Frostbite 1. How to help with different degrees of frostbite

Frostbite is a kind of tissue damage that occurs under the influence of low temperatures air. Various factors contribute to frostbite, thereby increasing its degree. These factors include external factors (humidity of clothing or air, wind, duration of exposure to cold, immobility, etc.) and internal factors general condition body exposed to low temperatures. Remarkably, the combined effect of several factors contributes to frostbite even at temperatures exceeding 0°C.

Degrees of frostbite

When considering frostbite, the first aid for which is determined in accordance with the accompanying factors, it is also important to have an idea about the degrees of frostbite. There are four of them, and it is in accordance with their characteristics that the subsequent assistance is provided.

• I degree. It is characterized by the greatest ease due to the short duration of the effect of cold and the initial pallor of the corresponding part of the body, followed by loss of sensation, in some cases with the appearance of sensations in the form of tingling / tingling. Then swelling appears, redness and itching form. Skin necrosis does not occur. Full recovery- a week after frostbite.
• II degree. Formed when exposed to cold for a longer time. This degree is characterized by manifestations of the first degree (relevant for subsequent degrees), feature manifested in the formation of blisters with transparent contents at the site of frostbite. After 1-2 weeks, integrity is restored, no scars remain.
• III degree. The effect of cold is prolonged, the temperature of the tissues increases. Bubbles with liquid have bloody contents with a blue-purple bottom. The death of skin elements is possible, dead tissues are rejected after a few weeks, followed by scarring.
• IV degree. The greatest exposure to cold. Frostbite is combined with manifestations of previous degrees, layers of all soft tissues are subjected to necrosis, bones and joints are often affected.

First aid for different degrees of frostbite

Thus, frostbite, for which first aid is provided immediately, provides for appropriate measures for specific degrees of impact.

I degree of frostbite requires warming the chilled areas with breath and warm hands until redness occurs. It also requires a light massage, rubbing using a woolen cloth. Next, a cotton-gauze bandage is applied.

Frostbite II-IV degrees provides for the need for rapid warming. No rubbing or massage is required. A heat-insulating bandage is applied to the affected surface (consisting of a layer of gauze, a thick layer of cotton wool, a layer of gauze over it and, finally, rubberized fabric or ordinary oilcloth). Fixation of the affected limbs is carried out using improvised materials (a piece of plywood, a plank, thick cardboard), which are superimposed, and then bandaged over the applied bandage. A jersey, padded jacket, woolen fabric, etc. can serve as a heat-insulating material.

In addition, the victim is given hot drinks and food, a little alcohol. Of the medicines, analgin and aspirin should be taken - one tablet each, two tablets each - papaverine and No-shpy.

General cooling determines an effective way to warm up by taking a warm bath from 24 degrees of water temperature, followed by a gradual increase. Moderate and severe cooling, especially in respiratory failure, require prompt delivery to the hospital.

In winter, the flow of patients in emergency rooms increases almost several times. The most common cause of this is fractures, sprains and other injuries. However, there is one type of injury that occurs almost exclusively in winter - hypothermia and frostbite (or "frostbite", as they are called by people not associated with medicine).

The only cause of frostbite is a rather long exposure to some parts of the body of low temperatures of air, snow, ice, water, chilled metal, etc. The effect of cold on the body as a whole leads to hypothermia (hypothermia), which, however, does not exclude the parallel occurrence of frostbite .

Frostbite contributing factors:

It should be noted that the ability to withstand frost largely depends on genetic factors. So the inhabitants of the Arctic (Eskimos, Aleuts, Chukchi) can withstand relatively long exposure to cold, while Africans can get frostbite even at + 10ºС.

Frostbite symptoms

The course of cold injury is divided into two periods:

• pre-reactive, or initial, calculated from the moment the effect of low temperature on the tissues begins and until the start of warming;
• reactive, starting from the moment of warming; in this period, hypoxia, inflammation and tissue necrosis develop.

In the pre-reactive period, numbness of the skin, itching, and a feeling of “stiffening” of the muscles first occur. With severe damage to the legs, a person loses the ability to walk, with damage to the hands, there is also an inability to use them. A little later, the feeling of cold is replaced by a burning sensation, itching and, as a result, a complete loss of sensitivity (anesthesia). Pain in this period is practically absent or extremely insignificant in intensity.

Only in the second period can one accurately determine the amount of damage and the degree of frostbite and make assumptions about the prognosis.

Frostbite, depending on the depth of tissue damage, is divided into 4 degrees:

• 1 degree. The victim feels severe burning pain in the area of ​​injury, experiences unbearable itching, sometimes forcing him to comb the affected skin. Often there are paresthesias in the form of "crawling crawling". Skin - purple, cyanotic or red.
• 2 degree. The main symptom is pain, which occurs on the second day during frostbite and lasts for 2-3 days. Visually, blisters filled with a clear liquid (similar to burns) are determined on the skin. They appear on the second day.
• 3 degree. The patient's sensations are approximately the same as with the 2nd degree of frostbite, but the pain is more intense and lasts longer. The skin is affected to its entire depth, over time it is torn off, forming wounds. As it heals, scars form.
• 4 degree. Affected not only the skin and subcutaneous tissue, but also muscles, ligaments, joints, bones. The intensity of pain depends on the depth and volume of the affected tissues. On the 12th day, a clear boundary between viable and dead tissues becomes visible.

