What to know about frostbite and hypothermia

David Schaffer, MD

Emergency Medicine | Medical Toxicology

It doesn’t happen often in South Carolina, but when frigid temperatures hit, so can cold weather injuries like frostbite and hypothermia. Emergency medicine physician David Schaffer, MD, answered some important questions about injuries that many South Carolinians are less familiar with.

Do frostbite and hypothermia actually happen in South Carolina?

“We’re not used to thinking about things like hypothermia and frostbite in the southeast United States, but it does happen,” Dr. Schaffer said. “One of the things that surprises people is that hypothermia does not just occur in the winter. It can even occur in the summer months. Many cases of hypothermia that come into the emergency department happen when the ambient temperature outside is around 50 degrees, which is not something you’d expect.”

This is because moisture is the biggest risk. If you get wet while out in the cold, even in temperatures in that are in the 40- to 50-degree range, you are at risk for hypothermia. Protect yourself by wearing quick-dry clothing made from polyester or nylon instead of cotton on the layer closest to your skin. Also wear extra layers, as well as gloves or mittens and earmuffs.

“Extremities like the hands, fingers, toes and ears are most exposed to frostbite,” Dr. Schaffer said.

What are the symptoms of frostbite?

Early signs of frostbite can include numbness and tingling in the hand, foot, toes, nose or ears.

“This can progress into pain or discoloration of the skin,” Dr. Schaffer explained. “The skin may start to turn purple or white in some people, or even a dark color.”

If this happens, it’s important to warm that extremity as soon as possible.

What should you do if you think you have frostbite?

If you think you have an extremity that’s at risk for frostbite (or the milder version, called frostnip), try to find a way to get that extremity warmer using your body, such as putting your hand in your armpit to warm up your hand, and try to get somewhere warm. Moist heat, such as warm water, is best. Don’t use hot water or put it up next to a hair dryer, heating pad or furnace.

“Avoid rubbing or massaging the hands or fingers to warm them up,” Dr. Schaffer warned. “Also, you don’t want to get the extremity warm and then immediately get it cold again. If you need to go to the hospital and you have to get that extremity cold again before you get there, then hold off on exposing it to heat.”

This type of cycle puts your extremity more at risk for amputation.

What are the signs of hypothermia?

Hypothermia occurs when the body’s temperature drops below 95 degrees Fahrenheit. Early signs of hypothermia can be hard to recognize but typically include:

• Intense shivering
• Exhaustion
• Confusion
• Slurred speech
• Memory loss
• Drowsiness
• Fumbling hands

Dr. Schaffer said the elderly and small children are most at risk for hypothermia.

“Small children in particular are not as good at preserving heat as adults,” he explained. “They may not be able to tell you they’re cold or even appear cold. They may not be shivering or be less responsive, as you might think someone with hypothermia would be. If you’re taking your kid out in the stroller for a walk, they need to have a hat and gloves on.”

Older adults with chronic conditions can also have significant problems from the cold temperatures.

What are some chronic conditions that are sensitive to cold weather?

People with lung conditions such as asthma, COPD emphysema or chronic bronchitis can often see an increase in lung problems during cold weather. The cold air can cause a spasm of the small airways in the lungs that can make it harder to breathe and increase cough. Air pollution levels also rise in the winter which can exacerbate asthma or COPD symptoms.

People with chronic heart disease also often experience worse symptoms during cold weather, but not necessarily because of the weather itself. Instead, it’s due to the activities that typically occur in cold weather, such as shoveling snow, which could trigger a heart attack.

“The most important thing is to recognize signs and symptoms that would warrant a call to 911, especially if you have a history of heart disease,” Dr. Schaffer said.

Look for symptoms such as chest pain or pain that radiates to one of the shoulders or down the arm. It’s also common to have a numb or tingling feeling in the arm or neck.

“Those types of symptoms absolutely cannot be ignored and need to be seen in the emergency department immediately,” he said.

Should everyone avoid strenuous activity during extreme cold?

“You don’t have to necessarily avoid strenuous activity just for cold weather,” Dr. Schaffer said, “but I do think that proper preparation is important. For instance, if you’re going out for a run during 20 degree temperatures in a T-shirt and light sweater, you may want to consider how far you’re running from the house in case something happens.”

Get additional cold weather tips here on Flourish.