Frostbite - First Aid

and Christiane Fux, medical editor

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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In the case of frostbite, the skin and the underlying tissue are damaged by the cold. Fingers, toes, nose, ears or cheeks are particularly affected. The reason: They are comparatively poorly supplied with blood and have a relatively large surface area in relation to their volume. Read here how you can recognize frostbite and properly provide first aid.

Brief overview

What is frostbite? These are damage to the skin caused by the cold and possibly also deeper-lying structures (such as muscles, etc.)
Signs: Depending on the severity of the frostbite, e.g. pale grayish, cold and numb skin, white spots on the face, painful skin blisters and ulcers, frostbite (dry, dead skin or blue-red blood blisters)
First aid: open tight-fitting clothing, remove wet and cold clothing, wrap the patient in a warm blanket, warm frozen parts of the body with your own body (e.g. push frozen hand into your armpit), pour warm, sugared drinks
When to the doctor For superficial frostbite, when the affected area of the skin is still numb after warming up. In the case of deep frostbite, call an emergency doctor immediately or bring the person affected to the hospital to avoid amputation.

Attention:

Never give a person with frostbite alcohol to drink! This dilates the blood vessels. The affected person then loses even more body heat.
The person concerned should never smoke! Nicotine narrows the blood vessels. Frozen parts of the body are then supplied with even less blood.
Do not rub frozen parts of the body with snow!

What are the signs of frostbite?

Frostbite manifests itself in the form of skin and tissue changes, sensory disturbances and pain. The exact type and extent of the symptoms depend on the severity of the cold damage.

Frostbite: symptoms by severity

Grade I: The skin is pale grayish in color, cold and numb. Round, white spots appear on the face. After warming up, the skin reddens, hurts and itches or tingles.
Grade II: Blisters or ulcers form immediately or after a few hours. They are very painful but can heal without scarring.
Grade III ("frost burn"): Recognizable by dry, dead skin areas (necrosis) or bluish-red blood blisters, after which wet necroses become visible. Dead tissue later turns black. After thawing, the affected areas are numb and hard. They heal with scarring. Amputation is also often necessary.

Frostbite is often associated with hypothermia. Since it can be life threatening, treating hypothermia is a priority. You can read about what to do then in the text Hypothermia.

First aid measures

The following first aid measures are useful for frostbite:

Open the affected person's clothes and shoes.
Remove wet, cold clothing and wrap the patient in warm (rescue) blankets.
Warm up frozen parts of the affected person on your own body. For example, slide your frozen hand under your clothing in your armpit.
You can warm the face, nose and ears of the person affected by laying on warm hands.
If possible, the person affected should actively move the frozen part of the body. Exception: the person affected should not walk with frozen feet or toes. Otherwise there is a risk of further tissue damage.
Cover frozen parts of the body loosely with a clean, preferably germ-free cloth or bandage. Avoid pressure!
Give the patient warm, sugared drinks (e.g. sweetened tea).

What to avoid in case of frostbite:

Do not open bubbles that have formed!
Avoid active heat from the stove or hot water bottle. Frozen areas of skin are numb, so that the person affected may not feel when it is getting too hot. Then there is a risk of burns.
You should not massage or rub frozen parts of the body. Both can further damage the skin!
Body parts that are frozen stiff should not be moved passively (e.g. by you as the first aider).

Slow heating in the bathtub

If possible, slowly warm the frozen part of the body in a cool water bath, which you gradually warm to a maximum of 40 ° C. Warning: this can be very painful! You should therefore only increase the water temperature slowly and gradually. If a thermometer is not available, you can check the temperature of the water with your hand or elbow. In the water bath, the patient should actively move the frozen part of the body.

When the skin is rosy again, the tissue has thawed, and the patient can move around easily, you can finish the bath. It shouldn't take more than 30 minutes so the skin doesn't soften.

When to the doctor

Superficial frostbite (Grade I) only affects the upper layers of the skin. You are not an emergency. They usually improve quickly if they are gently warmed up. If the area remains numb, however, you should see your family doctor.

Frostbite with blistering (grade II) should be examined by a doctor as soon as possible after first aid.

Deep frostbite (Grade III) can affect all layers of the skin as well as deeper lying areas such as muscles, tendons and bones. Take the patient to the nearest hospital as soon as possible or call the emergency doctor! Very severe frostbite must be treated in the hospital to prevent an amputation of frozen body parts as much as possible.

Take the patient's vaccination record with you if you can find it. The doctor needs to know if the person has been vaccinated against tetanus. This is important for treating frostbite.

Chilblains

Chilblains (pernions) are also caused by the cold: Repeated exposure to the cold causes the tissue to have poor blood supply and becomes inflamed. Puffy areas of red or sallow skin develop that can be itchy, painful, and blistered. Chilblains, however, are not actually frostbite, as no ice crystals damage the tissue here. They can occur even in moderate cold (above zero degrees). Chilblains preferentially develop on toes and fingers.

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