Frostbite is usually either open areas of the body - the nose, cheeks, ears, or the worst blood supply or the most susceptible to hypothermia - legs, fingers, hands.

With frostbite, tissues lose their ability to resist mechanical, physical and chemical damaging factors. Therefore, the main rule in first aid is not to perform actions that can aggravate damage. Here is why it is strictly forbidden:

• rub frostbitten places with snow, ice, ointments, alcohol-containing solutions (vodka, alcohol, cologne, etc.);
• warm the injury site with intense dry heat (cover with hot heating pads, bring it closer to an open flame or a beam of reflector heaters);
• douse with hot water;
• pierce blisters;
• smoking and drinking alcohol (this impairs microcirculation and slows down the restoration of blood circulation);
• to drink coffee.

The first thing to do is stop exposure to cold. For this, the victim must be moved to a warm room.

Remove all tight jewelry (if possible!) and be sure to remove wet or icy clothing (if necessary, cut it).

If it is possible to get prompt medical assistance, apply sterile dressings to the affected areas of the body. Remember to separate all fingers with gauze strips. Wrap your hands or feet with a warm cloth - a scarf, blanket, etc. Take the victim to medical institution trying to touch the affected areas as little as possible.

If qualified medical care (even pre-medical care) cannot be obtained in the near future, proceed as follows:

• place the injured limb in a container of water at a temperature of -18°C.
• Within 20-30 minutes, very smoothly bring the water temperature to 37-38°C.
• After half an hour, remove the limb, gently blot it with a soft cloth (do not rub!) And wrap it in a warm one.
• Give the person warm tea or water and an anesthetic tablet (not Citramon!), as he may experience severe pain when warmed up.
• Take measures to get the victim to a medical facility as soon as possible.

ATTENTION! Repeated freezing of an already warmed limb leads to more serious and deep damage. If you cannot guarantee that the frostbitten limb stays warm, it is better not to start warming it.

Hypothermia and frostbite are cousins”, very often affecting the same person at the same time. If the casualty shows signs of hypothermia, first aid for frostbite should be delayed. This is due to the fact that hypothermia affects the entire body, and can kill the patient, while only parts of the body suffer from frostbite.

Signs of hypothermia:

• lethargy;
• drowsiness;
• impaired coordination of movements;
• confused speech;
• loss of consciousness;
• decrease in blood pressure, decrease in frequency respiratory movements and pulse;
• drop in body temperature to critical figures.

First aid for hypothermia

If a person is conscious, then it is enough to transfer him to a warm room and give him a warm drink. In the absence of consciousness, attempts to give the victim hot drink are strictly prohibited. Just wrap it up, lay it on its side and call " ambulance».

How to prevent frostbite

Knowing the rules of first aid for frostbite is a necessary thing, but any doctor will say that prevention is better than cure. Therefore, it is worth observing simple rules of prevention:

• warm clothes according to the weather in several layers - it is commonplace, but many people neglect this;
• loose winter shoes without a heel - tight boots compress the leg, worsen its blood supply;
• the use of a scarf, hat, gloves - this way you can protect your face and hands from frost;
• refusal of metal jewelry, piercing of open parts of the body;
• giving up alcohol and smoking;
• high-calorie food;
• lubrication of exposed areas of the skin with a greasy cream.

If you are too cold - enter any warm room (shop, cafe, entrance) and warm up.

And the simplest rule - in severe frost, try not to go outside without special need.

Even if you are perfectly capable of providing first aid, it may not be enough. Therefore, any person with frostbite should be taken to a medical facility. Specialists will be able to accurately determine the amount of damage and prescribe the most gentle and at the same time the most effective treatment.

Bozbey Gennady Andreevich, emergency doctor

Frostbite or frostbite(lat. Congelatio) - damage to body tissues under the influence of cold. It is often accompanied by general hypothermia of the body and especially often affects such parts of the body as auricles, nose, insufficiently protected limbs, especially fingers and toes. Distinguished from "cold burns", which result from direct contact with extremely cold substances such as dry ice or liquid nitrogen. Most often, frostbite occurs in cold winters at temperatures environment below -10°C - -20°C. With a long stay outdoors, especially with high humidity and strong winds, frostbite can be obtained in autumn and spring when the air temperature is above zero.

Frostbite in the cold leads to tight and wet clothes and shoes, physical fatigue, hunger, forced prolonged immobility and uncomfortable position, previous cold injury, weakening of the body as a result of previous diseases, sweating of the legs, chronic diseases vessels lower extremities and of cardio-vascular system, heavy mechanical damage with blood loss, smoking, etc. Statistics show that quite often, severe frostbite, which led to amputation of limbs, occurs in a state of extreme intoxication.

