It is important to imagine the process of frostbite in order to competently provide assistance. Peripheral areas freeze first. Freezing gradually spreads deeper and covers all tissues, say, limbs. A serious mistake is not properly warming up frostbite. If the limb is immediately placed in heat, then warming occurs in the same direction as frostbite, i.e. First of all, the surface areas are heated. At the same time, the warmed area, while remaining alive, is deprived of blood supply, since the vessels in the deeper areas remain frozen and cannot provide blood to the thawed areas. And the restored metabolism as a result of warming requires blood supply. The latter is impossible and the heated area dies. In this regard, remember: first aid for frostbite of the extremities is the application of thermal insulating bandages (cotton wool, gauze, warm wrapping in a woolen scarf, etc.), but not for the purpose of warming, but for the purpose of thermal insulation. Warming the limb should be done from the inside: hot tea, alcohol in moderate doses, intravenous drip administration solutions heated to body temperature.
1. What is frostbite
Frostbite is damage to any part of the body (even death) under the influence of low temperatures. Frostbite most often occurs in cold weather. winter time at a temperature environment below 10-20 degrees. But even at positive temperatures, frostbite of the limbs is possible, especially in high humidity and strong wind.
Frostbite in the cold is caused by tight and wet clothes and shoes, physical fatigue, hunger, forced long-term immobile and uncomfortable position, previous cold injury, weakening of the body as a result of previous diseases, sweating of the feet, chronic diseases vessels lower limbs And of cardio-vascular system, heavy mechanical damage with blood loss, smoking, etc.
Statistics show that almost all severe frostbite leading to amputation of limbs occurred while heavily intoxicated.
2. Degrees of frostbite
Frostbite of the first degree (the mildest) usually occurs with short-term exposure to cold. Affected area 
the skin is pale, turns red after warming, in some cases has a purplish-red tint, and swelling develops. There is no dead skin. By the end of the week after frostbite, slight peeling of the skin is sometimes observed. Full recovery occurs 5-7 days after frostbite. The first signs of such frostbite are a burning sensation, tingling sensation followed by numbness of the affected area. Then they appear itchy skin and pain, which can be minor or severe.
Frostbite of the second degree occurs with longer exposure to cold. IN initial period there is pallor, coldness, loss of sensitivity, but these phenomena are observed with all degrees of frostbite. Therefore, the most characteristic sign is the formation of blisters filled with transparent contents in the first days after injury. Complete restoration of the integrity of the skin occurs within 1 – 2 weeks, granulations and scars are not formed. This is due to the fact that at this stage the skin does not die to its full thickness. Elements of healthy skin remain in the hair follicles, which will preserve the skin’s ability to regenerate, i.e. full restoration. In case of frostbite of the second degree after warming up, the pain is more intense and lasting than with frostbite of the first degree, skin itching and burning are disturbing.
With third degree frostbite, the duration of the period of cold exposure and decrease in temperature in the tissues increases. The blisters that form in the initial period are filled with bloody contents, their bottom is blue-purple, insensitive to irritation. The death of all skin elements occurs with the development of granulations and scars as a result of frostbite. In this case, the skin completely loses its ability to recover and the wound heals with a rough scar. Fallen nails do not grow back or grow deformed. The rejection of dead tissue ends in the 2nd - 3rd week, after which scarring occurs, which lasts up to 1 month. Intensity and duration pain more pronounced than with frostbite of the second degree.
Frostbite of the IV degree occurs with prolonged exposure to cold; the decrease in temperature in the tissues is the greatest. It is often combined with frostbite of the third and even second degree. All layers of soft tissue die, bones and joints are often affected.
The damaged area of the limb is sharply bluish, sometimes with a marbled coloration. Swelling develops immediately after warming and increases rapidly. The skin temperature is significantly lower than the tissue surrounding the frostbite area. Bubbles develop in less frostbitten areas, where there is frostbite of III – II degree.
The absence of blisters with significant swelling and loss of sensitivity indicate degree IV frostbite.
In conditions of prolonged exposure to low air temperatures, not only local damage is possible, but also general cooling of the body. General cooling of the body should be understood as a condition that occurs when body temperature drops below 34 degrees.
The onset of general cooling is facilitated by the same factors as with frostbite: high air humidity, damp clothing, strong wind, physical fatigue, mental trauma, past illnesses and injuries.
3. Degrees of general cooling: light, medium and heavy.
Mild degree: body temperature 32-34 degrees. Skin pale or moderately bluish, goose bumps, chills, and difficulty speaking. The pulse slows down to 60-66 beats per minute. Blood pressure is normal or slightly elevated. Breathing is not impaired. Local frostbite of I-II degree is possible.
Average degree: body temperature 29-32 degrees, characterized by severe drowsiness, depression of consciousness, and a blank look. The skin is pale, bluish, sometimes marbled, and cold to the touch. The pulse slows down to 50-60 beats per minute, weak filling. Blood pressure decreased slightly. Breathing is rare - up to 8-12 per minute, shallow. Frostbite of the face and extremities of I – IV degrees is possible.
