Frostbite of the hands, 3rd degree. How to provide assistance with varying degrees of frostbite

Frostbite is damage to the skin of the body under the influence of low temperatures.

Frostbite usually occurs in winter at air temperatures environment less than -10ºС. But such skin damage is possible in autumn and spring with strong winds and high air humidity, even at temperatures above zero.

In the article we'll talk about signs of frostbite, degrees of severity this state, as well as about methods of treating frostbite.

Causes

Many reasons contribute to frostbite:

• previous cold injury;
• immobile and uncomfortable body position for a long time;
• wet or tight shoes and clothing;
• hunger;
• physical fatigue;
• decrease in the body's defenses;
• chronic diseases of the cardiovascular system and blood vessels of the legs;
• sweaty feet;
• severe injuries with blood loss.

According to statistics, the majority of severe frostbite that led to amputation of limbs occurred when a person was heavily intoxicated.

The complex changes that occur under the influence of cold depend on the temperature and the duration of its decrease. When the air temperature is below -10ºС, frostbite occurs as a result of the action of cold directly on the skin tissue. But most frostbite occurs at air temperatures from -10ºС to -20ºС. In this case, spasm of small blood vessels occurs, which leads to a slowdown in blood flow and cessation of the action of tissue enzymes.

Frostbite of the fingers and toes is the most common.

Signs of frostbite

The initial sign of frostbite is the appearance of pale skin in the affected area, which is accompanied by increasing pain and tingling. At first, the intensity of the pain increases, but with further exposure to cold it gradually subsides. The affected area of ​​the body becomes numb and sensitivity is lost. If the limbs are affected, their functions are impaired. So, when fingers are frostbitten, a person cannot move them. The skin becomes dense and cold. Skin color also takes on signs of frostbite. It becomes bluish, yellow or white with a deathly waxy color.

Degrees of frostbite

The following degrees of frostbite are distinguished.

I degree of frostbite, the mildest. Occurs when exposed to cold for a short time. Signs of frostbite include changes in skin color. The affected area becomes pale, a tingling sensation appears, followed by numbness. After warming, it turns red, sometimes to a purple-red color, which is accompanied by swelling. There may be pain of varying intensity. 5-7 days after frostbite, there is often slight peeling of the affected skin. Recovery occurs 6-7 days after the lesion.

II degree of frostbite. Appears when exposed to cold for a longer period of time. Initial symptoms there is pallor and coldness of the affected area, loss of sensitivity. But the most characteristic sign of frostbite of this degree is the formation of blisters with transparent contents in the first day after the injury. When fingers or other areas become frostbitten, pain, burning and itching appear immediately after warming up. Skin restoration occurs within 1-2 weeks. In this case, scars and granulations do not form.

III degree of frostbite. It is characterized by the formation of blisters filled with bloody contents. Their bottom has a blue-purple color and is insensitive to irritation. Painful sensations are of high intensity and are characterized by a long period of flow. All skin structures in the affected area die. When the fingers become frostbitten, the nails that come off either grow deformed or do not grow back at all. After 2-3 weeks of rejection of dead tissue, scarring occurs, which takes about a month.

IV degree of frostbite. Usually combined with frostbite of the 2nd and 3rd degrees. All layers of skin tissue undergo necrosis. Muscles, joints, and bones are often affected. A sign of frostbite is a sharply bluish color of the damaged area, often with a marble coloring. After warming, swelling immediately forms and quickly increases in size. There is no sensitivity in the affected area.

First aid for frostbite

First aid for frostbite depends on the degree of damage, the general cooling of the person, his age and existing diseases.

First aid for frostbite involves the following measures:

• deliver the victim to a warm room;
• remove gloves, shoes, socks;
• take measures to restore blood circulation in the affected areas;

At the same time as providing first aid, you need to call a doctor: treatment of severe frostbite should be carried out under the supervision of specialists.