Under the influence of cold, complex changes occur in the tissues, the nature of which depends on the level and duration of the decrease in temperature. Under the influence of temperatures below -30 ° C, the main value in frostbite is the damaging effect of cold directly on the tissues, and cell death occurs. Under the influence of temperatures up to -10 - -20 ° C, at which most frostbite occurs, vascular changes in the form of a spasm of the smallest blood vessels. As a result, the blood flow slows down, the action of tissue enzymes stops, and the supply of oxygen to the tissues is significantly reduced.

Classification

Frostbite of the hands of the second degree

Frostbite I degree(most mild) usually occurs with short exposure to cold. The affected area of ​​the skin is pale, reddened after warming, in some cases it has a purple-red tint; edema develops. Skin necrosis does not occur. By the end of the week after frostbite, slight peeling of the skin is sometimes observed. Full recovery occurs by 5-7 days after frostbite. The first signs of such frostbite are a burning sensation, tingling, followed by numbness of the affected area. Then appear pruritus and pain, which can be both minor and pronounced.

Frostbite II degree occurs with prolonged exposure to cold. In the initial period, there is blanching, cooling, loss of sensitivity, but these phenomena are observed at all degrees of frostbite. Therefore, the most characteristic sign is the formation of blisters filled with transparent contents in the first days after the injury. Full recovery integrity of the skin occurs within 1 - 2 weeks, granulation and scarring are not formed. With frostbite of the II degree after warming, the pain is more intense and longer than with frostbite of the I degree, skin itching, burning are disturbing.

At frostbite III degree the duration of the period of cold exposure and decrease in temperature in the tissues increases. The blisters formed in the initial period are filled with bloody contents, their bottom is blue-purple, insensitive to irritations. There is a death of all elements of the skin with the development of granulations and scars as a result of frostbite. Descended nails do not grow back or grow deformed. Rejection of dead tissues ends on the 2nd - 3rd week, after which scarring occurs, which lasts up to 1 month. Intensity and Duration pain more pronounced than with frostbite II degree.

Frostbite IV degree occurs with prolonged exposure to cold, the decrease in temperature in the tissues with it is the greatest. It is often combined with frostbite III and even II degree. All layers of soft tissues become dead, bones and joints are often affected.

The damaged area of ​​the limb is sharply cyanotic, sometimes with a marble color. Edema develops immediately after warming and increases rapidly. The temperature of the skin is much lower than that of the tissues surrounding the area of ​​frostbite. Blisters develop in less frostbitten areas where there is frostbite III - II degree. The absence of blisters with significantly developed edema, loss of sensitivity indicate frostbite of the IV degree.

Under conditions of a long stay at low air temperature, not only local lesions are possible, but also a general cooling of the body. Under the general cooling of the body should be understood as a state that occurs when the body temperature drops below 34 ° C.

The onset of general cooling is facilitated by the same factors as with frostbite: high humidity, damp clothes, strong winds, physical overwork, mental trauma, past illnesses and injuries.

There are mild, moderate and severe degrees of general cooling.

Easy degree: body temperature 32-34°C. The skin is pale or moderately cyanotic, appear " goose-flesh”, chills, difficulty speaking. The pulse slows down to 60-66 beats per minute. Blood pressure is normal or slightly elevated. Breathing is not disturbed. Frostbite of I-II degree is possible.

Average degree: body temperature 29-32 ° C, sharp drowsiness, depression of consciousness, a meaningless look are characteristic. The skin is pale, cyanotic, sometimes marbled, cold to the touch. The pulse slows down to 50-60 beats per minute, weak filling. Arterial pressure is reduced slightly. Breathing is rare - up to 8-12 per minute, superficial. Frostbite of the face and limbs of I-IV degree is possible.

Severe degree: body temperature below 31°C. Consciousness is absent, convulsions, vomiting are observed. The skin is pale, cyanotic, cold to the touch. The pulse slows down to 36 beats per minute, weak filling, there is a pronounced decrease in blood pressure. Breathing is rare, superficial - up to 3-4 per minute. There are severe and widespread frostbite up to glaciation.

Etiology.

The direct cause of frostbite is the effect of low temperature on the human body. Human body has a system of thermoregulation that prevents thermal damage to tissues, but under the action of a number external factors, the effectiveness of thermoregulation is reduced, and frostbite occurs. These factors can be divided into the following main groups.

Weather Moisture and wind contribute to frostbite. Often, the occurrence of such injuries is possible at a positive air temperature, with strong winds and high humidity. Wind and high humidity increase heat transfer, reduce the thermal insulation properties of clothing and footwear.

The state of thermal insulation of the limb Tight shoes, prolonged immobility, the need to constantly hold an object in the hands, reduce the efficiency of microcirculation, and as a result, contribute to the occurrence of cold lesions.

