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Degrees of frostbite: first aid and prevention

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Frostbite occurs as a result of the fact that a very low temperature affects the surface of the skin, and tissue damage occurs that is located as close to the skin as possible.

In almost all cases, it is cheeks, nose, ears, and fingers, not only on the hands, but also on the feet that suffer from frostbite. Directly on the frost-bitten area, the formation of characteristic ice crystals occurs, which also appears in the cells between them by tissues.

You should not try to warm the frostbitten area if there is a risk that it can freeze again very soon, since such actions can only aggravate an already serious condition. It is also not recommended that the frostbitten place be heated too quickly, because this will provoke the appearance of quite strong and pronounced pain sensations.

When frostbite occurs, damage is caused by the severe cold of blood vessels, which are located directly in the area of ​​damage. As a result of this, the vessels begin to narrow significantly, which leads to a violation of the natural flow of blood to the affected area. This leads to the fact that the limb or some other part of the body will not receive the necessary amount of oxygen. Consequently, the formation of edema and rather large blisters begins, while a certain amount of affected tissue will die in parallel.

In approximately 95% of cases of frostbite, it is the limbs that suffer, because as a result of exposure to low temperatures, it is in them, in the first place, that the natural process of blood circulation is disturbed. The course of this disease is divided into a pre-reactive or latent period and a reactive period.

The onset of the latent period can last for several hours or days, and this also includes the period of time when the first symptoms of frostbite begin to appear in the victim before the stage of warming the entire body and the restoration of the natural circulation process begin. Also, this period may still be called hypothermia.

After the process of warming the damaged area begins, as well as the natural restoration of blood flow, the next period begins, which is divided into early and late. The early part consists of 12 hours, while it is characterized by disturbances in the natural microcirculation that have occurred, as well as certain changes that occur in the vascular wall, while blood clotting increases, there is a chance of thrombosis.

At the beginning of the late period, areas on which necrotic tissues are found begin to appear, while there is a likelihood that a dangerous infection also occurs. The most striking signs of this stage of frostbite is the appearance of intoxication, as well as a decrease in hemoglobin in the blood, and of course, a decrease in body temperature.

Depending on how deep the lesion occurred, today there are exactly four degrees of frostbite. In the event that frostbite of the first and second degree occurs, damage to superficially located tissues will occur, and with the development of the third, and, of course, fourth degree, the process of necrosis of tissues that are located much deeper begins.

The main characteristic of the formation of frostbite of the first degree is a violation of the natural process of blood circulation. At this stage, the onset of tissue necrosis does not begin, and the healing process begins already on the fifth or seventh day after receiving frostbite.

In case of frostbite of the second degree, the germ layer of the skin will remain intact. With this degree of frostbite, all changes will occur exclusively in the surface layer, and after a few weeks the restoration of destroyed cells begins.

In the case of the formation of frostbite of the third degree, necrosis will capture all layers of the skin. Does not occur with the time of restoration of damaged areas of the skin. Over time, the process of scab rejection begins, after which granulation tissue appears in its place, and a characteristic scar forms. In order to prevent scar formation, it is necessary to carry out a skin transplant operation, which is carried out during the stage of formation of granulation tissue.

The main characteristic of the formation of a fourth degree of frostbite is the onset of necrosis of the skin, as well as tissues, which are located much lower. In this case, the pathological process will affect not only tissues, but also bones, joints. There is the formation of gangrene of the extremities (wet or dry), most often its localization occurs on the hands or feet.

During the examination of the victim in order to conduct a successful treatment, it is important not only to detect the main symptoms of frostbite, but also to listen to the patient’s complaints and establish the conditions under which the injury was received.

The main signs of the occurrence of frostbite, which are characteristic directly for the latent period, are the formation of paresthesia directly in the affected area, as well as a feeling of numbness, and in some cases pain.

Immediately in the area of ​​frostbite, the skin begins to pale; there is a likelihood of cyanosis. Damaged skin becomes cold, insensitive or insensitive. One of the most important signs of severe frostbite is precisely the loss of sensitivity. At this stage, it is simply impossible to accurately determine the degree of damage.

