Talk:Frostbite

Wiki Education Foundation-supported course assignment
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Loriminassian, Hmanlove, 12jpt3, Katsajewycz, 9jg57, Rexpark3.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 21:30, 17 January 2022 (UTC)

Wiki Education Foundation-supported course assignment
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Angelwhit06. Peer reviewers: Rads4lyfe.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 21:54, 16 January 2022 (UTC)

Workplan for updates
I will review the manual of style and update the headers accordingly. I will do a literature search and fill in content where needed with appropriate references, links, and images. Finally, I will respond to peer review comments. I will update this workplan with my working outline.

Angelwhit06 (talk) 15:48, 1 March 2017 (UTC)
 * Lead -- expand and revise for readability
 * Classification: If relevant. May also be placed as a subheading of diagnosis -- remove, add content elsewhere - done
 * Signs and symptoms or Characteristics -- requires more references - done
 * Causes: Includes Risk factors, triggers, Genetics or genome, Virology (e.g., structure/morphology and replication). -- improve structure, add references, length of exposure - done
 * Mechanism: For information about pathogenesis and pathophysiology. -- simplify language and add references - done
 * Diagnosis: Includes characteristic biopsy findings and differential diagnosis. -- add section - done
 * Prevention or Screening (if the section only discusses secondary prevention it should follow the treatment section) -- add section - done
 * Treatment or Management: This might include any type of currently used treatment, such as diet, exercise, medication, palliative care, physical therapy, psychotherapy, self care, surgery, watchful waiting, and many other possibilities. Consider discussing treatments in a plausible order in which they might be tried, or discussing the most common treatments first. Avoid experimental/speculative treatments and preventive measures (e.g., prophylactic vaccines or infection-avoidance techniques). As per the policy of WP:NOTHOW, Wikipedia articles should not be written in a "how-to" style, but this does not prevent adding official guidelines of treatments or managements if these can be presented in an objective manner and with medically reliable sources. -- review references, add as needed, update or remove info about hyperbaric O2, throbmolytics
 * Outcomes or Prognosis. May also be labeled "Possible outcomes" or "Outlook". -- revise for readability
 * Epidemiology: factors such as incidence, prevalence, age distribution, and sex ratio. -- add section - done
 * History: Early discoveries, historical figures, and outdated treatments (not patient history) -- add section -done
 * Society and culture: This might include social perceptions, cultural history, stigma, economics, religious aspects, awareness, legal issues, notable cases -- add section - done
 * Research directions: Include only if addressed by significant sources. See Trivia, and avoid useless statements like "More research is needed". Wikipedia is not a directory of clinical trials or researchers. -- lit search, update as necessary
 * Special populations, such as Geriatrics or Pregnancy or Pediatrics -- add section
 * Other animals -- add section


 * Peer Review
 * Workplan: You adhered almost perfectly to your stated work plan. I'm not sure what the page looked like before, but your workplan really improved the page.


 * Readability: I feel like this is a very readable article for two reasons--first, the layout makes it super easy to read and find the relevant information you need. Second, the syntax and vernacular are perfect for Wikipedia's intended audience. I would consider moving the epidemiology section higher but that's a matter of opinion.


 * Sources: Very good mix of sources. Would maybe add a few more pictures because this is a disease most people recognize visually.


 * Lead: very readable lead section--I almost felt like I didn't need to even read the rest of the article.  — Preceding unsigned comment added by Rads4lyfe (talk • contribs) 16:21, 22 March 2017 (UTC)

Angelwhit06 (talk) 15:59, 1 March 2017 (UTC)

Causes of Frostbite
it should say the causes of frostbite -- —The preceding unsigned comment was added by 65.43.198.68 (talk • contribs).