General condition of the body A weakened body produces less heat and, as a result, is more susceptible to cold injury. The reasons leading to an increase in human vulnerability to cold are very diverse. The most common are injuries, blood loss, lack of food, fatigue and stress.

Various circulatory disorders The development of frostbite is largely facilitated by obliterating diseases of the extremities, various systemic diseases affecting capillaries, and larger vessels. Tissues with low vascularity, such as scar tissue, are more prone to frostbite.

Pathogenesis

First aid for frostbite

Actions in the provision of first aid vary depending on the degree of frostbite, the presence of general cooling of the body, age and concomitant diseases.

First aid consists in stopping the cooling, warming the limb, restoring blood circulation in the tissues affected by cold and preventing the development of infection. The first thing to do with signs of frostbite is to deliver the victim to the nearest warm room, remove frozen shoes, socks, gloves. Simultaneously with the implementation of first aid measures, it is urgent to call a doctor, an ambulance to provide medical assistance.

At frostbite I degree cooled areas should be warmed to redness with warm hands, light massage, rubbing with a woolen cloth, breathing, and then apply a cotton-gauze bandage.

At frostbite II-IV rapid warming, massaging 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, again a layer of gauze, and on top of oilcloth or rubberized fabric). The affected limbs are fixed with the help of improvised means (a board, a piece of plywood, thick cardboard), applying and bandaging them over the bandage. As a heat-insulating material, you can use padded jackets, sweatshirts, woolen fabric, etc.

The victims are given hot drinks, hot food, a small amount of alcohol, one tablet of aspirin, analgin, 2 tablets of "No-shpa" and papaverine.

It is not recommended to rub the sick with snow, as the blood vessels of the hands and feet are very fragile and therefore they can be damaged, and the resulting micro abrasions on the skin contribute to infection. You can not use the rapid warming of frostbitten limbs near the fire, uncontrolled use of heating pads and similar sources of heat, as this worsens the course of frostbite. An unacceptable and ineffective first aid option is rubbing oils, fat, rubbing alcohol on tissues with deep frostbite.

With general cooling mild degree enough effective method is warming the victim in a warm bath at an initial water temperature of 24 ° C, which is raised to normal body temperature.

At moderate and severe general cooling with respiratory and circulatory disorders, the victim must be taken to the hospital as soon as possible.

Medical triage of victims

Medical sorting is a necessary measure in case of mass admission of victims. According to the principle of need for medical care, the victims can be divided into 4 groups.

1. Requiring immediate qualified medical care (if not provided, a fatal outcome is possible with a high probability)
2. The provision of qualified medical care may be delayed (failure to provide assistance may lead to the development of complications in the future)
3. Those who do not need immediate qualified medical assistance (Providing qualified assistance can be delayed without significant harm to the health of the victim.)
4. Terminal and agonizing (despite the provision of assistance in most cases, a fatal outcome is possible)

In the event of a mass arrival of victims, medical assistance is provided to them, according to the order of the groups in the list.

Treatment

First aid

If you have frostbite on your fingers, ears, or other parts of your body, take the following steps:

• Shelter from the cold.
• Warm your hands by hiding them under your armpits. If frostbite affects the nose, ears, or parts of the face, warm these places by covering them with dry, warm gloves.
• Do not rub damaged areas. Never rub frostbitten skin with snow.
• If there is a risk of repeated frostbite, do not allow thawing of already affected areas. If they have already thawed, wrap them up so that they cannot freeze again.
• If warming the frostbite does not restore sensation, seek emergency medical attention. medical care. If professional help is not available soon, warm severely frostbitten hands or feet in warm (not hot!) water. Other affected areas (nose, cheeks, auricles) can be warmed by placing warm palms or heated pieces of cloth on them.

Qualified medical care

Rehabilitation

Prevention of hypothermia and frostbite

There are several simple rules, which will allow you to avoid hypothermia and frostbite in severe frost: Do not drink alcohol - alcohol intoxication (however, like any other) actually causes a lot of heat loss, at the same time causing the illusion of warmth. An additional factor is the inability to focus 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" - while between the layers of clothing there are always layers of air that perfectly retain heat. Outerwear must be waterproof. Tight shoes, lack of insoles, damp dirty socks often serve as the main prerequisite for the appearance of scuffs and frostbite. Special attention shoes should be given to those who often sweat feet. You need to put warm insoles in boots, and wear woolen ones instead of cotton socks - they absorb moisture, leaving your feet dry.

Do not go out into the cold without mittens, a hat and a scarf. The best way– mittens made of water-repellent and windproof fabric with fur inside. Gloves made of natural materials, although comfortable, do not save from frost. Cheeks and chin can be protected with a scarf. In windy cold weather, before going outside, lubricate open areas of the body with a special cream. 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 can “stick” to the skin with pain and cold injuries. Secondly, the rings on the fingers impede the normal circulation of blood. In general, in the cold, try to avoid contact of bare skin with metal. Get a friend's help - keep an eye on a friend's face, especially the ears, nose and cheeks, for any noticeable changes in color, and he or she will watch yours.