When warming up areas of frostbite, the natural process of blood circulation is restored, and the onset of the reactive period also begins. With frostbite at this stage, the main signs are the appearance of a tingling sensation and burning sensation, while the damaged area begins to itch very much, soreness can appear or significantly increase, and the injured areas become warm to the touch.

In the event that deeper skin layers were damaged during frostbite, then the pain will not intensify. In the reactive period, damaged skin become red and sometimes cyanotic (this occurs only with very severe frostbite), and swelling of damaged tissues also begins. The formation of severe edema is evidence that deep frostbite has occurred.

In almost all cases, a few days after receiving frostbite, it becomes possible to most accurately determine the extent and nature of the spread of damage.

The concept of frostbite

Frostbite refers to damage to the skin resulting from exposure to low temperatures. Most often, protruding parts of the body are affected - limbs, ears, nose, facial skin. Certain factors are noted that can provoke the appearance of frostbite of varying degrees.

  • Vascular disease
  • Intensive heat transfer of the body,
  • Injuries, weakened body, alcohol intoxication,
  • Violation of blood circulation.

People who are intoxicated suffer from frostbite quite often. At this moment, a person is poorly oriented in space. He has inhibited reactions to many stimuli; he may not feel unpleasant sensations in the freezing parts of the body.

Frostbite is included in the International Classification of Diseases and has its own code according to ICD-10 - T33-T35 - frostbite.

What are the symptoms of frostbite? How many degrees of disease? Regardless of the degree of the disease, there are a number of common symptoms.

  • The skin first becomes pale, then it turns red,
  • There is a tingling and burning sensation,
  • Numbness of the skin is noted,
  • There are painful sensations
  • Derma can itch.

There are two periods of frostbite.

  • Hidden. At this point, the disease is practically not manifested, there is no vivid symptomatology. Pain, pallor and coldness of the skin are noted.
  • Reactive period. Manifestations in this case depend on what degree of frostbite is diagnosed.

In a person with frostbite, mobility impairment, numbness, and a decrease in sensitivity are first noted. When thawing, a burning sensation arises, gradually turning into pain. The skin changes color from pale to bright red. With severe frostbite, blackening of the dermis is further noted.

During thawing and recovery, regardless of the degree of the disease, itching is noted. Often patients comb damaged areas to blood.

Diagnostics

In almost all cases, to diagnose frostbite, there is no need for additional clinical tests, since a rather vivid clinical picture is manifested.

In some cases, in order to more accurately determine the condition of internal organs that could be affected by frostbite, there is a need for an ultrasound scan. Also, the patient is assigned general clinical tests of urine and blood, studies are conducted, with which you can establish a general assessment of the condition of the body of the victim.

There are cases when it is quite difficult to establish the depth and degree of tissue damage during frostbite and to determine this will be possible only during the operation.

Degree of frostbite

How many degrees of frostbite exist? Specialists distinguish four stages. For each of them there are certain symptoms.

  • The first degree is considered the easiest. Appears as a result of a person being in the cold for a short period of time. At 1 degree, it is noted in adults and in children, blanching of the dermis is noted. After warming, it becomes red (sometimes burgundy). After a certain time, peeling begins. The presence of mild pain, itching, tingling is noted. Puffiness is possible. At this degree, tissue death is not diagnosed. Proper therapy can be cured in about a week.
  • For frostbite of the 2nd degree, more severe pain is characteristic. Itching, burning sensation, tingling, numbness are more severe than in the first stage. On the skin during frostbite, bubbles form filled with a clear liquid. The recovery period at this degree lasts about a couple of weeks, scars and scars do not appear.
  • The third stage of frostbite is considered more dangerous. At the same time, a person feels more severe manifestations of pain and burning. The limbs go numb. In the damaged areas, the appearance of blisters with blood contents is noted. For degree 3 frostbite, a decrease in the total body temperature and the death of the skin and nails are characteristic. The recovery period is at least three weeks, scars and scars may occur in the affected areas.
  • The fourth degree of frostbite is considered the most severe. A person feels severe numbness and pain in the affected areas. Soft tissues, bones and joints die. The skin becomes blue, almost black. Blisters with bloody contents form. There is practically no sensitivity, body temperature can rise to 39 degrees. Frostbite of the extremities at 4 degrees in most cases ends with gangrene and amputation.

