First aid for frostbite of various degrees. Nutrition for Frostbite

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 to the wind can have serious 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 to the touch the damaged areas of the body seem colder than the surrounding 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 (we will definitely consider stages, signs, first aid) 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 significantly lower than the general body temperature. 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 on the functioning of the circulatory system). The best ways to warm up in this situation are gentle 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 a medical facility - 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. For severe 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 is anything that can gradually heat up 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, a medical worker (it is better for him to do this) 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.

Good day, dear readers!

Winter is in full swing, and although the average annual temperature in northern regions around the world has increased, this does not mean that one day the frost can reach -30° or below. To avoid frostbite, I suggest you read the information in this article, in which we will not only look at what frostbite is, but also the first signs, symptoms, causes, prevention and first aid for this pathological condition. In addition, New Year is approaching, which many people celebrate, after which some of them fall asleep on the street without feeling the cold. So…

What is frostbite?

Frostbite (frostbite)– damage to body tissues due to exposure to low temperatures. Extreme frostbite can lead to tissue death, which is why, in some cases, frostbite on the limbs sometimes results in amputation.

Frostbite affects mainly protruding parts of the body - fingers and toes, then all extremities, as well as open areas of the body - nose, cheeks, ears and face in general.

Frostbite of body parts usually begins with exposure of the body to an ambient temperature of -10°C - -20°C, however, in regions with high humidity, or in autumn-spring, it can occur at -5°C or even 0 °C. The process of frostbite can be accelerated by a piercing strong cold wind or the presence of moisture (sweat) under clothing or in shoes.

Frostbite - ICD

ICD-10: T33-T35;
ICD-9: 991.0-991.3.

Signs of frostbite

Symptoms of frostbite are characterized by 4 degrees, each of which has its own characteristics. Let's look at the degree of frostbite in the body in more detail, but first, let's find out the first signs of frostbite.

The first signs of frostbite

• , and then redness of the skin;
• A burning sensation on the skin at the site of its lesion;
• Tingling, with a feeling of numbness;
• Minor pain, sometimes with tingling;
• Skin itching.

Degrees of frostbite

Frostbite 1st degree (mild frostbite). The safest, so to speak, frostbite occurs when a person is in the cold for a short time. Signs of mild frostbite are paleness of the affected area of ​​the skin, which, after warming it up, acquires a reddish tint, sometimes purplish-red, and after a while (a week) begins to peel off. In some cases, swelling may develop. Other symptoms include burning, numbness, itching and tingling in the affected area. Tissue necrosis usually does not occur with 1st degree frostbite. With the right measures, recovery occurs 5-7 days after the lesion.

Like other degrees of frostbite, it is characterized by a feeling of burning, numbness, itching and pain, sometimes with tingling in the affected area of ​​the skin, but with greater intensity. However, with frostbite of the 2nd degree, bubbles with clear liquid already form on the affected area. Healing usually occurs within 1-2 weeks; scars and other signs of injury do not remain on the skin.

It is characterized by more pronounced burning, numbness and acute pain in the affected area, in which the blisters are already filled with bloody content. Body temperature begins to drop. The skin at this stage begins to die, and even after recovery, granulations and scars remain on the affected areas. If your nails peel off due to frostbite, they then grow narrower, usually deformed. Recovery occurs within 2-3 weeks of treatment.

Frostbite 4th degree. It is characterized by severe pain in frostbitten areas and complete numbness. Soft tissues die, and bones and joints are often damaged. The skin takes on a bluish color, sometimes with marbled outlines. Body temperature drops. Blisters with bloody contents form next to frozen tissue. When warming up, severe swelling of frostbitten skin occurs. Sensitivity is usually lost. Sometimes treatment for grade 4 frostbite ends in gangrene and amputation of the frostbitten area/part of the body. In the inflammatory gangrenous process.

"Iron" frostbite

The so-called “iron” frostbite is a cold injury that develops as a result of contact of warm skin with a very cold metal object. For example, it is not uncommon for children to have their tongues stuck to a street fence or other metal structure.

The causes of frostbite, or factors that contribute to frostbite in the body, can be:

Weather. As we already mentioned in the article, the main cause of frostbite is exposure to low ambient temperatures on the body. The rate of frostbite increases if there is high humidity at a person’s location or if the wind blows on exposed areas of his body.

Clothes and shoes. When the clothing on the body is not enough to protect the body from the cold, then not only frostbite can occur, but also the person, with all the resulting results, including loss of consciousness and death. Also remember that synthetic fabrics are not a good way to protect against the cold, because... The skin under synthetic clothing usually does not breathe and therefore becomes covered in sweat. Next, the sweat cools down and, as a good conductor of temperature, transfers cold to the body. To prevent this from happening, try to give preference to clothing made from natural fabrics.

Shoes that are incorrectly selected for winter or cold weather are also often the cause of frostbite on the toes. This is usually facilitated by tight, uninsulated shoes with thin soles. Tight shoes cut off blood circulation and don't allow warm air to ventilate through your toes. Thin soles (up to 1 cm) and lack of insulation cannot protect your feet from good frost.

Choose clothes and shoes for winter that are slightly larger than your size, so that there is always room for warm air ventilation between your body and outerwear.

Other causes of frostbite include:

• Exposed areas of the body in the cold - no scarf, gloves, headdress, hood;
• Lack of body movement in the cold for a long time;
• Alcohol or drug intoxication;
• Overwork, malnutrition, (lack of dietary fat, carbohydrates or);
• Injuries, especially with bleeding, traumatic brain injury;
• The presence of various diseases, for example, heart failure, cachexia, Addison's disease, and others.

