Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
How should frostbite and other cold
weather-related injuries be treated?
The initial treatment for any cold weather-related injury involves removing
yourself or others from the precipitating cold environment, if possible, to
prevent further heat loss. Move indoors, and remove all wet clothing and
constricting clothing (such as socks, boots, and gloves), and replace with dry
clothing. Avoid massaging or rubbing the affected area, as this will only
aggravate the injury. It is important to note that some of these individuals may
also be suffering from hypothermia, a potentially life-threatening condition.
Chilblains
Gradually re-warm the affected area, and treatment can generally be
accomplished at home. Some individuals may benefit from various lotions, while
others may require treatment with corticosteroid creams. If open sores develop,
they should remain clean and be monitored for signs of infection.
Trench foot
Individuals with trench foot should have their wet shoes and socks removed,
and the feet should be elevated, cleaned and air dried. Depending on the
severity of the condition, some individuals may require antibiotics and/or
surgical management of infection or wet gangrene (tissue destruction by
bacterial infection, usually Clostridium spp) .
Frostnip
Frostnip will generally improve with conservative re-warming measures at
home. Frostnip to the hands, for example, can be treated by breathing into
cupped hands or placing the hands in the armpit area. Alternatively, the
affected area can be submerged in warm water until normal sensation is restored.
Frostbite
Frostbite requires immediate medical attention. Ideally, treatment should
be instituted in a health-care facility, when possible.
Prior to transport to a health-care facility, if possible, loosely wrap the
affected area in a dry sterile bandage or a clean blanket to prevent further
trauma. Cotton may be placed between the toes or fingers, if affected, to
prevent any potential damaging effects of rubbing against one another.
The most effective treatment measure for frostbite is rapid re-warming.
This is accomplished by immersing the affected area into a circulating tub of
warmed water that is between 40 to 42 C (104 to 108 F) for 20 to 40 minutes or
until thawing is complete. Warm wet packs at the same temperature may be used if
a tub is not available.
It is important NOT to rapidly re-warm and thaw the affected area if there
is a risk that it may refreeze. This leads to more severe tissue damage and must
be avoided.
During the re-warming process, the pain may be extreme and oral or
intravenous analgesics may be required.
After rapid re-warming is complete, the affected area should be dressed and
splinted. Further treatment will focus on wound care (debriding clear blisters,
applying aloe vera lotion, and monitoring for infection), pain control, and
providing a tetanus vaccine booster shot, if needed. Surgical consultation may
be obtained for managing wound care, as well as for the longer-term sequelae of
serious frostbite injuries that my require amputation of gangrenous tissue.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Hyperthyroidism is an excess of thyroid hormone resulting from an overactive thyroid gland. Symptoms can include increased heart rate, weight
loss, depression, and cognitive slowing. Treatment is by medication, the use of
radioactive iodine, thyroid surgery, or reducing the dose of thyroid hormone.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Raynaud's phenomenon is characterized by a pale-blue-red sequence of color changes of the digits, most commonly after exposure to cold. Occurring as a result of spasm of blood vessels, the cause is unknown. Symptoms of Raynaud's phenomenon depend on the severity, frequency, and duration of the blood vessel spasm. Treatments include protection of the digits, medications, and avoiding emotional stresses, smoking, cold temperature, and tools that vibrate the hands.
A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin. The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury. Treatments include applying an ice pack and pressure to the area by hand.
Gangrene may result when blood flow to a tissue is lost or not adequate to keep the tissue alive. There are two types of gangrene: wet and dry. All cases of wet gangrene are infected by bacteria. Most cases of dry gangrene are not infected. If wet gangrene goes untreated, the patient may die of sepsis and die within hours or days. Dry gangrene usually doesn't cause the patient to die. Symptoms of dry gangrene include numbness, discoloration, and mummification of the affected tissue. Wet gangrene symptoms include swelling, pain, pus, bad smell, and black appearance of the affected tissue. Treatment depends upon the type of gangrene and how much tissue is compromised by the gangrene.
Hypothermia is having a body core temperature of less than 35 C or 95 F. Most causes of hypothermia are preventable. Risk factors for hypothermia include age, mental status, medical conditions, and medications. Symptoms of hypothermia generally depend upon the severity of the condition. Treatment depends upon the severity of hypothermia. If not treated early, hypothermia can lead to cardiac arrest, coma, or death.
Growth plate fractures and injuries occur in the area growing tissue near the end of the long bones of children and teens. Both boys and girls are susceptible to growth plate fracture and injury. Common causes include: a fall while playing sports or playing on furniture or playground equipment, overuse injury from sports, injuries from competitive sports, child abuse, frostbite, and juvenile arthritis. Growth plate fracture and injury are classified into five categories according to the Salter-Harris Classification.
First aid is a complicated subject and it is situation-specific. First aid is the help and medical assistance that someone gives, not only to an injured person, but to a person who is sick. Preparedness is a key element of first aid, like having basic medical emergency kits in your home, car, boat, or RV. Cuts, puncture wounds, sprains, strains, nosebleeds are one type of injury that may require first aid; heart attacks, strokes, seizures, and heat stroke are examples of more critical first aid emergencies.
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