Depending on the degree of frostbite, a suitable treatment is selected.

Prevention

The basis for the prevention of frostbite is the prevention of a long time at low temperatures.

At the heart of an effective treatment for frostbite is exactly two points. First of all, the first medical aid should be provided to the victim directly on the spot, and only after that he can be transported to the hospital, where he will undergo inpatient treatment.

If it is suspected that frostbite has begun, the victim must be taken to some kind of warm room, after which the frostbitten area of ​​the body is immediately released from the constraining clothing. It is important to remember that it is strictly forbidden to warm the frostbitten area. The fact is that as a result of strong warming, a significant increase in all metabolic processes occurring in the tissues occurs, but at the same time a natural blood flow will not be ensured.

That is why in case of frostbite, to restore normal blood flow, rubbing is done, for example, in this case, you can use a simple dry towel.

In the event that, as a result of frostbite, a rather large area has been affected, and immediate surgical intervention is required, the victim is hospitalized, which is also necessary in case of a seriously impaired general condition of the patient.

Further, non-viable tissues will be excised in the hospital, and conservative drug therapy will be prescribed. Most often, the victim is prescribed painkillers and detoxifying drugs, intravenous infusion of blood substitutes, as well as drugs that will support the nervous and cardiovascular system.

The prevention issue is most acute in countries where the temperature drops very low, as the risk of frostbite increases significantly.

Causes of frostbite

There are several reasons for this.

  • Long stay in the cold,
  • Contact with a substance cooled to a very low temperature
  • Periodic exposure to adverse conditions - high humidity and low temperatures.

Very often frostbite of varying degrees occurs due to the fact that people dress not in the weather, in thin, easily blown and wet clothes. There are a number of diseases that increase the risk of frostbite of any degree.

  • Vascular problems - endarteritis, thrombosis. There is a violation of the blood supply to individual sites, which reduces heat generation.
  • Heart diseases. Often provoke the development of swelling in the limbs, which leads to a decrease in tissue resistance to cold temperatures.
  • Liver diseases also provoke circulatory disorders in various body systems.
  • Diabetes. The skin with this disease loses its sensitivity, as a result, it is not able to perceive hypothermia in the early stages.
  • Various injuries with the formation of edema lead to the fact that blood flow is disturbed in the damaged areas. This increases the likelihood of frostbite. In fractures, the applied gypsum is able to quickly cool and expose the limb located under it.

It is worth noting that the likelihood of frostbite increases in the third trimester of pregnancy and with alcohol intoxication. Causing the development of frostbite of varying degrees can certain factors that should be avoided.

First aid

If there is frostbite of any degree, a person needs help as soon as possible.

  • The victim must be moved to a warm, dry, calm place.
  • All cold clothes and shoes must be removed from it.
  • The patient is wrapped in a blanket, inside it is allowed to put heating pads with warm water.
  • The victim should be given a warm drink. The exceptions are coffee and alcohol. It is better to choose tea, milk, fruit drinks.
  • Do not heat damage under hot water, blow a hairdryer on it, apply it to the battery.
  • After the operations, the patient is allowed to take a warm bath. Water temperatures rise gradually.
  • After this procedure, the skin is wiped dry, put on warm, dry clothes, wrapped in a blanket.
  • In the absence of bubbles, it allows dressing, in other cases, you must contact a medical institution.

With a mild degree of frostbite, recovery occurs in a week. The remaining degrees of the disease are treated in a hospital.

How not to freeze and prevention

If the person is on the street. Then, in order to avoid frostbite, it is worth doing some exercises. You can’t stand in one place. You can do slopes, swing on your feet, perform jumps. If there is any warm room nearby, then you should go into it and warm yourself.

