Providing first aid for frostbite. Nutrition for Frostbite. Siberian Health. Prevention and treatment of frostbite types of degree general principles of care

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

Frostbite usually 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 focus on the signs of frostbite, the severity of this condition, as well as how to treat frostbite.

Causes

There are many reasons for frostbite:

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

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

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

Frostbite of the fingers and toes is the most common.

Signs of frostbite

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

Degrees of frostbite

There are the following degrees of frostbite.

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 injury.

II degree frostbite. Appears when exposed to cold for a longer period of time. The initial symptoms are blanching and cooling of the affected area, loss of sensitivity. But the most characteristic sign of frostbite of this degree is the formation of blisters with transparent contents on the first day after the lesion. With frostbite of fingers or other areas, pain, burning and itching appear immediately after warming. Skin recovery occurs within 1-2 weeks. In this case, scars and granulations are not formed.

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

IV degree frostbite. Usually combined with frostbite II and III degree. All layers of skin tissues undergo necrosis. Muscles, joints, bones are often affected. A sign of frostbite is a sharply cyanotic color of the damaged area, often with a marble color. After warming, edema immediately forms, which quickly increases in size. There is no sensation in the affected area.

First aid for frostbite

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

First aid for frostbite is to carry out the following activities:

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

Simultaneously with the provision of first aid, you need to call a doctor: the treatment of severe frostbite should be carried out under the supervision of specialists.

If the victim has symptoms of frostbite of the 1st degree, it is necessary to warm up the damaged areas with massage movements, with a woolen cloth until the skin turns red. After that, a cotton-gauze bandage is applied.

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

What should not be done when giving first aid?

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

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

frostbite treatment

Before starting treatment for frostbite, the victim is warmed.

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

In addition, solutions of glucose and rheopolyglucin are administered to the victim, which are preheated to 38ºС.

If blisters form on the affected area, they are pierced. After that, compresses with solutions of chlorhexidine and furacilin are applied to the frostbite sites. When suppurating 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 removing areas with dead tissue. If frostbite of the fingers, hands or feet has led to tissue necrosis, they are amputated.

Attention!

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

Winter is snow, frost and strong winds. Prolonged exposure to the street in frosty weather causes hypothermia and frostbite of different parts of the body. Most often, frostbite of the 2nd degree of severity occurs. With such an injury, there are no serious skin lesions, but for a favorable outcome, it is necessary to start treating the victim as soon as possible.

Signs of frostbite second degree

Frostbite is divided into 4 degrees of severity, depending on the depth of the lesion:

The 1st degree is characterized by blanching of the skin, tingling and burning at the site of the lesion. After warming the affected area, the skin becomes red;
The 2nd degree includes all the signs of the first, but blisters with a colorless liquid are added to them;
Grade 3 is characterized by damage to all layers of the skin. Bubbles in such cases have bloody contents;
Level 4 is the hardest. With this degree, not only the skin is affected, but also the tissues under the frostbitten area. Affected areas are blue and sometimes black.

The second degree of frostbite is between mild and severe frostbite. It affects only the upper layers of the skin. In cold weather, people most often freeze protruding or opening parts of the body: nose, ears, face, fingers of the upper and lower extremities.

There are many causes of frostbite of the 2nd degree of severity. Most often it occurs due to prolonged exposure to the street in frosty weather. Frostbite also occurs due to prolonged contact with cold objects. It can be ice, snow, metal or liquid nitrogen. Tight shoes, wet clothes, and damp weather all encourage hypothermia. Drinking alcohol in cold weather is a risk factor for frostbite.

Signs of frostbite of the second stage:

the skin is pale, sometimes even has a marbled tint;
sensitivity in the affected area is reduced, or completely absent;
after warming, the skin acquires a bright red hue;
there are blisters with a clear liquid on the 1-2nd day;
burning and tingling in the affected areas;
there may be swelling of the frostbitten area;
severe pain in the affected limbs.

When the first symptoms of frostbite appear, treatment should be started immediately.

First aid for a victim with frostbite of the second degree

First aid for frostbite begins with the fact that the victim needs to be warmed. It is important to start treatment on time, when the first symptoms of the disease occur. This will help avoid unwanted consequences.

First, the patient is taken to a warm room without drafts. If the exposure to frost continues, the second degree of severity will develop into the third. Next, you need to remove all wet and cold clothes from the victim, and change into dry warm clothes made from natural fabrics. Give the patient a warm drink to drink: tea or milk. Do not give coffee or alcohol. They dilate blood vessels and increase heat transfer by the human body.

If the body temperature does not return to normal, you can put the patient in a bath with a temperature of 18-19 ° C. The water temperature must be increased slowly, by 1-2 ° C, gradually bringing it to 37-38 ° C. It is dangerous to use hotter baths. This can only aggravate the patient's condition and cause unwanted complications.

You can use a light massage on the skin where there are no bubbles. After carrying out these steps, apply a clean bandage to the area with blisters. Further, it is better to consult a doctor, and he will tell you what to do to treat frostbite of the 2nd degree. Recovery usually occurs in 1-2 weeks, there are no traces on the skin with proper therapy.