Do not let the frostbitten area 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 on shoes again. It is necessary to reach a warm room as soon as possible. If your hands are cold, try warming them under your arms.

When you return home after a long walk in the cold, be sure to check for frostbite on the limbs, back, ears, nose, etc. Freezing frostbite can lead to gangrene and subsequent loss of a limb. As soon as you feel hypothermia or freezing of the extremities during the walk, you need to go to any warm place as soon as possible - a store, a cafe, an entrance - to warm up and inspect places potentially vulnerable to frostbite.

If your car has stalled away from a populated area or in an area unfamiliar to you, it is better to stay in the car, call for help or wait for another car to pass on the road.

Stay away from the wind - the chance of frostbite in the wind is much higher. Do not wet the skin - water conducts heat significantly better than air. Don't go out into the cold with wet hair after a shower. Wet clothes and shoes (for example, a person fell into the water) must be removed, the water wiped off, if possible, put on dry ones and bring the person to heat as soon as possible. In the forest, it is necessary to kindle a fire, undress and dry clothes, during this time vigorously doing physical exercise and basking by the fire.

It can be useful for a long walk in the cold to take with you a pair of interchangeable socks, mittens and a thermos with hot tea. Before going out into the cold, you need to eat - you may need energy.

It should be borne in mind that in children the thermoregulation of the body is not yet fully adjusted, and in the elderly and in some diseases this function is impaired. These categories are more prone to hypothermia and frostbite, and this should be taken into account when planning a walk. When letting a child go for a walk in the cold on the street, remember that it is advisable for him to return to warmth and warm up every 15-20 minutes.

Finally, remember that The best way to get out of an unpleasant situation is not to fall into it. If you do not like extreme sensations, in severe frost, try not to leave the house unless absolutely necessary.

Frostbite in animals

Dogs, like people, can get hypothermia and frostbite. AT extreme situations they often have to rely only on the help of their master, because in some situations - for example, in the forest on a hunt - one can hardly meet veterinarian. Therefore, the duty of every dog ​​owner is to have the necessary knowledge and skills in order to be able to help not only himself and his friend, but also the injured dog. You need to be attentive to the dog in order to recognize the disease in time and take action yourself or contact the veterinarian.

With frostbite, the first aid is to warm up as soon as possible. The affected area is wiped with alcohol, vodka or potassium permanganate and a warming bandage with cotton is placed. It's a good idea to give your dog warm, freshly brewed sweet tea.

It should also be noted that warming in a similar way leads mainly to the expansion of superficially located vessels, and activation of the metabolism of warmed tissues. Which can lead to their necrosis, due to the fact that between the warmed tissue and the deeper, warm tissues, there is a layer of unrecovered tissue with spasmodic vessels. Accordingly, ischemia occurs in the overlying areas, and as a result, massive cell death occurs. Which can lead to the formation of scabs and ulcers, or even loss of a limb.

Forecast - I frostbite / zhenie \u003d frostbite / nie to frostbite and frostbite. Frostbite of the first degree. Take precautions in case of frostbite. II frostbite / nie I; cf.; see frostbite II... Dictionary of many expressions

frostbite- nušalimas statusas T sritis Kūno kultūra ir sportas apibrėžtis Organizmo audinių sužalojimas nuo šalčio. atitikmenys: engl. freezing; frostbite vok. Abfrieren, n; Erfrieren, n rus. frostbite … Sporto terminų žodynas

Wed 1. the process of action according to Ch. frostbite, frostbite 2. The result of such an action. Explanatory Dictionary of Efremova. T. F. Efremova. 2000... Modern dictionary Russian language Efremova

Frostbite, frostbite, frostbite, frostbite, frostbite, frostbite, frostbite, frostbite, frostbite, frostbite, frostbite, frostbite (

frostbite- This is a local tissue damage that develops when exposed to cold. Frostbite has a latent and reactive period that occurs after warming. Pathology is manifested by a change in color, pain, sensory disturbances, the appearance of blisters and foci of necrosis. Damage III and IV degree leads to the development of gangrene and spontaneous rejection of the fingers. Treatment is carried out with vascular drugs (pentoxifylline, nicotinic acid, antispasmodics), antibiotics, physiotherapy; cupping pain syndrome carried out by novocaine blockades.

General information

frostbite- tissue damage that develops when exposed to cold. In Russia, the frequency of frostbite is about 1% of all injuries, with the exception of some regions of the Far North, where it rises to 6-10%. The feet are most often subject to frostbite, the hands are in second place, and the protruding parts of the face (nose, auricles, cheeks) are in third place. Treatment of pathology is carried out by specialists in the field of combustiology, traumatology and orthopedics.

