Topic Overview
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 is not well-heated during cold weather.
Injuries from cold exposure
- "Frostnip" usually affects skin on the face, ears, or fingertips. Frostnip 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 and feels cold, numb, and stiff or rubbery to the touch.
- Cold injuries, such as trench foot or chilblains, may cause pale and blistered skin like frostbite after the skin has warmed. These injuries occur from spending too much time in cold, but not freezing, temperatures. The skin does not actually freeze.
- An abnormally low body temperature (hypothermia) occurs when the body loses heat faster than it can make heat. 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 is not stopped.
Risk factors for cold exposure injury
There are many factors that increase your risk of injury from exposure to cold temperatures.
- Being a baby
- Being an older adult
- Drinking alcohol
- Being in outdoor conditions, such as high altitudes or windy, wet 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
Many people get cold hands or feet, which often are bothersome but not a serious health problem. You are more likely to feel cold easily if you:
- Do not 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, or malnourished people have low body fat.
- 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, causing the hands and feet to feel cold.
- Are under a lot of stress or feel tired. Chronic stress or anxiety can cause your nervous system to release adrenaline, which acts to narrow the blood vessels that supply blood to the hands and feet.
- Have a medical condition, such as hypothyroidism or Raynaud's phenomenon, that makes you feel or react more strongly to cold temperatures.
If you have already been exposed to the cold, first aid measures can warm you up and may even save your life.
Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.
Emergencies
Do you have any of the following symptoms that require emergency treatment? Call 911 or other emergency services immediately.
- Not breathing: See Rescue Breathing in the topic Dealing With Emergencies.
- Unconscious
- Symptoms of severe hypothermia, such as:
- Slow or shallow breathing
- Decreased level of consciousness
- Confusion or altered behavior, such as unusual aggressive, irrational, disoriented, or combative behavior
- Slurred speech
- Repeated stumbling when walking or unsteadiness when standing
Check Your Symptoms
If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.
Review health risks that may increase the seriousness of your symptoms.
If you have any of the following symptoms, evaluate those symptoms first.
- Cold skin in a foot, arm, leg, or hand that is not caused by cold exposure: Go to the topics:
- Hives, a rash, or itching after cold exposure: Go to the topics:
For information on how to take an accurate temperature, see the topic Body Temperature.
Do you have or does someone else have symptoms of low body temperature (early hypothermia) and a temperature of 95° (35°) or lower?
See significance of symptoms of low body temperature if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your symptoms.
Note: The questions below refer to a rectal temperature, which is considered the most accurate temperature. For information on how to take an accurate temperature, see the topic Body Temperature.
Call your health professional immediately if you answer "Yes" to any of the following questions.
Does a baby have a temperature of 97° (36°) or lower?
Does an older adult have a temperature of 95° (35°) or lower?
Do you have a temperature of 95° (35°) or lower after 1 hour of rewarming treatment?
Do you have a temperature of 95° (35°) or lower and any changes in your mental state, such as inability to focus your attention, after 1 hour of rewarming treatment?
Do you have a temperature of 95° (35°) or lower and you have severe shivering after 1 hour of rewarming treatment?
Do you have a temperature of 95° (35°) or lower and you have cold, pale, white skin or patches of pink-purple or blue-gray skin after 1 hour of rewarming treatment?
Do you have a temperature of 95° (35°) or lower and stiff or numb arms or legs after 1 hour of rewarming treatment?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Do you have or does someone else have symptoms of low body temperature (early hypothermia), but you have not taken a temperature?
See significance of symptoms of low body temperature if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your symptoms.
Call your health professional immediately if you answer "Yes" to any of the following questions.
Do you think your baby has a low body temperature?
Do you think an older adult has a low body temperature?
Do you think you have a low body temperature after 1 hour of rewarming treatment?
Do you think you have a low body temperature and you have changes in your mental state, such as inability to focus your attention, after 1 hour of rewarming treatment?
Do you think you have a low body temperature and you have severe shivering after 1 hour of rewarming treatment?
Do you think you have a low body temperature and you have cold, pale, white skin or patches of pink-purple or blue-gray skin after 1 hour of rewarming treatment?
Do you think you have a low body temperature and you have stiff or numb arms or legs after 1 hour of rewarming treatment?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Do you have symptoms of cold-injured skin, such as frostbite?
See significance of cold-injured skin if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your symptoms.
