Frostbite 4 degree treatment. The most terrible injury is frostbite of the fourth degree, terrible consequences. Classification of frostbite according to the depth of the lesion

Frostbite is a change in tissues under the influence of cold, leading to necrotic processes. The destruction is based on local circulatory disorders in a certain area of ​​the body. Blood vessels under the influence of cold spasm, causing ischemia. There are 4 degrees of tissue frostbite under the influence of cold. Frostbite of the 4th degree is the most severe.

Fourth degree frostbite symptoms

Frostbite of the fourth degree is characterized by necrosis of all layers of tissues. The clinical course of the pathological process occurs in the form of wet or dry gangrene. After moving to heat, frostbitten areas of the skin take on a gray-blue or dark purple color. At the same time, a so-called demarcation line is formed on the border between necrotic and healthy tissues. Healthy tissues over the affected ones begin to swell strongly. Frostbitten tissues lose all kinds of sensitivity. By the end of the first week after the defeat, a rejection zone is clearly formed. The zones of the pathological process with frostbite of the last degree form the shape of a triangle, which is turned with its apex towards healthy tissues. In this case, zones are distinguished:

• complete necrosis of tissues;
• irreversible processes;
• in which the violations are reversible;
• neurotrophic and vascular pathological processes.

The result of frostbite of the fourth degree is the loss of anatomical structures.

Do's and Don'ts when providing emergency care to a person with fourth-degree frostbite

First aid to the victim is provided by him or by the people who discovered him. It consists in the elimination of symptoms and conditions that directly threaten the life of the patient. This is a stop of external bleeding, primary resuscitation measures: artificial respiration, chest compressions. There are many folk methods for treating frostbite, but often they are ineffective and can even be harmful. When assisting a person with frostbite of the fourth degree, it is impossible:

• Give alcohol to the victim.
• Rub the skin with snow.
• Open the bubbles that have formed.
• Allow a person to step on their feet if they are frostbitten.

When providing assistance, the patient should be transferred to a shelter as soon as possible, given a warm drink and seek medical attention.

Important! With the 4th degree of frostbite, the general condition of the patient suffers greatly. This is fraught with the occurrence of severe intoxication and the development of a state of shock. Therefore, it is necessary to seek qualified help as soon as possible.

Which doctors treat severe frostbite

Severe frostbite is treated by several doctors. At the first stage, assistance is provided by an ambulance doctor. The main task is to prevent further cooling and increase in body temperature. The main goal is to restore blood circulation to areas of the body that have been subjected to cold, or to the body as a whole. In case of frostbite of open parts of the body, they must be warmed by all available means. The victim should be changed into dry clothes, to prevent additional injury when changing shoes.

If circumstances permit, it is necessary to warm the chilled part of the limbs in a bath, or in any other container suitable for this (bucket, pan, etc.). The water temperature must be gradually increased from +37⁰ C to +40⁰ C, but no more (so as not to cause overheating of the affected tissues). At the same time, with your hands, with a soapy soft sponge, gently massage the unaffected part of the body in the direction from the periphery to the center. To stimulate and restore blood circulation, rubbing the skin with camphor alcohol, glycerin, or simply with a hand moistened with water is also used.

In severe degrees of frostbite, infusion and transfusion therapy is used. It is aimed at restoring lost fluid, reducing general intoxication. Further treatment takes place in specialized medical institutions by doctors - combustiologists.

Treatment of frostbite of the fourth degree in a hospital

With the 4th degree of cold injury, not only all soft tissues die, but also bones. Long-term conservative treatment is erroneous. It leads to the appearance of complications - gangrene, intoxication and sepsis. Surgical treatment of frostbitten areas is carried out on the second or fourth day after the injury. The first stage is called necrotomy. Its goal is to transfer wet gangrene to dry, to prevent the development of intoxication. The operation is carried out without anesthesia, since the affected skin is devoid of all types of sensitivity. In this case, the skin is cut along with the underlying tissues, which contributes to the drainage of secretions and the formation of dry gangrene.

