Frostbite occurs when exposure to low temperatures causes freezing of the skin or other tissues. The initial symptom is typically numbness. This may be followed by clumsiness with a white or bluish color to the skin. Swelling or blistering may occur following treatment. The hands, feet, and face are most commonly affected. Complications may include hypothermia or compartment syndrome.
People who are exposed to low temperatures for prolonged periods, such as winter sports enthusiasts, military personnel, and homeless individuals, are at greatest risk. Other risk factors include drinking alcohol, smoking, mental health problems, certain medications, and prior injuries due to cold. The underlying mechanism involves injury from ice crystals and blood clots in small blood vessels following thawing. Diagnosis is based on symptoms. Severity may be divided into superficial (1st and 2nd degree) or deep (3rd and 4th degree). A bone scan or MRI may help in determining the extent of injury.
Prevention is through wearing proper clothing, maintaining hydration and nutrition, avoiding low temperatures, and staying active without becoming exhausted. Treatment is by rewarming. This should be done only when refreezing is not a concern. Rubbing or applying snow to the affected part is not recommended. The use of ibuprofen and tetanus toxoid is typically recommended. For severe injuries iloprost or thrombolytics may be used. Surgery is sometimes necessary. Amputation, however, should generally be delayed for a few months to allow determination of the extent of injury.
The number of cases of frostbite is unknown. Rates may be as high as 40% a year among those who mountaineer. The most common age group affected is those 30 to 50 years old. Evidence of frostbite occurring in people dates back 5,000 years. Frostbite has also played an important role in a number of military conflicts. The first formal description of the condition was in 1813 by Dominique Jean Larrey, a physician in Napoleon's army, during its invasion of Russia.
|Frostbitten toes two to three days after mountain climbing|
|Specialty||Emergency medicine, orthopedics|
|Symptoms||Numbness, feeling cold, clumsy, pale color|
|Complications||Hypothermia, compartment syndrome|
|Causes||Temperatures below freezing|
|Risk factors||Alcohol, smoking, mental health problems, certain medications, prior cold injury|
|Diagnostic method||Based on symptoms|
|Differential diagnosis||Frostnip, pernio, trench foot|
|Prevention||Avoid cold, wear proper clothing, maintain hydration and nutrition, stay active without becoming exhausted|
|Treatment||Rewarming, medication, surgery|
|Medication||Ibuprofen, tetanus vaccine, iloprost, thrombolytics|
Areas that are usually affected include cheeks, ears, nose and fingers and toes. Frostbite is often preceded by frostnip. The symptoms of frostbite progress with prolonged exposure to cold. Historically, frostbite has been classified by degrees according to skin and sensation changes, similar to burn classifications. However, the degrees do not correspond to the amount of long term damage. A simplification of this system of classification is superficial (first or second degree) or deep injury (third or fourth degree).
The major risk factor for frostbite is exposure to cold through geography, occupation and/or recreation. Inadequate clothing and shelter are major risk factors. Frostbite is more likely when the body's ability to produce or retain heat is impaired. Physical, behavioral, and environmental factors can all contribute to the development of frostbite. Immobility and physical stress (such as malnutrition or dehydration) are also risk factors. Disorders and substances that impair circulation contribute, including diabetes, Raynaud's phenomenon, tobacco and alcohol use. Homeless individuals and individuals with some mental illnesses may be at higher risk.
In frostbite, cooling of the body causes narrowing of the blood vessels (vasoconstriction). Temperatures below −4 °C are required to form ice crystals in the tissues. The process of freezing causes ice crystals to form in the tissue, which in turn causes damage at the cellular level. Ice crystals can damage cell membranes directly. In addition, ice crystals can damage small blood vessels at the site of injury. Scar tissue forms when fibroblasts replace the dead cells.
Rewarming causes tissue damage through reperfusion injury, which involves vasodilation, swelling (edema), and poor blood flow (stasis). Platelet aggregation is another possible mechanism of injury. Blisters and spasm of blood vessels (vasospasm) can develop after rewarming.