Doctor's advice. Cold burns of the second degree cannot be rubbed or treated with alcohol solutions. This will only aggravate the patient's condition. Do not pop bubbles yourself. It can cause wound infection

Do's and Don'ts when caring for a person with second-degree frostbite

Remember, your actions can both help and harm the patient with hypothermia. Therefore, it is necessary to know what can and cannot be done with frostbite in order to avoid complications of the condition.

Can be done with the 2nd degree of frostbite:

warm the affected area, give a warm drink;
change clothes, put the patient in the bathroom;
give the patient analgesics to relieve pain;
treat the affected areas with frostbite ointments;
apply a bandage;
do a light skin massage where there are no bubbles.

If everything is done correctly, it will bring relief to the patient and speed up recovery. All treatment procedures should be done carefully and slowly. If the patient's condition worsens, immediately call an ambulance.

What not to do when hypothermia:

undress and undress the patient in the cold;
keep the patient in cold and wet clothes;
warm the damaged areas with hot water, open fire or contact with hot objects: a battery, a hot heating pad, etc.;
strongly rub the affected areas of the skin;
treat blisters with alcohol or other antiseptics;
open bubbles on your own;
give hot drinks, coffee or alcohol;
apply a bandage on a dirty wound.

All these actions will cause negative consequences for the patient. Frostbite 2nd degree may develop into frostbite 3rd degree, or infection of the wound may occur. Frostbite with complications heals for a long time and requires treatment in a hospital. Therefore, before helping the victim, think about whether it will harm him. And if you are not sure what stage of frostbite is taking place, it is better to seek help from specialists.

When to See a Doctor

Usually, frostbite of the 1st-2nd degree of severity heals on its own within 2 weeks and does not require a visit to the doctor. But sometimes there are situations in which you can not do without the help of specialists. You need to see a doctor if:

large affected area;
body temperature does not normalize for a long time;
damaged areas of the skin do not heal for more than 2 weeks;
severe inflammation around the blisters;
clouding of the contents of the blisters, the appearance of pus in the wound;
severe pain;
sensitivity after warming did not appear.

It is difficult to heal such damage on your own. They require inpatient treatment, possibly even surgery. In the hospital, they will pick up antibiotics, creams or ointments, treat wounds and remove dead tissue. Therefore, you need to consult a doctor as soon as possible so that the affected area does not increase. Recovery with proper treatment will come quickly and without consequences.

Important! If the contents of the blisters are blood, you should immediately consult a doctor. This is already the third degree of severity and the treatment of such frostbite should take place only in a hospital under the supervision of specialists

Treatment of frostbite of the second degree folk remedies

Treating frostbite at home is a long and painstaking process that needs a lot of attention. It is important to choose the right components and recipes that will remove inflammation and speed up skin regeneration processes.

Compresses with calendula are very effective in the treatment of frostbite of the 2nd degree. Calendula tincture is mixed with water and a compress is made. The bandage is applied for 15-30 minutes several times a day for a week. Calendula removes inflammation, stimulates regeneration and makes scars less noticeable. You can also prepare baths from calendula.

Aloe leaves have antibacterial and anti-inflammatory effects. Therefore, crushed leaves, pulp or aloe juice are applied to the wound, wrapped with a bandage and left for half an hour. Such compresses protect the wound from infection and improve healing.

Accelerate the healing of lotion from chamomile, which is poured with boiling water and allowed to brew. After that, the infusion is filtered and the affected areas of the body are treated. Chamomile has anti-inflammatory and soothing properties. You can also make tea from chamomile and take it internally. This tea will improve blood circulation and increase immunity. Due to its properties, chamomile improves wound healing and prevents the development of complications.

For internal use, it is effective to use a decoction of viburnum, which improves blood circulation, increases the body's defenses and stimulates healing. Such a decoction must be made fresh every day and taken three times.

Remember, folk remedies are suitable for the treatment of mild to moderate frostbite without complications. Infected wounds require antibiotic treatment in the hospital. It is not possible to deal with them on your own. Therefore, if signs of wound infection appear, you should consult a doctor.

Frostbite Prevention

To prevent the negative effects of frost on the body, you need to properly prepare for going outside in cold weather. Start with the selection of winter clothes and shoes. Underwear should be dry and warm. Outerwear should be chosen from dense materials that will protect against strong wind and rain. Shoes with soles at least 1 cm thick. It is also important that clothes and shoes do not crush. Air conducts heat, so it's always better to wear several thin sweaters than one thick one.

Before going out, cover all parts of the body as much as possible. Use a hat, gloves and scarves. Don't go outside after showering or with wet hair. Don't go out into the cold hungry or tired. Going outside in such states threatens the development of rapid hypothermia. It is not advisable to go out into the cold after drinking alcohol. In an intoxicated state, a person's blood vessels are dilated and he quickly loses heat.

On the street, try not to stay in the cold for a long time. Every 30-40 minutes you need to warm up a little in warm rooms. It can be a shop, cafe or supermarket. The appearance of the first symptoms of frostbite is a sign that you need to warm up as soon as possible in a warm place. Try not to smoke or drink in the cold.