If the victim has symptoms of frostbite of the first degree, it is necessary to warm up the damaged areas with massage movements and a woolen cloth until the skin turns red. After this, apply a cotton-gauze bandage.

When providing first aid for frostbite, the victim is given hot food and drink. To reduce pain in the treatment of frostbite, Analgin, Aspirin, No-shpu, Papaverine are used.

What should you not do when providing first aid?

You cannot massage, rub, or warm up during frostbite of II, III, and IV degrees. In this case, a warming bandage is applied to the damaged surface. To do this, apply a layer of gauze, a thick layer of cotton wool on top, then again gauze and rubberized fabric or oilcloth. The affected limbs, for example, with frostbite of the fingers, are fixed using improvised means, bandaging them over the bandage.

Do not rub the victim with snow, especially if the fingers and toes are frostbitten. Blood vessels The limbs are very fragile and can be easily damaged by rubbing. This can lead to infection entering the resulting microcracks.

Treatment of frostbite

Before treatment for frostbite begins, the victim is warmed up.

After this, a mixture of solutions is introduced nicotinic acid, aminophylline, novocaine into the artery of the affected limb. To restore normal blood circulation and increase microcirculation, ganglion blockers, antispasmodics, trencal, and vitamins are used. In severe cases of damage, the patient is prescribed corticosteroids.

In addition, the victim is injected with solutions of glucose and rheopolyglucin, which are preheated to 38ºC.

If blisters form on the affected area, they are punctured. After that, compresses with solutions of chlorhexidine and furatsilin are applied to the frostbite areas. For suppuration of wounds, bandages with levosin, levomikol, and dioxykol are used.

Physiotherapy methods are used in the treatment of frostbite. Most often the victim is prescribed laser irradiation, ultrasound, magnetic therapy, UHF, diathermy (exposure to alternating electric current).

Surgery severe frostbite involves removing areas of dead tissue. If frostbite of the fingers, hands or feet has led to necrotic tissue, they are amputated.

Attention!

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.

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Frostbite is tissue damage caused by low temperatures. Often occurs along with hypothermia of the body. There are four in total or frostbite. The most vulnerable are open, protruding parts of the body and face: arms, legs, especially fingers, nose, ears.

The causes of the disease are prolonged exposure to cold, strong winds, and places of high humidity. Tight shoes and inappropriate clothing, exposed areas of the body. Symptoms of frostbite:

• general hypothermia, low temperature body (below 34 degrees);
• chills;
• slow breathing;
• decreased heart rate;
• disturbance of consciousness;
• low blood pressure;
• pallor, bluish skin tone.

Noticed in time and relieved symptoms, can significantly reduce the risk of frostbite. As first aid, it is necessary to warm the victim, give him hot drinks and food. Heat can be applied to the damage, but the degree of the disease must be taken into account so as not to lead to unpleasant consequences. Except common features and methods of treatment, there are specific ones characteristic of each stage of frostbite, which are listed below.

Degrees and their characteristics

1. Description: 1st degree frostbite is quite easily tolerated and can be easily treated. Signs: burning, itchy skin, tingling, numbness, pain. The first stage is characterized by a pale color of the damaged area of ​​the skin; when warmed, it becomes purple and swelling forms. During recovery, peeling of the skin may occur.
2. Frostbite of the 2nd degree shows signs of the first and includes an additional indicator in the form of the formation of bubbles at the sites of lesions in the first days after injury. The bubbles are filled with a clear liquid. As the wounds warm up, the pain intensifies, but no scars remain from the healing of such wounds.
3. Frostbite of the 3rd degree is characterized by the presence of blisters filled with blood. Damaged areas are insensitive to irritation. Frostbitten tissue is rejected by the body; if a finger and nail are exposed to cold, it will not grow back or will be severely deformed. After the frostbitten parts die off, a scarring process begins, which can last up to one month.
4. Frostbite of the 4th degree is the most severe, it is often combined with frostbite of the 2nd-3rd stage. In this case, bloody and transparent blisters form in areas with the second and third degrees of frostbite; in areas of the fourth degree, no bubbles are formed. Characterized by large swelling of the lesions and complete loss of sensitivity of the injured tissues. The recovery process is the longest possible consequences– amputation of frostbitten limbs.