Providing assistance for frostbite is aimed at warming the body and normalizing blood circulation in it. Let's look at first aid for frostbite in detail, step by step. So…

1. To warm up, take shelter in a windless place, preferably warm. If the victim cannot move independently, try to move him to a similar place.

2. Remove the frostbitten person's outer clothing and shoes, and if the inner clothing is wet, remove them too.

3. Wrap the person in a blanket. You can place heating pads with warm water (not hot) under the blanket.

4. To warm up, do not use contact of the frostbitten area with hot water, radiator, fireplace, heater and fire, or heat with a hairdryer, because these actions can cause burns, since the damaged part of the body is usually insensitive, and also destroy blood vessels. Warming must be done gradually!

5. Give the person a drink of hot tea, warm milk, fruit juice. Under no circumstances should you drink coffee or alcohol, which can only make the situation worse.

6. After the above steps, if possible, a frostbitten person can be placed in a bath with warm water, approximately 18-20°C, after some time, the water temperature can be increased, but gradually, to 37°C-40°C.

7. After the bath, carefully dry your skin with a towel, dress in dry clothes made from natural fabrics and lie back under the blanket, applying warm heating pads. Continue drinking hot tea.

8. If there are no blisters on the frostbitten area, wipe it with vodka or alcohol and apply a sterile bandage to it. You can begin to lightly massage the affected area with clean hands. Movements should be light so as not to damage the blood vessels, and directed towards the heart. If there are blisters in the area, massage should not be done in this place, so as not to spread it, for example.

9. Warming, rubbing and massage are done until the skin becomes reddish, warm and soft. During rewarming, the affected area may burn and swell.

10. If after the above steps sensitivity and mobility of the frostbitten part of the body does not appear, you need to call a doctor. When the protective functions of the immune system decrease, which makes a person vulnerable to various diseases, the functioning of the cardiovascular system is also disrupted, and this is another argument for consulting a doctor after frostbite, especially for children and the elderly.

Try not to use ointments for rubbing, because... they can aggravate the clinical picture of frostbite and complicate the further process of its treatment.

Mild frostbite, with the right actions, goes away in a couple of hours. In other cases, the speed of recovery depends on the professionalism of doctors and, of course, the Lord God!

First aid for “iron” frostbite

1. If a child sticks his tongue to metal, it is advisable to pour warm water over the grip area to avoid serious injury. If there is no water, you need to use warm breath. The heated metal usually releases its “victim”.

2. Disinfect the affected area - first rinse it with warm water, then, if it is not the tongue, treat the wounds with hydrogen peroxide. This product, thanks to its oxygen bubbles, will remove all dirt from the wound.

3. Stop the bleeding, which can be done with a hemostatic sponge or sterile bandage.

4. If the injury is severe or deep, consult a doctor.

Face. To warm up your face in the cold, you can do several deep bends forward or walk a little, leaning forward with your torso at the waist. Thus, blood circulation in the head improves. You can also rub your nose, cheeks and ears with your fingers, which also improves blood circulation in them and, accordingly, a surge of heat. Just refrain from rubbing frostbitten areas with snow, as this intensifies the pathological process of frostbite and can seriously harm the skin.

Fingers and toes. Remember how you threw a stone, in the same way, sharply, but without clenching your fingers into a fist, throw your arms forward. You can also put your fingers under your armpits. To warm your feet, you need to swing your legs back and forth, as if it were a pendulum moving. The more the legs swing and the higher the intensity of this action, the faster the legs warm up.

The body in general. Actively perform several elements of exercise - squats, push-ups, running in place.

However, remember, the more a person freezes, then warms up and freezes again, the worse it is for him, because... When warming up, sweat comes out of the skin, which is a good conductor of temperature, and if it cools down, then cold and frost will attack even more strongly.

Help the animals

Frost is a problem not only for many people, but also for animals. Some animals simply freeze to the floor and cannot get up on their own. Don’t be indifferent, fill a bottle with warm water and pour over the area where the animal is freezing. Feed him, if possible, give him a home, or bring him home for the night, and life will definitely reward you with the same kindness, and even more!

To avoid frostbite on your hands and feet, face and other parts of the body, pay attention to the following prevention rules:

— Do not go outside in severe frost unless necessary, and also do not drive a car in severe frost to distant places where the appearance of a car, and therefore help, may take a very long time. If the car stalls away from a populated area, do not get out of it unless necessary, so that warm air does not escape from the cabin. Call the rescuers, and if not, then leave a few signs near you on the road asking for help from passing vehicles.

— When going outside, dress carefully, leaving as little parts of your body exposed as possible.

— Clothes, especially underwear, should be made from natural fabrics. Instead of gloves, it is better to use mittens so that your fingers warm up against each other. Don't forget about the hood, which provides good protection from the wind. You can cover your face with a scarf. Shoes should be comfortable, not tight, with insulation, and the thickness of the sole should be at least 1 cm. Socks must be clean, dry and made of natural fabrics. Clothes and shoes should be slightly larger in size so that there is a layer of warm, well-ventilated air between the outer and lower clothing, as well as the foot and the wall of the shoe. Tight clothes interfere with blood circulation, and this is another reason to wear loose clothes and shoes. In addition, all outer clothing, preferably, should be waterproof.

- Dress like a cabbage, tucking all your clothes into each other.

— In the cold, you should not smoke or drink alcoholic or caffeine-containing drinks, which contributes to impaired blood circulation and the development of a deceptive feeling of warmth, while the skin actually gets frostbitten anyway.

— In frosty weather, do not go tired, hungry, after injuries or blood loss, on a diet with a minimum amount of fats and carbohydrates, hypotension, or poor coordination of movements.

— Do not carry heavy loads in cold weather, because... heavy bags pinching the fingers, disrupting blood circulation in them.

