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Cooling down of the body can be fatal, frostbite will be a “keepsake” for life. Even if there are no skin defects, the damaged area feels like pain every fall and winter, and redness – all year round.
At first, you feel cold and slightly numb. Sometimes it gets warm afterwards. After a while, you don’t feel anything anymore, and that’s the worst.
We associate frostbites with extreme cold and high mountain climbing. The name of this type of skin or tissue damage suggests that it only arises from frost. So how to explain the dozen or so cases of frostbite a year in Australia, or the fact that a 2010-year-old girl contracted them, who spent 6 days in the forest at the beginning of a fairly warm October XNUMX? We still know too little about the unpleasant and sometimes very dangerous effects of playing with the cold, although we live in a country where winter can be very, very bad.
Women’s Achilles cheek
There are few statistics on frostbite in the world medical literature. From research conducted by Finnish doctors from the Institute of Health in Oulu, we know that the nose, ears, cheeks and chin as well as fingers and toes are most exposed to frostbite. Some parts of the body are more likely to thaw women, others men. And so, ladies come to hospitals with frostbitten cheeks, noses, as well as thighs and knees, and the gentlemen are masters of frostbiting their ears. From the statistics of the Department of Health of England, it can be learned that the gentlemen are definitely leaders in the infamous frostbite statistics. As many as 92% of cases in the 2002/2003 winter season concerned them! The average age of a patient with such a problem is 42 years. Interestingly, the English recorded very few cases of frostbite in the elderly and children.
“Every year we call for children to be protected from the cold,” explained pediatrician James B. McGuire to Medical News. – Parents already know that babies need to be carefully dressed in winter and their body temperature should be checked frequently. The same applies to the elderly, they and their carers are aware of the dangers. The problem is with middle-aged people and teenagers. The mother, who wrapped the baby in a scarf, goes outside herself without gloves.
Those who like to walk without a hat and with an unbuttoned jacket, explaining in a cheerful tone to others that “hot plays” should learn one more item from the English statistics – although the average length of hospital stay in the case of treatment of frostbite is 3 days, the average length of the total treatment of deep frostbite is several months.
As the blood drains
Frostbites can also occur when … the body wants the best for us. Its main task is to protect what is most important, i.e. internal organs, the efficient operation of which is necessary for survival. Not wanting to lose heat, it constricts the blood vessels. It gradually reduces the blood supply to the skin, subcutaneous tissue, and then muscles. It is based on the assumption that when you have a choice, for example: an ear or a heart, you have to focus on protecting the heart, without which the operation of the ear does not make sense anyway.
You can get frostbites not only in bitter frost. When ten-year-old Karina, about whom all Poland heard about, wandered in the forest for several days, the temperature did not drop below zero. Cooling down of the body, wind and humidity are enough to get frostbites that are difficult to heal.
Who should be afraid of them?
• People who are in poor general condition, for example due to illness or exhaustion. Those with cardiovascular diseases (who have problems with proper blood supply to tissues) are particularly at risk. Risk factors include: ischemic heart disease, atherosclerosis, and diabetes.
• Smoking cigarettes or drinking alcohol. According to some doctors, lovers of a few cups of coffee a day are also more likely to suffer from frostbite.
• Hungry and thirsty.
• People with reduced mobility, such as infirm, very obese or with a broken limb.
In the cold months, wind and humidity are factors that contribute to the formation of frostbite. Military know a lot about them (let us remind you that during the seven-month offensive on the Eastern Front, over 60 German soldiers contracted frostbite). In modern Scandinavia, anyone who has received military training has also had courses in coping with difficult conditions. During one of them, a Norwegian soldier soaked his shoe in the river so that water got inside. He assumed a quick return to base would save him from frostbite. He rode a scooter for a few minutes in strong winds and several degrees of frost. But saving the entire foot was impossible. The case was described in the Norwegian press.
Superficial and deep frostbites
In Polish climatic conditions, XNUMXst degree frostbite usually occurs, although every winter there are also cases of necrosis and even damage to deep subcutaneous tissues. A three-point, and sometimes four-point scale is used to classify frostbite:
XNUMXst degree frostbite. Its formation is often preceded by pain or stinging, then the skin becomes insensitive. At first, it turns red when exposed to cold, as the blood vessels dilate to keep them warm. The peripheral vessels then contract to minimize heat loss in the body. The skin takes a chalky color. It may become swollen and stinging when heated. Feeling is preserved, but if the frostbite affects the fingers, their movement may be temporarily impaired. Such frostbites usually heal spontaneously, but hypersensitivity to cold, burning or itching may persist for a long time.