The process of frostbite differs from the process of non-freezing cold injury (NFCI). In NFCI, temperature in the tissue decreases gradually. This slower temperature decrease allows the body to try to compensate through alternating cycles of closing and opening blood vessels (vasoconstriction and vasodilation). If this process continues, inflammatory mast cells act in the area. Small clots (microthrombi) form and can cut off blood to the affected area (known as ischemia) and damage nerve fibers. Rewarming causes a series of inflammatory chemicals such as prostaglandins to increase localized clotting.
The pathological mechanism by which frostbite causes body tissue injury can be characterized by four stages: Prefreeze, freeze-thaw, vascular stasis, and the late ischemic stage.
Frostbite is diagnosed based on signs and symptoms as described above, and by patient history. Other conditions that can have a similar appearance or occur at the same time include:
People who have hypothermia often have frostbite as well. Since hypothermia is life-threatening this should be treated first. Technetium-99 or MR scans are not required for diagnosis, but might be useful for prognostic purposes.
The Wilderness Medical Society recommends covering the skin and scalp, taking in adequate nutrition, avoiding constrictive footwear and clothing, and remaining active without causing exhaustion. Supplemental oxygen might also be of use at high elevations. Repeated exposure to cold water makes people more susceptible to frostbite. Additional measures to prevention frostbite include:
Individuals with frostbite or potential frostbite should go to a protected environment and get warm fluids. If there is no risk of re-freezing, the extremity can be exposed and warmed in the groin or underarm of a companion. If the area is allowed to refreeze, there can be worse tissue damage. If the area cannot be reliably kept warm, the person should be brought to a medical facility without rewarming the area. Rubbing the affected area can also increase tissue damage. Aspirin and ibuprofen can be given in the field to prevent clotting and inflammation. Ibuprofen is often preferred to aspirin because aspirin may block a subset of prostaglandins that are important in injury repair.
The first priority in people with frostbite should be to assess for hypothermia and other life-threatening complications of cold exposure. Before treating frostbite, the core temperature should be raised above 35C. Oral or intravenous (IV) fluids should be given.
Other considerations for standard hospital management include:
If the area is still partially or fully frozen, it should be rewarmed in the hospital with a warm bath with povidone iodine or chlorhexidine antiseptic. Active rewarming seeks to warm the injured tissue as quickly as possible without burning. The faster tissue is thawed, the less tissue damage occurs. According to Handford and colleagues, "The Wilderness Medical Society and State of Alaska Cold Injury Guidelines recommend a temperature of 37–39 °C, which decreases the pain experienced by the patient whilst only slightly slowing rewarming time." Warming takes 15 minutes to 1 hour. Rewarming can be very painful, so pain management is important.
People with potential for large amputations and who present within 24 hours of injury can be given TPA with heparin. These medications should be withheld if there are any contraindications. Bone scans or CT angiography can be done to assess damage.
Blood vessel dilating medications such as iloprost may prevent blood vessel blockage. This treatment might be appropriate in grades 2–4 frostbite, when people get treatment within 48 hours. In addition to vasodilators, sympatholytic drugs can be used to counteract the detrimental peripheral vasoconstriction that occurs during frostbite.
Various types of surgery might be indicated in frostbite injury, depending on the type and extent of damage. Debridement or amputation of necrotic tissue is usually delayed unless there is gangrene or systemic infection (sepsis). This has led to the adage "Frozen in January, amputate in July". If symptoms of compartment syndrome develop, fasciotomy can be done to attempt to preserve blood flow.
Tissue loss and autoamputation are potential consequences of frostbite. Permanent nerve damage including loss of feeling can occur. It can take several weeks to know what parts of the tissue will survive. Time of exposure to cold is more predictive of lasting injury than temperature the individual was exposed to. The classification system of grades, based on the tissue response to initial rewarming and other factors is designed to predict degree of longterm recovery.
Grade 1: if there is no initial lesion on the area, no amputation or lasting effects are expected
Grade 2: if there is a lesion on the distal body part, tissue and fingernails can be destroyed
Grade 3: if there is a lesion on the intermediate or near body part, autoamputation and loss of function can occur
Grade 4: if there is a lesion very near the body (such as the carpals of the hand), the limb can be lost. Sepsis and/or other systemic problems are expected.
A number of long term sequelae can occur after frostbite. These include transient or permanent changes in sensation, paresthesia, increased sweating, cancers, and bone destruction/arthritis in the area affected.
