I frequently see patients who have suffered burns and resorted to some old-fashioned home remedies, like covering the injury with butter instead of the immediate application of cold water. Misconceptions on how to self-treat burns is easily surpassed by the “old wives’ tales” surrounding the prevention and treatment of frostbite injuries.
by Dr. John Foote from December 2014 issue
Some of the common errors include taking a shot of alcohol to ward off hypothermia and frostbite, which causes blood vessels to dilate at the skin resulting in more heat loss. Vigorous rubbing of the affected frostbitten area is also a no-no; this causes further harm to already damaged tissue. Rewarming a frostbitten area before returning to a warm environment—resulting in subsequent refreezing of the frostbitten area—causes even greater damage than the original frostbite.
More than 90 per cent of frostbite occurs in the fingers and toes, with the rest to the pointy bits like the face/nose, ears and penis—cross-country skiers, snowshoers and winter cyclists should beware of “frozen popsicle syndrome,” as it was dubbed by Dr. James McSherry.
Obviously, it’s best to prevent frostbite before it occurs by keeping your core temperature warm, and with the appropriate covering of the extremities.
If frostbite does occur, some simple measures will help prevent permanent damage. The simplest way to rewarm a frostbitten area is to place it in someone else’s groin (preferably not one also suffering from frostbite) or armpit for 10 minutes. If that option is not available, immersion in body-temperature water (37-38 C) for 15 to 20 minutes will suffice. The severe pain that occurs upon rewarming can be treated with ibuprofen, whose anti-prostaglandin effects also help decrease tissue damage. Rewarmed fingers can swell, so ring removal before rewarming is advised. Seek medical attention should the feeling or colour not return to the affected area upon rewarming, or if there’s extensive blistering or swelling after rewarming.
Doctors are divided on whether to pop frostbite blisters or to just leave them intact. Once a blister does pop or start to leak, it’s best to have it cleaned up (debrided) by someone with nursing or medical training. The “cleaning up” removes dead skin to reduce the risk of infection and includes the application of an appropriate dressing. Once the exposed shiny flesh under the blister is exposed, it should be covered with an antibiotic ointment (i.e. Polysporin) and gauze or equivalent dressing. This ensures that wounds stay moist, which allows new skin cells to “swim over the wound,” resulting in faster healing.
The dressing can be changed daily, usually after bathing. Contrary to popular belief, it’s okay to get cuts, burns and frostbitten areas wet in the shower. However, avoid scrubbing the area, use warm water only and avoid harsh soaps. Air dry or gently pat the area dry with gauze, then follow with a reapplication of the ointment and dressing. This should continue until the area is no longer scabby. Make sure that you’ve had a tetanus booster within the last 10 years.
If the area develops a widening redness, increased pain or pus, a secondary bacterial infection may have developed that requires medical care.
Severe frostbite is usually cared for in burn units by plastic surgeons. Newer recommendations include the use of clot-busting drugs (such as those used in strokes and heart attacks) and longer periods of observation before resorting to amputation.
And for male snowshoers, cross-country skiers and winter cyclists, you have received fair warning; perhaps you should consider upgrading your insulation by adding a fur-lined jock to your ski kit.
Dr. John Foote is an emergency room physician at Toronto’s Mount Sinai Hospital.