Call your health professional immediately if you answer "Yes" to any of the following questions.
Does your skin feel hard and stiff like a "block of wood"?
Do you have severe or burning pain that is not better after 1 hour of rewarming treatment?
Do you have cold skin that looks pale, white, pink-purple, blue-gray, shiny, or rubbery after 1 hour of rewarming treatment?
Do you have cold skin that feels numb, tingly, or prickly after 1 hour of rewarming treatment?
Call your health professional today if you answer "Yes" to the following question.
Do you have blisters or sores from cold exposure?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Do you have eye pain or vision changes? Note: You may not have any symptoms for 6 to 8 hours after cold exposure.
See significance of eye pain or vision changes if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your symptoms.
Call your health professional immediately if you answer "Yes" to any of the following questions.
Do you have severe eye pain?
Do you think you have snow blindness?
Do you have any loss of vision?
Do you have blurred or decreased vision?
Do you have double vision?
Do you have severe sensitivity to light (photophobia)?
Call your health professional today if you answer "Yes" to any of the following questions.
Have you had moderate eye pain or sensitivity to light for longer than 2 hours?
Do you have moderate eye pain or sensitivity to light that is not better after removing your contact lenses?
You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.
Has mild eye pain or sensitivity to light continued for 24 hours?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Do you think you have a skin infection after rewarming cold skin?
See significance of a skin infection if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your symptoms.
Call your health professional immediately if you answer "Yes" to any of the following questions.
Do you have peripheral arterial disease?
Do you have a disease or take a medicine that causes problems with your immune system?
Call your health professional today if you answer "Yes" to any of the following questions.
Do you have increased pain, swelling, redness, or warmth around the injury?
Do you have red streaks extending from the injury?
Do you have pus in or around the injury?
Do you know or think you have a fever?
You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.
Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around a wound for 24 hours or longer?
Have you had swollen lymph nodes near a wound for 24 hours or longer?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Are your hands, fingers, feet, nose, or ears sensitive to cold temperatures?
See significance of skin that is sensitive to cold temperatures if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your symptoms.
You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.
Do you have Raynaud's phenomenon and your reaction to cold has gotten worse since your last visit to a health professional?
Have you had repeated episodes of your fingers, hands, feet, nose, or ears turning pale, white, blue, cold, numb, or tingly after exposure to cold temperatures?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Are you worried that the cold-injured skin is dirty and you need a tetanus shot?
See significance of getting a tetanus shot if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your symptoms.
| Note: |
If you need a tetanus shot, call your doctor to arrange for the shot as soon as possible.
|
Call your health professional today if you answer "Yes" to any of the following questions.
Are you worried that the cold-injured skin has gotten dirty or has germs on it and your last tetanus shot was longer than 5 years ago?
| Note: |
Something is dirty if it has dirt, soil, spit, or feces on it. |
Are you not sure when you had your last tetanus shot?
Did you not get the first series of tetanus shots (primary vaccination series)?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.
Home Treatment
Most minor cold injuries will heal on their own, and home treatment is usually all that is needed to relieve your symptoms and promote healing. However, if you suspect you may have a more severe cold injury, use first aid measures while you arrange for an evaluation by your health professional. These first aid measures can also be used for children. Be sure to warm the child's whole body with blankets as well as the cold injured parts.
- If you have hypothermia, try immediate first aid measures. Stay calm, find shelter, change to dry clothes, keep moving, and drink warm fluids to prevent further heat loss and slowly rewarm yourself.
- If small areas of your body (ears, face, nose, fingers, toes) are really cold or frozen, try home treatment first aid to warm these areas and prevent further injury to skin. Warm small areas by blowing warm air on them, tucking them inside your clothing or putting them in warm water.
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.
Apply aloe vera or another moisturizer, such as Lubriderm or Keri Lotion, to windburned skin. Reapply often. There is little you can do to stop skin from peeling after a windburn—it is part of the healing process—but home treatment may make your skin feel better.
Use nonprescription artificial tears warmed to body temperature to moisturize and soothe eyes that are cold, sore, or dry from exposure to cold or wind.
| Try a nonprescription medicine to help treat your fever or pain: |
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| Be sure to follow these safety tips when you use a nonprescription medicine: |
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Symptoms to Watch For During Home Treatment
Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:
- Symptoms of a skin infection develop, such as redness, swelling, or pus.