Do not wear metal jewelry in frosty weather, and do not give children toys made of metal. Avoid touching metal objects outdoors with cold hands. The metal cools down quickly and causes frostbite of the 2nd or 3rd degree of severity.

If you are tired or feel sleepy, do not sit down to rest on the street - there is a danger of falling asleep. It is better to force yourself to reach a warm room to warm up or call for help.

By following these simple rules, you will protect yourself and your loved ones from hypothermia. Remember, disease prevention is always easier, safer and cheaper than treating them.

frostbite is damage to any part of the body (up to necrosis) under the influence of low temperatures. If you stay outdoors for a long time, especially with high humidity and strong wind, you can get frostbite in autumn and spring when the air temperature is above zero.

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

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

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

Signs of frostbite and general hypothermia:

The skin is pale bluish;

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

When warming, severe pain, redness and swelling of soft tissues appear;

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

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

There are several degrees of frostbite:

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

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

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

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

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

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

First aid for frostbite

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

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

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

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

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

Prevention of hypothermia and frostbite

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

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

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

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

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

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

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

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

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

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

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

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

- Don't wet your skin Water conducts heat much better than air. Don't go out into the cold with wet hair after a shower. Wet clothes and shoes (for example, a person fell into the water) must be removed, the water wiped off, if possible, put on dry ones and bring the person to heat as soon as possible. In the forest, it is necessary to kindle a fire, undress and dry clothes, during this time vigorously doing physical exercises and warming up by the fire.

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

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

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

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Frostbite is a typical pathological problem in winter. The process of damage to the soft tissues of the body due to the direct impact of low temperatures on them entails a lot of problems.

The specific symptoms of frostbite, the potential list of possible complications and treatment procedures depend on the depth of tissue damage - the so-called degree.

Below, you can learn in detail about their features, find out the possible consequences of frostbite and get answers to other questions related to this topic.

In the article you will learn everything about frostbite of the skin of 1, 2, 3, 4 degrees and the hallmarks of the degrees.

Description of the degrees of frostbite

In modern medicine, there are several types of frostbite classifications according to a number of different features. Firstly, the defeat of low temperatures is divided into:

Acute cold injury;
Freezing;
frostbite;
Chronic cold injury;
chill;
Cold-type neurovasculitis.

In addition, the pathology development mechanism may differ, which is formed after contact frostbite or exposure to cold air flows. Also, doctors distinguish 3 basic degrees of general frostbite - mild (with frostbite of 1 or 2 degrees), medium (cold damage of 1-3 degrees) and severe (all types of frostbite, up to complete glaciation).

In clinical practice, a four-level gradation of frostbite is most often used., determined by degrees according to the depth of tissue damage.

Other classifications of frostbite can be viewed.

It is often possible to accurately determine the degree of frostbite only after the warming procedure and the entry of the pathology into the reactive phase.

First degree frostbite

1 degree of frostbite is considered the mildest form of cold injury - almost every person has encountered this problem if he lives in areas with an appropriate climate (in particular, severe winters).

Frostbite of the 1st degree is formed after a short exposure to cold. Sometimes, this type of frostbite can be obtained even at positive temperatures, if a person is in a strong wind, gets wet, and is not dressed for the weather. Most often, in this case, the fingers of the upper or lower extremities, ears, nose, and sometimes the face are affected.

Frostbitten tissues acquire a pale or even whitish hue, the process of dying of the skin does not occur. In the process of developing frostbite, a person feels a burning sensation and tingling in the problem localization, which is soon replaced by partial or complete numbness. In more rare cases, 1 degree of cold injury accompanies pain and itching.

In the process of warming, the affected tissues acquire a red tint, and a slight swelling may form. The skin sometimes peels off, and its sensitivity returns a few hours after the cold exposure is removed.

The treatment procedure for the first degree of frostbite usually does not require specialized medical regimens and can be carried out at home. Key actions include:

Stopping contact with cold air and surfaces. It is necessary to return home as soon as possible, or go to any other warm room;
Dressing up. After getting into comfortable climatic conditions, you should immediately change clothes, taking off cold clothes, shoes and, if necessary, underwear;
Warming. The warming procedure can be carried out in a warm bath. Fill it with water with a temperature of about 25 degrees, immerse the limbs there, and then slowly raise the degree of heat of the water for half an hour to a normal physiological indicator (about 37 degrees of heat);
Food and drink. Have warm drinks and food immediately after the procedure;
Bed. Cover yourself with 2 warm blankets and stay in bed for at least 1 day.

With timely first aid procedures, complications after frostbite of the 1st degree do not appear.

Learn more about first aid for frostbite.

Second degree frostbite

Frostbite of the 2nd degree is formed after a longer exposure to cold tissues. The lesion captures not only the fingers and protruding parts of the body, but also the hands, the lower leg with the foot. Often, the cause of frostbite of this type is not only cold air, but also direct contact with cold objects and substances - for example, snow.

Signs of the 2nd degree of frostbite are more diverse, compared with a mild form of pathology, but it begins identically - this is blanching of the skin, loss of sensitivity in the affected tissues. Burning, tingling and numbness are more pronounced. After some time, the epithelium acquires a pronounced bluish-marble hue.

