Frostbite and Hypothermia – A Runner’s Approach to Diagnosis, Treatment & Prevention

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If you are a runner residing in Kona, Las Vegas or Palm Beach, this might not be the article you need to read. Your interests may be better satisfied with a piece about heat exhaustion or sunburn instead of this topic.  This article will focus on the exact opposite concerns which are faced by those running, living or spending time in cold conditions.  Frostbite and hypothermia are issues for runners in all areas that dip below freezing, not just for those trekking around Anchorage.

Remember it was hypothermia that ultimately ended Jack Nicholson’s character’s run at the end of The Shining. He was running for a different reason than you are, but still keep in mind running or strenuous active movements in cold conditions can’t be a hasty decision. No matter how experienced someone may be in frigid conditions, there needs to be plenty of preparation when going out for a winter-like run.

The following content will make novice to veteran runners more familiar with the conditions that can create frostbite and hypothermia. It will also offer information on the symptoms, treatments, and preventive measures.

What is Frostbite and Hypothermia?

When body tissue falls to the point of freezing, it becomes frostbite. The frozen tissue, which is usually skin, arises because there is a contraction of blood vessels which reduces oxygen and blood flow to the impacted areas.  This lack of blood flow creates the commonly thought of image of frostbite: color changes to the skin and tissues. For the person suffering from frostbite, pain evolves from a dull, aching feeling until all sensation is gone.

The areas of the human body often impacted by frostbite are toes, feet, hands, fingers, ears and nose. These spots are the danger zones of a cold weather injury since they are furthest away from the heat of the body’s core.

As exposure to cold weather increases, so do the chances of its more harmful effects. The same holds true for repeatedly being exposed to freezing temperatures and then being forced to thaw out quickly out of medical necessity.  Research shows that men are most likely to get frostbite than women and the chances of being stricken with it decrease after 65. The correlation with age is likely related to older, less active people not putting themselves in a position to get frostbite compared to those younger.

Certainly runners and bikers, of all ages, that continually work out in cold environments can become a victim to frostbite. More commonly, it is a work related problem for those with outdoor occupations. Frostbite is a considerable risk for soldiers, sailors, fishery and agricultural workers, as well as, those in the trades and manufacturing.

 

Both professional and recreational mountaineers are another high risk population for frostbite. Cold, rain and wind in high altitudes certainly puts someone at risk for frostbite no matter how much mountain experience they have garnered over the years.

What is a Hypothermia? 

Another severe cold weather injury with possible life threatening implications is hypothermia. When the body’s normal temperature of 98.6 Fahrenheit quickly drops under 95 F, it creates such a low amount of energy that internal body heat cannot be created fast enough to fight off the impending hypothermia.  A human body unable to maintain a healthy temperature opens up the possibility of weakened organs (hearts and lungs) and a damaged nervous system.

These issues, if not treated quickly, can lead to death. This is why the cold weather injuries of frostbite and hypothermia are so related to each other. There is a life threatening progression between the two.  When someone unwillingly encounters an instance of hypothermia because of exposure to frigid temperatures that is considered accidental hypothermia. For medical purposes, doctors sometimes need to lower a patient’s body to 95F. In that case it is called intentional hypothermia.

Just as with frostbite, those likely to fall into a case of hypothermia tend to be outdoors men. People such as climbers, hikers, fishermen – are those who can possibly fall through ice and be submerged into cold water or also could be stranded outside for an extended period of time. Being in frigid water for only seconds could lead to hypothermia.

According to the Center for Disease Control, from 1999 to 2002, a total of 4,607 death certificates in the United States had hypothermia-related diagnoses listed as the underlying cause of death or nature of injury leading to the underlying cause of death.  Looking at the frequency of hypothermia within particular states, Alaska, Wyoming and Montana are high on the list of the most cold related deaths from 1999 to 205. In Missouri, since 1979, there have been 569 deaths due to hypothermia.

 

What are the Stages of Frostbite?

