Posted by Forrest Brownell on August 05, 1997 at 17:40:35:
In Reply to: WH - Frostbite posted by Phil Winterbourne on August 05, 1997 at 14:24:26:
Frostbite seems a very distant possibility just now, but a glance at
the calendar tells me that, within six months' time, I'll be waking
to -40°F (-40°C) temperatures, so perhaps the possibility isn't so
remote after all.
Phil Winterbourne's father was right to question the doctor's advice
in Winter Holiday: rubbing with snow is not an accepted
treatment for frostbite. Indeed, the current fashion in medicine has
moved on still further: rubbing of any sort is now discouraged, though
'frost-nip' (the preliminary blanching of tissue which often precedes
deep freezing) can be treated by holding a warm hand against the
affected area, without rubbing.
The currently-accepted definitive treatment for deep frostbite, as
outlined in James A. Wilkerson's Medicine for Mountaineering,
4th Edition (1992), involves rapid rewarming in a temperature-controlled
(100°-108°F or 38°-42°C) water bath. Such treatment is best carried out
in hospital. In almost all circumstances, therefore, the best course
for a wilderness traveller is to 'walk out' to care, even if this
entails walking on a frozen foot.
Only if circumstances make this impossible-- if for example, the victim
is on an extended wilderness expedition in a truly remote location, or,
if an American, he lacks medical insurance -- should rapid rewarming be
attempted in the field or at home, and then only after taking every
precaution to avoid further injury to the rewarmed tissues.
I'd recommend most strongly that any reader who thinks he might find
himself in such a situation get Medicine for Mountaineering and
study pages 310-313 carefully, well in advance of need. On the one
occasion when I had to deal with frostbitten toes, I was very glad that
I had done so.
A caution born of my own experience: the pain on rewarming and
immediately afterward is, quite simply, excruciating. Have a thick
cloth pad handy to bite down on, or risk broken teeth.
The best treatment for frostbite, of course, is prevention:
no smoking, ample food, copious fluids and adequate clothing being the
essential elements.