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Quiz: Can You Properly Identify and Treat Frostbite?

C. Crawford Mechem, MD, MS

January 15, 2015

'Tis the season for warm holiday wishes and freezing cold temperatures. Frostbite, the most common type of freezing injury, is defined as the freezing and crystalizing of fluids in the interstitial and cellular spaces as a consequence of exposure to freezing temperatures. It can develop rapidly, especially when cold is combined with high winds.

Because no standardized reporting system or database for frostbite is available, its prevalence is unknown. With Jack Frost nipping, do you know how best to identify and treat this chilling condition? Test your knowledge with our short quiz.

Which of the following groups is most commonly affected?

Teenagers

Adult men

Elderly men

Elderly women

The most commonly affected group includes men aged 30-49 years, although all age groups are at risk. In one case study, the mean patient age was 41 years. Younger children have less adaptive behavioral reaction to cold stress; therefore, they have a greater risk for frostbite.

Most frostbite victims are male. This disparity may result from increased outdoor activity among males as opposed to genetic predisposition. Gender variations in susceptibility to cold-related injuries may exist that have not yet been fully elucidated.

For more on the epidemiology of frostbite, read here.

At what temperature does exposed skin begin to be at risk for frostbite?

-5°C

-10°C

-20°C

-25°C

Frostbite may occur when skin is exposed to a temperature lower than -10°C, resulting in vasoconstriction. The resultant decrease in blood flow does not deliver sufficient heat to the tissue to prevent the formation of ice crystals. The anatomical sites most susceptible to frostbite include hands, feet, and exposed tissues (eg, ears, nose, and lips).

For more on the background of frostbite, read here.

Which of the following is a characteristic of a third-degree frostbite injury?

Clear blister formation with surrounding erythema

Nonsensate, central, white plaque surrounded by a ring of hyperemia

Hemorrhagic blister formation

Mottled tissue, with nonblanching cyanotic skin that eventually becomes dry, black, and mummified

First-degree frostbite has the following characteristics:

·         Insensate, central, white plaque surrounded by a ring of hyperemia;

·         Epidermal involvement;

·         Erythema; and

·         Mild edema.

Second-degree frostbite has the following characteristics:

·         Full-thickness skin freezing;

·         Clear blister formation with surrounding erythema;

·         Hard outer skin but resilient tissue underneath; and

·         Substantial edema.

Third-degree frostbite has the following characteristics:

·         Subdermal plexus freezing;

·         Hemorrhagic blister formation;

·         Blue-gray discoloration of the skin;

·         Deep, burning pain on rewarming, lasting 5 weeks; and

·         Thick gangrenous eschar formation within 2 weeks.

Fourth-degree frostbite has the following characteristics:

·         Involvement of muscle, bone, and tendons;

·         Frozen, hard, and avascular skin and tissue underneath;

·         Mottled tissue, with nonblanching cyanotic skin that eventually becomes dry, black, and mummified;

·         Relatively little pain experienced on rewarming; and

·         Minimal to mild post-thaw edema

For more on the presentation of frostbite, read here.

What is the correct temperature at which water should be maintained during immersion to rewarm a frosbite injury?

40°C

50°C

55°C

65°C

Rewarm the frostbitten area as quickly as possible to salvage as much tissue and function as possible. The use of circulating water at 40-42°C is common. Do not allow the water to get too hot or too cold. Avoid premature termination of the rewarming process. Remember to treat pain associated with rewarming.

For more on the treatment of frostbite, read here.

How long after rewarming a frostbite injury should surgical debridement of tissue be peformed?

Immediately

Within the first 3 days

1 week

No earlier than 2-3 weeks

Early surgery usually is contraindicated in frostbite, because of the time the nonviable tissue takes to demarcate. Older series show that performing debridement earlier than 2-3 weeks after warming significantly increases the amount of viable tissue removed and is harmful to the patient, resulting in an increased amputation rate, mortality, and morbidity. The only indication for early surgical intervention is post-thaw compartment syndrome warranting fasciotomy.

For more on the treatment for frostbite, read here.

Related Resources ·         Frostbite ·         Emergent Management of Frostbite

 

Medscape © 2015  WebMD, LLC

Cite this article: Quiz: Can You Properly Identify and Treat Frostbite? Medscape. Jan 15, 2015.

 

 

 

 

 

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