Features of treatment of each degree

1-2 degrees of frostbite

For the first degree it will be appropriate home treatment, welcome to use folk recipes decoctions and herbs, oak bark. It is allowed to make hot compresses and take warm baths. Damaged skin should be rubbed with warm hands, light massage. After contact with water, you can use moisturizing creams (Xemosis, Coldcream, Trixera). The victim can be given analgin or aspirin.

2nd degree. First aid - as for the first stage, then the disease is treated by removing and cleaning the blisters, applying ointments and gels to damaged surfaces (Levomikol, Dermazin). Subsequent treatment is prescribed by the doctor. It consists of physiotherapeutic procedures and antibacterial injections.

3-4 stages of frostbite

At severe stages Frostbite is strongly not recommended to be treated at home! You should definitely consult a specialist and visit a clinic. Determine on appearance the degree of damage is difficult, primary signs Periods 3-4 are very similar and you should not try to distinguish them on your own.

It is impossible to rub or act directly on severe stage injuries. It is necessary to provide first aid to the victim: fix the frostbitten limb in a motionless state, using available means. The frostbitten part of the body can be bandaged with a clean (preferably sterile) material and only after that should it be insulated. Immediately call an ambulance or take the victim to the hospital.

For the third stage, physiotherapy is used, medications, in some cases, a plaster cast is applied to ensure immobility of the limb.

The fourth degree is difficult to treat, the most likely outcome is amputation.

Dangers of frostbite 3 and 4 degrees

The heaviest and dangerous stages– these are 3 and 4. The depth of these damages reaches bone tissue, there is a high risk of limb loss. After healing of such injuries, scars, scars, defects and deformations remain on the skin. Manifestations in the form of gangrene are frequent. Frostbitten tissues are difficult to restore - they die on their own or have to be amputated. How long the recovery process will take depends on the severity of the damage caused to the body, often it takes more than one month. In the fourth degree, fatalities are not uncommon.

For a speedy recovery, the victim of frostbite must be given proper care. If the patient has been discharged from the hospital, it is necessary to ensure the conditions of his detention and carefully follow the regime and simple but effective rules care, even at home.

To protect yourself from undesirable consequences frostbite, follow the basics of life safety:

• try not to be in the cold for a long time;
• if you find yourself in the cold, move more;
• do not drink alcohol or eat food in the cold, these actions lead to loss of heat from the body;
• do not smoke, smoking tends to reduce blood circulation;
• dress warmly and in layers, but prefer loose, non-squeezing clothing;
• keep your shoes dry;
• wear a hat, mittens, woolen socks;
• do not wear metal jewelry and accessories in the cold;
• do not expose the frostbitten area to the danger of freezing again, these are the most vulnerable areas;
• do not take off your shoes outside, even if your feet are very cold, this will lead to their swelling and it will be difficult to put on your shoes.

Frostbite is tissue damage caused by exposure to low temperatures. Frostbite most often affects peripheral or poorly protected areas of the body. The most common cases are frostbite of the toes, nose, cheeks, ears, and frostbite of the fingers. It is mistakenly believed that frostbite can only occur at sub-zero temperatures, in the presence of frost. In fact, in high humidity and cold winds, frostbite can occur at zero temperatures, and even a little higher.

Factors contributing to frostbite

The main mechanism of frostbite is a circulatory disorder caused by spasm of microcirculatory vessels. Accordingly, all those factors that impair blood circulation contribute to the occurrence of frostbite. Such damaging factors, in addition to cold, include:

• Tight, constricting shoes or clothing;
• Prolonged muscle tension (for example, squeezing the steering wheel with your hand, etc.);
• Exposure to alcohol;
• Diabetes mellitus, atherosclerosis and other diseases in which vascular patency is impaired;
• Blood loss;
• General weakness of the body.