The main differences from the first degree of frostbite are visible in the process of warming up - pain syndrome occurs almost immediately. The skin becomes not just reddish, but purple, while bubbles can form in the affected areas - they look like classic blisters, inside they contain a clear hemorrhagic liquid.

Skin itching and burning accompanies a person for several more days after frostbite, tissue sensitivity will return gradually, from 5 to 10 hours. The healing process with stage 2 frostbite can take up to 2 weeks - this is how long the tissues will need to fully restore their original appearance.

The first aid procedure at the initial stages is identical with the therapy of the 1st degree of cold injury. The only difference is the ban on artificial warming, which can damage blood vessels and cause a secondary bacterial infection.

After getting into the room, changing clothes and drinking plenty of warm water, you need to apply a heat-insulating bandage made of layers of gauze and cotton wool to the affected area, go to bed under a warm blanket and call the doctor at home - he will prescribe a further course of medical treatment.

With proper and timely therapy, the prognosis for the recovery of patients with 2nd degree frostbite is conditionally favorable - only in 15 percent of cases there is the development of local allergies, bacterial infections, and exacerbation of chronic diseases.

Third degree frostbite

The third degree of frostbite is characterized by severe cold damage, affecting not only the outer skin, but also the middle and deep layers of soft tissues.

In the process of development of pathology, the epithelium very quickly loses its sensitivity, its color becomes cyanotic with marble and gray shades. The pain syndrome is quite pronounced, accompanied by itching, tingling and numbness.

In the initial period of development of the 3rd degree of frostbite, large blisters and swellings form on the surfaces of soft tissues that have been negatively affected. Inside they are filled with a liquid substance with blood impurities. The bottom of these formations has a pronounced purplish-blue hue; when pressure is applied to it, there is no sensitivity.

Due to severe cold damage, the entire upper layer of the skin dies, and the soft tissues themselves are partially destroyed. In the process of painful healing, which lasts up to 1 month, the damaged elements are rejected with the formation of large scars and granulations. If the horny nail plates were frostbitten, then they do not return to normal until six months, slowing down their growth and producing a deformed structure.

The possibilities of first aid with 3 degrees of frostbite are significantly limited - this is a change of clothes, hot drinks (in the presence of a clear consciousness and a normal swallowing reflex), as well as the application of a heat-insulating bandage from several layers of gauze, cotton fabric, cotton wool and an upper edging in the form of polyethylene.

Fourth degree frostbite

4 degree frostbite is less common than 1-3, but has the most serious consequences for the human body. Quite often, such a cold lesion is combined with milder degrees, while capturing large areas of the body, up to 40-50 percent of the skin area.

Complications and consequences

Moderate and severe degrees of frostbite can lead to the most serious complications, even if medical therapy and first aid were carried out efficiently and in a timely manner. In its absence, the risks of developing a number of pathologies significantly increase, some of which directly threaten human life.

Typical consequences include:

Weakening of local and general immunity, which entails exacerbation of chronic diseases and the appearance of various syndromes;
Secondary bacterial infections caused by the penetration of pathogens into the bloodstream and soft tissues;
Various superficial defects of the skin - from dermatitis and eczema to pathological changes in the structure of the epithelium (scarring, etc.), requiring plastic surgery for tissue transplantation;
Necrosis of soft structures with the need for their surgical removal;
Cardiovascular pathologies;

Renal and liver failure, which is formed in the process of systemic negative effects of cold on the body;
The development of gangrene, the only way out of which is amputation;
The formation of sepsis in cases of severe forms of frostbite;
Critical drop in vital signs of blood pressure, respiration, pulse;
In the absence of first aid in the 4th stage of frostbite - a drop in body temperature below 24 degrees, disruption of the medulla oblongata, respiratory arrest and clinical death.

When is it necessary to see a doctor?

Modern medicine recommends contacting a medical specialist in any case of frostbite - often patients involved in self-diagnosis and home treatment are not able to correctly assess the degree of cold tissue damage, which entails an increased risk of complications. It is mandatory to undergo an examination in the following situations:

If there is a suspicion of 2 degrees of frostbite and above. If blisters with transparent or bloody contents have formed in the places of the affected localizations, the tissues and skin have darkened significantly with the formation of edema, other symptoms of moderate or severe forms of frostbite are revealed;
In the absence of a positive effect of home treatment. If first aid procedures do not help and the patient becomes worse, then hospitalization is necessary;
With extensive tissue damage. If the area of frostbite exceeds the area of the palm of an adult, then regardless of the degree of frostbite, you need to consult a doctor;
In case of frostbite in children or the elderly. Groups of special risk are the age up to 12 and after 50 years.

Features of frostbite of body parts

Frostbite of individual parts of the body has its own characteristics and course, depending on the degree of cold damage.

Arms

The upper limbs are more likely to suffer from frostbite than other parts of the body. This is facilitated by a finer structure of tissues and the proximity of blood vessels, as well as ignoring the wearing of mittens or gloves during frost or simply too cold, windy and humid weather. In the first degree, part of the hand turns white, a slight tingling and burning of the skin is diagnosed, and in the process of warming, the upper limbs turn red very quickly, a strong burning sensation is felt in the soft tissues, and the fingertips lose sensitivity for 1-2 days;

Legs

The lower extremities suffer from frostbite less often than the hands, but the main provoking factor in the development of cold injury is uncomfortable, tight and wet shoes, as well as the lack of active movement.

