothes.
Further Management of Frostbite

When appropriate, the following procedures may be carried out in frostbite:

  • Whirlpool bath – used to promote circulation in the affected part, debride necrotic tissue, permit normal circulation in the area and to help prevent infection.
  • Escharotomy – in this procedure an incision through the eschar is made. This procedure is done to prevent further tissue damage, to allow normal blood circulation and to permit movements or motion in the joints.
  • Fasciotomy – this is a surgical procedure where an incision is made in fascia in order to release pressure on the muscles, nerves and blood vessels. Fasciotomy is useful in treating compartment syndrome.

It is also important to instruct the patient not to use tobacco because the vasoconstrictive effects of nicotine further reduces the already deficient blood supply to the damaged tissues.