Cold exposure below freezing can cause local injury due to hypothermia. Cold burns or frostbite particularly impact exposed areas but potentially any area of the body. Fingers, ear lobes and toes are particularly susceptible to these types of injuries. Skin freezes at -2°C (28°F). Depending on how long the skin remains at that temperature will influence the degree of damage. Superficial frostbite injuries can either be second or third degree depending on depth. Deeper frostbite injuries can involve the joints, bone, and muscle tissue. Ulceration and gangrene can occur with deep third degree or deeper injuries. Unlike burns, which frequently cause the person to withdraw from the heat source, the exposure to cold can continue. Thus frostnip needs to be taken seriously because it can progress to full frostbite including all the complications (27,32,33,34).

Frostbite injuries are generally treated much by rewarming with warm, but not hot, water to minimize the tissue effects. Local care, antibiotics, debride-ment, and, in severe cases, reconstruction, may be necessary for appropriate treatment of frostbite injuries. As in the case of burns, fluid replacement is important, especially in blistering forms (35,36).

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