Frostbite tends to be the catchall word people use when describing cold weather injuries. There are different levels of frostbite and other significant ailments. All of the following pertain to runners who may be negatively affected by either short bursts or long runs in the cold.

Frostnip – essentially this is a less severe case of frostbite. Instead of the person losing feeling or having his or her skin turn blue, those inflicted by frostnip do encounter pain to the touch since it’s only the top layer of the skin that is frozen. The skin will look yellowish or white if there is frostnip.

If you have a track-record of running in the cold, it is possible you had a case of frostnip.


Frostnip on the hand

Superficial frostbite – the next stage in frostbite is when there is a greater amount of cold weather damage to the tissue or skin. At this point the skin hardens and tends to feel frozen. If treated quickly and effectively this level of frostbite may not lead to any damage. Once the person is warmed, skin can start to blister and become red. Hopefully this will be the full extent of any damage.

Deep frostbite – the highest and most concerning stage of frostbite. Now the skin is turning blue and the freezing is delving deeper into the body as it goes into muscles, tendons, nerves and as deep as the bones. Once skin exposed to deep frostbite warms, there is often the appearance of painful black blisters.

Chilblain (also known as perino, perniosis, Chill Burns) – occurs from over exposure to cold and humidity. This exposure causes damage to capillary beds. Chiliblain is often mistaken for frostbite (often in the toes and fingers) and tends to inflict those with a predisposition or existing serious medical issue.

Trench Foot – Was seen throughout World War I because soldiers with poorly fitting boots were over exposed to cold and moisture in the trenches throughout Western Europe. Today, it is a problem for homeless people living in cold and damp areas. In the case of trench foot, the injury is centralized in the feet and toes, which become swollen and numb and then covered by bleeding blisters.

Any tissue that has died because of the cold weather and not taken care of properly will lead to gangrene and may require a doctor to remove it professionally.

On a less severe note, runners who are active in cold situations can encounter a freezing cornea or frozen eyelashes.

Symptoms of Frostbite and Hypothermia

There are a range of frostbite symptoms that mirror the progression of the injury from the beginning, superficial stages to the much severe deep stages.  At the first onset of frostbite, there will be a cold sensation, tingling then will move on to numbness. The superficial frostbite will also make the skin white and somewhat frozen to the touch.

For runners conditioned to deal with pain, frostbite can be a deceptive injury because they might not feel the tissue worsening. Running in the cold is not the best place for a runner to practice the mantra of “mind over matter.” Cold weather runners must listen to their body and the elements.  If the frostbite worsens and goes into a deeper stage, all sensation in the skin is gone. The skin will become yellow and waxy-like and have a wooden feel to it. Once the skin is warmed up, the yellow skin will become blue and then later black when the tissue dies.

The warming-up phase after damaging cold weather exposure helps determine if its frostbite and the level of it. Once a person is warmed up and the blood starts to flow back at a normal pace, the area will become extremely painful. Any aches will then become throbbing patches and last for a string of days and weeks.

Once the heat is brought back into the body and the affected appendages warm, a doctor will be able to determine the amount of injured or dead tissue.

Breakdown of Symptoms:
*After being exposed to cold weather, skin starts tingling then becomes numb
* Skin will feel frozen and become white
* If condition worsens, skin turns yellow then blue and possibly black
* Once the body is warmed back up, numb skins becomes very painful
* Pain in the impacted tissue can last for days or weeks


Symptoms of Hypothermia

Just like with frostbite, there is a progression of symptoms with hypothermia that indicate its severity. Since a case of accidental hypothermia will likely happen without the opportunity to immediately take the person’s internal temperature, it is important to understand these symptoms in conjunction with exposure to cold elements.

During the onset of hypothermia, symptoms include shivering that won’t stop, bright red skin, fatigue, drowsiness, nausea, increased and fast paced breathing, and confusion.  If someone experiencing these symptoms is not helped or removed from a cold temperature/water, then it becomes a life-threating scenario. The person will become extremely confused, unable to speak and then will stop shivering. This is then followed by slow breathing and a lack of consciousness that can ultimately end in a coma.