 * I hope you mean something other than temperatureD-rew 04:24, 8 December 2006 (UTC)


 * Maybe list cryogenic solids/liquids, like, oh I don't know, dry ice and/or liquid nitrogen in there, since substances like that tend to cause frostbite in much the same way that corrosive substances (acids and bases) cause burns due to exothermic reaction with human flesh (particularly the water in it)... 2602:306:BCA6:8300:C1DE:FF3E:E9C7:EE70 (talk) 05:33, 17 September 2013 (UTC)

The introductory paragraph explains it in pretty good detail... Sahuagin 16:29, 21 January 2007 (UTC) should have something about long term treatments such as the best creams to use

Pain during rewarming
I'm not entirely sure if this is worthy of a mention, but I had the fingers on my right hand rewarmed after a moderate case of Frostbite, and it was without a doubt the most excruciatingly painful event of my life. The only real description I found in an article was "Once the area is rewarmed, there can be significant pain", which made me wonder what the author's definition of "significant pain" was! Incidentally, the doctor at the time told me there was going to be "some pain" but that pain meant the tissue was still alive. I honestly cannot think of anything more painful, it felt like someone had lit a blowtorch to the bone inside my fingers. Icemotoboy (talk) 22:37, 4 December 2007 (UTC) hi —Preceding unsigned comment added by 206.78.5.167 (talk) 17:51, 5 December 2007 (UTC) My feet hurts. :( —Preceding unsigned comment added by 69.230.186.20 (talk) 00:27, 9 February 2010 (UTC)

Vasoconstriction
I though vasoconstriction can occur at temperatures a lot greater than 0 degrees celsius. Vasoconstriction depends on a whole host of factors (psychological, due to spinal injury, temperature etc etc). "Approximately 60% of skin capillary circulation ceases in the temperature range of 3°to 11° C, whereas 35% and 40% of blood flow ceases in arterioles and venules, respectively.[67] Capillary patency is initially restored in thawed tissue, but blood flow declines 3 to 5 minutes later." I got this directly from the book Auerbach: Wilderness Medicine, 5th ed. from MD Consult. —Preceding unsigned comment added by 59.101.66.23 (talk) 07:37, 7 May 2008 (UTC)

Reassessed
I've reassessed this article as a start class because, as of the moment, it's largely unsourced. I'll get to work when I can but I'll be busy until the following weekend. —Cyclonenim (talk · contribs · email) 21:49, 15 September 2008 (UTC)

sharing warmth
"Contrary to popular belief sharing a sleeping bag or blanket with one or more other people, or even dogs, doesn't help to keep warm." <- i think this is false. why wouldn't it help? it would need a citation at least. what i have found on a web is instead "Finally the old stand by...to stay warm snuggle up to someone or use the Buddy System (share warmth with others). " at http://www.chiff.com/a/camping-sleep-warm.htm. so if no one justifies this i will have to change it —Preceding unsigned comment added by Josepsbd (talk • contribs) 21:30, 21 July 2009 (UTC)

Line in Treatment section not understandable
The line "This may produce a degree in the bodies core temperature and increase the risk of cardiac dysrhythmias" doesn't make sense to me. I'm not positive what the intended meaning is, so I'll leave for someone else to improve. I just wanted to draw attention to it. —Preceding unsigned comment added by 72.200.126.8 (talk) 19:02, 18 November 2009 (UTC)

History Section
I'm removing this section because there doesn't seem to be any relevance to frostbite, except that the victims probably suffered from it during them, and that's a pretty weak connection. Of course, if some of the experiments were meant to "study" frostbite specifically, then that might be worth including. mcs (talk) 13:25, 4 October 2010 (UTC)

Frostbite in elephants
At Buttonwood Park Zoo in New Bedford, MA, a 55-year old female Asian elephant named Ruth was found outside during last week's blizzard (1/3/14). She may have been outside in -5 degree F to -8 degree F for one and one half hours. The barn door was left unlocked and she left the heated barn.

The Zoo has said that she had hypothermia and frostbite on her ears and tail. Frostbite takes several weeks to manifest so there may be more.

Her treatment when they found her consisted of applying foil blankets, warm water towel compresses and keeping her near a radiant heater. Portions of her ears were lanced as they bubbled up in order to drain the fluid.

She exhibited edema (swelling) and cellulitis of all four legs. Ruth was given antibiotics to prevent gangrene and aspirin for pain.

