Some Basics...

• Frostbite and hypothermia are two different problems.
• Frostbite results from a cold injury to the skin. It occurs when nerves, blood vessels, and skin cells are frozen for a short time. It happens most often to the ears, nose, penis, fingers, and toes. A person can have frostbite if the body's core temperature is normal.
• In contrast, hypothermia signals a large decrease in the body's core temperature. A person with hypothermia may not have frostbite. Hypothermia is defined as a body temperature less than 95°F (35°C), measured rectally. Hypothermia can be deadly without intervention.

Symptoms

Frostbite can be classified like burns:

• Frostnip: This is mild frostbite. It may cause cold, tingling, or painful skin
• First Degree: Skin will be white and hard while frozen. There may be mild swelling after re-warming.
• Second Degree: Same as first degree. There will be blisters after 24 hours.
• Third Degree: Blue blisters that turn into dead skin.

Risk Factors

• Alcohol, Mental Illness: These impair a person's judgment. They reduce normal self-protective actions.
• Medical Conditions: May make a person predisposed to frostbite. People with diabetes, congestive heart failure, peripheral vascular condition, and Raynaud's disease are all at risk. People who have had frostbite are also at risk.
• Type of Contact: Frostbite is much worse if skin and clothing are wet. Touching bare hands to cold metal can cause frostbite right away. Touching bare hands to products that are stored outside in the cold can also cause frostbite. An example is gasoline.
• Length of Contact: The longer the exposure, the greater the heat loss and chance of frostbite. The wind-chill index on a cold day plays a part in how quickly frostbite happens.

Prevention

• Change wet gloves or socks right away.
• Limit time spent outdoors when the wind-chill temperature falls below zero.
• Know the first warnings of frostbite. Pain, tingling, numbness are early signs to go indoors.

Frostbite Prevention - Clothing

• Clothing: Dress in layers for cold weather. The first layer should be long underwear. This should be made of polypropylene or polyester, which takes moisture away from skin. The middle layer(s) should be fleece or wool. The outer layer serves as a windbreaker. It also needs to be waterproof. The layers should be loose, not tight.
• Hand Protection: Mittens are warmer than gloves. Wear a thin glove under the mitten for extra protection.
• Footwear: Do not wear shoes that are too tight. They can decrease circulation. Wear 1-2 pairs of socks made from wool or a wool blend. Wear a thin liner sock under the wool socks for extra protection. This should be made from polyester or polypropylene, which takes away moisture from skin.
• Headwear: Wear a hat. Over 50% of heat loss comes from the head.

1. What You Should Know:
   • Frostbite is called frost nip, first, second, or third degree based on the amount of damage it causes.
   • You can treat mild frostbite at home.
   • Here is some care advice that should help.
2. Frostbite Treatment - Re-warming:
   • Re-warm the area rapidly with wet heat.
   • Move into a warm room.
   • For Frostbite of Fingers and Toes: Put the body part in very warm water. A bathtub or sink is often the quickest option. The water should be very warm (104° to 108°F, or 40° to 42°C). It should not be hot enough to burn you. You should keep soaking in this warm water for about 30 minutes. A pink flush means circulation has returned to the body part. At this point, the numbness should be gone.
   • For Frostbite of the Face: Put a warm wet washcloth on the area. You should keep doing this for about 30 minutes.
   • With more severe frostbite, the last 10 minutes of re-warming can be quite painful.
   • If you are not using a tub, keep the rest of your body warm. Cover yourself with plenty of blankets.
3. Frostbite Treatment - Common Mistakes:
   • Do not put snow on the frostbitten area. This can cause damage to thawing tissues.
   • Do not re-warm with dry heat. This includes a heat lamp or electric heater. You could burn yourself but not feel it.
   • Do not re-warm if it could freeze again in the next couple hours. Freezing-warming-freezing causes more damage than freezing-warming.
4. Drink Warm Liquids: Drink warm liquids (such as hot chocolate).
5. Pain Medicines:
   • You can take one of the drugs listed below if you have pain.
   • They are over-the-counter (OTC) pain drugs. You can buy them at the drugstore.
   Acetaminophen (Tylenol):
   • Regular Strength Tylenol: Take 2 pills (650 mg) every 4-6 hours. Each pill has 325 mg of acetaminophen.
   • Extra Strength Tylenol: Take 2 pills (1,000 mg) every 8 hours. Each pill has 500 mg of acetaminophen.
   • Do not take more than (3,000 mg) of this drug per day.
   Ibuprofen (Motrin, Advil):
   • Motrin and Advil: Take 2 pills (400 mg) every 6 hours. Each pill has 200 mg of ibuprofen.
   • A second choice is to take 3 pills (600 mg) every 8 hours.
   Naproxen (Aleve):
   • Aleve: Take 1 pill (220 mg) every 8 hours. Each pill has 220 mg of naproxen.
   • A second choice is to take 2 pills (440 mg) every 12 hours.
   Extra Notes:
   • Use the lowest amount of a drug that makes your pain feel better.
   • Your doctor might tell you to take more than what is shown above. That is because your doctor knows you and your health problems.
   • Acetaminophen is safer than ibuprofen or naproxen in people over 65 years old. Acetaminophen is in many OTC and prescription drugs. It might be in more than one drug you are taking. Be careful how much you take. Too much of this drug can hurt the liver.
   • Caution- Acetaminophen: Do not take it if you have liver disease.
   • Caution- Ibuprofen and Naproxen:
     • Do not take ibuprofen or naproxen if you are pregnant.
     • Do not take these drugs if you have stomach problems or kidney disease.
     • Do not take these drugs for more than 7 days without checking with your doctor.
   • Read all package instructions.
6. Aloe Vera Ointment: Put aloe vera on the area 2 times a day for 5 days.
7. Tetanus Shot for Frostbite: If your last tetanus shot was more than 10 years ago, you need a booster.
8. Call Your Doctor If:
   • Color and feeling do not return to normal after 1 hour of re-warming
   • Frostbitten part develops blisters
   • You get worse