After 4-5 days after that, the second stage of surgical treatment is performed - necrectomy. Its essence is to remove dead tissue. With such active surgical tactics, the general condition of the patient improves significantly. Body temperature drops, appetite improves. The third stage of surgical treatment for frostbite of the extremities is performed one month after hypothermia. Amputate the limbs with the formation of a stump. The fourth stage is prosthetics. It is performed three to four months later, after the formation of a full-fledged scarring of the wounds.

Is it possible to cure frostbite of the fourth degree with folk remedies

Treatment of frostbite with folk remedies has the right to exist only with lesions of the first and second degree. At the same time, the general condition of the patient suffers slightly and he does not require the provision of qualified medical care. It is unacceptable to treat frostbite of the last degrees with folk remedies. Without timely medical attention, such patients are at a very high risk of death.

Frostbite Prevention

To avoid frostbite, you must follow simple rules:

• Do not drink alcoholic beverages in the cold. Ethanol dilates blood vessels, contributing to the rapid release of heat. On the other hand, an intoxicated person cannot adequately assess the situation and his sensitivity decreases.
• Do not smoke. Nicotine impairs blood circulation in peripheral tissues, contributing to frostbite.
• Do not wear tight fitting clothing. It is better when there is a small air gap between the layers of clothing. It creates thermal insulation and prevents heat loss.
• Do not wear tight shoes, which is a factor that disrupts the circulation of blood in the tissues of the legs and contributes to frostbite.

Doctors do not recommend wearing metal accessories in the cold. The metal cools very quickly and can stick to the body, causing frostbite. If you are planning a long trip in frosty weather, it is advisable to bring spare socks, gloves and a thermos with hot tea.

There are enough cold regions in Russia: more than two-thirds of the population is constantly at risk of freezing. It happens that people die even when the air temperature is above zero, to say nothing of frost! To know how to keep warm, let's figure out what happens in the human body when the thermometer outside the window drops lower and lower.

In the normal state, the temperature of the human body ranges from 36.4 to 37.5 ° C, falling below 25 and rising above 43 ° C is deadly. At rest, heat is generated mainly by the abdominal cavity up to 55%, and with an average muscular load, priority is given to the muscles up to 75% of the total heat generation. It is believed that the lowest air temperature that a person can endure for a long time without clothes is 2 ° C. But do not try to repeat this experience, it requires long professional training, good health and good heredity. Here, for example, the Eskimos have a basic metabolism - chemical thermoregulation is 30% higher than that of the inhabitants of central Russia, and is genetically fixed.

Among people who are not particularly resistant to cold, the number of frostbite jumps sharply at a temperature of -10 ° C. In this case, open or poorly protected areas of the body (ears, nose, fingers and toes) most often suffer. Additionally, wet and tight clothing, hunger, physical overwork, alcohol intoxication, chronic heart and vascular diseases, blood loss, smoking, and some similar factors increase the risk. There are 4 degrees of frostbite.

Frostbite 1 degree- the skin on the frostbitten area is pale, when heated, it takes on a reddish or purplish-red hue, swells. Symptoms: tingling, numbness, burning, minor but severe itching and pain. The cells remain viable. After 1 week peeling may occur.

Frostbite 2nd degree

Frostbite 2nd degree- the site turns pale, loses sensitivity, in the first days after frostbite bubbles form with transparent contents. When warming, itching and pain are more pronounced. Recovery requires 1-2 weeks.

Frostbite 3 degrees

Frostbite 3 degrees- vesicles in the area of ​​frostbite are filled with bloody contents with a blue-purple bottom, there is no sensitivity. Warming up causes severe pain. Skin elements die with subsequent scarring. The nail plate may not grow or grows deformed. Dead tissue is sloughed off after 2-3 weeks, scarring occurs within 1 month.

Frostbite 4 degrees

Frostbite 4 degrees- the area of ​​frostbite is cyanotic with a marble color. After warming, immediately there is a strong swelling without blisters, the sensitivity is not restored. All layers of soft tissues undergo necrosis, joints and bones suffer.