Causes of frostbite

The cause of tissue damage can be frost, direct contact with an object cooled to an extremely low temperature (contact frostbite) and long-term periodic cooling in conditions of high air humidity ("trench foot", chilliness). Factors contributing to the development of frostbite are strong winds, high air humidity, a decrease in local and general immunity (as a result of illness, injury, beriberi, malnutrition, etc.), alcohol intoxication, tight clothing and shoes that cause circulatory disorders.

Pathogenesis

Exposure to low temperatures causes persistent vasospasm. The rate of blood flow decreases, blood viscosity increases. Shaped elements"Clog" small vessels, blood clots form. Thus, pathological changes frostbite occurs not only as a result of direct exposure to cold, but also as a result of a reaction from the vessels. Local circulatory disorders provoke disorders of the vegetative nervous system governing the activities of all internal organs. As a result, inflammatory changes develop in organs remote from the site of frostbite ( respiratory tract, bones, peripheral nerves and gastrointestinal tract).

Frostbite symptoms

Clinical manifestations are determined by the degree and period of the lesion. The latent (pre-reactive) period of frostbite develops in the first hours after injury and is accompanied by poor clinical symptoms. Minor pain, tingling, impaired sensitivity are possible. The skin in the area of ​​frostbite is cold, pale.

After tissue warming, a reactive period of frostbite begins, the manifestations of which depend on the degree of tissue damage and the complications caused by the underlying pathology.

There are four degrees of frostbite:

• With frostbite of the 1st degree, moderate edema appears in the reactive period. The affected area becomes cyanotic or becomes marbled. The patient is disturbed by burning pains, paresthesias and pruritus. All signs of frostbite disappear on their own within 5-7 days. Subsequently, it often remains hypersensitivity affected areas to the effects of cold.
• Frostbite II degree is accompanied by necrosis of the surface layers of the skin. After warming, the affected area becomes cyanotic, sharply edematous. On days 1-3, blisters with serous or serous-hemorrhagic contents appear in the area of ​​frostbite. When the blisters open, a painful wound is exposed, which heals on its own in 2-4 weeks.
• With frostbite III degree necrosis extends to all layers of the skin. In the pre-reactive period, the affected areas are cold, pale. After warming, the site of the lesion becomes sharply edematous, blisters filled with hemorrhagic fluid appear on its surface. When opening the blisters, wounds with a painless or slightly painful bottom are exposed.
• Frostbite IV degree is accompanied by necrosis of the skin and underlying tissues: subcutaneous tissue, bones and muscles. As a rule, areas of deep tissue damage are combined with areas of frostbite of I-III degrees. Areas of frostbite IV degree pale, cold, sometimes slightly edematous. There is no sensitivity.

With frostbite III and IV degree dry or wet gangrene develops. Dry gangrene is characterized by gradual drying of tissues and mummification. The area of ​​deep frostbite becomes dark blue. In the second week, a demarcation furrow is formed, separating necrosis from "living" tissues.

Spontaneous rejection of fingers usually occurs 4-5 weeks after frostbite. With extensive frostbite with necrosis of the feet and hands, rejection begins more late dates, especially in cases where the demarcation line is located in the area of ​​the bone diaphysis. After rejection, the wound is filled with granulations and heals with the formation of a scar.

Chilling occurs with periodic cooling (usually at temperatures above 0) and high humidity. On the peripheral parts of the body (hands, feet, protruding parts of the face), dense cyanotic-purple swellings appear. The sensitivity of the affected areas is reduced. The patient is worried about itching, bursting or burning pain. Then the skin in the area of ​​chilliness becomes rough and cracked. When the hands are affected, physical strength decreases, the patient loses the ability to perform delicate operations. In the future, erosion or development of dermatitis is possible.

Chilliness develops with moderate, but prolonged and continuous exposure to damp cold. Initially, sensory disturbances appear in the area thumb, gradually spreading to the entire foot. The limb becomes edematous. With repeated cooling and warming, it is possible wet gangrene.

frostbite treatment

The victim must be moved to a warm room, warm, give tea, coffee or hot food. Frostbite areas should not be rubbed vigorously or warmed quickly. When rubbing, multiple microtraumas of the skin occur. Warming up too fast will result in normal level metabolic processes recovers faster than the blood supply to the affected areas. As a result, necrosis may develop in malnourished tissues. The best result is achieved when warming "from the inside" - applying heat-insulating cotton-gauze dressings to the area of ​​frostbite.

Upon admission to the traumatology department, the patient with frostbite is warmed. A mixture of solutions of novocaine, aminophylline and nicotinic acid is injected into the artery of the injured limb. Prescribe drugs to restore blood circulation and improve microcirculation: pentoxifylline, antispasmodics, vitamins and ganglionic blockers, with severe lesions- corticosteroids. Solutions of rheopolyglucin, glucose, novocaine and heated to 38 degrees are administered intravenously and intraarterially. saline solutions. Patient with frostbite is prescribed antibiotics a wide range actions and anticoagulants (heparin for 5-7 days). Carry out a case novocaine blockade.