Severe: body temperature below 31 degrees. There is no consciousness, convulsions and vomiting are observed. The skin is pale, bluish, and cold to the touch. The pulse slows down to 36 beats per minute, weak filling, and there is a pronounced decrease in blood pressure. Breathing is rare, shallow - up to 3-4 per minute. Severe and widespread frostbite up to glaciation is observed.
4. First aid for frostbite
Actions when providing first aid medical care vary depending on the degree of frostbite, the presence of general cooling of the body, age and concomitant diseases.
First aid consists of stopping the cooling, warming the limb, restoring blood circulation in cold-damaged tissues and preventing the development of infection. Remember the mechanisms of frostbite covered at the beginning of this article. The first thing to do if there are signs of frostbite is to take the victim to the nearest warm room, remove frozen shoes, socks, and gloves. Thermal insulating bandages are applied to frostbitten areas of the body (hands, feet). Simultaneously with carrying out first aid measures, it is necessary to urgently call a doctor, ambulance to provide medical care.
In case of frostbite of the first degree, the cooled areas are isolated by applying a cotton-gauze bandage and bandages made of other heat-insulating materials. At the same time, measures are taken to generally warm the victim (warm room, hot tea, alcohol)
For frostbite II-IV general principle is saved. A heat-insulating bandage is applied to the affected surface (a layer of gauze, a thick layer of cotton wool, another layer of gauze, and oilcloth or rubberized fabric on top). The affected limbs are fixed using available means (a board, a piece of plywood, thick cardboard), applying and bandaging them over the bandage. Padded jackets, sweatshirts, woolen fabric, etc. can be used as heat-insulating material.
The victims are given a hot drink, hot food, a small amount of alcohol, a tablet of aspirin, analgin, 2 tablets of No-shpa and papaverine.
It is not recommended to rub the sick with snow, as blood vessels The hands and feet are very fragile and therefore can be damaged, and the resulting micro-abrasions on the skin contribute to infection. You should not use quick warming of frostbitten limbs by the fire, or uncontrolled use of heating pads and similar heat sources, as this worsens the course of frostbite. An unacceptable and ineffective first aid option is rubbing oils, fats, rubbing alcohol into tissues for deep frostbite.
With general mild cooling, it is sufficient effective method is to warm the victim in a warm bath at an initial water temperature of +24 degrees, which is raised to normal temperature body +37 degrees.
At average and severe general cooling with impaired breathing and circulation of the victim must be taken to the hospital as soon as possible.
5. “Iron” frostbite
In practice, there are also cold injuries that occur when warm skin comes into contact with a cold metal object. Worth a curious baby's grab bare hand for some piece of iron or, even worse, lick it with your tongue, and it will stick tightly to it. You can free yourself from the shackles only by tearing them off along with your skin. The picture is downright heartbreaking: the child squeals in pain, and his bloody hands or mouth leave the parents in shock.
Fortunately, an “iron” wound is rarely deep, but it still needs to be disinfected urgently. First rinse it with warm water and then with hydrogen peroxide. The oxygen bubbles released will remove any dirt that has gotten inside. After this, try to stop the bleeding. A hemostatic sponge applied to the wound helps a lot, but you can get by with a sterile bandage folded several times, which you need to press firmly and hold until the bleeding stops completely. But if the wound is very large, you should immediately consult a doctor.
It happens that a stuck child does not risk breaking away from the treacherous piece of iron, but loudly calls for help. Yours correct actions will help avoid deep wounds. Instead of tearing off the skin and meat, simply pour warm water over the stuck area (but not too hot!). Having warmed up, the metal will definitely release its unlucky captive.
6. Prevention of hypothermia and frostbite
There are a few simple rules that will allow you to avoid hypothermia and frostbite in severe frost:
Do not drink alcohol - alcohol intoxication (like any other) actually causes greater heat loss due to the expansion of peripheral blood vessels and increased heat transfer processes, at the same time creating the illusion of warmth. An additional factor is the inability to concentrate on the signs of frostbite.
Do not smoke in the cold - smoking reduces peripheral blood circulation, and thus makes the limbs more vulnerable.
Wear loose clothing - this promotes normal blood circulation. Dress like a cabbage - in this case, between the layers of clothing there are always layers of air that perfectly retain heat. Outerwear must be waterproof.
Tight shoes, lack of insoles, and damp, dirty socks are often the main prerequisites for the appearance of abrasions and frostbite. Special attention It is necessary to pay attention to shoes for those whose feet often sweat. You need to put warm insoles in your boots, and wear woolen socks instead of cotton ones - they absorb moisture, leaving your feet dry.
Do not wear metal (including gold, silver) jewelry – rings, earrings, etc. – in the cold. Firstly, the metal cools much faster than the body to low temperatures, as a result of which it is possible to “stick” to the skin with pain and cold injuries. Secondly, rings on the fingers impede normal blood circulation. In general, in cold weather, try to avoid contact of bare skin with metal.
Use a friend's help - watch your friend's face, especially the ears, nose and cheeks, for any noticeable changes in color, and he or she will watch yours. If these areas become pale, warn each other.