First aid for frostbite

First aid for frostbite depends on the severity of the victim's condition. But what should definitely be done right away - take the person to the nearest warm room, remove frozen shoes, socks, gloves. First aid for frostbite - the victim is given a hot drink and food, a tablet of acetylsalicylic acid, an anesthetic, drotaverine and papaverine. As for alcohol, in the cold, in no case should you give it to the victim! Alcohol causes vasodilation and significantly increases heat transfer. But indoors, a small amount of alcohol may be in place, because in this case, the expansion of spasmodic peripheral vessels is what needs to be achieved as soon as possible in order to prevent tissue death.

First aid for frostbite:

First aid for frostbite - with frostbite of the 1st degree, the chilled areas should be warmed to redness with warm hands, light massage, breathing, and then apply a cotton-gauze bandage. At 2-4th degree, on the contrary, one should not use rapid warming and massage, but it is necessary to get to the hospital as soon as possible, in many cases minutes count, and if you delay, it becomes impossible to save, for example, fingers. Before medical assistance, it is better to apply a heat-insulating bandage on the affected surface (a layer of gauze, a thick layer of cotton, again a layer of gauze, and on top of oilcloth and rubberized fabric, you can use padded jackets, sweatshirts, woolen fabric) and fix the affected limbs with improvised means over the bandage.

What not to do with frostbite:

• rub frostbitten areas with snow - this injures the skin and capillaries, even if the damage is not visible to the eye;
• apply rapid warming (heating pads, batteries, etc.), this only worsens the course of frostbite;
• rubbing oils, grease, rubbing alcohol on tissues with deep frostbite, this is not only ineffective, but can also damage tissues even more.

With general hypothermia of a mild degree, it is enough to warm the victim in a warm bath at a water temperature of 24 ° C, gradually raising it to normal body temperature. In moderate and severe degrees, when breathing and blood circulation are disturbed (pulse up to 60 beats per minute or less), the victim must be urgently taken to the hospital, and not attempted to be treated on his own, which cannot be done with frostbite.

Children are a special risk group - their thermoregulation is still imperfect, they lose heat through the skin faster than adults, and they may not have the common sense to return home on time to prevent frostbite. Attention is also required for older people, often their microcirculation is no longer so effective. Therefore, it is advisable for children and the elderly walking in the cold every 15-20 minutes to return to warmth and keep warm. In the cold season, you need to take special care of each other, and then winter with its sparkling beauty, games and walks will only be a joy.

Under conditions of prolonged exposure to low ambient temperatures, a pathological state of general frostbite occurs (synonyms: hypothermia, hypothermia), which develops when the body temperature drops below 34 C (with its rectal measurement). It is important to know what to do if this happens to someone close to you. This article will tell you how many degrees of frostbite exist, and how to deal with them.

What does general frostbite mean?

General frostbite, unlike local frostbite, is a general body process associated with exposure to the body of water or air with a temperature below 0 C (or above zero, but accompanied by strong wind, dampness). This occurs when the intensity of the decrease in temperature indicators exceeds the reserve capacity of the thermoregulation system.

The process is greatly accelerated by being in the wind in wet clothes.

Very often, general frostbite is accompanied by local frostbite of individual areas. If the body temperature (rectal) during general frostbite falls below 24 C, the person dies.

Active factors leading to general frostbite:

1. Ambient temperature: the rate of heat loss increases in direct proportion to the decrease in ambient temperature.
2. Humidity: The rate of hypothermia is directly related to humidity readings. In conditions of high humidity, the thinnest water layer forms on the surfaces. At the same time, the rate of general frostbite in the aquatic environment is 13–15 times higher than heat loss in air.
3. Wind strength: under wind load, the heated air shell around the human body does not have time to form. At the same time, the heat transfer rate already with a wind of 10 m/s increases by 4 times.

The extreme danger, often not realized by a freezing person, is a combination of wet clothes, wind and low temperature (even 5-7 degrees above zero).

About why frostbite of the third, second, first degree can occur, we will describe below.