There is a lack of comprehensive statistics about the epidemiology of frostbite. In the United States, frostbite is more common in northern states. In Finland, annual incidence was 2.5 per 100,000 among civilians, compared with 3.2 per 100,000 in Montreal. Research suggests that men aged 30–49 are at highest risk, possibly due to occupational or recreational exposures to cold.
Frostbite has been described in military history for millennia. The Greeks encountered and discussed the problem of frostbite as early as 400 BCE. Researchers have found evidence of frostbite in humans dating back 5,000 years, in an Andean mummy. Napoleon's Army was the first documented instance of mass cold injury in the early 1800s. According to Zafren, nearly 1 million combatants fell victim to frostbite in the First and Second World Wars, and the Korean War.
Notable cases of frostbite include Captain Lawrence Oates, an English army captain and Antarctic explorer, who died of complications of frostbite in 1912. In 1982, noted American rock climber Hugh Herr lost both legs below the knee to frostbite after being stranded on Mount Washington in a blizzard. In addition, many Mount Everest explorers have lost digits and limbs to frostbite. Beck Weathers, a survivor of the 1996 Mount Everest disaster, lost his nose and hands to frostbite. In 1999, Scottish mountaineer, Jamie Andrew had all four limbs amputated due to sepsis from frostbite sustained climbing the Mont Blanc massif.
Evidence is insufficient to determine whether or not hyperbaric oxygen therapy as an adjunctive treatment can assist in tissue salvage. Cases have been reported, but no randomized control trial has been performed on humans.
Medical sympathectomy using intravenous reserpine has also been attempted with limited success. Studies have suggested that administration of tissue plasminogen activator (tPa) either intravenously or intra-arterially may decrease the likelihood of eventual need for amputation.
Acroosteolysis is resorption of the distal bony phalanges. Acroosteolysis has two patterns of resorption in adults: diffuse and bandlike.
The diffuse pattern of resorption has a widely diverse differential diagnosis which includes: pyknodysostosis, collagen vascular disease and vasculitis, Raynaud's neuropathy, trauma, epidermolysis bullosa, psoriasis, frostbite, sarcoidosis, hypertrophic osteoarthropathy, acromegaly, and advanced leprosy.The bandlike pattern of resorption may be seen with polyvinyl chloride exposure and Hadju-Cheney syndrome.A mnemonic commonly used for acro-osteolysis is PINCHFO.Pyknodysostosis, Psoriasis,
Injury (thermal burn, frostbite),
Collagen vascular disease (scleroderma, Raynaud's),
Familial (Hadju-Cheney, progeria),
Occupational (polyvinyl exposure),
Acroosteolysis may be associated with minimal skin changes or with ischemic skin lesions that may result in digital necrosis.Adirondack Frostbite
The Adirondack Frostbite were a professional ice hockey team in the United Hockey League. They played their home games at the Glens Falls Civic Center in Glens Falls, New York.
UHL action came to Glens Falls in 1999, when the American Hockey League's Adirondack Red Wings disbanded. In 2000, hockey returned to the area with the relocation of the Winston-Salem IceHawks from Winston-Salem, North Carolina to Glens Falls to become the Adirondack IceHawks. The team was renamed Adirondack Frostbite in 2004. In 2004, ESPN SportsCenter anchor Steve Levy and NHL analyst Barry Melrose became the team's owners and the team changed its name to the Frostbite.
On January 13, 2006, head coach Marc Potvin was found dead in his hotel room in Kalamazoo, Michigan hours before his team was to play the Kalamazoo Wings.