To reduce the stimulation of recovery processes, reduce swelling and pain syndrome, physiotherapy is carried out (magnetotherapy, ultrasound, laser irradiation, diathermy, UHF). Bubbles are pierced without being removed. Alcohol-chlorhexidine and alcohol-furatsilin wet-drying dressings are applied to the frostbite area, with suppuration - dressings with antibacterial ointments. With significant edema, orthopedic traumatologists perform fasciotomy to eliminate tissue compression and improve blood supply to the area of ​​frostbite. With the preservation of pronounced edema and the formation of areas of necrosis, necrectomy and necrotomy are performed on days 3-6.

After the formation of the demarcation line, the volume is determined surgical intervention. As a rule, under the damaged skin in the demarcation zone, viable soft tissues therefore, in dry necrosis, expectant treatment is usually chosen to save more tissue. With wet necrosis, there is a high probability of developing infectious complications with the spread of the process "up" through healthy tissues, so expectant management is not applicable in such cases. Surgical treatment with frostbite IV degree is to remove dead areas. Amputation of necrotic fingers, hands or feet is performed.

Forecast and prevention

With superficial frostbite, the prognosis is conditionally favorable. Limb functions are restored. In the remote period, increased sensitivity to cold, malnutrition and vascular tone in the area of ​​the affected area persist for a long time. Perhaps the development of Raynaud's disease or obliterating endarteritis. With deep frostbite, the outcome is the amputation of a part of the limb. Prevention includes the choice of clothes and shoes, taking into account weather conditions, the rejection of a long stay on the street in cold weather, especially when intoxicated.

frostbite is damage to any part of the body (up to necrosis) under the influence of low temperatures. With a long stay outdoors, especially with high humidity and strong winds, frostbite can be obtained in autumn and spring when the air temperature is above zero.

lead to frostbite in the cold tight and wet clothes and shoes, physical overwork, hunger, forced long-term immobile and uncomfortable position, previous cold injury, weakening of the body as a result past illnesses, sweating of the legs, chronic diseases of the vessels of the lower extremities and the cardiovascular system, severe mechanical damage with blood loss, smoking, etc.

Statistics show that almost all severe frostbite that led to amputation of limbs occurred in a state of severe alcohol intoxication .

Under the influence of cold, complex changes occur in the tissues, the nature of which depends on the level and duration of the decrease in temperature. When the temperature is below -30 degrees C, the main value in frostbite is the damaging effect of cold directly on the tissue, and cell death occurs. Under the action of temperatures up to -10-20 degrees C, at which most frostbite occurs, vascular changes in the form of a spasm of the smallest blood vessels are of paramount importance. As a result, blood flow slows down, the action of tissue enzymes stops.

Signs of frostbite and general hypothermia:

The skin is pale bluish;

Temperature, tactile and pain sensitivity are absent or sharply reduced;

When warmed up, they appear severe pain, redness and swelling of soft tissues;

With deeper damage, blisters with bloody contents may appear in 12-24 hours;

With general hypothermia, a person is lethargic, indifferent to the environment, his skin is pale, cold, his pulse is frequent, blood pressure is lowered, body temperature is below 36 ° C

There are several degrees of frostbite:

Frostbite I degree(most mild) usually occurs with short exposure to cold. The affected area of ​​the skin is pale, reddened after warming, in some cases it has a purple-red tint; edema develops. Skin necrosis does not occur. By the end of the week after frostbite, slight peeling of the skin is sometimes observed. Full recovery occurs by 5-7 days after frostbite. The first signs of such frostbite are a burning sensation, tingling, followed by numbness of the affected area. Then there is skin itching and pain, which can be both minor and pronounced.

Frostbite II degree occurs with prolonged exposure to cold. In the initial period, blanching appears, the skin becomes cold, sensitivity is lost, but these phenomena are observed at all degrees of frostbite. Therefore, the most characteristic sign is the formation of blisters filled with transparent contents in the first days after the injury. Full restoration of the integrity of the skin occurs within 1-2 weeks, granulation and scarring are not formed. With frostbite of the II degree after warming, the pain is more intense and longer than with frostbite of the I degree, skin itching, burning are disturbing.

With frostbite III degree the duration of the period of cold exposure and decrease in temperature in the tissues increases. The blisters formed in the initial period are filled with bloody contents, their bottom is blue-purple, insensitive to irritations. There is a death of all elements of the skin with the development of granulations and scars as a result of frostbite. Descended nails do not grow back or grow deformed. Rejection of dead tissues ends on the 2nd-3rd week, after which scarring occurs, which lasts up to 1 month. The intensity and duration of pain is more pronounced than with frostbite II degree.

Frostbite IV degree occurs with prolonged exposure to cold, the decrease in temperature in the tissues with it is the greatest. It is often combined with frostbite III and even II degree. All layers of soft tissues become dead, bones and joints are often affected.