The video below will tell you about the dangers of general frostbite:

Predisposing factors

The state of general frostbite is aggravated by:

• previous cold injury;
• wet clothes and wet shoes;
• forced immobility;
• fatigue from physical overstrain, ;
• long stay without food;
• : the influx of warm blood from the internal regions into the dilated vessels of the superficial tissues creates a false sensation of warming. But, rapidly cooling, the blood returns to the central "core" of the body (organs and vessels of the chest and peritoneum), reducing body temperature.

Signs of frostbite

Categories of risk

• early and elderly (up to 15 and over 65);
• babies who have an underdeveloped thermoregulation system;
• women, pregnant women;
• injured, with pain shock;
• with great loss of blood;
• weakened after illness;
• suffering from anemia, beriberi;
• prone to having cardiovascular pathologies, cachexia (exhaustion), cirrhosis, Addison's disease, diabetes mellitus, hypothyroidism.

About the signs and characteristics of 1, 2, 3, 4 degrees of frostbite of fingers, toes and other parts of the body, read below.

Signs of the condition at different stages

With general frostbite, there are three stages, which are characterized by the risk of a certain degree of frostbite.

Symptoms of hypothermia in stages:

Since the stages of clinical signs of general frostbite fall outside specific temperature ranges, a classification of the degree of hypothermia according to body temperature has been introduced.

This video tells about the degrees of frostbite:

Degrees of general frostbite

Degrees of general frostbite according to body temperature:

About the treatment and consequences of frostbite 1, 2, 3, 4 degrees, read on.

Frostbite degrees

How to help a person

emergency measures

Include "passive" warming of the patient.

Very rapid rewarming of a person with generalized frostbite often results in a sudden drop in blood pressure, shock, and a high risk of death.

What should be done:

1. Immediately place the patient in a warm room.
2. Call an ambulance.
3. Immediately release the victim from wet clothes and shoes.
4. Don't let sleep.
5. Quickly dry the body with a cotton cloth, put on dry underwear, socks, wrap first in a cotton sheet, then cover with blankets (several layers). Be sure to cover your head.
6. If the victim's ears are not frostbitten, you can gently rub and warm them with your hands or a warm cloth.

If the person is conscious:

1. Give him a drink of hot sweet coffee, tea (necessarily with sugar), you can drink broth. Drinking should not be too hot, so as not to burn the mucous membrane of the mouth, esophagus and stomach.
2. Permissible 25 - 50 grams of strong alcohol (if there are no contraindications), optimally - hot milk or cocoa with cognac.
3. Give chocolate (as much as the person wants).
4. Feed him if he can and wants to eat.

Allowed (for mild frostbite):

• soft massage of the body, hands and feet (if there is no frostbite above degree I), rough rubbing can cause.
• warm baths with a gradual increase in water temperature, starting from 2-3 degrees higher than body temperature and reaching figures 10-12 higher than the initial temperature within an hour.

Many experts do not recommend disturbing and moving the patient, as well as undressing him during massage and before placing him in the bath. The most optimal is considered "dry" slow warming under the covers and the internal use of hot drinks.

When you need a hospital

A frozen person with an average degree of general frostbite must be hospitalized if:

• stupor (numbness due to oxygen starvation of the brain) or convulsions;
• violation of breathing and heart rhythm;
• lack of response to warming;
• frostbite of body parts II - IV degree;
• existing vascular, heart diseases, diabetes mellitus.

If a person is not breathing, the pulse on the carotid artery is not determined, they immediately start resuscitation at home or at work (ventilation of the lungs, heart massage), while simultaneously carrying out all “passive warming” activities.

Differences in degrees of frostbite

First Aid Medicines

In the absence of contraindications for existing diseases, the victim of general frostbite is allowed to:

• Antispasmodic drugs. Adult doses: 40-80 mg three times a day (first in tablets, with improvement in ampoules), Papaverine 40 mg up to 4 times a day.

Antispasmodics can be used only after the restoration of blood circulation and signs of warming of the victim (increase in body temperature up to 35-36 C, pressure up to 100-110 / 70-60). Otherwise, their use can dramatically worsen the condition.

