Fast Five Quiz: Frostbite and Hypothermia

Richard H. Sinert, DO

Disclosures

December 03, 2020

First-degree frostbite has the following characteristics:

  • Nonsensate, central, white plaque surrounded by a ring of hyperemia

  • Epidermal involvement

  • Mild edema

Sequelae over the next few weeks include desquamation, transient swelling and erythema, and cold sensitivity.

Second-degree frostbite has the following characteristics:

  • Full-thickness skin freezing

  • Clear blister formation with surrounding erythema

  • Hard outer skin but resilient tissue underneath

  • Substantial edema

Blisters contain high amounts of thromboxane and prostaglandins. They contract and dry within 2-3 weeks, forming a dark eschar that sloughs off in 4 weeks, leaving poorly keratinized skin that is easily traumatized. Sequelae include paresthesias, hyperhidrosis, and persistent or transient cold sensitivity.

Third-degree frostbite has the following characteristics:

  • Subdermal plexus freezing

  • Hemorrhagic blister formation

  • Blue-gray discoloration of the skin

  • Deep burning pain on rewarming, lasting 5 weeks

  • Thick gangrenous eschar formation within 2 weeks

Read more about the physical examination findings associated with frostbite.

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