Do not allow the frostbitten area to freeze again - this will cause much more significant damage to the skin.
Do not remove shoes from frostbitten limbs in the cold - they will swell and you will not be able to put your shoes back on. It is necessary to get to a warm room as soon as possible. If your hands are cold, try warming them under your arms.
If your car stalls away from settlement or in an unfamiliar area, it is better to stay in the car, call for help by phone, or wait for another vehicle to pass on the road.
Hide from the wind - the likelihood of frostbite in the wind is much higher.
Do not wet your skin - water conducts heat much better than air. Don't go out into the cold with wet hair after a shower. Wet clothes and shoes (for example, a person has fallen into water) must be removed, wiped off the water, if possible, put on dry ones and bring the person into warmth as quickly as possible. In the forest, you need to light a fire, undress and dry your clothes, while vigorously doing physical exercise and warming himself by the fire.
It can be useful for a long walk in the cold to take with you a pair of replacement socks, mittens and a thermos with hot tea. Before going out into the cold, you need to eat - you may need energy.lt;a href="http://click.hotlog.ru/?2201715" target="_blank"gt;lt;img src="http://hit40.hotlog.ru/cgi-bin/hotlog/count? s=2201715amp;im=303" border="0" width="88" height="31" title="HotLog: shows the number of visitors for today, yesterday and total" alt="HotLog"></a> !}
Cold injuries are diverse, differing in area and degree of damage, and in the mechanism of development. However, they have one common feature– in all cases, the body is affected by low temperature, causing characteristic changes in the tissues. They range from mild to deep and irreversible, which can lead to death.
Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category
Total work experience over 25 years. In 1994 he graduated from the Moscow Institute of Medical and Social Rehabilitation, in 1997 he completed a residency in the specialty “Traumatology and Orthopedics” at the Central Research Institute of Traumatology and Orthopedics named after. N.N. Prifova.
The classification of cold injuries is based on for various reasons. In particular, by area affected There are two types of injury:
- General – freezing, hypothermia;
- Local – frostbite of a part of the body (most often the hands, feet, nose, ears, face).
By the nature of the contact The following types of cold injury are distinguished:
- Indirect (being at low air temperatures);
- Direct (general and local contact with a cooled environment: water, metal, etc.).
In addition, they highlight acute form injuries (single hypothermia or frostbite) and chronic.
The second form is characterized by prolonged exposure to cold and repeated frostbite. There are two main manifestations of it:
- Chills – chronic inflammation areas of the body that are constantly exposed to cold. It manifests itself as purple, bluish spots on the skin, severe itching.
- Cold neurovasculitis– damage to skin capillaries due to chronic exposure to cold. It looks like small pinpoint hemorrhages, accompanied by swelling and pain.
Fever and neurovasculitis develop in people whose profession involves prolonged exposure to cold, vagrancy combined with alcoholism, etc.
Freezing degrees
General cooling (hypothermia) begins when body temperature drops below 36 °C. In this case, the balance of heat in the body is disturbed - losses exceed heat production.
The following degrees of hypothermia are distinguished:
- First (easy). Body temperature drops to 36° (measured in the rectum). The skin turns pale, lips turn blue, goose bumps appear, and chills appear. Heart rate drops slightly arterial pressure remains normal. A person moves less, speech slows down.
- Second (middle). The temperature drops to 35-34°. Stupor ensues. The skin is cyanotic, marbled, and cold to the touch. Pulse and breathing become shallow, blood pressure drops. The person reacts poorly to external stimuli, the consciousness is confused, the gaze does not focus.
- Third (heavy). Temperature below 32-31°. The human body acquires a characteristic pose: legs and arms are bent at the joints, brought to the chest and abdomen. The muscles become very tense and the limbs cannot be straightened. Because of this situation, this stage is also called convulsive. There is no consciousness, the pupils react poorly to light. The peripheral pulse is very weak. Sometimes it can only be found on the femoral/carotid arteries. Blood pressure is extremely low or cannot be determined instrumentally.
When body temperature drops below 30°, cold shock develops. The prognosis worsens, but successful resuscitation is possible with competent first aid and prompt delivery of the victim to the intensive care unit.
Note that hypothermia occurs in isolation or in combination with local injuries - frostbite.
Types of frostbite by development mechanism
When exposed locally to the skin, cold leads to cell dehydration, changes in protein structure, and damage cell membranes ice crystals. As a result, cryonecrosis develops - tissue death. The nature of a cold injury resembles a burn injury, and the corresponding term is used - cold burn. In case of deep damage, frostbite treatment is carried out in burn or surgical departments hospitals.
Low temperatures affect people in different ways. According to the development mechanism The following types of frostbite are distinguished:
- Frostbite from exposure to cold air. The most common injury. Occurs at temperatures below 15-25°C (with high humidity and strong winds from -5°). The depth of tissue damage depends on the temperature and time of exposure.
- Contact frostbite. Less common. Characterized by direct contact with an object cooled to a temperature below 35-40° (frostbite by cryogenic gas, liquid, metal).