• Painkillers. It is imperative to relieve pain, since it contributes to the strengthening of negative manifestations, increasing the likelihood of shock. To do this, use up to 3 times a day, 0.5 grams (can be injected), Ketonal 100 mg (3 times) or in ampoules (1-2 per day).
• Antihistamines. General frostbite may be accompanied by a sharp development, which further aggravates the condition of the victims. To prevent and weaken possible allergic reactions and at the same time reduce inflammation of a non-bacterial nature, apply: Pipolfen injection or in tablets.

A specialist will tell you how to deal with general frostbite in this video:

Frostbite is dangerous to health and even to human life. The level of danger depends on the location and degree of tissue damage. And this, in turn, is due to how quickly first aid for frostbite arrived.

If frostbite and frostbite are synonyms (doctors prefer the term "frostbite"), then hypothermia and frostbite are not the same thing. Frostbite refers to the states of acute cold injury along with hypothermia (freezing). Hypothermia occurs when the body temperature drops below the bar that allows the body to function normally. But this is the general state. Whereas frostbite is a LOCAL tissue damage with a violation of their structure.

Both frostbite and hypothermia are the result of exposure to low temperatures. To supercool or freeze something, it is not always necessary to stay in the cold for a long time. Sometimes, even at positive temperatures, such phenomena occur if you are poorly dressed, the wind is blowing and it is humid outside. Even faster hypothermia occurs in cold water.

Hypothermia and frostbite do not always occur at the same time. A person who has received general hypothermia of the body may not freeze anything. Conversely, under a certain set of circumstances, frostbite occurs without hypothermia. Moreover, a person may not even notice it. Often, frostbite is detected already upon arrival home, and then not immediately.

Frostbite classification

The following types of frostbite are distinguished according to the extent of the lesion and the severity of the condition.

The mild form includes frostbite 1 and 2 degrees. A person develops goose bumps, it is pale and cyanotic, chills, speech difficulties, slowing of the pulse to 60-66 beats per minute.

The average form is manifested by marble skin coloration, a pulse of 50-60 beats per minute, frostbite of the face and limbs of 1-4 degrees.

The severe form is characterized by loss of consciousness and frostbite of the 4th degree, up to icing of the whole body. But more often there is damage to the hands, feet, nose, ears and open skin, that is, areas where blood circulation is worse, and there is more contact with cold air.

Frostbite is also subdivided into "non-contact" and contact. The first occurs as a result of exposure to cold air. Contact frostbite occurs as a result of contact with a cold object. But this phenomenon should not be confused with cold burns resulting from exposure to icy substances, such as dry ice and liquid nitrogen.

Separately, immersion frostbite is distinguished, or in the people - a trench foot. In damp and cold, but above zero, air, a person who does not take off his shoes for a long time sweats and freezes his foot. First, the disease is characterized by numbness and swelling, redness of the skin of the foot, and then blisters inflate on the skin, after which tissue necrosis occurs, followed by infection. Contrary to popular belief, using fat to protect your feet from the cold only hastens the onset of trench foot.

Degrees (stages) of frostbite

Frostbite is also conditionally divided into degrees, or stages, which differ from each other in the depth of tissue damage and clinical manifestations. Stages replace one another: from the first to the fourth in ascending order.

Frostbite 1 degree

Light frostbite is stated at 1 degree. The skin is pale, but generally looks normal. After warming, the area turns red and swells. Tissue necrosis does not occur. The maximum that will happen is peeling within a week or two after warming up. Frostbite of the 1st degree is treated for a week and passes without consequences.

Frostbite 2nd degree

If frostbite of the 1st degree occurs with a short exposure to cold, then for the second degree you need to stay in the cold longer. At first it may seem that the matter did not go beyond the 1st degree: the skin is pale, cyanotic, numb. But after warming at 2 degrees bubbles form with a clear liquid. The blisters are not dangerous and disappear after one to two weeks. The main thing is not to open them yourself, so as not to bring the infection. This is done only by a doctor.