Signs of frostbite

Features of frostbite and its main danger The fact is that the signs of frostbite appear fully only a day after it occurs. Therefore, when in the cold, it is necessary to pay attention to signs of circulatory disorders, and take urgent measures when they appear.

The first signs of frostbite are whitening of the tissues. White spots appear on the cheeks and are most often noticed. The ears and nose also turn white, but this may go unnoticed, and the whiteness of the toes cannot be detected at all, since they are hidden by shoes. In case of frostbite of fingers, you need to focus on loss of sensitivity. Pain during the period of spasm (freezing) is not a characteristic sign of frostbite; it occurs only in the next phase - the phase of paralytic vasodilation. During freezing, pain is possible, but, as a rule, it is very minor.

Tissue damage occurs during the vasodilation phase called the reactive period of frostbite. The reaction occurs after the cessation of exposure to cold. Therefore, the full signs of frostbite, as already mentioned, appear 24 hours after a person has been exposed to freezing. It is impossible to form an opinion about the depth of frostbite until the end of the reactive period.

Depending on the depth of the lesion, there are four degrees of tissue frostbite. However, in the pre-reactive phase they have no differences in manifestation; all signs of frostbite relate to the reaction phase:

• First degree frostbite. Skin purplish red or of blue color, subsequently peeling is observed in the frostbitten areas. The affected areas are completely restored, only their increased sensitivity to the cold;
• Second degree frostbite. The superficial areas of the dermis die, resulting in the formation of blisters similar to those caused by burns. Unlike burn blisters, frostbite blisters contain fluid mixed with blood (hemorrhagic contents). Subsequently, the affected tissues are also restored completely, and, as with the first degree of frostbite, they forever retain increased sensitivity to cold;
• Third degree frostbite. Not only the skin, but also the subcutaneous tissue dies. At first, it is also possible to form blisters with hemorrhagic contents, then in their place areas of dead tissue remain. Healing is quite long, scar tissue forms at the site of the lesion, and a cosmetic defect remains forever;
• The fourth, most severe degree of frostbite. Death occurs not only of superficial, but sometimes also of deep tissues - skin, subcutaneous tissue, muscles and even bones. Dead tissue is removed or rejected on its own, resulting in gross defects, tissue deformation, and sometimes, especially with frostbite of the fingers, loss of part of the limb. Healing of fourth degree frostbite is very long and can occur over several months.

First aid for frostbite

First aid for frostbite is to stop exposure to cold as quickly as possible. The victim must be taken to a warm place. It should be remembered that the main damage occurs during the reactive period, so warming, especially after a long stay in the cold, should be gradual in order to reduce the intensity of the reaction as much as possible.

The best way to warm the victim during first aid for frostbite is a warm bath, the temperature of which is increased gradually, starting from 20°C and reaching 40°C. Then the damaged area of ​​the body must be washed with soap to avoid infection, and rubbed with a soft towel. Do not roughly rub with snow, wool, etc., so as not to cause additional damage to already damaged skin.

If it is not possible to take a warming bath in case of frostbite, first aid consists of rubbing the damaged areas with alcohol, a warm, damp cloth, or at least simply vigorously massaging them to restore blood circulation. When frostbite occurs on the fingers, it is necessary to massage them for quite a long time, since this is a peripheral part of the body, and the blood supply here is the last to be restored. An indicator that everything is being done correctly is the restoration of sensitivity, including pain. Therefore, first aid for frostbite includes taking painkillers.

Also, first aid for frostbite is to take a warming substance orally. These can be hot drinks (tea, milk, cocoa), hot food, a small amount of alcohol is acceptable - but only when the victim is already warm. Remember that in the pre-reactive phase, alcohol can significantly aggravate the problem.