In addition, there are characteristic types of injuries that occur under certain combinations of conditions:
- "Trench foot". It is named so because it was first described among combatants. Occurs during prolonged (34 days) exposure to wet shoes at a temperature close to 0° with periodic incomplete warming.
- "Immersion foot (hand)". Frostbite occurs when a limb is immersed in water at a temperature of +1-8°. Because water has high heat capacity and thermal conductivity, it cools the limb faster and more deeply than air.
Degrees of frostbite
Accurate diagnosis of the extent of damage is carried out only after warming up and first aid. To assess the severity of injury, the following classification is used:
I degree. Clinically manifested by pallor (cyanosis, marbling) and coldness of the skin, a tingling, burning sensation, as if burned with boiling water. After warming, redness and swelling develop, followed by exfoliation of the stratum corneum.
II degree. Movement of fingers (hands, feet) is difficult. Superficial sensitivity disappears, deep sensitivity is significantly reduced. Pain is felt in the joints of the fingers, deep in the tissues. Subsequently, the skin peels off, fluid-filled blisters form, and as fluid accumulates, they merge together and burst. There is severe swelling and bluish/yellowing of the skin.
III degree. This stage is also characterized by blisters, but due to the destruction of the capillaries, the contents are stained with blood. Subsequently, the skin dries out, acquires a gray-yellow color, and peels off. When the deep layers heal, areas are formed that are replaced connective tissue(scarring). Often purulent arthritis develops in the affected joints. There is a risk of infection and the development of wet gangrene.
IV degree. Characterized by irreversible necrosis. After warming up, the skin darkens from the edges of the injury to the center. The frostbitten area remains cold to the touch and there is no sensitivity.
After a few days, a demarcation line is formed - a clearly visible boundary of the lesion. On one side, a grade I-III injury is determined, and on the other, the skin takes on a deep black color, the tissues mummify (dry gangrene).
Conclusion
Cold can cause irreparable harm to human health. If stage 1 hypothermia, like superficial frostbite, passes without a trace, then deep injuries require long-term recovery and can lead to disability or death of the victim.
Signs of cold injury. What to do if you have frostbite
Cold injury- injury, the main damaging factor of which is the effect of low temperature (cold) on the body as a whole or locally.
ETIOLOGY AND PATHOGENESIS
There are factors that cause cold injury and factors that contribute to its development.
Factors causing cold injury include:
high air humidity
strong wind
low ambient temperature, etc.
Factors contributing to the development of injury include:
poor blood circulation in cold-affected areas of the body (obliterating endarteritis, varicose veins veins, diseases of the cardiovascular system, immobile position, tight shoes)
reduced resistance to low temperatures (previous thermal injuries, limb injuries, etc.)
reduced body resistance (fatigue, vitamin deficiency, metabolic disorders, exhaustion, etc.)
Often the cause is prolonged exposure to the cold by persons under the influence of alcohol.
When exposed to cold on the entire body as a whole, they speak of general cooling of the body (freezing), and when exposed to local cold - about local damage (frostbite).
General cooling (hypothermia, freezing)– decrease in body temperature to 35 degrees. C and below, is accompanied by metabolic disorders and inhibition of vital functions of the body.
Hypothermia is a consequence of an imbalance in heat balance and develops in cases where heat transfer in the body exceeds heat production.
During the development of hypothermia, phases of compensation and decompensation of thermoregulation are distinguished.
IN compensation phase heat transfer decreases and heat production increases. Heat production is provided mainly by muscle tremors and increased muscle tone.
IN decompensation phase heat transfer predominates, while the body’s activity and metabolic rate sharply decrease. The functions of the central nervous system are inhibited. Rapidly occurring drowsiness deprives the freezing person of the opportunity to actively fight further cooling.
There are 3 degrees of severity of freezing:
1st degree (mild) (adynamic stage) - characterized by a decrease in body temperature to 34°C. Accompanied by pallor or slight cyanosis of the skin, pallor of the lips, chills, the appearance of “goose bumps”, slow pulse, blood pressure (BP) remains normal or slightly increases, breathing, as a rule, is not rapid, the victim feels severe weakness, his movements slow, sluggish, speech difficult.
2nd degree (medium) (stuporous stage) - characterized by a decrease in body temperature to 26–33°C. The skin is pale, bluish, cold to the touch, and sometimes has a marbled color. Movements are severely difficult, severe drowsiness, depression of consciousness, a blank look, and lack of facial expressions are observed. Blood pressure is reduced, the pulse is significantly slowed and the pulse is weakly filled and breathing is rare and shallow.
3rd degree (severe) (convulsive stage) - characterized by a decrease in body temperature to 26°C or less. There is no consciousness, convulsions are possible (trismus), upper limbs bent in elbow joints attempts to straighten them are met with strong resistance, the lower limbs are brought to the stomach, the abdominal muscles are tense.
The skin is pale, bluish, cold. The pulse is very rare, weak in filling, sometimes palpable only in the carotid or femoral arteries. Blood pressure is sharply reduced or not determined. Breathing is rare, shallow, intermittent, hoarse.