The main feature of the 2nd degree of frostbite, from a medical point of view, is that the horny, granular and, possibly, partially papillary-epithelial layers of the skin are affected. The process does not extend beyond these layers.

Frostbite 3 degrees

Prolonged exposure to cold and low temperatures results in grade 3 frostbite. Bubbles that form after thawing are filled with red hemorrhagic fluid. Skin cells die, scars form in place of dead tissues. If a person has received frostbite of the limbs, then the nails fall off, and in their place new ones either do not grow, or grow deformed.

At the 3rd stage of frostbite, skin necrosis is observed with a possible transition to fatty tissue. Tissue rejection lasts about 4-5 weeks, after which the areas are scarred within a month. This process is painful, the general condition of a person worsens: intoxication, changes in body temperature, apathetic state of the patient are observed.

Frostbite 4 degrees

To get frostbite of the most severe degree, you need to stay in the cold for a very long time. More often this happens with drunk people who could not assess the level of danger in time.

At 4 degrees of frostbite, the deep layers of tissues die, up to the bones. The damaged area is cyanotic or marbled. Immediately after warming, it swells, but there is no sensitivity. The skin becomes grayish blue or dark purple. Later, blisters with black contents appear, and after a while the area becomes mummified: it dries, becoming blue-black. Or wet necrosis occurs.

A distinct border between dead and healthy tissues appears only after 10-17 days. Within two months, tissue rejection occurs. For example, fingers may fall off. Even if this does not happen on its own, the prognosis for stage 4 frostbite is unfavorable: the limb is amputated, dead tissue is removed. The final healing is completed only after a year.

During the rehabilitation period, the general condition of the patient is unsatisfactory, dystrophic changes occur in the organs. Constant pain and intoxication exhaust a person.

Causes of frostbite

We have already found out that frostbite requires cold air, water (temperature below +8 degrees Celsius) or an object with high thermal conductivity. What can additionally become prerequisites for frostbite?

• Tight and damp clothes and shoes.
• Low immunity, the presence of an illness or a recent illness.
• Overwork.
• Pregnancy.
• Drinking alcohol and smoking in the cold.
• Going outside on an empty stomach.
• Prolonged immobility of the body in the cold.
• Injuries, wounds, blood loss.
• Childhood and old age.
• High humidity and wind. The higher the humidity, the less aggressive the temperature is needed for a person to get frostbite or hypothermia.

Under the influence of low temperature, vasospasm first occurs, which slows down blood flow, stops the action of enzymes, reduces the supply of oxygen to the tissues - and degenerative processes occur. This is to put it simply. The main meaning of the situation is that pathological changes in frostbite initially develop not in the cells themselves, but in the vessels - and only then in the tissues. This process is called secondary necrosis.

Signs of frostbite

The first signs of frostbite are easy to miss. Tingling and a numb nose or hand, as a rule, do not scare anyone, but in vain. Tingling, pain, and loss of sensation are among the first symptoms of frostbite. In this case, the skin is pale or cyanotic due to a slowdown in blood circulation. A person is disturbed by goose bumps and chills. And only after a while bubbles and blisters appear during frostbite. This does not happen during a stay in the cold, but after warming. The most commonly affected fingers and toes, nose and ears, so they need to be checked and warmed all the time.

First aid for frostbite

Having found a frostbitten person, you must first decide whether it is worth warming him up urgently. If there is a possibility of repeated frostbite, for example, during transport to the hospital, then it is better not to start rewarming until it is possible to keep the person warm at all times. Otherwise, repeated frostbite will be much more serious and traumatic.

If conditions are favorable, first aid for frostbite should occur as quickly as possible. It depends on how competently the person who saves the victim of frost behaves, whether she survives and whether she has limbs. We propose the following algorithm of actions.

First aid for frostbite should exclude exposure to cold. Take the person to a warm place, or at least to a place where there is no wind. Immediately call an ambulance or rescuers. Then you can take some action before help arrives at the scene.