Treatment of frostbite

Treatment for frostbite consists of as much quick recovery blood circulation in damaged tissues, preventing the addition of a secondary infection, creating conditions for better healing of tissues damaged by frostbite and combating intoxication that occurs when decay products of dead tissue enter the blood. Treatment tactics for frostbite depend on the stage.

Treatment of frostbite of the first and second stages consists of treating superficial injuries with anti-inflammatory ointments and covering them with an aseptic bandage. During the healing stage, physiotherapy is actively used for tissue regeneration.

Treatment of third and fourth degree frostbite requires surgical intervention to remove large areas of necrosis. Surgical treatment of frostbite is carried out when the dead tissues are separated from healthy ones - on days 8-14. Then apply drug therapy, aimed at combating inflammation, maintaining normal blood circulation, restoring the strength and functions of the body.

Video from YouTube on the topic of the article:

Frostbite: classification, signs, first aid, prevention - this is what worries many people with the onset of the cold season. Warm scarves and hats, multi-layered clothing do not always protect against the piercing cold wind, and no one has canceled general hypothermia. And if we add here cold burns that can occur, for example, in production, then the problem becomes truly large-scale.

The fact is that many of us know only the basics, supported by various folk beliefs, which are not always correct and sometimes can only harm an already injured patient. So let’s first figure out what frostbite is in general, and then we’ll think about how to deal with it.

A little theory

By definition, frostbite is tissue damage caused by exposure to cold. Most often, the hands, ears, lips, cheeks suffer - those parts of the body that we do not always protect with clothes from all weather surprises. Frostbite on the cheeks, the signs and first aid for which are familiar to all of us, manifests itself, for example, in redness of the skin, tingling (this is the mildest case), which people try to combat by rubbing, believing that blood flow will help restore heat exchange. In addition, frostbite can also be caused by a so-called cold burn - this is when a person touches an object whose temperature is significantly lower than the environment, for example, liquid nitrogen. This occurs much less frequently, but it still occurs, so you should have at least the slightest idea about cold burns.

Causes

The conversation should start with the reasons, right? In principle, the first signs of frostbite and first aid for them are known to everyone, but at the same time we do not always believe that prolonged exposure even to the wind can cause severe consequences. Doctors say that general hypothermia, one of which is frostbite, can be caused by a number of reasons.

Has anyone thought that excessive sweating can also be the root cause of frostbite? When we secrete fluid, we freeze much faster; remember the feeling when you come out of the water after swimming in the summer. The same can be said about wet clothes - this is why it is not recommended to allow children to play outside for a long time in winter - kids with their snowball slides get wet very quickly. No one has canceled the factors that weaken the body, such as hunger, general weakness, blood loss (here it concerns not only injuries, but also menstrual bleeding). Circulatory disorders, due to which heat exchange suffers, are not even worth mentioning - this is an obvious fact. Even an uncomfortable position can cause hypothermia and frostbite. Signs, first aid, prevention concern many people. We recommend you remember: any prolonged exposure to cold can lead to injury, so be careful even when you seem to be in no danger.

Signs

What are the first signs of frostbite and first aid for them?

It should be noted that each process goes through several stages. Of course, everything depends on the degree of exposure to cold and the time of this exposure - for example, it cannot be said that after five to ten minutes of exposure to the cold frostbite can already occur. Signs and first aid in brief are an assessment of the condition of the damaged area of ​​the body and a series of measures taken to maximize the relief of the consequences of frostbite.

First degree

There are several degrees. The first - the easiest - is characterized by redness of the skin and tingling, but all this goes away after the person warms up. The consequences of such contact with cold are peeling of the skin, but nothing more. In principle, many have encountered this, so in this situation, despite the sonorous word “frostbite”, the signs and first aid for which are generally known, there is no need to panic - everything will go away on its own.