Breakdown of Symptoms:
* Shivering
* Bright red skin
* Drowsiness
* Change in breathing pattern
* Confusion
* Shivering stops and the person loses ability to communicate
* Loss of consciousness

What Makes the Body Lose Heat?

Most often the body loses radiated heat from unprotected areas. This why wearing hats and gloves in the cold is so important – it keeps the radiated heat from escaping.

Another reason the body loses heat is from direct contactcoming in close contact with something very cold, such as water, will immediately sap heat from a person’s body. Direct contact with wet clothes will speed the heat up from leaving the body. Finally, wind is a factor in body heat loss since the wind helps to remove the thin layer of warm air that protects the skin.

Causes of Frostbite and Hypothermia

For runners or anybody in general, frostbite is caused from over exposure to cold conditions. What amounts to how much time equates to over exposure varies between individuals. During stints out in the cold, skin and body tissue can be damaged to the point of frostbite. While it is most common to experience frostbite in the ears, nose, hands and feet, it can affect any part of the body.

Hall of Fame NFL quarterback Dan Fouts to this day still feels the lingering effects of frostbite in his fingers and toes after playing a game in Cincinnati with 59-below-zero wind chill back in 1982. There are some variables than increase a person’s chance of becoming inflicted with frostbite. Certainly smokers and those with diabetes are at risk of frostbite because of what both do to blood flow within the body. There is a similar concern for those who take beta-blockers and drink alcohol.

Someone who has Raynaud phenomenon is also at a higher risk of frostbite. Raynaud phenomenon is a lesser known condition that features poor blood flow to the ears, nose, toes and fingers because of cold weather. From a physical standpoint, frostbite results from the body narrowing blood vessels in response to cold temperature stimuli. That defensive mechanism then limits blood flow to extremities.  Body parts with less blood flow can then get dangerously cold and create a situation where tissue can freeze. Resulting ice crystals inside the body can lead to cell and tissue damage.  The tissue will die if there is no restoration of blood flow into the affected region.

Causes of Hypothermia

Hypothermia is usually the next step after severe frostbite so the causes between the two are similar. Essentially hypothermia becomes a significant concern when the body loses heat faster than it can create it. Hypothermia can be caused by traumatic exposure to cold weather/water, but it can also occur from prolonged exposure to frigid conditions.

A fisherman or boater falling into freezing water is probably the most common scenario someone could envision as a cause for hypothermia. However, wearing inappropriate clothing in cold weather or not changing out of wet, damp clothing can also trigger the onset of hypothermia.

The very young and old are most susceptible to hypothermia. Alcohol and drug use can also increase the chances of suffering hypothermia. Alcohol might make a person feel warm internally; however its intake not only impairs judgement but it makes the blood vessels expand which leads to more heat leaving the body. Some antidepressants, antipsychotics, and narcotics also negatively impact the body’s ability to regulate its heat.

Diagnostic Practices for Frostbite and Hypothermia

Someone suspecting a case of frostbite needs to see a physician so the impacted skin and tissue can be professionally examined. Pressure or massage should not be administered on the injured area, but if possible, wrap it in sterile gauze pads. Also, wet clothes and tight fighting jewelry should be removed.

Drinking warm beverages will help replace lost fluids.  A health care professional will attempt to warm the tissue by immersing it in warm – not hot – water. This step is important to prevent hypothermia. The recommended temperature for a warm water bath to combat frostbite is between 104-105.8 degrees F. Unfortunately for the victim, this initial step in the process can be painful.

Often a physician will look for symptoms of dehydration when looking at frostbite cases. The vital signs the doctor will focus on are temperature, pulse and blood pressure. Perhaps after a few weeks, the doctor will ask for X-rays but that does not normally happen during an initial diagnosis.  The level of frostbite is judged by the doctor based on the appearance of skin color, an icy texture to the touch, sensation felt by the victim and the severity of blood blisters.