— Before going out into the cold, exposed areas of the body can be lubricated with special products (for example, special cream, lard or animal oil), but under no circumstances use moisturizers for these purposes.

— Do not wear metal jewelry in the cold, because... the metal cools quickly and can stick to the body, transferring cold to it, and can also contribute to cold injury.

- If you feel the first signs of frostbite, take shelter in a warm place - in a store, a cafe, or, in extreme cases, in the entrance, but if you are far in the mountains, call rescuers, and at this time take shelter at least under the snow, because it is a poor conductor of heat. You can bury yourself under the snow during a snowstorm.

— Do not, under any circumstances, remove shoes from frostbitten feet, as they may immediately swell, after which it may no longer be possible to put the shoes back on, and your feet will become even more vulnerable to frost.

- Hide from the wind.

— Don’t go out into the cold after a shower with wet clothes.

— When hiking, be sure to take a change of warm clothes with you, incl. socks, mittens, underwear, and don’t forget a thermos with hot tea.

— Don’t allow yourself to get frostbitten and warm up twice, because... this increases the risk of severe trauma to damaged tissues.

— Do not let children and elderly people out into the cold unattended for a long time.

- Do not give children objects with metal parts to play with in the cold - shovels, children's weapons, etc.

— After a long walk, examine yourself to see if you have frostbite; if so, follow the first aid steps, and then, if necessary, consult a doctor. Remember, if frostbitten tissue is left without proper attention, this can lead to gangrene, and then amputation of that part of the body.

Be careful!

Tags: frostbite on hands, frostbite on fingers, frostbite on feet, frostbite on face, frostbite on cheeks, frostbite on nose

It is the result of local damaging effects of low temperatures on body tissue. Protruding parts of the body, such as fingers and toes, cheeks, nose and ears, are more often affected by frostbite. The severity of frostbite is determined by the volume of tissue affected, as well as possible complications. Persons without a fixed place of residence who do not have the minimum conditions to prevent frostbite are most susceptible to it.


Interesting Facts

• Drinking alcoholic beverages in the cold to keep warm is a myth. Alcohol causes peripheral vasodilation, which ultimately leads to increased heat loss from the body.
• Irreversible changes rarely extend above the wrist and ankle joints, due to the good blood supply to the forearms and legs.
• Children under one year of age are more susceptible to hypothermia due to insufficient development of the thermoregulation center at this age.
• Increased ambient humidity increases the thermal conductivity of both skin and clothing, accelerating the rate of heat loss.
• Rubbing frostbitten limbs with snow does not warm up, but takes away the remaining heat. In addition, after such rubbing, microscopic cracks and scratches may appear on the skin, into which microbes can enter and cause suppuration after the affected area thaws.

Limb structure

Over millions of years of evolution, the human body has acquired many reflexes that are designed to maintain vitality in various conditions of its stay. One of these reflexes is the reflex of centralization of blood circulation. The essence of this reflex is as follows. When the ambient temperature decreases, the body, through the action of the autonomic nervous system, constricts the blood vessels of the periphery, directing blood flow to vital organs, thereby simultaneously preventing unnecessary heat loss. On the scale of the entire organism, this reflex certainly has a positive effect, but for the limbs it is negative, since prolonged vascular spasm deprives them of the necessary blood supply, reducing resistance to low temperatures.

The last, but no less significant physiological feature of the body, which seems important in the context of frostbite, relates to the innervation of the limbs. In this case, we are talking about sensitive nerve fibers that transmit tactile, proprioceptive, and, importantly, temperature and pain information to the brain. Under conditions of frostbite, the speed of transmission along nerve fibers decreases tenfold, up to a complete stop. This explains the insidiousness of frostbite - the patient does not feel that he is receiving a cold injury and, accordingly, does not prevent frostbite in a timely manner.

Causes of frostbite

• weather;
• cloth;
• individual characteristics of the body and disease.

Weather

Cloth

Individual characteristics of the body and diseases

Diseases and conditions that increase the risk of frostbite include:

• deep vein thrombosis;
• Raynaud's disease and syndrome;
• injuries;
• state of alcoholic intoxication;
• blood loss;
• pregnancy in the third trimester.

Deep vein thrombosis
In this case, we are talking about the most common thrombosis of the deep veins of the leg and, less commonly, the thigh. There are many reasons for this disease, for example, a passive lifestyle, smoking, atherosclerosis, injuries and much more. The mechanism of the damaging effect is the obstruction of blood outflow from the limb, slowdown of blood circulation in it and tissue hypoxia ( hypoxia is called insufficient oxygen content in tissues). As a result, as with the previous disease, heat production in the limb decreases, which predisposes it to frostbite, even at moderately low temperatures.

Raynaud's disease and syndrome
Raynaud's disease is an innate paradoxical reaction of the body to cold. Raynaud's syndrome is characterized by the same clinical manifestations, but the cause of their occurrence lies in another disease, which is often curable. This disease is characterized by persistent, more pronounced than normal, spasm of small blood vessels when exposed to a cold environment. As a result, patients are forced to constantly keep their hands warm, otherwise they become white, acquire a marble tint and are very painful. Tissue ischemia ( ischemia is a tissue condition in which the blood flow does not correspond to the costs necessary for its normal functioning), as in previous diseases, will lead to an increased likelihood of frostbite.

Injuries
Severe bruises, sprains, and fractures are dangerous in themselves, but they can also contribute to frostbite. The reason lies in the swelling that inevitably accompanies the injury in the following hours, days, and sometimes weeks. Edema involves the accumulation of plasma, the liquid part of the blood, in damaged tissue. Congestion involves stagnation and low blood flow in the area of ​​injury, leading to insufficient oxygen and nutrient supply. In such conditions, the likelihood of frostbite increases. Don't forget about plaster, which is sometimes necessary to treat an injury. The cast itself is capable of quickly cooling to ambient temperature and cooling the limb through direct skin contact.

