Extreme Cold and Injuries – Signs of Frostbite and Hypothermia

With extreme temperatures setting in this weekend comes the severe risk of cold-related injuries. We spoke with Mark Fitzgerald, MD, with Milford Regional Physician Group about the cold-related injuries he sees in urgent care and how to prevent them.

What are the most common cold-related injuries you see in the winter?

“In urgent care winter is an interesting season for us, where we see a lot of cold-related issues coming in. I always like to put into perspective that far and wide, the most common thing we see a lot of is falls on ice. And especially with a mild winter like we’ve had so far, you get a lot of the rapid thawing and freezing. A lot of people have been hit with unexpected falls on ice this year and so we’re getting a lot of visits for injuries. That’s one of the big things I see most commonly. It’s one of the things we see a lot of in urgent care. Whether it’s extreme cold or mild cold, I ask people to be as careful as they can when they’re going outdoors.

When it comes to the extreme cold like we have coming up, we ask people to be very cautious because it’s so easy to get injured from extreme cold and not even realize it’s happening. Things like frostnip and frostbite get much more prevalent as we hit extreme cold temperatures like we’re going to hit over the weekend. It can set in and people can not even realize it’s happening. The biggest thing I stress to people is that the best prevention is staying indoors as much as you can, not exposing yourself to the extreme temperatures unnecessarily. But times when people do want to, I tell them it’s really important to dress in multiple layers, not just necessarily one thick layer which can kind of deceive how warm you’re feeling. It’s most important to guard the parts of your body that are most prone to cold injury, your face, cheeks, nose, fingers and toes.

How can people not feel frostbite onsetting?

What can fool people is a lot of times is that when you’re out in the cold for a while you’ll start to notice your hands and feet turning numb, feeling cold, and sometimes feeling sore. But from that point they can progress and get worse, and frostbite and frostnip can set in. And because they’re already cold and numb, you won’t notice that you’re kind of getting worse after that point in time. When it’s cold, but not extreme cold, you have a wider margin of error where if you’re not sensing how cold you are, your body can still kind of tolerate that. But when it’s really cold, those injuries can progress much more quickly and you have a much smaller window to be able to take care of them before they cause harm to the body that’s much harder to repair. 

What’s the window for exposed skin getting frostbite in the cold?

The window can be a few short minutes. And there are even some cases where if people have touched cold metal objects outside in extreme cold, they’ve developed frostbite within a minute just from the contact of that cold surface. Barriers to that cold are so important, especially for prone parts of the body like the fingers. There’s been a lot of suggestion recently that things like mittens are better options than gloves, just because you can still lose a lot of heat to a glove because of the fingers being individually protected, whereas a mitten gives you the ability for your fingers to be closer together and retain heat better. 

What are the signs of hypothermia?

Hypothermia very similar to frostbite, where people are going to be much more prone to developing hypothermia when it’s so cold. As we’ve all experienced, you can feel when you’re getting cold, but your body does reach a point where it loses its ability to sense exactly how cold you are, and that’s when it gets dangerous. It’s very akin to things like heat stroke when people lose their ability to sense how hot they are in the summer. But there gets to be a point where your body has to compensate for the extreme cold by shutting off smaller blood vessels and trying to pull your heat into your core. And what that can do is it can make people feel warmer than they are. You may be outside, you may be shoveling, you may be just walking around, and you may actually start to feel warm and feel like you need to shed layers. That’s what’s so contradictory and deceiving about hypothermia, is it can trick people into getting worse by making them think they need to shed a layer because they feel so warm. Medically, we define hypothermia as when your core temperature is reaching 95 or below. When people are reaching that stage, it really is hard for them to assess on their own how cold they are and what their risk of hypothermia is. 

What do you advise for this kind of weather?

We often advise people in urgent care to be careful with their own bodies in the extreme cold, but also to be very cautious about their environment and make sure that they’re using safe heating sources at home. We do occasionally get visits for people who have carbon monoxide poisoning or injuries from heaters. We want to make sure that people are using appropriate heating sources that can be used indoors and make sure that they’re using them safely as well.