Diagnostic Practices for Hypothermia

After the person is changed out of wet and cold clothing, warmed up, a doctor will take the patient’s internal temperature to determine if it has fallen under 95F. Some cases of hypothermia have lowered a body temperature to 82 degrees F.

As with frostbite these initial diagnostic steps allow a medical professional to determine the level of hypothermia. The levels of hypothermia based on body temperature are as followed: mild hypothermia is 89-95 degrees F; next is moderate hypothermia at 82-89 degrees F; and finally severe hypothermia at lower than 82 degrees F.  If a person is shivering without voluntary control, that is a sign of mild hypothermia. Rigid muscles are a sign of severe hypothermia. Experts in hypothermia say to watch out for the fumbles, stumbles and mumbles signs. A person loses control of his body and thinking when the core temperature falls near hypothermia levels.

Treatment for Frostbite and Hypothermia

The most ideal way to warm up a person’s suffering from frostbite would be done in a whirlpool that has an antiseptic added into it. Using a bath for warming purposes should last for 30 minutes and be done multiple times per day until the wounded area shows signs of healing. In this case, healing will be seen as improved skin color and the growth of new skin.

When pain becomes an issue, a prescription for opiates or morphine may be used. If the pain does not reach the level where narcotics are needed, ibuprofen is the best option.  Also, antibiotics will be needed to ward off any resulting infection.  In the most severe cases, a burn specialist will be needed since frostbite has many of the same complications as a burn from a high temperature. To combat clots forming in the frozen blood vessels, a doctor may need to use thrombolytic therapy, and inject medicine directly into the affected area. Iloprost, which widens blood vessels, is another common medicinal approach to frostbite.

Research shows the use of thrombolytic therapy and the use of Iloprost provides the best results if administered within 24 hours of severe cold exposure.  The final and least desirable treatment is amputation (or debridement) to the injured body part(s) and tissue. This would be most likely done on toes and fingers. However, doctors will be extremely conservative with amputation and will wait for weeks/months to make a decision in hopes there is some level of healing occurring within the tissue.

A person who suffered any levels of frostbite should expect months of follow-up visits with the doctor.  There are commonly long term effects of hypothermia such as increased sensitivity to cold weather, chronic pain, sensory loss, excessive sweating, arthritis, stiffness or numbness. The pharmaceutical option to combat the after-effects of frostbite is amitriptyline.

Treatment for Hypothermia

The first step in treating hypothermia is to rewarm the body to both conserve the heat left in it and replenish the energy it is burning to create more internal heat. A shivering person has the ability to rewarm the body at a rate of nearly 2 degrees C each hour.  Since hypothermia may result in loss of consciousness, cardiopulmonary resuscitation (CPR) may be necessary. Under a doctor’s care, warmed IV fluid can be used along with heated humidified oxygen.

Someone who is conscious should be given both liquids and solids to help create warmth and heat. Hot liquids (warm water and sugar), carbohydrates, fats and sugars can create heat surges in the body. Coffee since it contains caffeine and is a diuretic should be avoided.  A hypothermia wrap made out of a sleeping bag is another technique to help keep the person as warm as possible. The best sleeping bag (which must be dry and free of any moisture) is one with a polypropylene layer to it since it will keep sweat off the skin. Chemical heat packs and hot water bottles can also provide immediate and necessary warmth to a hypothermia victim.

Prevention of Frostbite and Hypothermia

Ask yourself, do you need to be outside? Do you really need to run in weather that is so cold? Is there another physical activity you can do indoors instead of running in dangerous elements?

Deciding whether or not to go outside for a run in the cold can’t be gauged solely on the temperature, it should be done on the wind chill factor. If you must be outside in freezing temperatures, then dressing accordingly is the best way to prevent frostbite. However, hats and gloves are not fool proof methods. In fact mittens are better to wear when outside and running since they trap heat within the bunched fingers than gloves.