It is worth remembering that during intense physical exercises, sweat acts on the skin, which will also cool and lower body temperature.

Signs, symptoms and stages of frostbite

To correctly ensure that the provision of first aid after frostbite is effective, you should be aware that all frostbite of the skin is divided into severity:

1st easy degree. If you get a slight frostbite, the signs of it are a feeling of slight tingling, burning, numbness of the skin. The skin in the affected areas turns pale, after its warming a small edema appears, which has a crimson-red tint, then peeling begins. Usually, the skin is restored within a week without leaving any other marks.

2nd degree. В этом случае, признаки обморожения конечностей помимо покраснения, шелушения кожи, включают волдыри, содержащие прозрачную жидкость. При согревании человек испытывает болезненные ощущения, зуд. На полное восстановление может уйти около 2 недель.

3rd degree. Such a frostbite is very dangerous. Its sign is the appearance of blisters, with a bloody filling, such frostbite often ends with necrosis. Skin restoration is long, sometimes it takes a month or more, it ends with the formation of scars.

4th degree. Frostbite affects all layers of soft tissues, is characterized by pronounced edema, loss of sensitivity, often ends in necrosis, tissue necrosis. According to statistics, frostbite of the 4th degree is the cause of amputation of limbs.

Frostbite

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

Usually frostbite occurs in winter when the ambient temperature is less than -10ºС. But such a skin lesion is possible in autumn and spring with strong winds and high humidity, even at temperatures above zero.

The article will discuss signs of frostbite, the severity of this condition, as well as methods of treating frostbite.

Many reasons contribute to frostbite:

  • previous cold injury
  • motionless and uncomfortable body position for a long time,
  • wet or tight shoes and clothes,
  • hunger,
  • physical overwork
  • decrease in body defenses,
  • chronic diseases of the cardiovascular system and blood vessels of the legs,
  • sweating feet
  • severe injuries with blood loss.

According to statistics, most severe frostbite, which led to amputation of the extremities, occurred during severe alcohol intoxication of a person.

Complex changes that occur under the influence of cold depend on the temperature and the duration of its decline. In the case when the air temperature is below -10 ° C, frostbite occurs as a result of the action of cold directly on the skin tissue. But most frostbite occurs at an air temperature of -10ºС to -20ºС. In this case, spasm of small blood vessels occurs, which leads to a slowdown in blood flow and the termination of the action of tissue enzymes.

The most common frostbite of the fingers and toes.

Signs of frostbite

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

Degree of frostbite

The following degrees of frostbite are distinguished.

I degree of frostbite, the easiest. Occurs when exposed to cold for a short time. Signs of frostbite include a change 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 a slight peeling of the affected skin. Recovery occurs 6-7 days after the defeat.

II degree of frostbite. Appears when exposed to cold for a longer period of time. The initial symptoms are blanching and cooling of the affected area, their 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 lesion. When frostbite of fingers or other areas immediately after warming appears pain, burning and itching. Skin restoration occurs within 1-2 weeks. In this case, scars and granulations are not formed.

ІІІ degree of frostbite. It is characterized by the formation of bubbles filled with bloody contents. Their bottom has a blue-purple color, is insensitive to irritation. Pain sensations are of high intensity and are characterized by a long period of the course. In the affected area, all skin structures die. When the fingers are frostbitten, the nails that have come off either grow deformed or not grow 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 II and III degree. All layers of skin tissue undergo necrosis. Often affected muscles, joints, bones. A sign of frostbite is the sharply cyanotic color of the damaged area, often with a marble color. After warming, swelling immediately forms, which rapidly increases in size. There is no sensitivity in the affected area.