Heart failure
Heart failure is the inability of the heart to perform its function in the required volumes - pumping blood. It is a serious disease that can be either congenital or acquired. It usually debuts in old age, however, it also occurs in young people. One of the complications of heart failure is progressive edema of the lower extremities. Edema, as mentioned earlier, reduces tissue resistance to low temperatures.

Cirrhosis of the liver
This disease is a slow, but, unfortunately, irreversible replacement of healthy functional liver tissue with connective non-functional tissue. Patients with cirrhosis are more susceptible to frostbite for two reasons. First, the liver is a heat-producing organ. Blood passing through it transports the generated heat to other tissues. Accordingly, if liver function suffers, then the peripheral tissues receive less heat. Secondly, with this disease, ascites develops - the accumulation of fluid in the abdominal cavity. When ascites becomes so severe that it stretches the abdominal wall like a ball, fluid begins to compress the inferior vena cava, thus preventing sufficient blood flow from the lower extremities. Swelling develops, blood circulation in the lower extremities slows down, which ultimately leads to excessive heat loss and decreased heat generation.

Diabetes
A serious disease, the substrate of which is damage to the endocrine part of the pancreas, which produces the hormone insulin. To maintain the vital functions of the body, patients with diabetes are forced to inject insulin from outside for the rest of their lives. However, even though the patient receives correct and timely treatment, after 5 to 7 years, delayed complications such as diabetic neuropathy occur ( peripheral nerve damage) and angiopathy ( vascular damage). The target organs for these complications are the retina, kidneys, heart and, which is important for frostbite, the blood vessels of the lower extremities. As a result of neuropathy, the skin becomes less sensitive and the patient does not feel when he receives any injury. As a result of angiopathy, large and small vessels that nourish the skin become sclerotic and lose their patency, and, accordingly, their ability to adequately nourish the skin. The resulting lack of cold sensitivity, combined with poor blood supply, creates conditions for increased risk of frostbite.

Addison's disease
This disease, like the previous one, is endocrine and consists of a deficiency of adrenal hormones. Normally, the adrenal cortex produces 3 categories of hormones - mineralocorticoids ( aldosterone), glucocorticoids ( cortisol) and androgens ( androsterone). With aldosterone deficiency, excess sodium and water are released from the body. With cortisol deficiency, the tone of blood vessels is significantly reduced. Summing up the above effects, the result is a decrease in blood pressure. The greater the hormone deficiency, the stronger the severity of arterial hypotension. Under such circumstances, the body reacts by redistributing blood circulation in favor of vital organs, leaving the periphery, that is, the limbs, without nutrition. Objectively, such patients have pale and cold extremities, which at subzero temperatures will certainly lead to frostbite.

State of alcoholic intoxication
There is a myth that drinking alcohol causes the body to warm up. However, there are some clarifications that are unknown to most. In addition to the inhibitory, for many pleasant, effect on the central nervous system, alcohol also acts on the vessels of the periphery, dilating them. As a result, a large amount of blood flows to the skin and the rate of heat exchange between the body and the environment increases significantly. This explains the short-term rush of heat after drinking alcohol. However, after some time, the body's heat reserves run out, and it becomes unable to warm itself. The main tool of the thermoregulation system, the tone of skin vessels, is paralyzed by alcohol. Such a person is more likely to suffer heatstroke at high ambient temperatures, and frostbite at low temperatures.

Blood loss
This condition consists of an insufficient amount of blood or certain of its components ( liquid part or cells) in the bloodstream. More often, blood loss is caused by injury to a blood vessel and leakage of blood into the external environment. When the volume of circulating blood decreases, peripheral vessels spasm, and blood flows to such vital organs as the brain and spinal cord, heart, kidneys and liver. In conditions of insufficient blood supply, the muscles of the limbs are not able to produce thermal energy for a long time at low temperatures. A decrease in tissue heat production leads to an increase in the rate of frostbite.

Pregnancy in the third trimester
Most women who have given birth know firsthand about the difficulties associated with carrying a child in the third trimester of pregnancy. Starting from the thirtieth week of pregnancy, the fetus, together with the membranes, begins to compress the mother’s abdominal organs and the main blood vessels - the inferior vena cava and the abdominal aorta. The inferior vena cava has a thinner wall compared to the wall of the abdominal aorta, so the blood flow in it deteriorates more. It is with this phenomenon, medically called “inferior vena cava syndrome,” that swelling of the legs in pregnant women is associated. Edema, as mentioned above, predisposes to frostbite.

Degrees of frostbite

Degree	Development mechanism	External manifestations	Demonstration
I	Only the stratum corneum and granular layers of the skin are affected.	Paleness of the skin, followed by redness. Sensitivity is fully preserved.
II	Damage to the horny, granular and papillary layers of the skin. Seepage of infiltrate into microcracks of the skin with the formation of blisters.	The pallor of the skin gives way to blueness. Sensitivity decreases. Nails turn blue and then fall off. The blisters are filled with yellowish liquid. Spontaneous healing in the second week without any residual scar.
III	Damage to all layers of skin, subcutaneous fat and superficial muscles. Blood vessels become brittle and lose their integrity.	The skin is dark burgundy in color. There is no sensitivity. The blisters are filled with bloody fluid. Progressive swelling of soft tissues. When areas of necrosis form, surgical intervention is necessary. Healing by scarring.
IV	The entire limb is affected, down to the bones and joints. Dry gangrene develops.	The skin is gray-black. The frostbitten part of the limb dries out and separates from the healthy tissue. There is swelling and signs of inflammation in the border tissue. In the absence of timely surgical intervention and monitoring of wound healing, there is a high risk of purulent complications.