- Blisters develop after you begin home treatment.
- Symptoms have not gotten better or have gotten worse after 1 hour of rewarming treatment.
- Symptoms become more severe or frequent.
Prevention
Many cold injuries can be prevented by protecting yourself when you are outdoors in cold weather.
General tips
- Bring an emergency kit if you are going into the backcountry so you are prepared for cold, wet, or windy weather conditions that might arise.
- Head for shelter that will protect you from wind and rain if you get wet or cold.
- Avoid doing too much activity and sweating. Sweating increases heat loss through evaporation so you will feel cold.
- Avoid touching metal, especially with wet hands, because it will make you feel colder and may cause frostbite.
Nutrition tips
- Eat plenty of food to help maintain your body heat. Carry high-calorie foods, such as candy bars and trail mix, when going out in cold weather.
- Drink plenty of water. Carry extra water with you and drink it hourly. Your urine should be clear, not yellow or orange. If you are not urinating every 2 to 3 hours, you probably are not drinking enough fluids.
- Do not drink alcoholic beverages. Alcohol:
- Interferes with the body's ability to regulate body temperature.
- Affects judgment. For example, a person may not put on additional clothing when it is needed if his or her judgment is changed by alcohol.
- Can cause blood vessels in the skin to dilate. This increases heat loss.
- Reduces your ability to sense cold because it depresses the nervous system.
- Do not use caffeine and do not smoke while in the cold. 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, causing the hands and feet to feel cold.
Clothing tips
- Wear proper clothing and shoes. Keep extra protective clothing and blankets in your car in case of a breakdown in an isolated area. Know the different ways in which the body loses heat so you can protect yourself from cold exposure.
- Keep your hands and feet dry. Wear mittens instead of gloves. Wear socks that retain warmth and keep moisture away from your skin.
- Protect your eyes from cold and wind by wearing glasses or goggles if you are planning outdoor activities.
Prevention measures for children
Children may not be aware of cold temperatures. Parents need to understand the ways in which the body loses heat and:
- Limit the amount of time a child is out in cold, wet, or windy weather.
- Dress children appropriately for the weather conditions. Remember C-O-L-D:
- Cover your child's head, neck and face as much as possible since a lot of heat loss can occur in these areas. These areas are also at risk for frostnip or frostbite. Apply lip protection.
- Overexertion (being too active) can cause your child to sweat and chill more quickly. Sweating causes clothing to become damp and increases heat loss.
- Layers of clothing will keep your child warm and protect your child best against wind and cold conditions.
- Dry is key in preventing cold injury. Keeping your child dry with waterproof clothing reduces heat loss.
- Keep close watch on your children's body heat even in the summer when they are swimming in a lake or pool for a long time.
- Teach children to avoid touching cold metal with bare hands or licking extremely cold metal objects. Cold is transmitted more easily through metal and increases the risk of a cold injury, such as frostbite. Also, your child's tongue might stick to the cold metal and be difficult to remove.
Older or less active people can prevent indoor hypothermia by dressing warmly while indoors and keeping room temperatures above 65° (18°).
Be aware that some states fund programs to help low-income families add insulation or "weatherize" their homes to keep the family warm. In addition, some low-income families may qualify for help in paying their heating bills. Contact your state or local energy agency or the local power or gas company for more information.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment
You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:
- What are your main symptoms?
- How long have you had your symptoms?
- What was the weather when you were outdoors and your symptoms began?
- How long were you exposed to cold temperatures?
- Have you had cold injuries before? Do you have any continuing problems because of them?
- What first aid home treatment measures have you tried? Did they help?
- If your skin was frozen, how long was it frozen? Did it rewarm? Did it get frozen again?
- Were you using any illegal drugs, alcohol, or tobacco at the time of your cold exposure?
- Are you currently taking any medicine? If so, are you following the prescribed dosage and schedule? Has there been any recent change in your dosage or schedule?
- Do you have any health risks?
Credits
| Author | Jan Nissl, RN, BS |
| Editor | Susan Van Houten, RN, BSN, MBA |
| Associate Editor | Tracy Landauer |
| Primary Medical Reviewer | William M. Green, MD - Emergency Medicine |
| Specialist Medical Reviewer | H. Michael O'Connor, MD - Emergency Medicine |
| Last Updated | July 5, 2007 |
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