With frostbite of the 1st degree, it is necessary to warm up the chilled areas with a light massage with your hands or a woolen cloth, as well as breathing. Then - apply a bandage. Also, with a mild degree of frostbite and hypothermia, you can place the patient in a warm bath. Initially, the water temperature should be 20 ° C, then the bathroom is slowly heated to 37 degrees. About how to do it.

With frostbite of 2-4 degrees, it is impossible to aggressively warm a person. A heat-insulating bandage is immediately applied to the affected area: from gauze, cotton wool, polyethylene and other improvised means. It consists of several layers: each should be thicker than the previous one. Next, the affected limb is fixed, the patient is dressed in dry warm clothes and covered with a blanket. The victim is given a pill or an injection of an anesthetic, an antispasmodic (no-shpa, etc.) and an antihistamine (antiallergic) agent (for example, tavegil, suprastin) is injected. Also shown is sweet warm, but not hot tea or regular warm water.

What not to do with frostbite

Do not forget the rule: emergency care should not harm. Rescue actions for frostbite can not only help, but also kill a person. For example, too much rubbing with severe hypothermia and frostbite causes a sharp flow of blood to the periphery and tissue damage, as well as an increase in blood pressure and stroke. Therefore, at first, at least roughly determine the severity of the situation, and only then act.

To provide first aid for frostbite, do not rub a person with snow. This will damage the blood vessels and cause infection. Moreover, you can not use fire, a battery or a hot heating pad.

Likewise, for severe frostbite, rubbing on oils and grease or rubbing alcohol will only make things worse. You can rub with alcohol only with a mild form of frostbite, when the skin is already warmed up and not obviously damaged.

Bubbles in the affected area cannot be opened on their own: this way you damage the tissue and cause infection. Moreover, this is not always necessary: ​​doctors often use drainage.

With frostbite, active movements are prohibited. The body has already lost heat and will not be able to warm itself. But it is now easy to damage tissues and say goodbye to the last energy.

Suppress the urge to give the patient alcohol or coffee to drink. These drinks are prohibited.

Frostbite treatment

Mild frostbite can be treated at home. If sensitivity returns to the warmed area within half an hour, there are no blisters, the skin color has become normal, then you can not consult a doctor. If the area is warm, but there is no sensitivity, there are blisters, swelling persists, or the skin color is unhealthy, go to the hospital. In this case, the treatment of frostbite is prescribed by a doctor.

With a serious cold injury, the patient is hospitalized. Sometimes frostbite is sent home to be treated, given a referral for physiotherapy and a prescription for medication. Difficult cases are treated in the hospital.

Doctors recommend using broad-spectrum antibiotics (penicillin, streptomycin, etc.) and frostbite ointment. This is done to soften damaged skin and heal tissues, as well as to prevent infection. Levomekol ointment with an antibiotic is perfect. It is effective to use a product that contains levomekol and beeswax (for example, Voskopran).

Professional medical care for frostbite includes the following measures:

• The introduction of tetanus toxoid.
• Taking antiaggregants and anticoagulants (to affect blood properties), vasodilators, plasma substitutes, angioprotectors (to protect the heart), antioxidants, antihypoxants (to increase tissue resistance to oxygen deficiency), hepatoprotectors (to protect the liver), membrane protectors, antibiotics (antibiotics for frostbite are needed to counteract infections), immunocorrectors, analgesics (for pain relief). The exact list of medicines is prescribed by the doctor observing the patient.
• The resulting blisters are opened under sterile conditions in a special way, dead tissue is removed, then a sterile therapeutic bandage is applied.
• Hardware methods of treatment: hyperbaric oxygenation (use of oxygen under pressure), biogalvanization (exposure to current), laser therapy, barotherapy (impact on the body of increased or decreased pressure), UHF, electrophoresis, magnetotherapy, heat therapy.
• In case of tissue necrosis, surgical operations after frostbite are prescribed, aimed at amputation or removal of areas of dead tissue.

The healing periods for a mild form of frostbite last a week, an average one - up to two months, and a severe one - up to a year.