The zookeepers also walked her and after about three hours she began "normal shivering," according to zoo records of the incident.

Three weeks after the incident, about half of her ears sloughed surface tissue and the tissue below was revealed as pink.

The tip of her trunk and tail also were frostbitten.


 * First, you didn't provide a reference, but a bigger issue is that this isn't encyclopedic information. This isn't information that people would be looking for when they look up frostbite. Like I said, this is certainly an interesting story, but it doesn't add anything valuable to the article. I applaud you for being bold and making this change. I hope you stick around and continue to contribute wikipedia! Let me know if you have any questions. Attaboy (talk) 21:47, 28 January 2014 (UTC)
 * Yes we need an overview. Not single cases. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 06:48, 29 January 2014 (UTC)

Here's the reference: http://books.google.com/books?id=oCpiZA61tyQC&pg=PA249&dq=elephant+frostbite&hl=en&sa=X&ei=5Sf0UpWGAc3JsQS08IHQDQ&ved=0CCsQ6AEwAA#v=onepage&q=elephant%20frostbite&f=false Actually, it was information that I was looking for when Ruth was left outside.There are multiple cases, including an Illinois zoo elephant, and two Russian circus elephants (http://www.webpronews.com/vodka-saves-elephants-from-frostbite-2012-12.) Still, as long as there are elephants kept in cold climates,this is a possible outcome. I also have photos which can be added. — Preceding unsigned comment added by 50.176.175.41 (talk) 00:28, 7 February 2014 (UTC)

Pictures
There are hundreds of articles that desperately need images, and yet someone decided they'd rather add three pictures of the nastiest feet to this article instead. I don't understand what value that has. Maybe if there was some sort of spoiler that could hide the images as long as a user didn't hover of them, it'd be okay. But seriously, that's making it hard for me to read this article. — Preceding unsigned comment added by 2601:9:700:5DC:8C18:B6F3:975A:494D (talk) 22:53, 11 January 2015 (UTC)
 * Then you REALLY don't want to see the gangrene image. Remember, things once seen cannot be unseen. David notMD (talk) 21:22, 3 November 2017 (UTC)

Question -- can an Ice bath cause frostbite?
Wondering -- if water temperature is cold (but above freezing) can frostbite still happen? Or must there be freezing? There is discussion here.--Tomwsulcer (talk) 13:31, 6 October 2016 (UTC)
 * Answer appears to be not. Frostbite requires formation of ice crystals in tissues. Sea water freezes at 28.4 F (-2 C), but even that unlikely to cause frostbite in immersed hands or feet, as blood also has a freezing point around -2 to -3 C. David notMD (talk) 16:58, 6 November 2017 (UTC)

Suggested changes
Hello, we are a group of medical students editing this page as part of our class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:
 * 1) We propose adding the following sentence to the end of the Pre-hospital_care section: “Ibuprofen is often preferred to aspirin due to the latter’s non-specific inhibition of postaglandins, a subset of which is beneficial in injury repair. ”
 * 2) We propose adding information to the Vasodilators section. Namely; “In addition to vasodilators, sympatholytic drugs can be used to mitigate the detrimental peripheral vasoconstriction characteristic of frostbite. "
 * 3) We propose adding a more organized description of the pathophysiology of frostbite to the Mechanism section. Specifically, “The pathological mechanism by frostbite induces freezing injury on body tissues can be characterized by four stages: Prefreeze, freeze-thaw, vascular stasis, and the late ischemic stage. ”
 * 4) We also propose briefly explaining the four pathologic phases:
 * 5) “The prefreeze phase involves the cooling of tissues in the absence of ice crystal formation. ”
 * 6) “The ice-crystals form in the freeze-thaw phase resulting in cellular damage and death. ”
 * 7) “The third vascular stasis phase is marked by the coagulation of blood or the leaking of blood out of the vessels. ”
 * 8) “The consequence of inflammatory events, ischemia and infarction results in the late ischemic stage. ”
 * 9) We also propose adding a sentence to the Prevention section: “Repeated cold water immersion makes people more susceptible to frostbite, thus people should avoid swimming and rain in cold conditions. ”
 * 10) We propose changing the Research directions section on hyperbaric oxygen therapy to say: “Despite the presence of multiple case reports in which hyperbaric oxygen therapy was a successful adjunctive treatment for frostbite, no randomized controlled trial has been performed to test its efficacy. Hyperbaric oxygen therapy is used to salvage tissue in many conditions, but it is not routinely used in practice to treat frostbite. ”