Heart sounds are muffled. The pupils are constricted and do not react or react poorly to light.
First aid:
In cases of stuporous freezing, infusion therapy is carried out aimed at replenishing the body's energy resources, eliminating metabolic acidosis and improving microcirculation. Ringer's solution, sodium chloride 0.9%, 10% glucose solution with insulin and 0.25% novocaine solution (glucose-novocaine mixture), 20 ml-40% glucose solution IV, 4% sodium bicarbonate solution (correction) are administered intravenously acidosis after taking a blood test for acid-base balance). It is advisable to administer solutions heated to body temperature (+37-38 °C). To reduce vascular spasm and improve microcirculation, use no-shpu 2 ml (or 2 tablets orally) or papaverine 2 ml-2% solution (or 1 tablet orally). Antihistamines: tavegil 2 ml or suprastin For bradycardia, atropine (0.5-1.0 ml of 0.1% solution) is administered.
When transported by an ambulance team, victims are inhaled with an oxygen-air mixture.
When providing assistance to victims with general cooling of the convulsive degree, the patient is intubated and transferred to mechanical ventilation. Infusion therapy includes the drugs described above. Glucocorticosteroids (prednisolone) are administered according to indications. In case of severe hypotension, the administration of vasopressors is indicated (dopamine 200 mg drip per 250 ml-0.9% NaCl). Against the background of infusion of warm glucose solutions with insulin - the introduction of vitamins C and group B, correction of acidosis.
A decrease in body temperature to 22 °C is considered fatal.
Frostbite- tissue damage caused by prolonged exposure to low temperatures. In most cases, frostbite affects peripheral parts of the body (face, feet, ears, nose, etc.). Depending on the cooling conditions and clinical course, the following types of lesions are distinguished:
frostbite from exposure to cold air;
frostbite of the “trench foot” type (Trench foot. Develops as a result of prolonged (at least 3–4 days) cooling in a humid environment, alternating with incomplete warming of the cooled areas of the feet (in wet snow, swamps and humid tropics). The first signs of such frostbite are pain in the joints of the feet, paresthesia of various nature and disturbances of all types of sensitivity (so-called pain anesthesia).
frostbite of the “immersion foot” type (Occurs mainly in shipwrecks at sea in the cold season and ejection of flight crews into the water. The lesion develops as a result of intense cooling of the limb in a highly thermally conductive environment, the temperature of which ranges from -1.9 to +8 ° C. The severity of the injury depends on the temperature of the water and the duration of stay in it. Soon after immersing the limbs in cold water, a feeling of numbness, difficulty and pain in the movements of the fingers, and cramps of the calf muscles begin 2-5 hours after the cessation of cold exposure, the reactive stage begins. Stage II is marked by skin hyperemia, severe swelling of the legs, multiple blisters appear, pain and sensitivity disorders of soft tissues appear, and muscle strength decreases. With grade III–IV damage, skin hyperemia and blisters form much later, and a wet scab is formed.);
contact frostbite (Contact frostbite occurs when naked areas of the body (usually hands) come into direct contact with sharply cooled metal objects.)
In addition, there are known forms of chronic injury caused by prolonged exposure to cold (chills, cold neurovasculitis, etc.).
Chill is understood as a type of chronic frostbite of mainly exposed parts of the body (hands, face, ears, etc.), often occurring under the influence of systematic, but mild and short-lived cooling.
There are 4 degrees of severity of frostbite: 1st degree - skin damage in the form of reversible circulatory disorders. The skin is swollen, hyperemic, dark blue or purple-red skin color. Pain, tingling and itching are noted. Subsequently, slight peeling of the epidermis is observed.
Remains
increased sensitivity
4th degree - necrosis of the entire thickness of soft tissues and bone structures, vessels are spasmed (As a result of prolonged vascular spasm, irreversible changes occur in frostbitten tissues.) Healing duration is up to 1 year, formation of extensive scars and amputation stumps.
Periods of development inflammatory process with frostbite
In the pre-reactive period, vasospasm develops, followed by ischemia. The basis of pathogenetic treatment of local cold injury is:
Applying thermal insulating bandages to the affected area of the body or limb segment for at least 24 hours;
Refusal of measures aimed at premature warming of the surface layers of chilled tissues (massage, warm baths, warming compresses, etc.). This external warming leads to restoration of tissue metabolism without concomitant restoration of blood flow;
Conducting vasoactive regional (intraarterial, intravenous or intraosseous) and systemic infusion therapy using angiolytics, antioxidants, disaggregants, anticoagulants. Thus, by stimulating regional blood flow, warming of the limb or its segment is ensured, as if from the inside;
Immobilization of affected limbs;
General warming of the victim.
In the early reactive period, reperfusion syndrome develops (toxic components enter the blood when blood flow is restored), which is associated with warming of ischemic tissues. The basis of pathogenetic treatment should be invasive measures used for high-temperature thermal injuries, in combination with local bandage treatment, antibacterial and thermophysical therapy and surgical interventions, as indicated, aimed at maximizing the preservation of viable tissue.