Symptoms of frostbite

• decreased mobility;
• decreased sensitivity;
• burning sensation;
• pain;
• change in skin color;
• blisters;
• tingling.

Decreased sensitivity
Decreased sensitivity, as well as decreased mobility, starts from the fingertips and spreads up the limb. First of all, tactile sensitivity decreases, and then other types of sensitivity. Pain and proprioceptive sensitivity ( feeling of one's own body) decrease last. The mechanism of this phenomenon is the dysfunction of sensitive skin receptors. Slowing down their metabolism will lead to an increase in the sensitivity threshold. In other words, more intense stimulation will be required for a nerve impulse to form and be transmitted to the brain.

Burning feeling
A burning sensation occurs at the beginning of thawing of the affected part of the body and precedes the onset of pain. More often, this symptom is present in frostbite of degrees I - II and is absent in frostbite of degrees III - IV. The burning sensation is accompanied by severe redness of the skin. The reason is the paralytic dilation of the vessels supplying the affected area, and the direction of a large flow of blood to it. After prolonged cold, the normal blood temperature is perceived as high, causing a burning sensation.

Pain
The intensity of pain depends on the degree of damage and the number of nerve receptors per unit area of ​​skin. For example, a frostbitten elbow will hurt less than a frostbitten hand. As swelling increases, the pain will intensify. The nature of the pain is acute, burning and tearing. It is important to note that pain occurs only when the frostbitten limb thaws. As long as the tissue is exposed to low temperatures, the victim will not feel pain. In medicine, this phenomenon is called cold anesthesia. Pain develops in parallel with the development of the inflammatory process and corresponds to its severity. During inflammation, biologically active substances are released into the tissue, which have a strong irritating effect on the nerve endings, causing pain.

Change in skin color
The dynamics of skin color changes are as follows. During the initial period of frostbite, the skin is pale with a matte tint. This skin color is explained by spasm of the blood vessels supplying the skin. With mild frostbite, the pallor of the limb is replaced by a burgundy color. With more severe frostbite, the pallor, bypassing the burgundy color, gradually turns into cyanosis. Prolonged vascular spasm leads to nutrient deficiency and excess metabolic products. Metabolic products accumulate and change skin color. The final skin color is black. Black skin has no potential for recovery and is therefore considered unviable.

Blisters
Blisters develop with frostbite of degrees II, III and IV. The fluid that accumulates in them is clear and bloody. At the site of the blister formation, the patient can feel the pulsation of the vessels located at its bottom. Blisters develop due to the destructive effect of low temperatures on the granular and papillary layers of the skin. A feature of these layers is a relatively weak intercellular connection. When liquid gets into the places where the bonds are broken, it exfoliates the skin and forms a cavity in it - a blister. In more serious frostbite, blood from damaged blood vessels penetrates into the blister along with the intercellular fluid.

Itching
Itching is an extremely unpleasant sensation, forcing the patient to constantly scratch the itchy area. An objective sign of severe itching is numerous scratches, in some places until there is blood. With frostbite, itching may occur at the beginning of the reactive period ( defrost period) and during the recovery period. The mechanism for the development of itching is the release of inflammatory mediators such as histamine and serotonin into the affected tissues. The above-mentioned mediators irritate the nerve endings and cause an itching sensation.

Tingling
This symptom is characteristic of the recovery period after frostbite. Characterized by periodic attacks of paresthesia ( "needles", "goosebumps"). The origin of this phenomenon is the same as that of the more famous “phantom pains” ( when a long amputated limb hurts). After severe frostbite, a decrease in skin sensitivity is observed for a long time. Tingling is nothing more than a reaction of the brain to a decrease in intensity or complete absence of sensitive impulses that previously came from the frostbitten part of the body. In other words, the brain tries to compensate for the lack of sensations by producing its own sensations. Thus, the tingling sensation is felt in the limb, but is formed in the head.

First aid for frostbite

1. Find a warm room, take off cold shoes and clothes. It takes time for clothes to become warm again, so it is better to change them.
2. Rub the affected area with a soft, warm cloth. Rubbing the skin causes blood to flow to it. Hot blood, passing through the vessels of the skin, gives off some of the heat, warming it. It is important to note that rubbing with snow is contraindicated because snow does not retain the heat generated by friction the way fabric does. In addition, the crust of the crust can leave microcracks on the skin, into which an infection such as tetanus or Pseudomonas aeruginosa can enter.
3. Drink a hot drink. Hot tea, coffee or broth, entering the stomach, is an additional source of thermal energy, which is transmitted by the blood throughout the body.
4. Place your feet in slightly warm water ( 18 – 20 degrees) and slow ( in two hours) heat the water to 36 degrees. Avoid putting your feet in cold water or rubbing them with cold water as this will only increase the area affected. However, you should not immediately place the limbs in hot water, since they must be warmed slowly and evenly, otherwise the number of dead cells will eventually increase.
5. In the absence of water, it is recommended to wrap the limb in foil ( shiny side inward), cotton wool or a special thermal blanket. Wrap several layers of a regular blanket over the foil. Wrap the body in warm clothes. Under such conditions, the limb will warm up slowly and from the inside, which will preserve the viability of most of the affected cells.
6. Give the limb an elevated position. This maneuver aims to prevent blood stagnation and thereby reduce the intensity of edema.

