area because of reduced circulation. As ice crystals form, the frozen extremity appears white, yellow-white, or mottled blue-white, and is cold, hard, and insensitive to touch or pressure.
Frostbite is classified as superficial or deep, depending on the extent of tissue involvement.
Superficial Frostbite. - In superficial frostbite, the surface of the skin will feel hard, but the underlying tissue will be soft, allowing it to move over bony ridges.
This is evidence that only the skin and the region just below it are involved.
To treat superficial frostbite, follow these steps:
1. Take the casualty indoors.
2. Rewarm hands by placing them under the armpit, against the abdomen, or between the legs.
3. Rewarm feet by placing them in the armpit or against the abdomen of a buddy.
4. Gradually rewarm the affected area by warm water immersion, skin to skin contact, or hot water bottles.
5. Never rub a frostbite area.
Deep Frostbite. - In deep frostbite, the freezing reaches into the deep tissue layers. There are ice crystals in the entire thickness or the extremity. The skin will not move over bony ridges and feels hard and solid.
The objectives of treatment are to protect the frozen areas from further injury, to rapidly thaw the affected area, and to be prepared to respond to circulatory or respiratory difficulties.
To treat deep frostbite, follow these steps:
1. Carefully assess and treat any other injuries first. Constantly monitor the casualty's pulse and breathing since respiratory and heart problems can develop rapidly. Administer CPR if necessary.
2. Make no attempt to thaw the frostbitten area if there is a possibility of refreezing. It is better to leave the part frozen until the casualty arrives at a medical facility equipped for long term care. Refreezing of a thawed extremity causes severe and disabling damage.
3. Treat all casualties with injuries to feet or legs as litter patients. When this is not possible, the casualty may walk on the frozen limb, since it has been proved that walking will not lessen the chances of successful treatment as long as the limb has not thawed out.
4. When adequate protection from further cold exposure is available, prepare the casualty for rewarming by removing all constricting clothing such as gloves, boots, and socks. Boots and clothing frozen on the body should be thawed by warm water immersion before removal.
5. Rapidly rewarm frozen areas by immersion in water at 100°F to 105°F or 38°C to 41°C. Keep the water warm by adding fresh water, but do not pour it directly on the injured area. Ensure that the frozen area is completely surrounded by water; do not let it rest on the side or bottom of the tub.
6. After rewarming has been completed, pat the area dry with a soft towel. At first, the injured area will feel numb and look mottled blue or purple. Later it will swell, sting, and burn. Blisters may develop and should be protected from breaking. Avoid pressure, rubbing, or constriction of the injured area. Keep the skin dry with sterile dressings and place cotton between the toes and fingers to prevent them from sticking together.
7. Protect the tissue from additional injury and keep it as clean as possible (sterile dressings and linen should be used).
8. Try to improve the general morale and comfort of the casualty by giving hot, stimulating fluids such as tea or coffee. Do not allow the casualty to smoke or use alcoholic beverages while being treated.
9. Transfer the casualty to a medical facility as soon as possible. During transportation, slightly elevate the frostbitten area and keep the casualty and the injured area warm. Do not allow the injured area to be exposed to the cold.
Before transporting the casualty, ensure that the patient is stable enough to be moved. First, make sure that all hemorrhaging is under control and wounds have been dressed. Second, make sure that all fractures have been splinted and the victim has been treated for shock. If morphine or an IV was administered, see that the casualty has been marked and a U.S. Field Medical Card filled out. The casualty's vital signs should be stable so there will be no problems in route.
It is a basic principle that an injured person must be given essential treatment before being moved. However, it is obviously impossible to treat injuries while the casualty is in a position of immediate danger.Continue Reading