In the late reactive period, all necessary conservative and surgical measures are carried out aimed at reducing intoxication, preventing and fighting infection, removing non-viable tissue and reconstructive operations aimed at restoring lost skin and soft tissue, revascularization of damaged deep anatomical structures.
First aid for frostbite
When providing it, they use methods that ensure rapid restoration of blood circulation. The victim is taken to a warm room. Warm the limbs (healthy and frostbitten) for 40-60 minutes. in a bath with a gradual increase in water temperature from 20 to 40°C. During the first stage of frostbite, the frostbitten limbs are washed with soap and a massage is carried out from the periphery to the center, continuing until the skin becomes warm and red, the damaged and adjacent areas of the skin are lubricated with 5% tincture of iodine and covered with an alcohol bandage. The limbs are given an elevated position. Wrapping frostbitten areas with improvised means. Warm drink.
In case of frostbite of II-IV degree, rapid warming, massage or rubbing should not be done. Apply a heat-insulating bandage to the affected surface (a layer of gauze, a thick layer of cotton wool, another layer of gauze, and oilcloth or rubberized fabric on top). The affected limbs are fixed using available means (a board, a piece of plywood, thick cardboard), applying and bandaging them over the bandage. Padded jackets, sweatshirts, woolen fabric, etc. can be used as heat-insulating material. The victims are given a hot drink, hot food, a tablet of aspirin, analgin, 2 tablets of No-shpa and papaverine.
To accelerate warming and desensitization - iv 10 ml of 10% calcium chloride solution, cardiovascular, painkillers and antihistamines - according to indications. If respiratory function is impaired, mechanical ventilation is performed.
It is not recommended to rub patients with snow, since the blood vessels of the hands and feet are very fragile and therefore may be damaged, and the resulting micro-abrasions on the skin contribute to infection. You should not use quick warming of frostbitten limbs by the fire, or uncontrolled use of heating pads and similar heat sources, as this worsens the course of frostbite. An unacceptable and ineffective first aid option is rubbing oils, fats, rubbing alcohol into tissues for deep frostbite.
Cold injury concept
Cold injury is relatively uncommon, occurring in only 0.07% of surgical patients. However, ignorance of the features of manifestations and first aid for cold injury can lead to the fact that victims will experience irreversible changes in tissues, and then permanent disability. A fatal outcome cannot be ruled out.
Severe disturbances in vital processes begin to develop when tissue temperature drops to 35–33°C; at temperatures below 25°C, biological reactions practically stop.
Although most often cold injuries develop at subzero temperatures. However, they can also occur at ambient temperatures above 0°C, in particular at air temperatures of +(5–8)°C in combination with high wind speeds and relative air humidity exceeding 70-80%. Factors that contribute to the development of cold injury include: causing disturbances blood circulation in certain parts of the body (for example, tight shoes).
Cold injury develops most quickly when the body comes into contact with water at a low temperature. Staying in a body of water with a temperature of up to 10°C in a few minutes can lead to the death of an organism that is not adapted to extreme influences (for comparison, it should be noted that in air at a temperature of 0°C, fatal cooling can occur in 10–12 hours).
In persons who are in a state of physical fatigue, signs of cold injury appear in a shorter period of time. Factors that reduce the body's resistance to low temperatures are a state of strong alcoholic and drug intoxication.
There are local (frostbite itself) and general (cooling or freezing) reactions of the body to the effects of cold. Often, victims simultaneously experience both local and general manifestations of cold injury.
Frostbite
Frostbite refers to local tissue damage that occurs under the influence of low temperatures. Frostbite depending on the depth of tissue damage divided into 4 degrees: I and II – superficial, III and IV – deep.
IN latent period manifestations of frostbite are the same at all degrees. Complaints boil down to a specific feeling of cold, tingling and burning in the affected area. The victim may be bothered by itching and aching joints. Then comes a complete loss of sensitivity. Hyperemia (redness) of frostbitten areas is replaced by sharp blanching. The skin is moderately swollen. Neither the depth nor the extent of tissue damage can be determined during this period. Bubbles, which allow one to judge the degree of frostbite, appear, as a rule, on the second day or later. Due to this, in most cases it takes at least 5–7 days for precise definition depth of damage
fabrics. No matter how mild frostbite may seem, it is very important to provide competent first aid to the victim in the early stages.
IN reactive period , coming after warming, signs of damage begin to develop, including necrosis and inflammation.
At frostbite I degree paleness is observed, which is replaced by redness with a bluish tint as it warms up, swelling of the skin, pain in the form of intense pain or slight tingling and a feeling of “crawling goosebumps”.
At frostbite II degree bubbles appear filled with a clear liquid, the bottom of which is the inner unaffected layer of skin, sensitive to the application of a swab moistened with alcohol. More often, blisters form on the peripheral parts of the extremities. In some cases, the peeled epidermis (top layer of skin) can be removed from the finger in the form of a case, sometimes along with the nail. The skin in the area of the blisters is reddened and swollen over a large area.