For frostbite, the following medications are most often used:

• Antispasmodics. This group is used to more quickly relieve spasm of peripheral vessels and supply warm blood to the skin. Papaverine 40 mg 3 – 4 times a day is used as antispasmodics; drotaverine ( no-shpa) 40 - 80 mg 2 - 3 times a day; mebeverine ( duspatalin) 200 mg 2 times a day.
• Nonsteroidal anti-inflammatory drugs ( NSPV). Nonsteroidal anti-inflammatory drugs are used to reduce the intensity of inflammation in the frostbite area. Medicines in this group are contraindicated for stomach diseases. The maximum course duration is 5 – 7 days. NSAIDs suitable for the treatment of frostbite are acetylsalicylic acid ( aspirin) 250 – 500 mg 2 – 3 times a day; nimesulide 100 mg 2 times a day; ketorolac ( ketanov) 10 mg 2 – 3 times a day.
• Antihistamines. This group of drugs is used primarily for allergic reactions of various origins, as it acts by inactivating biologically active substances involved in the development of the immune response. It also has a pronounced anti-inflammatory effect. Frequently used antihistamines are suprastin 25 mg 3–4 times a day; clemastine 1 mg 2 times a day; Zyrtec 10 mg once a day.
• Vitamins. Of the vitamins, vitamin C will have the most significant effect, since it strengthens the vascular wall and “heals” blood vessels damaged by low temperatures. Use 500 mg 1 – 2 times a day.

If during treatment it is not possible to independently reduce the temperature to low-grade levels ( 37 – 37.5 degrees), the pain does not go away, purulent discharge appears from the site of frostbite, then you need to seek qualified medical help. If side effects of treatment develop, such as allergic reactions to drug components, abdominal pain, shortness of breath and other symptoms, it is also necessary to call an ambulance.

Treatment of frostbite

Determining the need for surgery takes time. When hastily removing the frostbite, you can remove a lot of excess tissue or, conversely, leave tissue that will die over time. The boundaries of frostbite become clearly visible with the appearance of a demarcation line on the third to fifth day of the reactive period. Only then does it become clear to the surgeon whether it is worth taking up the scalpel and to what extent.

The time from the moment of thawing until the appearance of the demarcation line is not missed. The patient is prescribed medications and procedures designed to improve the nutrition of the affected tissues and restore the values ​​of the body's vital signs, such as blood pressure, blood glucose levels, blood electrolyte composition and much more.

Medicines prescribed during the reactive period of frostbite:

• analgesics ( painkillers), including drugs– for the purpose of relieving pain and unpleasant experiences associated with them;
• anti-inflammatory– to control the inflammatory process;
• antispasmodics– drugs that reduce muscle tone and improve oxygen delivery to tissues;
• anticoagulants and antiplatelet agents– drugs that thin the blood and prevent the formation of blood clots;
• vasodilators- drugs designed to improve blood circulation in affected vessels.
• cardiovascular drugs– to prevent heart attack and maintain effective blood circulation;
• antibiotics– to fight the attached infection;
• antitetanus serum– for the prevention of tetanus;
• angioprotectors- in order to restore vessels damaged by low temperatures;
• detoxification solutions– drugs that neutralize decay products and toxins in the blood.

Procedures prescribed during the reactive period of frostbite:

• Perineural sympathetic blocks. Blockades are carried out by introducing an anesthetic into the nerve sheath in order to temporarily disable it and dilate the vessels innervated by it. With the dilation of blood vessels, blood supply and, accordingly, nutrition of the affected limb improves. It is used no more than once every 2–3 months, including during the recovery period.
• Vacuum drainage. It is a method of drying the focus of necrosis to prevent its suppuration and prevent the development of wet gangrene. Apply daily for 30 minutes - 1 hour for the required number of days.
• Infrared irradiation. Irradiation with infrared light is carried out to prevent the lesion from becoming wet. It is carried out once a day for 10 – 20 minutes per session.
• Hyperbaric oxygenation. It is a method in which the affected limbs or the entire body is in an environment with increased oxygen content and increased atmospheric pressure. This procedure helps improve the penetration of oxygen into the affected tissues. It takes place for several hours every day.
• Biogalvanization. Biogalvanization is a physiotherapeutic method that helps accelerate metabolism and regenerate affected cells. It is carried out daily for several hours for the required number of days. Effective during the recovery period too.
• UHF. UHF is a method of exposing the focus of frostbite to ultra-high range radiation in order to accelerate recovery processes. It is carried out daily for 10 - 15 minutes in a course of 10 days. Effective during the recovery period.
• Electrophoresis. Method of delivery of medicinal solutions ( potassium iodide, lidase) through the skin into the lesion. Used daily or every other day for 10 – 15 minutes per session for a course of 10 days. Effective, including during the recovery period.
• Ultrasound. Exposure of the affected tissue to ultrashort sound waves can speed up the process of their recovery. Apply daily for 10-15 minutes in a course of 10 days. Has an analgesic effect.

Surgical treatment for frostbite:

• necrectomy– removal of the focus of necrosis;
• necrotomy– an incision to determine the depth of necrosis;
• fasciotomy– incision of the fascia to reduce swelling and pain;
• amputation– removal of a dead limb segment;
• reamputation– repeated amputation above the level of the first due to the spread of gangrene;
• skin graft transplantation– plastic surgery to close a large skin defect.

• gangrene;
• impossibility of restoring a limb segment;
• the bottom of the wound is bone;
• beginning sepsis;
• toxemia;
• acute renal failure;
• acute liver failure.

Frostbite surgery

Operation
The patient is brought into the operating room and lies down on the table. The surgeon and his assistant treat the surgical field with antiseptic solutions and limit it with sterile material. Depending on the type of anesthesia, the patient will be given appropriate instructions. The patient is put under anesthesia. When pain relief occurs, the surgeon makes the first incision. Subsequently, the wound is cleaned of non-viable tissue. The anesthesiologist monitors vital signs during the operation and maintains the required depth of anesthesia. After cleaning from necrotic tissue is completed, the wound is sutured if its edges close without strong tension or irregularities. If the defect is large, the wound remains open. The patient will later undergo plastic surgery to graft skin onto the resulting defect. In cases where part of a limb has to be amputated, the remaining stump is not sutured to ensure that gangrene does not spread further. Only after making sure of this, a repeat operation is performed in order to form the correct stump. When all the necessary manipulations have been completed, a drainage in the form of a rubber tube or glove is installed in the patient’s wound. At the end of the operation, the patient is removed from anesthesia and transported to the ward.

Postoperative period
After the operation, the patient is under the supervision of medical personnel. Every day, and if necessary, more often, blood and urine are taken for tests, drainage is monitored, and the wound is dressed. Temperature measurements are taken every 2 – 3 hours. The timing of wound healing varies depending on the volume of surgical intervention, the type of healing ( with or without scarring), age and health status of the patient. On average, for a young healthy person this period lasts from two weeks to two to three months. In the elderly and patients with concomitant diseases, it is usually twice as long, although there are exceptions. With positive dynamics, good tests for at least two days in a row and no complications, the patient is discharged from the hospital.

Prevention of frostbite

• Clothing must be appropriate for the temperature, dry and of the correct size.
• If you don’t have warm clothes, you can insulate yourself using plain paper or scraps of fabric crumpled up and placed between layers of clothing.
• Don't stand still, move. The human body is capable of expending more than six thousand calories per day, most of which is spent on heat generation.
• Don't wear tight shoes. The sole should be at least a centimeter thick;
• If possible, find an external heat source and light a fire.
• Meals should be taken on time. The proportion of fats and carbohydrates in the diet should be increased. Sources of fat can be, for example, lard, sunflower oil, meat; sources of carbohydrates are flour products, rice, potatoes.
• People with poor circulation need warmer clothing.
• Do not use alcohol to warm yourself up. Alcohol has only a short-term effect, followed by worsening freezing.

Frostbite or frostbite is damage to body tissues caused by exposure to low temperatures. Frostbite is often accompanied by general hypothermia of the body and especially often affects protruding parts of the body, such as the ears, nose, and insufficiently protected limbs, especially fingers and toes. Spreads from more distant areas (fingertips, nose, ears) of organs to less distant ones.

Most often, frostbite occurs in the cold winter when the ambient temperature is below −20-10 °C. If you stay outdoors for a long time, especially in high humidity and strong winds, frostbite can occur in the fall and spring when the air temperature is above zero.

Signs, symptoms and stages of frostbite

In order to ensure that first aid for frostbite is provided effectively, you should know that all skin frostbite is divided into degrees of severity:

1st mild degree. If you get mild frostbite, its signs are a feeling of slight tingling, burning, and numbness of the skin. The skin on the affected areas turns pale, after it is warmed, a slight swelling appears, having a purplish-red tint, then peeling begins. The skin usually recovers within a week, leaving no other marks.

2nd degree. In this case, signs of frostbite in the extremities, in addition to redness and flaking of the skin, include blisters containing clear liquid. When warming up, a person experiences pain and itching. Full recovery may take about 2 weeks.

3rd degree. This kind of frostbite is very dangerous. Its sign is the appearance of blisters filled with blood; such frostbite often ends in necrosis. Skin restoration takes a long time, sometimes taking a month or more, and ends with the formation of scars.

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

Causes of frostbite

Frostbite in the cold is caused by tight and wet clothes and shoes, physical fatigue, hunger, forced long-term immobile and uncomfortable position, previous cold injury, weakening of the body as a result of previous diseases, sweating of the feet, chronic diseases of the blood vessels of the lower extremities and the cardiovascular system, severe mechanical damage with blood loss, smoking, etc.

When drinking alcohol, peripheral blood vessels dilate, which is characterized by increased heat loss, while normally they narrow when exposed to cold. Quite often, severe frostbite leading to amputation of limbs occurs precisely in a state of strong alcohol intoxication, for reasons that are not likely of a physiological nature, but primarily due to the inability of a drunk person to take timely measures against freezing; in the case of severe intoxication, the ability to move normally is lost, awareness of danger disappears, and a person can simply fall asleep in the cold, which often leads to death.

First aid for frostbite

First aid does not exclude professional medical assistance and is intended only as an emergency measure. If you suspect frostbite, you should seek qualified medical care. Early treatment reduces the severity of consequences.

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

First aid actions vary depending on the degree of frostbite, the presence of general cooling of the body, age and concomitant diseases.

First aid consists of stopping cooling, warming the extremities, restoring blood circulation in cold-damaged tissues and preventing the development of infection. The first thing to do if there are signs of frostbite is to take the victim to the nearest warm room, remove frozen shoes, socks, and gloves. At the same time as carrying out first aid measures, it is necessary to urgently call a doctor or an ambulance to provide medical assistance.

In case of frostbite of the first degree, the cooled areas should be warmed until reddened with warm hands, light massage, rubbing with a woolen cloth, breathing, and then apply a cotton-gauze bandage.

In case of frostbite of II-IV degree, rapid warming, massage or rubbing should not be done. Apply a heat-insulating bandage to the affected surface (a layer of gauze, a thick layer of cotton wool, another layer of gauze, and oilcloth or rubberized fabric on top). The affected limbs are fixed using available means (a board, a piece of plywood, thick cardboard), applying and bandaging them over the bandage. Padded jackets, sweatshirts, woolen fabric, etc. can be used as heat-insulating material.

