Frostbite (frostbite)

Causes and symptoms of frostbite (frostbite)

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What is frostbite (cold injury)?

Under the influence of low temperatures and prolonged stay in the open air likely local cooling of the body (frostbite) or General cooling (freezing). Contribute to frostbite and freezing in high humidity or strong wind. In addition to adverse climatic factors, the chance of frostbite increases with vascular disease, Smoking and consumption of alcohol beverages, mismatch of clothing and footwear environmental conditions.

Causes frostbite (frostbite)

Frostbite under the action of low temperatures affects the skin and tissues located more deeply. Exposure to cold is not in itself cause frostbite. Tissue death occurs due to circulatory disorders. Spasm and paresis of the vessels, reducing the speed of blood circulation, stagnation of blood cells and blood clots – the main causes of necrosis. Over time in the walls of blood vessels increases endothelial layer, which is impregnated with a plasma formed areas of necrotic tissue, there is connective tissue and occurs obliteration of the vascular wall.

Therefore, necrosis when frostbite develops gradually and captures the reactive phase. The reason for occlusive disease and eating disorders tissue become changes that occur in the vascular wall.

The symptoms of frostbite (frostbite)

In 95% of cases when frostbite affects the extremities, as under the influence of low temperatures in them in the first place blood circulation. In the course of the disease distinguish between the latent period (prereactive) and reactive. The first lasts a few hours or a day and covers the time elapsed from the first symptoms of frostbite before rewarming the body and restore the normal functioning of the circulatory system. This period is also called period of hypothermia.

The next period, which begins with the warming of the affected organ and restore blood flow, is divided into early and late. Early covers 12 hours and is manifested by disruption of the microcirculation, changes in the vascular wall, increased blood clotting and thrombosis. In the later period there are areas of nekrotizirovannah tissue, the accession of infection. The characteristic symptoms of frostbite at this stage are:intoxication, decrease in hemoglobin in the blood, lowering body temperature.

Depending on the depth of the lesion tissue there are four degrees of frostbite. When the first and second degree frostbite affects the superficial tissue, with the third and fourth, the process of ossification goes on tissues located more deeply.

First degree frostbite is characterized by impaired circulation. At this stage does not develop tissue necrosis, and the recovery occurs in five to seven days.

In second degree frostbite remains intact germ layer of the skin. All changes occur only in the surface layer, the destroyed cells which recover in a couple of weeks.

In third-degree frostbite necrosis encompasses all layers of the skin. Affected skin do not regenerate. Eventually there is a separation of the eschar, in its place formed granulation tissue and then scar, the appearance of which can prevent the skin transplantation is made at the stage of formation of granulation tissue.

Fourth degree frostbite is characterized by necrosis of the skin and tissues located more deeply. The pathological process affects the bones and joints. Appears limb gangrene (dry or wet), localized in most cases in the feet or hands.

On examination, the patient for successful treatment is important not only to identify symptoms of frostbite, after hearing the complaint of the victim, but to clarify the conditions that cause their appearance. In the conversation with the patient going medical history, are established by various factors: temperature and humidity, presence of wind, the residence time in low temperatures, the nature of first aid and its volume.

Symptoms of frostbite characteristic latent period of the disease is the appearance of paresthesia in the affected areas, numbness, and sometimes pain. In the area of frostbite noted the pale skin, in some cases, cyanosis. The skin is cold, insensitive or insensitive. Loss of sensitivity may be the first symptom of severe frostbite. To ascertain the extent of the disease at this stage is impossible.

As the warming plots frostbite is recovering their circulation and there comes the reactive period. Symptoms of frostbite at this stage are a tingling and burning sensation, the skin begins to itch, appears or increases the pain, the damaged areas become warm to the touch. If frostbite affects the deep layers of the skin, the pain is not amplified. The skin is in a reactive period, become red or cyanotic (in cases of severe frostbite), tissue swollen. Strong swelling indicatedeep frostbite.

The degree of frostbite and the nature of its distribution is installed, usually after a few days.

Under the influence of alternating periods of cooling and warming of the extremities and in special environmental conditions (temperature 0-10 degrees Celsius and high humidity) may develop a certain kind of local frostbite – "trench foot". Cooling lasts a few days and the first symptoms of frostbite appear a few days after cessation of exposure to low temperatures.

The disease begins to manifest itself as aching in the lower extremities, burning, numbness. Appears swelling, the skin of the foot is pale and cold, its sensitivity is lost. Later, the skin is covered with bubbles with hemorrhagic content, on their day there are areas of necrotic tissue, joined by symptoms of intoxication: increased body temperature and heart rate, weakness. Common complication of the disease is sepsis.

Treatment of frostbite

The nature and scope of primary health care depends on the degree of frostbite, the presence or absence of General hypothermia, concomitant diseases. First aid is reduced to the cessation of cooling, warming of extremities, restoration of disturbed blood circulation, the prevention of infection. For activities which must be accomplished primarily at assisting the affected, include the delivery of the patient in a warm place, freeing the frozen parts of the body from the cold clothes, doctor on call.

In first degree frostbite is frozen skin warm warm hands, do a light massage, rubbing with a cloth made of wool, bandage of cotton and gauze.

From the second to the fourth degree, the frozen skin areas warm up quickly, rubbing is not carried out. A bandage is applied of insulating materials. The limbs are fixed. The patient is given hot drinks, food, some alcohol, pill acetylsalicylic acid, analgin tablet, but-shpa (80 mg), tablet of papaverine. The affected skin should not be rubbed with snow, it is not recommended to warm limbs by the open fire, the uncontrolled use of sources of heat, RUB the oil skin, fat, and alcohol in the defeat of the deep-seated layers of the skin.

Mild frostbite can be used to warm the victim in a bath with water temperature of 24 degrees Celsius, gradually increasing it to a normal body temperature.

For moderate and severe degrees of frostbite, the patient must be immediately hospitalized.

Medicalpomosh napravlena na vosstanovlenie narushennogo krovoobrasheniya, mestnoe lechenie porazhenij, profilaktiku inficirovaniya, lechenie uzhe inficirovannyh uchastkov kozhi. dlya lecheniya otmorozheniya ispolzuutsya konservativnye i hirurgicheskie metody.

v kachestve konservativnogo metoda lecheniya obmorozhenij primenyaetsya infuzionnaya terapiya. v pozdnem reaktivnom periode naznachaut dezintoksikaconnye preparaty, krovezameniteli, lekarstvennye sredstva immunologicheskogo ryada, parenteralnoe pitanie. ispolzuut bakteriofagi, provodyat antibiotikoterapiu, primenyaut himicheskie antiseptiki.

hirurgicheskoe lechenie otmorozhenij svoditsya k udaleniu nekrotizirovannyh uchastkov kozhi i peresadke na mesto defekta sobstvennyh tkanej.

mestnoe lechenie zakluchaetsya v smene antisepticheskih povyazok. chetvertaya stepen lecheniya obmorozheniya, kak pravilo, ne obhoditsya bez hirurgicheskogo vmeshatelstva. pered operaciej provoditsya konservativnaya terapiya.