Second degree

Let's move on to the second degree, which is much less pleasant. Naturally, this is not a one-step process. After passing through the first stage, the skin first turns pale and then may acquire a bluish tint. Sensitivity disappears, and the damaged areas of the body seem colder to the touch than those surrounding them skin. After some time, bubbles appear, very similar to those that occur during a burn - in principle, this is a burn, only a cold one, which was mentioned above. Under no circumstances should they be pierced - you will have to wait a week, or even two, until the skin recovers on its own. No rubbing - this will damage the blisters, which will significantly complicate the healing process.

Third degree

Next comes the third degree. Here the blisters are filled with bloody fluid, and the skin underneath is blue-brown in color, which indicates its necrosis. Here you cannot do without consequences - scars and cicatrices are guaranteed to remain in place of the blisters, moreover, if, for example, your hands are subject to frostbite, then the damaged nails will be restored already deformed. The body gets rid of dead tissue within two to three weeks; everything, of course, depends on the degree. After that, it takes about another month for complete healing and recovery. So frostbite (stages, signs, first aid medical care we will definitely consider), can be much more dangerous than a banal tingling sensation with redness.

Fourth degree

The worst is the fourth degree. There is practically no chance of recovery here - the cold destroys not only the skin, but also penetrates to the very bone. The damaged part of the body turns blue, sometimes a semblance of marbling appears, that is, not a uniform color, but with peculiar darker and lighter inclusions. The affected area of ​​the body reacts to warming in a completely different way than we are used to: the development of edema immediately begins. Of course, this stage is associated with the second and third, but blisters at this stage appear only on less affected areas of the body. Where it is already the fourth stage, sensitivity is completely absent, in addition, the temperature of the skin itself is much lower general temperature bodies. Unfortunately, the consequences are irreversible; it is after passing the fourth stage that amputation is most often resorted to. That is why it is important to notice frostbite in time, the signs and first aid for which seem to be obvious. Timely intervention can save a person’s not only health, but also life.

First aid

Now that we have examined frostbite, stages, signs, the treatment should also be studied. Perhaps it’s better to start in stages.

In the first stage, it is enough to simply warm the victim, but in no case should you do this abruptly (many mothers advise their children to place a frozen part of the body under hot water, without thinking that such actions will be a huge stress for the body - such a contrast has a huge impact to work circulatory system). Best ways to warm up in this situation - careful massage, breathing, light stroking - everything should be done very carefully so as not to cause even more harm.

First aid for severe frostbite

But with subsequent degrees everything is not so simple. Under no circumstances should you rub, massage, etc. - this will disrupt the integrity of the blisters that appear and, therefore, will significantly increase the healing time, as mentioned above. It is necessary to apply a bandage that will gradually warm the area of ​​the body (cotton wool, gauze, bandages - anything, but you do not need to wet or lubricate the bandages with alcohol or anything similar). The victim is wrapped in a blanket and taken to medical institution- self-help in this situation will not work at all.

A universal remedy is a hot drink - it will help you warm up not only from the outside, but also from the inside. With strong pain Analgesics can also be used.

Not funny at all

In case of so-called “iron” frostbite - this is when your child thought of licking metal in the cold and stuck to it, in no case should you use force in attempts to “separate” them. Hot water- anything that can gradually heat both the metal and the child, as a result of which after some time the victim will come unstuck on his own. But if there is no choice and you still have to tear it off, then be sure to treat the wound with hydrogen peroxide and apply bandages to prevent infection.

Basic mistakes

Frostbite (signs and first aid) in children is no different from all of the above in adults. Will you give your child alcohol to keep him warm? That's right, no. So don’t give it to an adult either, because it won’t help the injury in any way, and it can worsen the patient’s condition, and it’s unlikely that doctors will like contact with someone who is intoxicated - this, after all, significantly complicates treatment.

