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Cold Temperature Exposure
It's easy to get cold quickly if you are outside in wet, windy, or cold weather. Cold temperature exposure can also happen if you spend time in a dwelling or other building that isn't well heated during cold weather.
Injuries from cold exposure
- "Frostnip" usually affects the skin on the face, ears, or fingertips. It may cause numbness or blue-white skin color for a short time. But normal feeling and color return quickly when you get warm. No permanent tissue damage occurs.
- Frostbite is freezing of the skin and the tissues under the skin because of temperatures below freezing. Frostbitten skin looks pale or blue. It feels cold, numb, and stiff or rubbery to the touch. You can also get a skin injury by touching cold items such as dry ice without protection.
- Cold injuries, such as trench foot and chilblains, may cause pale and blistered skin like frostbite after the skin has warmed. These injuries occur from spending too much time in temperatures that are cold, but not freezing. The skin doesn't actually freeze.
- Eye pain or vision changes caused by cold exposure most often occur in people who try to force their eyes open in high winds or cold weather, or during activities such as snowmobiling or cross-country skiing. Snow blindness isn't directly caused by cold temperatures. But it does occur in snow conditions. Sunlight reflecting off the snow can cause a corneal injury or burn. Eyelids may become red and swollen. Eyes may feel dry and like they have sand in them.
- An abnormally low body temperature (hypothermia) occurs when the body loses heat faster than it can make heat. (There may be other reasons a person has a low body temperature.) Early symptoms of hypothermia include shivering (in adults and older children); clumsy movements; apathy (lack of concern); poor judgment; and cold, pale, or blue-gray skin. Hypothermia is an emergency condition. It can quickly lead to unconsciousness and death if the heat loss isn't stopped.
Risk factors for cold exposure injury
There are many things that increase your risk of injury from exposure to cold temperatures. They include:
- Being a baby. A baby's ability to regulate body temperatures isn't well developed. And a baby's body heat is lost faster when exposed to cold weather conditions.
- Being an older adult. Older people don't produce as much heat energy. And they may have health conditions that make it harder for them to regulate their body temperature as well as other people do.
- Drinking alcohol. Alcohol may affect your judgment. For example, a person may not put on more clothing when it's needed if their judgment is affected by alcohol.
- Being in outdoor conditions, such as high altitudes or wet and windy weather, or being immersed in cold water.
- Not being dressed properly, having wet skin, or wearing wet clothing.
- Being tired or dehydrated.
- Being exposed to cold temperatures in your workplace, such as working in cold-storage units.
- Having certain health risks. Health conditions, such as diabetes or cancer, or any medicines you take may affect how you regulate your body temperature.
Many people get cold hands or feet. This is often bothersome, but it's not a serious health problem. You're more likely to feel cold easily if:
- You don't have much body fat. Fat under the skin helps keep you warm. People who have low body fat may be more likely to get hypothermia. Babies, older or ill adults, and malnourished people have low body fat.
- You smoke cigarettes or drink caffeine. Nicotine (from tobacco) and caffeine cause narrowing of the blood vessels in the hands and feet. When blood vessels are narrowed, less blood flows to these areas. This causes the hands and feet to feel cold.
- You're under a lot of stress or feel tired. Chronic stress or anxiety can cause your nervous system to release adrenaline. It narrows the blood vessels that supply blood to the hands and feet.
- You have a medical condition, such as hypothyroidism or Raynaud's phenomenon, that makes you feel or react more strongly to cold temperatures.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Pain in children under 3 years
It can be hard to tell how much pain a baby or toddler is in.
- Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
- Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
- Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.
Early symptoms of hypothermia may include:
- Cold, pale, or blue-gray skin.
- Clumsy movements.
- Poor judgment and a lack of interest in or concern about what's going on.
- Not speaking clearly.
Cold injury to the skin may cause:
- Severe pain.
- Numbness, tingling, or a prickly feeling.
- Hard, stiff, shiny, or rubbery skin.
- Cold, pale, white, pink-purple, or blue-gray skin.
- Blisters or sores.
Low body temperature means:
- In an adult or older child, 95°F (35°C) or lower.
- In a baby, 97°F (36.1°C) or lower. Rectal temperatures are the most accurate.
Some people's skin is very sensitive to cold temperatures and reacts abnormally. For example:
- The fingers, toes, nose, or ears may turn pale or white. Later they may turn blue.
- These areas may feel numb and tingly and feel very cold to the touch.
- As the areas warm, they may turn red and start to throb.
Symptoms of severe hypothermia may include:
- Stumbling and having trouble walking.
- Weakness, confusion, or extreme sleepiness.
- Slow, shallow breathing.
- Slow or uneven pulse.
- Passing out.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Home treatment is usually all that's needed to relieve your symptoms. Here are some things you can do to help your body warm up after being exposed to cold temperatures.
- Stay calm.
Fear and being too active cause sweating. Sweating can make you feel chilled.
- Find shelter.
Get out of the cold, the wind, or the water.
- Get dry.
Remove cold, wet clothes. Put on dry clothing—made of moisture-wicking fabrics, such as wool, polyester, or nylon (not cotton)–that insulates well. Cover your head. Wrap up in blankets.
- Move around.
Activity heats up the body and improves blood flow. But avoid sweating. It cools the body.
- Drink warm fluids.
Try to avoid fluids that contain alcohol or caffeine.
- Rewarm small areas of your body that are cold.
If your ears, face, nose, fingers, or toes are really cold or frozen, try to warm them by blowing warm air on them, tucking them inside your clothing, or putting them in warm water.
- Try lotions.
Apply aloe vera or another moisturizer, such as Lubriderm or Keri lotion, to windburned skin. Reapply often. There's not much you can do to stop skin from peeling after a windburn. It's just part of the healing process.
- Try artificial tears.
Nonprescription artificial tears warmed to body temperature can moisturize and soothe eyes that are cold, sore, or dry from exposure to cold or wind.
Frostbitten skin may be more sensitive after the cold injury. The injured skin area should be protected with sunscreen and protective clothing to prevent further skin damage. The color of the injured skin may also change over time.
When to call for help during self-care
Call a doctor if any of the following occur during self-care at home:
- New or worse blisters.
- New or worse signs of infection, such as redness, warmth, swelling, pus, or a fever.
- Symptoms occur more often or are more severe.
Preparing For Your Appointment
You can help your doctor diagnose and treat your condition by being prepared for your appointment.
Current as of: July 1, 2021
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine