Dr. Piere Ghassibi
Our winters are very cold, so let us review the dangers of exposure. We know that less than a thirty- minute exposure to very low temperatures can result in injury by freezing of the skin and underlying tissues. This can also happen in skin covered by clothing, especially if wet. Because the skin gets numb, we may not realize that we have a problem. The skin area may be pale then change to red or purple in color. Smoking, drinking alcohol, having diabetes, some medications, all make the situation worse.
An early frostnip can progress to a worse frostbite then to a chilblain with hardening, swelling, and blistering, infection, and disturbances in sweating. Unless the injury is slight, healing may take many days to a few weeks. A severe prolonged exposure may cause permanent skin damage with ulcers and gangrene.
Treatment should involve rewarming in warm water at 100 degrees Fahrenheit for at least 20 minutes. Re-exposure to extreme cold after having rewarmed the problem area can cause even more subsequent damage; so, no re-exposure should be allowed. With treatment and rewarming, pain can reappear, and pain meds may be required. An oral pill to widen the blood vessels is occasionally prescribed by the doctor.
After one episode like this, the body becomes more prone to cold injury in the future.
Any persistent swelling, bluish color, poor pulses, severe pain, blistering or skin damage need a visit to a clinician ASAP.
Total body hypothermia, as we know, is more immediately serious and requires general rewarming in the emergency room with monitoring of the heart and possibly warming the inside of the body with warm irrigation of the stomach, bladder, or intravenous treatment.
It is nice to know that prompt attention to cold injuries can prevent otherwise serious problems.
Because soldiers were prone to foot disease from very cold weather along with humidity from wet shoes, a condition called “trench foot’,’ the soldiers in the first World War were requested to check each other’s feet at bedtime.
P. Ghassibi, MD