The damaged area of ​​the limb is strongly cyanotic, sometimes with a marble color. Edema develops immediately after warming and increases rapidly. The temperature of the skin is much lower than that of the tissues surrounding the area of ​​frostbite. Blisters develop in less frostbitten areas where there is frostbite III-II degree. The absence of blisters with significantly developed edema, loss of sensitivity indicate frostbite IV degree.

Under conditions of a long stay at low air temperature, not only local lesions are possible, but also a general cooling of the body. Under the general cooling of the body, one should understand the state that occurs when the body temperature drops below 34 degrees C.

First aid for frostbite

First of all, it is necessary to warm the victim in a warm room. Warming of the affected part of the body should be gradual, slow, mostly passive. Unacceptable (!) rub frostbitten parts of the body with hands, tissues, alcohol, and even more so with snow! (Such recipes are extremely tenacious and still exist among the people.) The fact is that these measures contribute to thrombosis in the vessels, deepening the processes of destruction of the affected tissues.

The injured need wrap in a warm blanket(with general hypothermia) or (with frostbite) apply a heat-insulating cotton-gauze bandage to the affected part of the body(7 layers) to accumulate heat and prevent premature warming of superficial tissues (and, accordingly, the formation of a temperature difference between superficial and deep tissues). The use of a thermally insulating bandage makes it possible to slow down the external warming of the affected area several times while ensuring the general warming of the body.

If an arm or leg is frostbitten, it can be warmed in the bath, gradually increasing the water temperature from 20 to 40 ° C and within 40 minutes gently (!) massaging the limb. On the inner surface of the thigh or shoulder, you can additionally put a warm heating pad y. To the injured give plenty of warm drink like sweet tea.

From drug treatment it is advisable to use an anesthetic (analgin - 0.1 g) and a vasodilator (eufillin - 1/4 tablet, noshpa - 0.005 g or nicotinic acid - 0.01 g) agents, as well as tinctures of valerian or motherwort (5-10 drops) as soothing.

If warming after frostbite is accompanied by moderate pain (the victim gradually calms down), sensitivity, temperature and color are restored skin, independent full-fledged movements, then the limb is wiped dry, the skin is treated with 70% alcohol (or vodka) and a dry bandage with cotton wool is applied. The ear, nose or cheek are liberally lubricated with petroleum jelly and a dry warming bandage with cotton wool is applied.

Prevention of hypothermia and frostbite

There are a few simple rules that will allow you to avoid hypothermia and frostbite in severe frost:

- Don't drink alcohol- Alcohol intoxication causes a large loss of heat. An additional factor is the inability to focus on the signs of frostbite.

- Don't smoke in the cold- Smoking reduces the peripheral blood circulation, and thus makes the limbs more vulnerable.

- Wear loose clothing- It promotes normal blood circulation. Dress like a "cabbage" - while between the layers of clothing there are always layers of air that perfectly retain heat.

Tight shoes, lack of insoles, damp dirty socks often serve as the main prerequisite for the appearance of scuffs and frostbite. Particular attention should be paid to shoes for those who often sweat feet. You need to put warm insoles in boots, and wear woolen ones instead of cotton socks - they absorb moisture, leaving your feet dry.

- Do not go out into the cold without mittens, a hat and a scarf. The best option is mittens made of water-repellent and windproof fabric with fur inside. Gloves made of natural materials, although comfortable, do not save from frost. Cheeks and chin can be protected with a scarf. In windy cold weather, before going outside, lubricate open areas of the body with a special cream.

- Do not wear metal in the cold(including gold, silver) jewelry.

- Get help from a friend: keep an eye on your friend's face, especially the ears, nose, and cheeks, for any noticeable changes in color, and he or she will keep an eye on yours.

- Don't take off your shoes in the cold from frostbitten limbs - they will swell and you will not be able to put on shoes again. It is necessary to reach a warm room as soon as possible. If your hands are cold, try warming them under your armpits.

Returning home after a long walk in the cold, be sure to make sure there is no frostbite on the limbs, back, ears, nose, etc.

As soon as you feel hypothermia or freezing of the extremities during a walk, you need to go to any warm place as soon as possible- a shop, a cafe, an entrance - for warming and inspecting places potentially vulnerable to frostbite.

- Hide from the wind- the likelihood of frostbite in the wind is much higher.

- Don't 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 fell into the water) must be removed, the water wiped off, if possible, put on dry ones and bring the person to heat as soon as possible. In the forest, it is necessary to kindle a fire, undress and dry clothes, during this time vigorously doing physical exercises and warming up by the fire.

- Before going out into the cold, you need to eat.

- Children and the elderly are more prone to hypothermia and frostbite. When letting a child go for a walk in the cold outside, remember that it is advisable for him to return to a warm room every 15-20 minutes and warm up.

Finally, remember that the best way to get out of an unpleasant situation is not to get into it. In severe frost, try not to leave the house unless absolutely necessary.