At frostbite III degree the blisters contain bloody fluid, their bottom is bluish-purple, insensitive to the application of alcohol.
At frostbite IV degree Dark, flabby blisters are found, their bottom is insensitive to the application of alcohol, is colored purple and has a typical vascular pattern. On days 8–10, secondary blisters filled with cloudy liquid may form.
The first priority emergency first aid in case of frostbite, it is the cessation of the effect of low temperature on the affected area of the body, its “correct” warming.
Primary warming begins in a warm room without the use of heating pads, warm water etc. ( during a period when it is impossible to determine the degree of frostbite, intense warming can lead to active absorption of necrosis products if the victim has developed deep tissue damage).
If, as you warm up, blisters do not appear and the sensitivity of the skin is restored, it is permissible to gently rub the frostbitten areas with a warm, clean hand or soft cloth with movements from the periphery to the center.
Then it is advisable to treat the affected area with alcohol and lubricate with sterile Vaseline oil and apply an aseptic bandage, insulating it with cotton wool.
If deep frostbite is suspected (tissue sensitivity is not restored), massage is strictly contraindicated. After applying a sterile dressing, it is necessary to perform transport immobilization (to ensure immobility of the injured limb) and urgently transport the victim to a medical facility.
Rubbing frostbitten areas of the body with snow is unacceptable, as ice crystals can have a significant damaging effect on the skin, with properties altered as a result of frostbite.
After local procedures, the victim must be given a hot, sweet drink (tea, coffee, etc.).
Despite the fact that frostbite begins as a local process, the accumulation of necrosis products in tissues can lead to severe general disorders, which can result in permanent disability or even death. After providing first aid, you must immediately seek qualified medical help.
General cooling
The impact of low temperatures on the entire body for a time exceeding the compensatory capabilities of thermoregulatory mechanisms leads to general
cooling (freezing), in which the central nervous and cardiovascular systems are most affected.
In contrast to frostbite, with general cooling, characteristic signs are also observed in the latent period, that is, at a time when the reduced body temperature remains. In the development of general cooling processes, 4 phases can be distinguished:
· 1st phase– due to pronounced spasm of peripheral vessels and increased heat production, body temperature even rises slightly (up to 37 ° C);
· 2nd phase– despite maximum heat production (active movements, muscle tremors), body temperature decreases by 1–2°C. The skin is pale, the pulse is weak with a moderately reduced frequency (56–60 per minute), consciousness is clear, reflexes are preserved. There is slight excitement;
· 3rd phase– body temperature drops to 27–34°C. Motor activity drops sharply. Heat production decreases. Muscle tremors give way to muscle paralysis. Pain sensitivity disappears. Consciousness is darkened, confused, reflexes are weakened. The amplitude of respiratory movements is reduced. When body temperature drops below 30°C, disorders develop heart rate;
· 4th phase– body temperature drops below 27°C. Breathing is not detected. There is no pulse in the peripheral arteries. Reflexes are not detected. There is no pain sensitivity. As cooling progresses, death occurs.
It's important to know that clinical death, which occurs as a result of general cooling of the body, has a slightly longer duration than with other mechanisms leading to death. It should be especially noted that clinical death resulting from cooling from immersing a person in “ice” water can last up to 40–60 minutes (according to some sources, up to 2 hours). These facts must be taken into account when providing assistance to victims who show signs of freezing.
Emergency first aid carried out in a volume depending on the phase of general cooling. For phase 1 manifestations, no special treatment methods are required. Transferring the victim to a warm room leads to rapid normalization of his condition.
If signs of the 2nd phase of general cooling are noted (body temperature 34–35°C), warming should be more active, with the obligatory use of hot, sweet drinks (tea, rosehip infusion) in a volume of up to 1 liter for 30–40 minutes .
When cooling the 3rd phase, along with warming the victim, the immediate start of extensive drug therapy at the level of qualified medical care is required.
Signs of the 4th phase of general cooling are indicators to begin with cardiopulmonary resuscitation carried out against the background of warming the victim. A set of resuscitation measures is carried out for the time necessary to restore the pulse in the peripheral arteries and resume rhythmic breathing with distinct movements chest and the appearance of pupillary reactions to light. The listed signs of effective resuscitation can be recorded when the body temperature reaches 33–35°C. Often artificial ventilation and indirect massage hearts continue during the transportation of the victim.
Frostbite is damage to a part of the body (even death) due to exposure to low temperatures. Most often, frostbite occurs during winter frosts, but you can get frostbite in the fall and spring when the air temperature is above zero with high humidity and wind.
Frostbite is caused by tight and wet clothing and shoes, physical fatigue, hunger, prolonged immobility and uncomfortable position, weakening of the body as a result of past diseases, chronic diseases of the cardiovascular system, blood vessels of the lower extremities, blood loss, and alcohol intoxication.
Degrees of frostbite
Frostbite of the 1st degree - blanching of the skin, burning sensation, tingling sensation followed by numbness; after warming up, the frostbitten area becomes purplish-red, swollen, itchy skin and short-term aching pain appear. By the end of the week after frostbite, the skin peels.