The victim rarely pays attention to mild forms of frostbite of the legs. unlike hands, which are used more often in everyday life. The result is sad statistics - the largest number of amputations in gangrenous processes in soft tissues falls on the lower limbs;

Head

Frostbite of the head deserves special attention. If, in mild forms of damage, cold affects mainly the ears, nose, cheeks and face, then, starting from the 2nd stage of frostbite, the risks to the health and even life of the victim increase significantly, since the pathology is often combined with hypothermia of the head, leading to the development of inflammation of the meninges ( its soft outer structures). Moreover, if no assistance is provided and the temperature of this part of the body drops to 24 degrees Celsius, the work of the elongated structure of the above-mentioned organ is disrupted, which can lead to respiratory arrest and clinical death.

It is the result of a local damaging effect of low temperatures on body tissues. Protruding parts of the body, such as fingers and toes, cheeks, nose and auricles, are more likely to experience frostbite. The severity of frostbite is determined by the volume of affected tissues, as well as possible complications. The most susceptible to it are persons without a fixed place of residence, who do not have the minimum conditions for preventing frostbite.

Interesting Facts

Drinking alcoholic beverages in the cold to keep warm is a myth. Alcohol contributes to the expansion of peripheral vessels, which ultimately leads to an increase in 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 lower legs.
Children under one year old are more prone to hypothermia due to insufficient development of the thermoregulation center at this age.
High ambient humidity increases the thermal conductivity of both skin and clothing, helping to accelerate the rate of heat loss.
Rubbing frostbitten limbs with snow does not warm, but takes away the remnants of 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.

The structure of the limbs

To fully understand the causes and mechanism of development of frostbite, knowledge of some features of the human body is necessary. It is known that the muscles are the main organ of heat production, and the skin is the main organ of heat transfer. Accordingly, the ratio of the volume of the muscle mass to the area of \u200b\u200bthe skin that covers it will show how much one or another part of the body is prone to frostbite. For example, let's take a leg, which consists of a massive thigh, a less massive lower leg and foot. The thigh is covered with muscle tissue on all sides and is very richly supplied with blood, unlike the foot, the bones of which are in contact with the environment through a thin muscle layer and skin. It turns out that the farther away from the body a part of the body is located, the more it is prone to freezing.

In addition to muscles, heat in the body is produced in some organs. The most "hot" of them is the liver. The heat produced by these organs is carried by the bloodstream throughout the body, giving off more heat energy on its way to closer parts of the body. From the foregoing, it turns out that the more distant parts of the body physiologically receive less heat and are therefore more vulnerable to low temperatures.

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

Last but not least, the physiological feature of the body, which seems important in the context of frostbite, refers 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 transmission rate 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

The causes of frostbite are conventionally divided into three groups:

weather;
clothes;
individual characteristics of the organism and disease.

Weather

In addition to cold, which is directly a damaging factor in frostbite, wind speed and atmospheric humidity are also important. At a wind speed of 5 meters per second, the heat transfer rate doubles; at a wind speed of 10 meters per second, it increases 4 times, and so on exponentially. Increased air humidity leads to the formation of a thin film invisible to the eye on the surface of objects, which increases the thermal conductivity of any substance and, in particular, skin and clothing. Accordingly, humidity increases heat loss.

Cloth

It is worth saying about clothing that it must correspond to the temperature outside. Clothing made from natural materials is preferred. It has many advantages. Wool does not create a “thermos” effect, minimizing sweating, it is pleasant to the touch, and, most importantly, nothing will warm your hands and cheer you up like dry woolen knitted mittens or gloves. Air is known to be a poor conductor of heat, so it is needed in small amounts in the spaces between layers of clothing. Sweaters and jackets should not fit too tightly to the body. Shoes must be waterproof, with sufficiently high soles ( at least one centimeter thick). In no case should you wear tight shoes in cold weather. Firstly, the above-mentioned air layer preventing heat loss is not formed. Secondly, the compressed limb experiences a lack of blood supply, reducing its resistance to cold.

Individual characteristics of the organism and diseases

At the end of the twentieth century and the beginning of the twenty-first century, the number of patients with cardiovascular, endocrine, tumor and other diseases has increased significantly. The proportion of such people in society is already large and continues to grow. Therefore, it is necessary to mention any disease, in context and in relation to others. Frostbite is no exception, because where a healthy person will not freeze under any circumstances, a sick person will surely suffer.

Diseases and conditions that increase the risk of frostbite include:

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

Obliterating endarteritis
At the heart of this disease are atherosclerotic plaques that form in the arteries. As it grows, such a plaque narrows the lumen of the vessel and, accordingly, reduces blood flow to that part of the limb, which is located further away. Insufficient blood supply to the limb helps to reduce heat generation in it and as a result increases the chances of frostbite. The most susceptible to this disease are smokers and people who eat a large amount of carbohydrates and fats of animal origin, as well as leading a passive lifestyle.