Another mistake that Russian people repeat over and over again is rubbing with snow, according to the principle “well, at least with something.” We forget that snow consists of tiny ice crystals, which will once again damage already damaged skin, destroying capillaries that have become fragile under the influence of cold. It is very unlikely that this will have a beneficial effect on recovery.

Frostbitten feet

Probably the most common is frostbite of the feet, the signs and first aid for which are not known to everyone. Let's try, using the example of a part of the body that we need so much, to figure out what to do in the event of such a nuisance.

We already know the procedure for dealing with frostbite of various degrees. Now let's talk about more serious, outpatient treatment. The first degree is treated with electric light baths, and at home they simply apply antiseptic bandages if the skin is damaged. In the second degree medical worker(it is better for him to do this) he must open the bubbles with a cloudy liquid, then treat the wounds with an antiseptic and apply an antiseptic bandage, which will have to be changed every two hours. When the skin is restored, the patient will also have to undergo a course of physical therapy. In the third and fourth degrees, there is a need to remove dead tissue, so surgery, even a small one, cannot be avoided. And, of course, antiseptics, you can’t live without them.

Finally

In conclusion, I would like to say that frostbite, signs and first aid for this problem is a topic that everyone should be familiar with, at least minimally. No one is immune from the most banal hypothermia, the consequences of which can be much more serious than a mild cold. Even a temporary loss of sensitivity and slight redness can serve as signals that everything is not as good as it should be. Warm up gradually, do not abuse alcohol, dress warmly and always think that cold is a serious danger. Be careful even when it seems that it is not so cold, and then everything will be fine.

Frostbite- This is local tissue damage that develops when exposed to cold. Frostbite has a latent and reactive period that occurs after warming up. The pathology is manifested by discoloration, pain, sensory disturbances, the appearance of blisters and foci of necrosis. Damage of the III and IV degrees leads to the development of gangrene and spontaneous rejection of the fingers. Treatment is carried out 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 incidence 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 affected by frostbite, the hands are in second place, and the protruding parts of the face (nose, nose) are in third place. ears, cheeks). Pathology treatment 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 ultra-low temperature (contact frostbite) and prolonged periodic cooling in conditions of high air humidity ("trench foot", chills). Factors contributing to the development of frostbite are strong winds, high humidity, decreased local and general immunity (as a result of illness, injury, vitamin deficiency, malnutrition, etc.), alcohol intoxication, tight clothing and shoes that cause poor circulation.

Pathogenesis

Exposure to low temperatures causes persistent vasospasm. The speed of blood flow decreases, blood viscosity increases. Shaped elements Small vessels become clogged and 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 blood vessels. Local circulatory disorders provoke disorders of the autonomic nervous system regulating 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).

Symptoms of frostbite

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

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

There are four degrees of frostbite:

• With frostbite of the first degree, moderate swelling appears in the reactive period. The affected area becomes cyanotic or acquires a marbled color. The patient is worried burning pain, paresthesia and skin itching. All signs of frostbite disappear on their own within 5-7 days. Subsequently, increased sensitivity of the affected area to cold often remains.
• Frostbite of the second degree is accompanied by necrosis of the superficial layers of the skin. After warming up, the affected area becomes bluish and sharply swollen. On days 1-3, blisters with serous or serous-hemorrhagic contents appear in the area of ​​frostbite. When the blisters are opened, a painful wound is exposed, which heals on its own in 2-4 weeks.
• With frostbite of the third degree, necrosis spreads to all layers of the skin. In the pre-reactive period, the affected areas are cold and pale. After warming, the affected area becomes sharply swollen, and blisters filled with hemorrhagic fluid appear on its surface. When the blisters are opened, wounds with a painless or slightly painful bottom are exposed.
• IV degree frostbite 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 I-III degrees. Areas of IV degree frostbite are pale, cold, and sometimes slightly swollen. There is no sensitivity.

