Arctic Blast Increases Risk of Frostbite, Hypothermia

Jan. 25, 2011— -- Dr. Sandra Schneider, professor and chair emeritus of the department of emergency medicine at the University of Rochester Medical Center, has seen her share of frostbite cases. Some were so bad that patients arrived with extremities filled with blood blisters, and left with amputated fingers and toes.

Schneider recalled one instance about 10 years ago, when a patient's hand had gotten stuck in a freezer.

"I guess his hand was wet and it went against the ice in the freezer and got stuck," said Schneider. "It was a new apartment and he didn't know what to do, so he turned off the refrigerator and waited for it all to melt."

When the man finally appeared in Schneider's emergency room, he had a frostbitten blistered area the size of a quarter on the back of his hand.

"We treated the patient as we do in normal frostbite cases: with warm water and some mild pain medication," said Schneider.

Now, as many Americans feel the arctic blast moving across the country, doctors are warning people to take extra care in bundling up and staying out of the cold.

A day like today can bring on health problems in a matter of moments. Frostbite, in particular, is a major threat; it can occur in under a minute at extremely cold temperatures. The term is shorthand for the literal freezing of body tissue, usually skin. The most vulnerable areas to frostbite include fingers, toes, noses, cheeks and ears.

According to the National Weather Service, frostbite can occur within 5 minutes in temperatures between 0 degrees and -19 degrees Fahrenheit.

"When the wind chill factor starts heading toward zero degrees, frostbite becomes a very real hazard for anyone caught outside, unprepared for wind and frigid temperatures," said Dr. Lewis Marshall, chairman of emergency medicine at Brookdale University Hospital Medical Center, in Brooklyn, N.Y.

The initial stage of frostbite usually affects the top skin layers and does not lead to long-term damage. As freezing continues, second-degree frostbite may set in. The skin can become hard and waxy, and blisters may form a day or two after the freezing.

Third degree frostbite consists of a deep frostbite, where the skin turns blue or black, and the muscles, nerves and vessels have all frozen as well. The area is temporarily debilitated, and, in some cases, permanently damaged.

In extreme cases of frostbite, the area can be infected with gangrene, where the affected body part will eventually fall off if it is not amputated first.

"If you get frostbite, especially second degree or above, you should be very careful for the next year," said Dr. Schneider. "It takes a good 12 months for that to heal, and there can be a great deal of tissue and nerve damage."

Dr. Jeffrey Sankoff, an emergency medicine physician in Denver, said that the most common mistake frostbite sufferers make is in what they wear outside.

The Dangers of Frostbite

"They don't dress for it," said Sankoff. "Function must rule fashion in the case of staying warm. Lack of good gloves and footwear is the most common thing we see."

And, in a tidbit that could surprise even the most avid of winter athletes, Schneider said: "It's better to leave a frostbitten area frozen then to go through a freeze, thaw, freeze, and thaw period."

"You should only begin warming the area up if you can keep the area warm, and take special precautions to keep them from freezing again," she said.

Repetitive warming and freezing can cause ice crystals in the tissue, which only multiplies the damage done to the frostbitten skin.

Either way, the re-warming process can be quite painful, so doctors encourage frostbite sufferers to go to the emergency room, where the warming process can be treated in a controlled setting.

Emergency doctors usually soak the frostbitten area in warm, not hot, water. Pain medication is administered to patients as necessary. Physicians monitor the area for evidence of blisters or infection.

"We treat severe frostbite much like a burn," said Schneider. "We wait to see how deep the area is involved, and we'll sometimes use skin grafts. If the area is beyond salvageable, we'll prepare for an amputation."

Cold Hands Clinic

Patients with poor circulation, like those who suffer from diabetes, Raynaud's disease, lupus and scleroderma, may have an increased risk of frostnip and frostbite.

The University of Chicago Medical Center launched the Cold Hand Clinic last month, to help diagnose and treat patients with cold hand problems.