Deep vein thrombosis
In this case, we are talking about the most common deep vein thrombosis of the leg and less often of 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 to impede the outflow of blood from the limb, slowing down blood circulation in it and tissue hypoxia ( hypoxia is the lack of oxygen in the tissues). As a result, as in the previous disease, heat production in the limb decreases, which predisposes to frostbite, even at moderately low temperatures.

Raynaud's disease and syndrome
Raynaud's disease is a congenital 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, often treatable. This disease is characterized by a 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 turn white, acquire a marble hue and hurt a lot. Tissue ischemia ( ischemia is a tissue condition in which blood flow does not correspond to the costs necessary for its normal functioning), as in previous diseases, will increase the likelihood of frostbite.

Injuries
Severe bruises, sprains, fractures are dangerous in themselves, but they can also contribute to frostbite. The reason lies in the edema, which 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 tissues. Clustering suggests congestion and low blood flow to the area of injury, leading to inadequate oxygen and nutrient supply. In such conditions, the likelihood of frostbite increases. Do not forget about gypsum, which is sometimes necessary to treat an injury. By itself, the cast is able to quickly cool to ambient temperature and cool the limb through direct skin contact.

Heart failure
Heart failure is the inability of the heart to perform its function - pumping blood. It is a serious disease that can be both congenital and 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 the resistance of tissues to low temperatures.

Cirrhosis of the liver
This disease is a slow, but, unfortunately, irreversible replacement of healthy functional liver tissue with non-functional connective 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 the rest of the tissues. Accordingly, if liver function suffers, then peripheral tissues receive less heat. Secondly, with this disease, ascites develops - the accumulation of fluid in the abdominal cavity. When ascites becomes so pronounced that it stretches the abdominal wall like a ball, the fluid begins to compress the inferior vena cava, thus preventing sufficient outflow of blood from the lower extremities. Edema develops, blood circulation in the lower extremities slows down, which ultimately leads to excessive heat loss and a decrease in heat generation.

Diabetes
A severe disease, the substrate of which is damage to the endocrine part of the pancreas that produces the hormone insulin. To maintain the vital activity of the body, patients with diabetes mellitus are forced to inject insulin from the outside for the rest of their lives. However, even though the patient receives correct and timely treatment, delayed complications such as diabetic neuropathy occur after 5 to 7 years ( 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 feed the skin become sclerosed and lose their patency, and, accordingly, the ability to adequately nourish the skin. As a result, the lack of cold sensitivity combined with poor blood supply creates an increased risk for frostbite.

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

The state of alcoholic intoxication
There is a myth that the use of alcoholic beverages leads to warming of the body. However, there are some clarifications that are unknown to most. In addition to the inhibitory, for many pleasant, action on the central nervous system, alcohol also acts on the vessels of the periphery, expanding 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 instrument of the thermoregulation system - the vascular tone of the skin - is paralyzed by alcohol. Such a person is more likely to get heatstroke at high ambient temperatures, and frostbite at low temperatures.

blood loss
This condition consists in an insufficient amount of blood or certain components of it ( liquid part or cells) in the bloodstream. More often, blood loss is caused by injury to a blood vessel and outflow of blood into the external environment. With a decrease in the volume of circulating blood, the vessels of the periphery spasm, and blood rushes 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, in medicine called the "inferior vena cava syndrome", that swelling of the legs in pregnant women is associated. Edema, as mentioned above, predisposes to frostbite.

Frostbite degrees

Degree	Development mechanism	External manifestations	Demonstration
I	The defeat of only the horny and granular layers of the skin.	Paleness of the skin, followed by redness. Sensitivity is preserved in full.
II	The defeat of the horny, granular and papillary layers of the skin. Leakage of the infiltrate into the microcracks of the skin with the formation of blisters.	The pallor of the skin is replaced by blue. The sensitivity is reduced. Nails turn blue with subsequent falling off. The blisters are filled with a yellowish liquid. Self-healing in the second week without residual scar.
*III*	The defeat of all layers of the skin, subcutaneous fat and superficially located muscles. Blood vessels become brittle and lose their integrity.	The skin is dark burgundy. There is no sensitivity. The blisters are filled with bloody fluid. Progressive soft tissue edema. With the formation of zones of necrosis, the intervention of a surgeon 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 healthy tissue. There is swelling and signs of inflammation in the border tissue. In the absence of timely surgical intervention and control of wound healing, the risk of purulent complications is high.

Frostbite symptoms

Frostbite symptoms usually occur in the following sequence:

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

Decreased mobility
This symptom manifests itself gradually from the fingertips, spreading up the limb. A decrease in the mobility of a frostbitten segment occurs due to a slowdown in the conduction of a motor impulse. The tissue through which the nerve passes cools it greatly. When cooled, the properties of the nerve fiber wall change, which leads to a decrease in the speed of conduction along it. In addition, muscle fibers, to which a nerve impulse arrives late, also lose their ability to excite due to a slowdown in metabolism.