General classification of low temperature lesions

  • Acute cold
  • Freezing (damage to internal organs and body systems)
  • Frostbite (development of local necrosis with extensive secondary changes)
  • Chronic cold damage
  • Cold neurovasculitis
  • Chills

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

  • Mild: The skin is pale, bluish, “goose bumps” appear, chills, speech difficulties. The pulse slows down to 60-66 beats per minute. Blood pressure is normal or slightly elevated. Breathing is not broken. Frostbites of the I — II degree are possible.
  • Medium grade: body temperature 29-32 ° C, characterized by sharp drowsiness, depression of consciousness, pointless look. The skin is pale, cyanotic, sometimes with a marble color, cold to the touch. The pulse slows down to 50-60 beats per minute, weak filling. Blood pressure is slightly reduced. Rare breath - up to 8-12 per minute, shallow. Frostbite of the face and limbs of I-IV degrees are possible.
  • Severe degree: body temperature below 31 ° C. Consciousness is absent, convulsions, vomiting are observed. The skin is pale, bluish, very 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. Severe and widespread frostbite is observed, up to glaciation.

Separate Imersion frostbite (trench foot): foot damage with prolonged exposure to cold and damp. Occurs at temperatures above 0 ° C. It was first described during the First World War of 1914-1918 among soldiers during their long stay in moist trenches. In mild cases, painful numbness, swelling, redness of the skin of the feet appear, in cases of moderate severity - serous-bloody bubbles, in severe form - necrosis of deep tissues with the addition of infection, the development of wet gangrene.

The depth of tissue damage

  • Frostbite I degree (most light) usually occurs with a short exposure to cold. The affected area of ​​the skin is pale, has a marble color, after warming it turns red, in some cases it has a crimson-red hue, edema develops. Skin death 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 itchy skin and pain appear, which can be both minor and pronounced.
  • Frostbite II degree occurs with a longer exposure to cold. In the initial period, there is blanching, cooling, loss of sensation, but these phenomena are observed at all degrees of frostbite. Therefore, the most characteristic symptom is the formation of blisters filled with transparent contents in the first days after an injury. Complete restoration of the integrity of the skin occurs within 1 - 2 weeks, granulation and scars 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, itching, burning are worried.
  • Frostbite III degree exposure to cold for a longer and greater decrease in temperature in the tissues. The bubbles formed in the initial period are filled with bloody contents, their bottom is blue-purple, insensitive to irritation. There is a death of all skin elements with the development in the end of frostbite of granulations and scars. Converged nails do not grow back or grow deformed. Rejection of dead tissue ends at 2 - 3 weeks, after which there is scarring, which lasts up to 1 month. The intensity and duration of pain is more pronounced than with frostbite of the II degree.
  • Frostbite IV degree occurs with prolonged exposure to cold, the decrease in temperature in the tissues with it is greatest. It is often combined with frostbite III and even II degree. All layers of soft tissues are mortified, 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 skin temperature is much lower than in the surrounding tissue. Bubbles develop in less frostbitten areas where there is frostbite of the III — II degree. The absence of bubbles with significantly developed edema, loss of sensitivity indicate frostbite of the fourth degree.

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

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

What should not be done in first aid?

You can not do massage, rubbing, warming when frostbite II, III and IV degrees. In this case, a warming dressing is applied to the damaged surface. To do this, apply a layer of gauze, on top - a thick layer of cotton wool, then again gauze and rubberized fabric or oilcloth. Affected limbs, for example, during frostbite of the fingers, are fixed with the help of improvised means, bandaging them over the bandage.

Do not rub the victim with snow, especially when frostbitten fingers and toes. The blood vessels of the limbs are very fragile and easily rubbed when rubbed. This can lead to infection in the resulting microcracks.

Frostbite treatment

Before starting treatment, frostbite of the victim is warmed.

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

In addition, glucose and rheopolyglucin solutions are injected into the victim, which are preheated to 38 ° C.

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

In the treatment of frostbite, physiotherapy methods are used. Most often, the victim is prescribed laser irradiation, ultrasound, magnetotherapy, UHF, diathermy (exposure to alternating electric current).

Surgical treatment of severe frostbite consists in the removal of areas with dead tissue. If frostbite of fingers, hands or feet has led to necrotizing tissues, they are amputated.

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

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