"When we first thought about this idea, we wanted to join together to establish a clinic that provides a comprehensive assessment of these cases," said Dr. Nadera Sweiss, assistant professor of medicine at the University of Chicago Medical Center and an expert member of the Cold Hand Clinic physician team.

Treatment options at the clinic are highly individualized, said Sweiss.

"We start with prevention, and look at how patients can protect their hands," said Sweiss. "If that doesn't work, we go onto medication."

Most of the physicians will first administer calcium channel blockers, drugs that are often used to treat high blood pressure, heart pain and abnormal heart rhythms. If those don't work, doctors will look into other medications, like antidepressants, blood thinners, and even Botox and Viagra.

"Theoretically, the idea is that these medications help improve blood flow," said Sweiss. "But everything has side effects, especially since everything is off-label."

Sweiss said that the success rate for the various medications ranges from 30 to 50 percent in cold hand patients, and she stressed that the use of these medications for cold hand treatments is not FDA approved and proper clinical trials research for cold hand conditions are limited.

Hypothermia

Along with frostbite, hypothermia is another cold weather condition that can be dangerous to people unprepared for the weather.

Dr. Richard Bradley, associate professor of emergency medicine and chief of EMS and disaster medicine at the University of Texas Medical School at Houston, reiterated the importance of keeping warm when temperatures plummet.

"The onset of hypothermia can be very difficult to detect," said Bradley. "We lose a lot of people every year from it, because people often don't realize they're becoming hypothermic."

Hypothermia occurs when body temperature falls below 95 degrees Fahrenheit.

"As the body temperature goes down, people will begin to shiver in order for the body to generate heat," said Marshall. "As the body temperature falls below 90 degrees, shivering stops and body can no longer regulate temperature. "

Other symptoms of hypothermia include clumsiness and confusion, drowsiness, a weak pulse and shallow breathing.

"As the hypothermia worsens, people realize even less that they're getting colder," said Bradley. "We see this a lot in people who are alone and don't have anyone to say, 'Hey, you don't look so good.'"

Hypothermia in the Homeless

Dr. Christopher McStay, chief of service at Bellevue Hospital Center Emergency Department, said that it is rare to see hypothermic patients, except for in the homeless population.

"They are, of course, at high risk and doubly so due to a high percentage of comorbid psychiatric and substance abuse," said McStay.

McStay credited New York City's department of homeless service for its "exceptional" efforts in monitoring of known patients who refuse to seek shelter indoors.

Paradoxical Undressing

To make matters worse, 20 to 50 percent of hypothermia deaths are associated with paradoxical undressing. Some severe hypothermia sufferers will begin to take off their clothing, which only increases the rate of body heat loss.

"The brain starts playing tricks," said Schneider. "Hypothermic people will think it's hot, and they'll start undressing to cool down."

There is no one way to treat hypothermic patients who come into the emergency room. There are a variety of ways to warm a patient up. Heated blankets that warm the entire body are available in many emergency departments. For patients who are severly hypothermic, doctors may use the same equipment they do for open heart surgery.

Schneider said that she will sometimes circulate a hypothermic person's blood for them through heated coils, or they'll circulate warm saline through the body and give the patient warm oxygen.

Avoiding Frostbite and Hypothermia

Doctors encourage you to dress for the weather, even if you'll only be outside for a minute. Wear layers of light, loose-fitting clothing and carry an extra pair to replace if the first pair gets damp.

Doctors encourage people to stay completely covered when braving the elements.

"Dress appropriately, with numerous layers for warmth," said Sankoff. "Be aware of the wind, as wind chill is a significant issue with lower temperatures."

Those with poor circulation must be extra vigilant, and everyone should avoid alcohol in freezing temperatures, since it increases blood flow to the body's skin, making a person feel warm while the body loses heat.

"Winter can be a glorious time to enjoy the outdoors," said Marshall. "If you wear the right clothes, stay dry, and take a few precautions…you'll keep it that way."