We sincerely appreciate your time and welcome any feedback or further suggestions you may have. We look forward to working with you to improve the quality of this article 9jg57 (talk) 04:22, 6 November 2017 (UTC)
 * Can you reword this in easier to understand English? So for example "Ibuprofen is often preferred to aspirin as aspirin may block certain chemicals important in injury repair."
 * Doc James (talk · contribs · email) 06:18, 6 November 2017 (UTC)
 * Kudos for finding citations that provide PDFs of the complete articles rather than just the abstract. And I am supporting Doc James' suggestion for wording that can be understood by an educated person who does not have any medical education. Consider putting double brackets   around words and terms that already have existing Wikipedia articles. If you get this correct, will show up as blue lettering once you Save changes (red if you messed up). It is even possible to link to an article even though you use slightly different wording: hyperbaric oxygen therapy will link to the "Hyperbaric medicine" article, yet match your text. To see what I did, view it in Edit mode. There is no need to repeat linking each time you use a word(s). David notMD (talk) 15:27, 6 November 2017 (UTC)
 * I agree. Many of these suggestions need rewording. Avoid words like "mitigate" and "adjunctive".JenOttawa (talk) 02:41, 7 November 2017 (UTC)

Thank you for taking the time to provide us with feedback. Based on the suggestions above, we are amending our original post to avoid the use of jargon and focus on using terms understood by a lay audience. Specifically, we will be making the following changes:

Hmanlove (talk) 18:18, 10 November 2017 (UTC)
 * “Ibuprofen is often preferred to aspirin because aspirin may block a subset of prostaglandins that are important in injury repair.”
 * “In addition to vasodilators, sympatholytic drugs can be used to counteract the detrimental peripheral vasoconstriction that occurs during frostbite.”
 * “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.
 * Four pathologic phases:
 * 1) “Prefreeze phase: involves the cooling of tissues without ice crystal formation”
 * 2) “Freeze-thaw phase: ice-crystals form, resulting in cellular damage and death”
 * 3) “Vascular stasis phase: marked by blood coagulation or the leaking of blood out of the vessels”
 * 4) “Late ischemic phase: characterized by inflammatory events, ischemia and tissue death”
 * “Repeated cold water immersion makes people more susceptible to frostbite, thus people should avoid swimming and prolonged exposure to rain in cold conditions.
 * “Despite multiple case reports in which hyperbaric oxygen therapy was a successful supplementary treatment for frostbite, no randomized controlled trial has been conducted to test its efficacy. Hyperbaric oxygen therapy is used to salvage tissue in many conditions but is not routinely used in practice to treat frostbite.”
 * I noticed that you used ref # 3 from the journal: Wilderness and Environmental Medicine. I am not familiar with this journal. After googling, I found: 2016 Impact Factor: 0.694. Is another Wikipedian who has experience in the field able to comment on the quality of this journal?JenOttawa (talk) 18:41, 10 November 2017 (UTC)

Thank you for your feedback regarding the impact factor of this journal. This article was chosen because it is a systematic review of the topic published within the past five years and was also recommended to us by our expert consultant. Furthermore, given that wilderness medicine is a niche area, it is reasonable that the impact factor of this particular journal is relatively small. 9jg57 (talk) 14:56, 15 November 2017 (UTC)

Image positioning
Would it not make sense to move the three related images of a frost-bitten foot together, thus showing how frostbite damage progresses over time? Having them dispersed through the article seems to weaken the strength of their informative message. Would anyone disagree to this suggestion? Nick Moyes (talk) 22:15, 4 August 2020 (UTC)