For runners, there is usually an unwillingness to remove themselves from the elements, for those who are often stricken with frostbite, it is an inability to remove themselves from the elements. Most cases of frostbite come from homeless people, those who abuse and misuse alcohol and drugs, or those involved with car accidents/breakdowns. That is why it is imperative to pack extra clothing and blankets in a car trunk – especially those living and traveling in cold weather locations.As for another reason not to smoke or drink alcohol, those engaging in these activities increase their chances of frostbite because of the impact they have on blood flow.

Not just runners, but all those braving cold conditions should dress for the weather. That means dressing in multiple layers and clothes should be loose fitting within layers to prevent any restriction of the blood flow. You want cold weather work-out gear that wicks away sweat. A windproof jacket (Gore-Tex) and running pants provide the best outer layer.

Waterproof shoes and sneakers should protect the feet along with multiple pairs of socks. The first pair in contact with the feet should be composed of a synthetic fiber to help take sweat away. Try to make the outer sock a woolen one and avoid cotton socks all together in the cold. There needs to be coverage on the head (thermal hat made of wool or fleece), ears and nose. Many retailers offer effective cold weather face shields and neck gaiters.  Skiers often wear neck gaiters to protect their neck and face, so it can be used for runners as well.

Also, a balaclava, or ski mask, is a good defense to use when working out in the cold.  A balaclava is made of wool or fleece and covers the entire head with only part of the face and eyes exposed.

Balaclava

If your face is exposed don’t forget  how much medicinal value your grandmother placed on Vaseline. A liberal dose of Vaseline on the lips, nose and face combats chapping and windburn.

Finally, wearing goggles or at least sunglasses will help protect the eyes from cold weather and wind.

Prevention of Hypothermia

Much like with frostbite, preventing hypothermia is based on making the proper cold weather decisions. First, do you need to be out in the cold and putting yourself in jeopardy of hypothermia? There should also be caution about the use of alcohol and smoking in cold weather situations.  Don’t just laugh off someone shivering in the cold as a sign of weakness. Stay alert to shivering as it is a primary step in the hypothermia process and should lead a person right back into a warmer environment.

Layered clothing and Gore-Tex exteriors will help with wind and water/snow. If someone needs to be outside in hypothermia conditions, extra warm and dry clothing must be immediately accessible and used.Keep in mind the acronym of COLD — cover, overexertion, layers, dry – to protect against hypothermia or other severe cold weather injuries. The overexertion relates to sweating in cold weather and creating harmful moisture on the body and clothes.

Since hypothermia is a considerable risk for fisherman and boaters out on cold water, life jackets must be mandatory worn on the body at all times. No matter how experienced of a swimmer a person is, the life jacket will help someone who has fallen into cold water conserve energy and body heat.

Because of the dangers of the cold, a person should not be alone outside running, boating or doing another other similar activity. Having a partner provides safety and the ability for someone to get help if needed. A companion can also provide body heat by huddling close to each other if needed.

If someone is running alone and becomes injured or stricken from the cold, he or she could pack dry leaves or other dry debris inside clothing to help create another layer of warmth until help can be arranged.

Conclusion

Frostbite and hypothermia are serious injuries that result from overexposure to cold temperatures. There are different levels of severity for both frostbite and hypothermia. In the most severe cases of frostbite there can be amputation of an appendage, and death is a possibility with the highest level of hypothermia.

Runners must use their best judgement when doing a cold weather workout. No matter the amount or experience running in cold weather does not make someone immune from frostbite.  If someone must go out for a run in winter-like situations, proper clothing on the face, hands and feet are the best ways to fight off frostbite.

With the information presented in this article, you should be able to identify the symptoms of frostbite and hypothermia, and prevent it from becoming a serious injury.

Stay protected and keep on running!

Some of the Sources Used while Conducting our Research

The sources cited in this article are from reputable sources with information from medical professionals, you should not take the information in this article as professional medical advice. Consult a doctor before trying anything listed in this article.

 

Sources

  1. Web MD Staff, Understanding Frostbite -- the Basics, WebMD, May 11, 2017
  2. Mayo Clinic Staff, Hypothermia, Mayo Clinic, May 12, 2017
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