The areas most commonly affected are the face andextremities.The symptoms of frostbite are progressive.Victims generally incur this injury without beingacutely aware of it. Initially, the affected skin reddensand there is an uncomfortable coldness. Withcontinued heat loss, there is a numbness of the affectedarea due to reduced circulation. As ice crystals form,the frozen extremity appears white, yellow-white, ormottled blue-white, and is cold, hard, and insensitiveto touch or pressure. Frostbite is classified assuperficial or deep, depending on the extent of tissueinvolvement.Superficial Frostbite.—In superficial frostbitethe surface of the skin will feel hard, but the underlyingtissue will be soft, allowing it to move over bonyridges. This is evidence that only the skin and theregion just below it are involved. General treatment forsuperficial frostbite is as follows:1. Take the victim indoors.2. Rewarm hands by placing them under thearmpits, against the abdomen, or between thelegs.3. Rewarm feet by placing them in the armpit oragainst the abdomen of the buddy.4. Gradually rewarm the affected area by warmwater immersion, skin-to-skin contact, or hotwater bottles.5. Never rub a frostbite area.Deep Frostbite.—In deep frostbite, the freezingreaches into the deep tissue layers. There are icecrystals in the entire thickness of the extremity. Theskin will not move over bony ridges and will feel hardand solid.The objectives of treatment are to protect thefrozen areas from further injury, to rapidly thaw theaffected area, and to be prepared to respond tocirculatory or respiratory difficulties.1. Carefully assess and treat any other injuriesfirst. Constantly monitor the victim’s pulse andbreathing since respiratory and heart problemscan develop rapidly. Be prepared to administerCPR if necessary.2. Do not attempt to thaw the frostbitten area ifthere is a possibility of refreezing. It is better toleave the part frozen until the victim arrives at amedical treatment facility equipped forlong-term care. Refreezing of a thawedextremity causes severe and disabling damage.3. Treat all victims with injuries to the feet or legsas litter patients. When this is not possible, thevictim may walk on the frozen limb, since it hasbeen proven that walking will not lessen thechances of successful treatment as long as thelimb has not thawed out.4. When adequate protection from further coldexposure is available, prepare the victim forrewarming by removing all constrictingclothing such as gloves, boots, and socks. Bootsand clothing frozen on the body should bethawed by warm-water immersion beforeremoval.5. Rapidly rewarm frozen areas by immersion inwater at 100F to 105F (38C to 41C). Keepthe water warm by adding fresh hot water, but donot pour the water directly on the injured area.Ensure that the frozen area is completelysurrounded by water; do not let it rest on the sideor bottom of the tub.6. After rewarming has been completed, pat thearea dry with a soft towel. Later it will swell,sting, and burn. Blisters may develop. Theseshould be protected from breaking. Avoidpressure, rubbing, or constriction of the injuredarea. Keep the skin dry with sterile dressingsand place cotton between the toes and fingers toprevent their sticking together.7. Protect the tissue from additional injury andkeep it as clean as possible (use sterile dressingsand linen).8. Try to improve the general morale and comfortof the victim by giving hot, stimulating fluidssuch as tea or coffee. Do not allow the victim tosmoke or use alcoholic beverages while beingtreated.9. Transfer to a medical treatment facility as soonas possible. During transportation, slightlyelevate the frostbitten area and keep the victimand the injured area warm. Do not allow theinjured area to be exposed to the cold.4-64
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