With frostbite of degrees III and IV, dry or wet gangrene develops. Dry gangrene is characterized by gradual drying of tissue and mummification. The area of ​​deep frostbite turns dark blue. In the second week, a demarcation groove is formed, separating necrosis from “living” tissue.

Spontaneous finger rejection usually occurs 4-5 weeks after frostbite. In case of extensive frostbite with necrosis of the feet and hands, rejection begins at a later date, especially in cases where the demarcation line is located in the area of ​​the diaphysis of the bones. After rejection, the wound is filled with granulations and heals with the formation of a scar.

Chill occurs during periodic cooling (usually at temperatures above 0) and high air humidity. Dense bluish-purple swellings appear on peripheral parts of the body (hands, feet, protruding parts of the face). The sensitivity of the affected areas decreases. The patient is bothered by itching, bursting or burning pain. Then the skin in the area of ​​chills becomes rough and covered with cracks. When the hands are affected, it decreases physical strength, the patient loses the ability to perform delicate operations. In the future, erosion or development of dermatitis is possible.

Chill 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 swollen. With repeated cooling and warming, wet gangrene is possible.

Treatment of frostbite

The victim must be moved to a warm room, warmed up, and given tea, coffee or hot food. Frostbitten areas should not be intensively rubbed or warmed quickly. When rubbing, multiple microtraumas of the skin occur. Warming up too quickly leads to normal level metabolic processes is restored faster than the blood supply to the affected areas. As a result, necrosis may develop in tissues deprived of nutrition. The best result is achieved by warming “from the inside” - applying heat-insulating cotton-gauze bandages to the frostbite area.

Upon admission to the traumatology department, a patient with frostbite is warmed up. A mixture of solutions of novocaine, aminophylline and nicotinic acid is injected into the artery of the damaged limb. Drugs are prescribed to restore blood circulation and improve microcirculation: pentoxifylline, antispasmodics, vitamins and ganglion blockers, and for severe lesions - corticosteroids. Solutions of rheopolyglucin, glucose, novocaine and heated to 38 degrees are administered intravenously and intra-arterially. saline solutions. Antibiotics are prescribed to a patient with frostbite. wide range actions and anticoagulants (heparin for 5-7 days). A sheath novocaine blockade is performed.

To reduce stimulation of recovery processes, reduce swelling and pain, physiotherapy is carried out (magnetic therapy, ultrasound, laser irradiation, diathermy, UHF). The bubbles are punctured without being removed. Alcohol-chlorhexidine and alcohol-furacilin wet-dry bandages are applied to the area of ​​frostbite; in case of suppuration, bandages with antibacterial ointments are applied. If there is significant swelling, orthopedic traumatologists perform fasciotomy to eliminate tissue compression and improve blood supply to the frostbite area. If pronounced edema persists and areas of necrosis form, necrectomy and necrotomy are performed on days 3-6.

After the demarcation line is formed, the volume of surgical intervention is determined. As a rule, viable tissues remain under damaged skin in the demarcation zone. soft fabrics, therefore, with dry necrosis, a wait-and-see treatment approach is usually chosen, allowing more tissue to be saved. With wet necrosis, there is a high probability of developing infectious complications with the process spreading “up” healthy tissues, therefore, wait-and-see tactics are not applicable in such cases. Surgical treatment for frostbite of the fourth degree consists in removing dead areas. Amputation of necrotic fingers, hands or feet is performed.

Prognosis and prevention

For superficial frostbite, the prognosis is conditionally favorable. The functions of the limb are restored. In the long-term period, increased sensitivity to cold, disturbances in nutrition and vascular tone in the area of ​​the affected area persist for a long time. The development of Raynaud's disease or obliterating endarteritis is possible. With deep frostbite, the outcome is amputation of part of the limb. Prevention includes choosing clothes and shoes taking into account weather conditions, avoiding prolonged stay outside in cold weather, especially while intoxicated.