XNUMXnd degree frostbite. All layers of the skin are damaged. When heated, the skin is swollen, blisters appear on it, colored with bloody fluid. Feeling is preserved. Healing is spontaneous but takes time and can leave scarring.
XNUMXrd degree frostbite. They cause damage to the subcutaneous tissue and thrombosis of small blood vessels. The heated skin initially develops severe swelling beyond the limits of frostbite and dark purple or purple blisters. As the nerve endings are destroyed, feeling is lost. If no infection occurs, the dead parts of the skin will separate from the undamaged ones.
XNUMXth degree frostbite. The skin is swollen and turns brown or black in color. Muscles, sometimes bones, are damaged, and vascular thrombosis is irreversible.
Snow in the shoe
Thirty-five-year-old Wojciech Michalski, a rock climbing instructor, frostbitten his toes during a mountain expedition in 2008. Talking about those events, he lists the mistakes he made: lack of physical preparation for the expedition, resulting in staying in the cold for too long, not enough fluids consumed, inappropriate footwear.
By the time he descended into the shelter, he already had a complete list of risk factors: fatigue, dehydration, and hypothermia. The snow that got into the shoe was the last link in the chain. When Wojciech reached the shelter after 18 hours, he did not know that something bad had happened. There was nothing to hell, it didn’t hurt, the feeling in my fingers seemed to be preserved. He ate dinner, drank a lot, and soaked his feet in warm water. He noticed that his fingers turned from white to dark gray due to the heat, but he ignored it, tired. “Much later, the doctor realized that I made a mistake by soaking my feet in water,” he recalls. The water was too hot, which I couldn’t judge without feeling. Paradoxically, the heat has wreaked further havoc.
In the morning the toes were still gray and the feet were swollen all over. The hospital was diagnosed with 5rd degree frostbite. Bloody blisters appeared on the fingers. Wojciech was given anticoagulant and anti-tetanus drugs. The fingers turned to a bloody mass, but I felt no pain. After XNUMX days, the previously white parts of the fingers turned pink. It took a long time to heal. After two months my first nail fell off, then another one – she adds. Today Wojciech has impaired sensation in the toes and circulation in the toes. He still likes to climb, although he is very careful in winter.
What does oxygen have in the wound?
In the treatment of frostbite, drugs that support circulation, painkillers and antibiotics to prevent infection are used. Surgical treatment to remove dead or infected tissue is rarely necessary in Poland. If scars form, reconstructive procedures are performed.
Poles found out that deep and infected frostbites can be treated with oxygen when ten-year-old Karina was admitted to the Hyperbaric Medicine Clinic of the University Clinical Center in Gdynia. She underwent several treatments in a hyperbaric chamber there, which stopped the process of spreading gas gangrene.
What is the procedure in such a chamber? First of all: it provides damaged tissues with more oxygen. The patient breathes 100% oxygen at increased pressure. The pressure of oxygen in the lungs increases, so that more of it dissolves in the plasma and reaches the damaged tissues. What does it do? In this area, blood circulation is improved and swelling is reduced. Bacteria multiply more slowly and the effectiveness of antibiotic therapy increases.
Although before starting this form of therapy, the doctors feared that the girl would have to have her entire feet amputated, she ended up losing her toes, which – as they assured – should not prevent her from walking. Thanks to Karina’s fate, oxygen treatment has become “fashionable”. When the first patients with frostbite appeared this winter, they sometimes asked where they could go for hyperbaric treatment. There are currently several centers with such chambers in Poland, but hopefully there will be no need to visit them. Every winter we have the best weapon against frost – common sense.
Worth knowing
Better to prevent than to freeze
On cold days, it is best to put on several layers of clothing, taking care not to cause pressure points. A foot tucked into two pairs of thick socks and a tight shoe will be exposed to the harmful effects of cold as a result of impaired circulation. Under no circumstances should you drink alcohol “to warm up”, because thanks to it you will get rid of the heat much faster. Let’s try to drink plenty of warm fluids to thin the blood, which will then reach the blood vessels faster. The exposed skin on the face should be lubricated with greasy creams intended for winter use.
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