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Cover up: Frostbite can do more than nip at fingers, toes and nose, doctors say

Karl Zebarth, shows off his severe frostbite of the hands he got on New years Eve, at the burn unit at Sunnybrook Hospital in Toronto on Thursday, January 9, 2014. THE CANADIAN PRESS/Nathan Denette
January 13, 2014 - 8:41 AM

TORONTO - It seemed to Karl Zebarth like a good idea at the time: he had just left a friend's New Year's Eve party and decided to dash through the park to his nearby home in Georgetown, Ont., a quick shortcut taken before without incident.

But Zebarth, dressed only in a light sweater and jeans, slipped on the slick surface left by the pre-Christmas ice storm and cut his hands, which he'd thrown out to break his fall.

He couldn't get up.

"I had drunk a little, but not a lot. It was just the ice," says Zebarth, 24, who was rescued by a young couple walking by who heard his calls for help and summoned an ambulance.

The temperature with the wind chill was close to a frigid -20 C that night, and within minutes frostbite had begun to set in on his gloveless hands.

He was treated for hypothermia and frostbite at a nearby hospital and discharged, but the next day he realized his hands were worse than he'd realized.

"When I got home, my hands started throbbing, the pain was really bad, and I knew something else needed to be done," says Zebarth, who was sent by ambulance to Sunnybrook Health Sciences Centre in Toronto.

"They were terrible," he says of his fingers. "They were very swollen, very colourful — black, purple, yellow — and they were losing a bit of skin. I started getting blisters that started bleeding."

Depending on how low the temperature plunges, frostbite can start developing even within seconds in exposed body parts like the nose, earlobes, fingers, hands and toes, explains Dr. Marc Jeschke, director of Sunnybrook's burn unit, where Zebarth spent a week being treated.

As with burns, there are different degrees of frostbite, ranging from superficial — often called frostnip — to extremely deep freezing that can even destroy bone.

Exposure to bitterly cold temperatures causes blood and other fluids in the tissues to crystallize, "almost like a freezer," says Jeschke.

"At the beginning, it's painful," he says. "We all know this when we go out and shovel snow, all of a sudden it's painful. Then after a while, because of the crystallization and the cold, it has an anesthetic effect. It means you don't feel it."

"So all of a sudden, your warning signs are gone. So then you don't know something bad is happening. When the pain goes away, usually that's a very bad thing."

If someone suspects they have frostbite, they should get indoors and bathe the affected area in lukewarm water — not hot, as that can cause more damage — and take ibuprofen for pain and inflammation, says Jeschke.

Avoid exposing frostbitten areas to direct heat from a stove, heating pad or fireplace, as that could cause burns to skin that has lost sensation.

"Anything that's of major concern, persisting, and all of a sudden you have blisters, red skin, white skin, yellow skin, that should be looked at in an ER," he says. "Basic black means that the tissue is dead."

While frostbite can result in amputation, the condition has a much better regenerative capacity than serious burns, and doctors start with less aggressive treatment.

That includes first warming the patient with special blankets and perhaps warm intravenous fluids, covering the skin with aloe vera and applying antibacterial agents to ward off infection.

"If there's no infection, it can heal back up," says Jeschke. "That's the beauty of a frostbite."

But in severe cases, frostbite can lead to complications, from gangrene requiring amputation to organ failure from the body's inflammatory response to sepsis from unchecked infection. "You can actually die from it," he says.

But, of course, prevention is the best medicine, Jeschke stresses.

"Don't do anything stupid, be cognizant," he says. "Put lots of layers of clothes on, protect your face, wear hats. Don't go swimming and stand outside with wet hair, which increases conduction."

One patient who was admitted to the unit last year was pumping gas into his vehicle without wearing gloves and spilled gasoline all over his hands. The temperature was about -10 C and it took only about 10 seconds for him to get frostbite.

"It was ridiculously short because gasoline conducted the cold extremely well. All 10 fingers, both hands and arms were involved. But he luckily healed very nicely," Jeschke says of the man, who was in hospital for two weeks.

More recently, he treated a patient who came in with frostbitten earlobes: he'd been shovelling snow with the thermometer at a bone-chilling -30 C and hadn't worn a hat; another man ended up with frostbite in his fingers after shovelling his car out of a pile of snow with bare hands.

Some people are more susceptible to the cold and in greater danger of frostbite, including children, the elderly and those with circulation problems, doctors say.

Drinking alcohol also can make a person more vulnerable to frostbite if they go outdoors with inadequate winter clothing.

"People get drunk, pass out, or they have a snowball fight while totally drunk and they don't feel it (the cold) because they have alcohol intoxication," says Jeschke.

"You only get frostbite or burned when you're unreasonable, when your brain doesn't tell you: 'Man, I'm doing something wrong or stupid.'"

As for Zebarth, his fingers are healing and he's been given exercises to help recover muscle strength and control. While he's able to move his hands, he doesn't yet know if skin grafts will be needed or whether he has permanent damage.

"I certainly learned my lesson of dressing properly when it's this cold," says the recent Acadia University graduate. "It scared the heck out of me."

"And a lot of college, university kids make the same mistake. I see it all the time, you know, 'I just live down the road. I'm just going to go home. I don't really need a sweater.'"

When the temperature plunges, "you've got to bundle up," Zebarth warns. "You've got to expect the unexpected and just always dress prepared."

News from © The Canadian Press, 2014
The Canadian Press

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