The Frostbite suspended operations on June 12, 2006 after the team could not come to a lease agreement with the Glens Falls Civic Center. Professional hockey would not return to the Adirondack region until 2009, when the Adirondack Phantoms (formerly the Philadelphia Phantoms) of the AHL relocated to Glens Falls.Aerosol burn
An aerosol burn is an injury to the skin caused by the pressurized gas within an aerosol spray cooling quickly, with the sudden drop in temperature sufficient to cause frostbite to the applied area. Medical studies have noted an increase of this practice, known as "frosting", in pediatric and teenage patients.Adiabatic expansion causes the gas (with a low boiling temperature) to rapidly cool on exit from the aerosol applier. According to controlled laboratory experiments, the gas from a typical deodorant spray can reduce skin temperature by up to sixty degrees Celsius.The form of injury is freezing of the skin, a type of frostbite. It is highly advised for those who suffer from frostbite to seek medical attention.In rare cases aerosol-induced burns can be severe enough to necessitate skin grafting.Destructible environment
In video games, the term destructible environment, or terrain deformation, refers to an environment within a game which can be wholly or partially destroyed by the player. It may refer to any part of the environment including terrain, buildings and other man-made structures.Early examples include the Taito shooter games Gun Fight (1975) and Space Invaders (1978), where the players could take cover behind destructible objects. An early example of fully destructible environments can be found in Namco's 1982 game Dig Dug, in which the whole of each level is destructible, though enemies can usually only follow the player through a combination of pre-made tracks and paths made by the player. A similar game released that same year was Mr. Do! by Universal. In most games that feature destructible terrain, it is more common for only part of the environment to be destructible to prevent players being able to cut their way directly to the goal.
An early example of a shooter game that featured fully destructible environments was Kagirinaki Tatakai, an early run & gun shooter developed by Hiroshi Ishikawa for the Sharp X1 computer and released by Enix in 1983. The Worms series also features terrain which can be completely obliterated.
The earliest first-person shooter example may be Ghen War, released in 1995 for the Sega Saturn, which featured a 3D terrain map generator that allows fully destructible environments. However, the trend to make more and more items and environmental features destroyable by the player hearkens all the way back to the explosive barrels in Doom (1993). Games like Blood II: The Chosen (1998) also featured major amounts of destroyable objects, in that game a room filled with objects could be turned into an empty room filled only with debris.
Newer iterations of this feature can be observed in games such as the Dragon Ball Z: Budokai Tenkaichi and Dragon Ball: Xenoverse where the fighters' dashes and super moves can destroy large rock formations and buildings, Spring, Crysis (CryEngine 2), Mercenaries 2: World in Flames, Battlefield: Bad Company (Frostbite 1.0), Battlefield: Bad Company 2 (Frostbite 1.5), Battlefield 1943 (Frostbite 1.5), Black, and Red Faction: Guerilla (Geo-Mod). Future implementations are core facets of gameplay and can be found in Battlefield 3 (Frostbite 2), Diablo 3, Battlefield 4 and Battlefield 1 (Frostbite 3).EA DICE
EA Digital Illusions CE AB (DICE) is a Swedish video game developer based in Stockholm. The company was founded in 1992 and has been a subsidiary of Electronic Arts since 2006. Its releases include the Battlefield, Mirror's Edge and Star Wars Battlefront series. Through their Frostbite Labs division, the company also develops the Frostbite game engine.FIFA 17
FIFA 17 is a sports video game in the FIFA series developed and published by Electronic Arts, that was released in September 2016. This is the first FIFA game in the series to use the Frostbite game engine. Borussia Dortmund midfielder Marco Reus serves as the cover athlete on the game.FIFA 20
FIFA 20 is an upcoming football simulation video game published by Electronic Arts, as the 27th installment in the FIFA series. It was first announced at a press conference at E3 2019, and is set to be released on 27 September 2019.FIFA Online 4
FIFA Online 4 is a free-to-play massively multiplayer online football developed by EA Spearhead and published by Nexon. It was announced on 2 November 2017, and released on 17 May 2018 in South Korea. It is released in various Southeast Asia countries before the FIFA World Cup on 14 June. No date has been revealed for an English version yet.Frostbite (2006 film)
Frostbite (Swedish title: Frostbiten) is a Swedish comedy horror film from 2006 directed by Anders Banke.