Desensitization
The decrease in sensation, as well as the decrease in mobility, begins at 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) are the last to decrease. The mechanism of this phenomenon is a violation of the function of sensitive skin receptors. A slowdown in their metabolism will lead to an increase in the threshold of sensitivity. In other words, a greater intensity of irritation is required in order for the nerve impulse to form and be transmitted to the brain.

burning sensation
A burning sensation occurs at the beginning of the thawing of the affected part of the body and precedes the onset of pain. Most often, this symptom is present with frostbite of I-II degrees and is absent with frostbite of III-IV degrees. Burning is accompanied by severe reddening of the skin. The reason is the paralytic expansion of the vessels that feed the affected area, and the direction of a large flow of blood to it. After prolonged cold, 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 the skin. For example, a frostbitten elbow will hurt less than a frostbitten hand. As the swelling increases, the pain will increase. The pain is sharp, burning and tearing in nature. It is important to note that pain occurs only when a frostbitten limb is thawed. As long as the tissue is under the influence of 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 change is as follows. In the initial period of frostbite, the skin is pale with a matte tint. This skin color is due to spasm of blood vessels that feed the skin. With frostbite of mild degrees, the pallor of the limb is replaced by a burgundy color. With more severe frostbite, pallor, bypassing the burgundy color, gradually turns into cyanosis. Prolonged vasospasm leads to nutritional deficiencies and an excess of metabolic products. Accumulating metabolic products change the color of the skin. The final skin color is black. Black skin does not have the potential to recover, so it is considered non-viable.

blisters
Blisters develop with frostbite II, III and IV degrees. The fluid that accumulates in them is clear and bloody. At the site of the formation of a blister, the patient can feel the pulsation of the vessels located at its bottom. Blisters develop as a result of 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 enters the place of rupture of bonds, it exfoliates the skin and forms a cavity in it - a blister. In more severe frostbite, blood from damaged blood vessels enters the blister along with the interstitial 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 scratching, in some places - up to blood. With frostbite, itching may occur at the beginning of the reactive period ( thaw period) and during the recovery period. The mechanism of itch development is the release of inflammatory mediators such as histamine and serotonin into the affected tissues. The aforementioned mediators irritate the nerve endings and cause an itching sensation.

tingling
This symptom is typical for the recovery period after frostbite. characterized by intermittent attacks of paresthesia "needles", "goosebumps"). The origin of this phenomenon is the same as that of the more well-known "phantom pains" ( when an 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 the complete absence of sensitive impulses that previously came from a 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 is felt in the limbs, and is formed in the head.

First aid for frostbite

Frostbite Algorithm:

Find a warm room, take off cold shoes and clothes. It takes time for clothes to warm up again, so it's best to change them.
Rub the affected area with a soft, warm cloth. Rubbing the skin leads to blood flow to it. Hot blood, passing through the vessels of the skin, gives off part of the heat, warming it. It is important to note that rubbing with snow is contraindicated, since snow does not retain the heat generated by friction, as cloth does. In addition, the crust of the infusion can leave microcracks on the skin, into which an infection such as tetanus or Pseudomonas aeruginosa can get.
Have a hot drink. Hot tea, coffee or broth, getting into the stomach, is an additional source of thermal energy, which is transmitted by blood throughout the body.
Soak feet in lukewarm water 18 - 20 degrees) and slowly ( in two hours) to heat water up to 36 degrees. Avoid placing your feet in cold water or rubbing with cold water, as this will only increase the affected area. However, you should not place the limbs immediately and in hot water, since they must be warmed slowly and evenly, otherwise the number of dead cells will increase as a result.
In the absence of water, it is recommended to wrap the limb with foil ( shiny side in), cotton wool or a special thermal blanket. Wrap over the foil with several layers of a regular blanket. Wrap your 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.
Give the limb an elevated position. This maneuver aims to prevent stagnation of blood 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 the flow of warm blood to the skin. As antispasmodics, papaverine 40 mg 3-4 times a day is used; drotaverine ( no-shpa) 40 - 80 mg 2 - 3 times a day; mebeverine ( duspatalin) 200 mg 2 times a day.
Non-steroidal anti-inflammatory drugs ( NSPW). Non-steroidal anti-inflammatory drugs are used to reduce the intensity of inflammation in the frostbite area. Medicines of this group are contraindicated in diseases of the stomach. The maximum duration of the course 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 ( ketans) 10 mg 2-3 times a day.
Antihistamines. This group of drugs is used mainly 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. Commonly used antihistamines are suprastin 25 mg 3 to 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” vessels damaged by low temperatures. It is used 500 mg 1-2 times a day.

The above dosages of drugs are calculated for an adult. Before use, a preliminary consultation with a doctor is expected.

If, during treatment, it is not possible to independently bring down the temperature to subfebrile numbers ( 37 - 37.5 degrees), the pain does not go away, purulent discharge from the place of frostbite appears, then you need to seek qualified medical help. In the event of the development of side effects of treatment, such as allergic reactions to drug components, abdominal pain, shortness of breath and other symptoms, it is also necessary to call an ambulance.

frostbite treatment

Frostbite treatment is primarily aimed at maintaining the viability of the maximum amount of affected tissue. To this end, the limb must be warmed, being careful, since rapid warming can lead to the phenomenon of " afterdrop". The essence of this phenomenon lies in the sharp flow of cold blood from the frozen limb into the bloodstream. The resulting contrast between warm skin and cold, abrupt blood flow contributes to a sudden drop in pressure and the development of shock.

