Jan 13, 2017

Announcer: Is it bad enough to go to the emergency room, or isn't it? You're listening to "ER or Not" on The Scope.

Interviewer: Time for another episode of "ER or Not." That's where we give you a scenario and you get to play along and decide whether or not you think that this is something worth going to the emergency room for. Dr. Troy Madsen's an emergency room physician from University of Utah Health Care. Today's "ER or Not": frostbite. Let's say the scenario is somebody's out shoveling their driveway, a particularly heavy snow, out for a long period of time using the snow blower or whatever, think they might have frostbite. ER or not?

Dr. Madsen: So frostbite would be a reason to go to the ER. And the reason I say that is because this is the sort of thing where if it's severe frostbite and it's not treated appropriately, it can really put you at risk of potentially losing a finger or a toe, sometimes even a little bit more than that, depending on how extensive this frostbite is.

So as you mentioned, you always hear about these cases in the news of people being trapped in the wilderness and getting frostbite there. And now and then, we'll see those sorts of things, but for the average person, the times frostbite happens are exactly like you mentioned. It's often early in the season, really cold weather, you get a big snowstorm, someone gets out there, maybe they're not dressed adequately for the cold. They're out there shoveling snow for an hour or whatever period of time to get that driveway cleared off, it's cold, their feet are getting cold.

Interviewer: Maybe even like a wind chill going on.

Dr. Madsen: Yeah, a little bit of wind chill, as well, and then they come inside. You know, their toes are numb out there. They figure, "Okay, I'm in the cold. Yeah, my toes are numb." They come inside, and then their toes are still numb and then just really, really, really start to hurt. And they look down at their toes, they look like they're not getting a lot of good blood perfusion. Maybe they're just like this kind of whitish color to them.

Those are all signs of frostbite, and that's really classically the kind of frostbite cases we see. It's not like we see this all the time, but when we see it, that's often what we see, the average person just out there or something, just thinking, "My hands are cold, my feet are cold," ends up being something much more serious.

Interviewer: Normally feet? Normally hands? Normally extremities?

Dr. Madsen: Most cases I've seen have been feet.

Interviewer: Okay.

Dr. Madsen: And certainly, you can see . . . but for whatever reason, it's been feet that I've seen most of the serious cases on. So, again, the reason to come, to make sure we get that area rewarmed, which we do by just continually circulating, putting that foot in lukewarm water, continually circulating water through there to get it rewarmed, get it back to a normal temperature. It's incredibly painful to go through that process. We'll treat it with pain medication as well, as you're going through it to get that blood perfusing back into those toes.

Oftentimes, we have to get our burn doctors to take a look at these areas if it's severely affected to get their input in terms of the care of the wounds there. But it can be a serious thing and a reason to go to the ER.

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