Frostbite

The ears, nose, and cheeks, in that order, are most at risk for frostbite. Exposure to subfreezing temperature is the main risk factor, but wind chill also greatly affects heat loss from the skin by convection. Protective clothing greatly diminishes the risk.

There are three grades: grade I frostbite, in which the skin is erythematous and edematous; grade II frostbite, in which the skin blisters and forms bullae; and grade III frostbite, which results in local necrosis of the dermis over 1 to 2 weeks. To assess the severity of frostbite, the physician must examine the tissue from several hours up to 2 days after the typical skin blanching occurs.

Treatment consists of quickly warming the ear with gauze soaked in saline at 38° to 40° C (100.4°-104.0° F). Any blisters that form should be allowed to reabsorb spontaneously. Topical antibiotic ointment can be applied, and viability of the tissue should be assessed periodically.

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