It is not recommended to rub patients with snow, since the blood vessels of the hands and feet are very fragile and therefore may be damaged, and the resulting micro-abrasions on the skin contribute to infection. You should not use quick warming of frostbitten limbs by the fire, or uncontrolled use of heating pads and similar heat sources, as this worsens the course of frostbite. An unacceptable and ineffective first aid option is rubbing oils, fats, rubbing alcohol into tissues for deep frostbite.

For mild general cooling, a fairly effective method is to warm the victim in a warm bath at an initial water temperature of 24°C, which is raised to normal body temperature. With moderate and severe degrees of general cooling with impaired breathing and circulation, the victim must be taken to the hospital as soon as possible.

When going for a long walk in the cold, wear several layers of clothing - the air between them will retain heat. Take with you spare woolen socks, insoles, and mittens. It is not recommended to wear metal jewelry in the cold, as metal cools much faster than the human body. Before going out, you need to eat a hearty meal; your body may need a lot of energy to fight the cold. It's a good idea to take a thermos with hot tea with you. “Warming up” with alcohol can lead to serious consequences, as it only gives the illusion of warmth and disrupts adequate perception. Most frostbite resulting in limb amputation occurs while intoxicated. If you feel your limbs freezing, warm yourself up in any warm room. An already frostbitten area should not be subjected to re-freezing - the injury will be much more serious.

Classification and types of frostbite

There are several classifications of frostbite based on different principles.

General classification of damage due to low temperatures

• Acute cold injury
• 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.

• Easy degree: The skin is pale, bluish, “goose bumps” appear, chills, difficulty speaking. The pulse slows down to 60-66 beats per minute. Blood pressure is normal or slightly elevated. Breathing is not impaired. Frostbite of I-II degree is possible.

• Average degree: body temperature 29-32 °C, characterized by severe drowsiness, depression of consciousness, blank look. The skin is pale, bluish, sometimes marbled, and cold to the touch. The pulse slows down to 50-60 beats per minute, weak filling. Blood pressure decreased slightly. Breathing is rare - up to 8-12 per minute, shallow. Frostbite of the face and extremities of I-IV degrees is possible.

• Severe degree: body temperature below 31 °C. There is no consciousness, convulsions and vomiting are observed. The skin is pale, bluish, and very cold to the touch. The pulse slows down to 36 beats per minute, weak filling, and there is a pronounced decrease in blood pressure. Breathing is rare, shallow - up to 3-4 per minute. Severe and widespread frostbite up to glaciation is observed.

Separately allocate immersion frostbite (trench foot): damage to the feet due to prolonged exposure to cold and dampness. Occurs at temperatures above 0 °C. It was first described during the First World War (1914-1918) in soldiers who spent a long time in damp trenches. In mild cases, painful numbness, swelling, and redness of the skin of the feet appear; in cases of moderate severity - serous-bloody blisters; in severe forms, there is necrosis of deep tissues with the addition of infection, and the possible development of wet gangrene.

According to the mechanism of frostbite development

• From exposure to cold air
• Contact frostbite

According to the depth of tissue damage

• Frostbite I degree(the mildest) usually occurs with short exposure to cold. The affected area of ​​the skin is pale, has a marbled color, turns red after warming, and in some cases has a purplish-red tint; edema develops. There is no dead skin. By the end of the week after frostbite, slight peeling of the skin is sometimes observed. Full recovery occurs 5-7 days after frostbite. The first signs of such frostbite are a burning sensation, tingling sensation followed by numbness of the affected area. Then skin itching and pain appear, which can be either minor or severe.

• Frostbite II degree occurs with prolonged exposure to cold. In the initial period there is pallor, coldness, loss of sensitivity, but these phenomena are observed with all degrees of frostbite. Therefore, the most characteristic sign is the formation of blisters filled with transparent contents in the first days after injury. Complete restoration of the integrity of the skin occurs within 1 - 2 weeks, granulations and scars are not formed. In case of frostbite of the second degree after warming up, the pain is more intense and lasting than with frostbite of the first degree, skin itching and burning are disturbing.

• Frostbite III degree exposure to cold is longer and there is a greater decrease in temperature in the tissues. The blisters that form in the initial period are filled with bloody contents, their bottom is blue-purple, insensitive to irritation. The death of all skin elements occurs with the development of granulations and scars as a result of frostbite. Fallen nails do not grow back or grow deformed. The rejection of dead tissue ends in the 2nd - 3rd week, after which scarring occurs, which lasts up to 1 month. The intensity and duration of pain is more pronounced than with frostbite of the second degree.

• Frostbite IV degree occurs with prolonged exposure to cold; the decrease in temperature in the tissues is greatest. It is often combined with frostbite of the third and even second degree. All layers of soft tissue die, bones and joints are often affected. The damaged area of ​​the limb is sharply bluish, sometimes with a marbled coloration. Swelling develops immediately after warming and increases rapidly. The skin temperature is significantly lower than in the surrounding tissue areas. Bubbles develop in less frostbitten areas where there is frostbite of the III-II degree. The absence of blisters with significantly developed edema and loss of sensitivity indicate degree IV frostbite.

In conditions of prolonged exposure to low air temperatures, not only local damage is possible, but also general cooling of the body. General cooling of the body should be understood as a condition that occurs when body temperature drops below 34 °C.

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

The peculiarity of frostbite and its main danger 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 do not differ in manifestation; all signs of frostbite relate to the reaction phase:

• First degree frostbite. The skin is purplish-red or blue in color, and subsequently peeling is observed in frostbitten areas. The affected areas are restored completely, only their increased sensitivity to cold remains;
• 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 of frostbite consists of restoring blood circulation in damaged tissues as quickly as possible, 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 for third and fourth degree frostbite requires surgery 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 drug therapy is used to combat inflammation, maintain normal blood circulation, and restore strength and body functions.

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