As well as the horror theme, various parts also have pure humour elements, and it is considered a horror/comedy by some newspapers that rated it. The film takes place in a small town in northern Sweden during midwinter, making the environment perfect for vampires—because there are no sunny hours during the dark and cold Nordic winter days.Frostbite (G.I. Joe)
Frostbite is a fictional character from the G.I. Joe: A Real American Hero toyline, comic books and animated series. He is the G.I. Joe Team's Snow Cat driver and debuted in 1985.Frostbite (Mead novel)
Frostbite is a vampire novel written by Richelle Mead. It is the second novel in the #1 New York Times bestselling series, Vampire Academy. Frostbite continues the story of the main character, Rose Hathaway including her bond with Princess Vasilisa "Lissa" Dragomir, her budding romance with her instructor Dimitri Belikov, and her education in becoming a Guardian.Frostbite (game engine)
Frostbite is a game engine developed by DICE, designed for cross-platform use on Microsoft Windows, seventh generation game consoles PlayStation 3 and Xbox 360, and eighth generation game consoles PlayStation 4 and Xbox One.
The game engine was originally employed in the Battlefield video game series, but would later be expanded to other first-person shooter video games and a variety of other genres. To date, Frostbite has been exclusive to video games published by Electronic Arts.Lists of Transformers characters
This is a list of articles listing the many characters included in the Transformers media franchise.The Adventures of Rocky and Bullwinkle and Friends
The Adventures of Rocky and Bullwinkle and Friends is the blanket title for an American animated television series that originally aired from November 19, 1959, to June 27, 1964, on the ABC and NBC television networks. The current blanket title was imposed for home video releases over 40 years after the series originally aired and was never used when the show was televised; television airings of the show were broadcast under the titles of Rocky and His Friends from 1959 to 1961, The Bullwinkle Show from 1961 to 1964, and The Rocky and Bullwinkle Show (or The Adventures of Rocky and Bullwinkle or The Adventures of Bullwinkle and Rocky) in syndication. Produced by Jay Ward Productions, the series is structured as a variety show, with the main feature being the serialized adventures of the two title characters, the anthropomorphic flying squirrel Rocky and moose Bullwinkle. The main adversaries in most of their adventures are the two Russian-like spies Boris Badenov and Natasha Fatale, both working for the dictator Fearless Leader. Supporting segments include Dudley Do-Right of the Mounties (a parody of old-time melodrama), Peabody's Improbable History (a dog named Mr. Peabody and his boy Sherman traveling through time), and Fractured Fairy Tales (classic fairy tales retold in comic fashion), among others.Rocky and Bullwinkle is known for quality writing and wry humor. Mixing puns, cultural and topical satire, and self-referential humor, it appealed to adults as well as children. It was also one of the first cartoons whose animation was outsourced; storyboards were shipped to Gamma Productions, a Mexican studio also employed by Total Television. The art has a choppy, unpolished look and the animation is extremely limited even by television animation standards at the time, yet the series has long been held in high esteem by those who have seen it; some critics described the series as a well-written radio program with pictures.The show was shuffled around several times (airing in afternoon, prime time, and Saturday morning timeslots), but was influential to other animated series from The Simpsons to Rocko's Modern Life. Segments from the series were later recycled in the Hoppity Hooper show.
There have been numerous feature film adaptations of the series' various segments, such as the 2000 film The Adventures of Rocky and Bullwinkle, which blended live-action and computer animation; and the 1999 live-action film Dudley Do-Right. Both films received poor reviews and were financially unsuccessful. By contrast, an animated feature film adaptation of the "Peabody's Improbable History" segment, Mr. Peabody & Sherman, was released to positive reviews in 2014. A rebooted animated series also based on "Peabody's Improbable History", The Mr. Peabody & Sherman Show, debuted on Netflix in October 2015.Another reboot animated series based on the main segment, The Adventures of Rocky and Bullwinkle premiered on Amazon Video on May 11, 2018.
In 2013, Rocky and His Friends and The Bullwinkle Show were ranked the sixth Greatest TV Cartoon of All Time by TV Guide.Underwater ice hockey
Underwater ice hockey (also called Sub-aqua ice hockey) is a minor extreme sport that is a variant of ice hockey. It is played upside-down underneath frozen pools or ponds. Participants wear diving masks, fins and wetsuits and use the underside of the frozen surface as the playing area or rink for a floating puck. Competitors do not use any breathing apparatus, but instead surface for air every 30 seconds or so.
It is not to be confused with underwater hockey, in which the floor of a swimming pool and a sinking puck are used.
Consequences of external causes (T66–T78, 990–995)