It takes time to determine the need for surgery. With a hasty removal of the focus of frostbite, you can remove a lot of excess tissue or, conversely, leave tissue that will eventually die off. The boundaries of frostbite become clearly visible with the appearance of a demarcation line on the third or 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 to 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 vital signs of the body, such as blood pressure, blood glucose, blood electrolytes and much more.

Medications prescribed in the reactive period of frostbite:

analgesics ( painkillers), including drugs- in order to relieve 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;
vasodilating- drugs designed to improve blood circulation of the affected vessels.
cardiovascular drugs- in order to prevent a heart attack and maintain effective blood circulation;
antibiotics- to fight the associated infection;
tetanus toxoid- for the prevention of tetanus;
angioprotectors- in order to restore vessels affected by low temperatures;
detox solutions- drugs that neutralize decay products and toxins in the blood.

This list is not exhaustive and may be modified by the attending physician.

Procedures prescribed in the reactive period of frostbite:

Perineural sympathetic blocks. Blockades are carried out by introducing an anesthetic into the nerve sheath in order to temporarily turn it off and expand the vessels innervated by it. With the expansion of blood vessels, the blood supply and, accordingly, the nutrition of the affected limb improves. It is used no more than 1 time in 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. It is applied daily for 30 minutes - 1 hour for the required number of days.
infrared irradiation. Irradiation with infrared light is carried out in order to prevent wetting of the lesion. 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 a high oxygen content at high atmospheric pressure. This procedure improves the penetration of oxygen into the affected tissues. It takes place every day for several hours.
Biogalvanization. Biogalvanization is a physiotherapeutic method that accelerates the metabolism and regeneration of damaged cells. It is carried out daily for several hours the required number of days. Effective during the recovery period.
UHF. UHF is a method of influencing the frostbite area with ultra-high 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. The method of drug solution delivery ( potassium iodide, lidase) through the skin to the lesion. It is used daily or every other day for 10 - 15 minutes per session in a course of 10 days. Effective, including during the recovery period.
Ultrasound. The impact on the affected tissues of ultrashort sound waves allows you to speed up the process of their recovery. It is applied daily for 10 - 15 minutes in a course of 10 days. It has an analgesic effect.

After the formation of the demarcation line, the surgeon specifies the degree of frostbite and decides whether or not to intervene.

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 flap transplantation- plastic surgery to close a large skin defect.

Indications for surgery for frostbite are:

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

frostbite operation

Preparatory stage
The day before the operation, the patient is given a strong antibiotic to prevent postoperative infection of the wound. Stop taking anticoagulants and antiplatelet agents to avoid excessive bleeding on the operating table. Patients with diabetes are switched from oral medications to injectable insulin. 12 hours before the operation, the patient is forbidden to eat. Only drinking water is allowed. The area to be operated on must be washed and shaved.

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 anesthesia occurs, the surgeon makes the first incision. In the future, the wound is cleaned of non-viable tissues. The anesthesiologist during the operation monitors vital signs and maintains the required depth of anesthesia. At the end of cleaning from necrotic tissues, the wound is sutured if its edges close without strong tension and irregularities. If the defect is large, then the wound remains open. The patient will later undergo plastic surgery to graft the skin on the resulting defect. In the case where part of the limb has to be amputated, the remaining stump is not sutured in order to make sure that the gangrene does not spread further. Only after making sure of this, a second operation is performed in order to form the correct stump. When all the necessary manipulations are completed, the patient is placed in the wound drainage in the form of a rubber tube or glove. At the end of the operation, the patient is taken out of anesthesia and transported to the ward.

Postoperative period
After the operation, the patient is under the supervision of medical staff. Every day, and if necessary, even more often, blood and urine are taken for analysis, discharge through drainage is controlled, and the wound is dressed. Temperature measurement is made every 2 - 3 hours. The terms of wound healing vary depending on the volume of surgical intervention, the type of healing ( with or without scarring), age and health status of the patient. On average, in a young healthy person, this period lasts from two weeks to two to three months. In the elderly and patients with concomitant diseases - 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.

Frostbite Prevention

Practical recommendations for preventing frostbite are as follows:

Clothing must be temperature appropriate, dry and of the right size.
In the absence of warm clothes, you can warm yourself with plain paper or scraps of fabric, crumpled and placed between layers of clothing.
Don't stand still, keep moving. The human body is able to spend more than six thousand calories per day, most of which is spent on heat generation.
Don't wear tight shoes. The sole must be at least a centimeter thick;
If possible, find an external source of heat, light a fire.
Meals must be timely. In the diet, the proportion of fats and carbohydrates should be increased. Sources of fat can be, for example, lard, sunflower oil, meat; sources of carbohydrates - flour products, rice, potatoes.
People with poor circulation need warmer clothing.
Do not use alcohol for warming purposes. Alcohol gives only a short temporary effect, followed by an aggravation of freezing.