FROSTBITE

Ma. Isabel B. Barredo

Frostbite
acute freezing of the tissues as a result of

exposure to low environmental temperatures below the freezing point of intact skin the inflammatory process that occurs with frostbite is similar to that after a thermal burn The severity of a frostbite injury depends on the environmental temperature to which the skin is exposed, and to how long it is exposed to a low temperature.

Most cases of frostbite are encountered in:

soldiers persons who work outdoors in the cold homeless people athletes engaging in sports with seasons

extending into the cold months of the year winter outdoor enthusiasts, such as Nordic skiers

Any part of the body can be affected by frostbite, but the extremities, such as the feet, ears or hands are the more common sites for it to occur.

 Risk Factors Diabetes Peripheral neuropathy Use of beta-blockers

CLASSIFICATIONS OF FROSTBITE

Signs and Symptoms

Pins and needles feeling followed by numbness Hard, pale, and cold skin that has been exposed to

the cold for too long The area may ache or throb. Lack of sensation As the area thaws, the flesh becomes red and very painful Very severe frostbite may cause: Blisters Gangrene Damage to tendons, muscles, nerves, and bone

Assessment
o o o

History: Circumstances surrounding incident Intensity and duration of exposure; onset of symptoms Obtain past health history including allergies and a list of current medications including over the counter drugs o Tetanus immunization status o Risk Factors associated with Frostbite i.e.( peripheral vascular disease, Raynauds phenomenon, peripheral neuropathy, diabetes, poor nutrition, use of alcohol, drugs and tobacco and patients who are on Beta-Blockers)

Physical: Location of frostbite Degree of frostbite according to Classification of Frostbite chart Vital signs Level of consciousness Complete assessment of lung fields if history of submersion in cold water Pain scale

MANAGEMENT

Emergency Management (F-R-O-S-T-B-I-TE)

The main goal of emergency management for frostbite is the restoration of normal body temperature.

F For injuries in the lower extremities, do not allow the patient to walk. Move the person to a warmer place and shelter him or her from cold. R Remove all constricting clothing and jewelries. These items may impair circulation. O Observe the patient for signs of hypothermia or lowered body temperature and manage the condition accordingly.

S Sterile dressings should be used to wrap the affected part if immediate medical help is available before rushing the patient to the emergency department for further care. It is important for the nurse to remember to separate the fingers and toes in doing so.
T The extremity can be rewarmed using controlled and rapid rewarming. Rewarming fist aid may be given in cases where immediate care is unavailable. To do this, the affected area is placed and soaked for 30 to 45 minutes in a 37 to 40 degree Celsius whirlpool until the tips of the injured part flushes. The flush would indicate that the circulatory flow is re-established. To aid the warming process, the water should be kept circulating.

 B Be sure to conduct a physical assessment to observe for o o o o

concomitant injury such as: Soft tissue injury Dehydration Alcohol coma Fat embolism I In dressing frostbite injuries, it is essential to use strict aseptic technique. Damages from frostbite make the patient susceptible to infection. T Tetanus prophylaxis can be given if there is associated trauma E Encourage hourly movement of the affected digits to promote maximal restoration of function and to prevent contractures.

The Rewarming Process

Early rewarming of the tissue appears to decrease injury or damage. Before and during the process of rewarming the following should be done:

Administer an analgesic for pain per doctors prescription. The

rewarming process may be very painful. To avoid further mechanical injury, the affected part should be handled gently. Massage should never be done in this case. The rewarmed part should be protected. Blebs or blisters should NOT be ruptured. Blebs develop an hour to few days after the process of rewarming. A sterile gauze or cotton should be placed between the fingers or toes of affected extremity. This is done to prevent maceration. To help control swelling, elevate the affected extremity or body part. In cases where the feet are involved, bed cradles may be used to prevent contact with bedclothes.

Further Management of Frostbite

Whirlpool bath used to promote circulation in the

affected part, debride necrotic tissue, permit normal circulation in the area and to help prevent infection. Escharotomy in this procedure an incision through the eschar is made. This procedure is done to prevent further tissue damage, to allow normal blood circulation and to permit movements or motion in the joints. Fasciotomy this is a surgical procedure where an incision is made in fascia in order to release pressure on the muscles, nerves and blood vessels. Fasciotomy is useful in treating compartment syndrome.

Prevention
Avoid -

a. Extreme cold b. Wet clothes c. Chilly Wind During cold weather, wear several layers of clothing Wear accessories likea. Mittens, not gloves b. Two pairs of socks c. Hat / scarves to cover both ears well Get enough food and rest Avoid alcohol immediately before exposure to cold Avoid cotton clothing

Possible Nursing Diagnosis

Hypothermia Risk for infection Altered tissue perfusion Sensory alteration

Thank you!