Frostbite of the second degree occurs with longer exposure to cold. At first there is pallor, coldness, loss of sensitivity, but these phenomena are observed with all degrees of frostbite. After warming up, the pain is more intense and lasting than with frostbite of the first degree; skin itching and burning are disturbing. Characteristic sign– formation of blisters with transparent contents in the first days after frostbite. Skin healing occurs within 1 – 2 weeks, granulations and scars do not form.
With frostbite of the third degree, the intensity and duration of pain is more pronounced than with frostbite of the second degree. First, blisters filled with bloody contents form. All layers of skin die. The rejection of dead tissue ends in the 2nd - 3rd week, followed by the development of granulations and scars, which lasts up to 1 month. Fallen nails do not grow back or grow ugly.
Frostbite of the IV degree occurs with prolonged exposure to cold; the decrease in temperature in the tissues is the greatest. All layers of soft tissue die, bones and joints are often affected.
The damaged area of the limb is sharply bluish, sometimes with a marbled coloration. Swelling develops immediately after warming and increases rapidly. The skin temperature is significantly lower than the tissue surrounding the frostbite area. Bubbles develop in less frostbitten areas, where there is frostbite of III – II degree. The absence of blisters with significant swelling and loss of sensitivity indicate degree IV frostbite.
In conditions of prolonged exposure to low air temperatures, not only local damage is possible, but also general cooling of the body. This is a condition that occurs when body temperature drops below 34oC.
The onset of general cooling is promoted by the same factors as during frostbite.
There are light, medium and severe degrees of general cooling.
Mild degree: body temperature 32-34 degrees. The skin is pale or moderately bluish, goose bumps, chills, and difficulty speaking appear. Pulse less than 60 beats per minute. Blood pressure is normal or slightly elevated. Breathing is not impaired. Frostbite of I-II degree is possible.
Moderate degree: body temperature 29-32 degrees, drowsiness, depression of consciousness. The skin is cold, pale, bluish, sometimes marbled in color. The pulse slows down to 50 beats per minute, weak filling. Blood pressure is reduced. Breathing is rare - up to 8-12 per minute, shallow. Frostbite of the face and extremities of I – IV degrees is possible.
Severe: body temperature below 31 degrees. No consciousness, convulsions, vomiting. The skin is pale, cold, and bluish. The pulse slows to 36 beats per minute, weak filling, blood pressure is sharply reduced. Breathing is rare, shallow - up to 3-4 per minute. Severe and widespread frostbite up to glaciation is observed.
First aid for frostbite
Actions to provide first aid vary depending on the degree of frostbite, the presence of general cooling of the body, age and concomitant diseases.
The first thing to do if there are signs of frostbite is to take the victim to the nearest warm room, remove frozen shoes, socks, and gloves. At the same time, it is urgent to call an ambulance.
In case of frostbite of the first degree, the cooled areas should be warmed until reddened with warm hands, light massage, breathing, and then apply a cotton-gauze bandage.
In case of frostbite of II-IV degree, rapid warming, massage or rubbing should not be done. Apply a heat-insulating bandage to the affected surface (a layer of gauze, a thick layer of cotton wool, another layer of gauze, and oilcloth or rubberized fabric on top). The affected limbs are fixed using available means (a board, a piece of plywood, thick cardboard), applying and bandaging them over the bandage. Padded jackets, sweatshirts, woolen fabric, etc. can be used as heat-insulating material.
The victims are given a hot drink, hot food, a small amount of alcohol, an aspirin tablet, an analgin tablet, and 2 No-shpa tablets.
Do not rub frostbitten areas with snow! This causes further cooling, causes microdamage, and contributes to infection. In case of deep frostbite, do not rub oils, fats, or rub with alcohol. Do not use heating pads or other heat sources to quickly warm frostbitten limbs near a fire.
For mild general cooling, a fairly effective method is to warm the victim in a warm bath at an initial water temperature of 24oC, which is raised to normal body temperature.
With moderate and severe degrees of general cooling with impaired breathing and circulation, the victim must be taken to the hospital as soon as possible.
Prevention of hypothermia and frostbite
Before going out into the cold, you need to eat.
Do not drink alcohol - alcohol intoxication causes greater heat loss.
Do not smoke in the cold - smoking causes spasm of peripheral blood vessels.
Wear loose and layered clothing to help keep you warm. Outerwear must be waterproof.
Tight, wet shoes are a prerequisite for abrasions and frostbite.
Don't go out into the cold without mittens, a hat and a scarf. Gloves don't protect you from the cold.
In windy, cold weather, before going outside, lubricate exposed areas of the body with pork or goose fat.
Do not wear metal jewelry in the cold. In general, in cold weather, try to avoid contact of bare skin with metal.
Watch your friend's face, and he will watch yours.
Do not remove shoes from frostbitten limbs in the cold - they will swell and you will not be able to put your shoes back on. It is necessary to get to a warm room as soon as possible. If your hands are cold, try warming them under your arms.
Doctor Regional center medical prevention Natalia Borisovna Plotnikova
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