Consequences of frostbite

The consequences of frostbite can be dire. If at the first degrees of frostbite it is not so difficult to avoid the development of complications, then at 3-4 degrees, negative consequences will definitely appear. This is first of all:

• nervous disorders and loss of sensation;
• infectious processes;
• necrosis;
• tetanus;
• erysipelas;
• phlegmon - acute purulent inflammation under the skin;
• skin atrophy - thinning of the epidermis, dermis and fatty tissue;
• ulcer;
• gangrene;
• limb amputation;
• scarring;
• cartilage tissue change;
• atrophy of bones and cartilage;
• cyanosis - cyanosis of the skin and mucous membranes;
• department of nails;
• sweating of the legs;
• endarteritis of the legs - damage to the arteries;
• an acute reaction of the body to the slightest hypothermia.

Irreversible changes in local frostbite in people who can be saved rarely extend beyond the wrist on the hands and ankle on the legs. The defeat of zones that go beyond these limits leads to a general hypothermia of the body, incompatible with life.

Frostbite Prevention

Prevention of frostbite includes the following measures.

Before going out into the cold, it is advisable to eat a hearty meal. The body needs energy to keep warm. The more calories the food, the better.

In the cold and before going out into the cold, you should not drink alcohol: intoxication causes heat loss as a result of the expansion of peripheral vessels. In addition, drunks inadequately assess their condition.

Do not smoke in the cold: smoking constricts the peripheral vessels and makes the skin defenseless against the cold.

If you go out into extreme cold for a long time, then use a frostbite cream or ointment for your face: goose fat, bear fat, badger fat or just a fatty (nourishing) body cream, but not moisturizing. Fat should be smeared about 30-60 minutes before going outside.

Preventive measures to avoid frostbite include wearing warm, loose, layered clothing. Under the bottom, if physical activity is planned, it is advisable to wear thermal underwear: it will absorb sweat and thereby eliminate one of the hypothermia factors. To absorb sweat on your feet, wear wool socks, not synthetics.

Cover your cheeks and nose with a scarf - it will protect vulnerabilities. And put on gloves or mittens on your hands: it is better from waterproof material on the outside, and inside - with fur.

Also, in the cold, you can’t turn up winter clothes, even if you just went out for bread. Warmth will quickly escape through rolled up jeans or sleeves. In addition, exposed areas of the body get frostbite more easily.

If you feel your hands freezing, hide your palms in your armpits or make rotational movements with your hands from your shoulder. When your feet freeze, swing your legs forward. This method is good if there is no general hypothermia: it causes blood to rush to the limbs, warming them. But if the whole body is already supercooled, then you should not take blood from the internal organs: it is better to sacrifice arms and legs.

Hide from the wind. Find a place if possible. Even if it's unheated. It's better than standing in the open.

Do not touch metal with bare skin when in the cold. And do not wear metal objects on your body. Such products quickly remove heat from the body. In addition, due to frost, the finger may swell and fix the ring.

In the cold, you should also not touch gasoline, which quickly takes away heat. Work with it only if waterproof gloves are worn on the hands.

A good method of preventing hypothermia is hardening. It helps to develop resistance to cold: hardened ones produce heat in the body more intensively than non-hardened ones, so they are less likely to overcool.

Frostbite- this is a specific skin lesion under the influence of low temperatures, strong winds and high humidity, with a reduced reactivity of the body. Most often, limbs and protruding parts of the body are susceptible to such damage: ears, nose, cheekbones. Tight shoes and limited mobility predispose to the development of frostbite, as a result of which there is a violation of microcirculation and innervation of the skin. Violation of the blood supply can occur not only in severe frost. Oxygen, necessary for tissues for normal life, ceases to flow to them already at 8 degrees above zero. Therefore, under additional conditions, such as tight and wet clothing, constant holding of an object in the hands, prolonged immobility and weakening of the body by stress, malnutrition, beriberi, spasm of the smallest vessels occurs, blood flow disturbances in them and deficiency of tissue enzymes. Thus, the saturation of tissues with oxygen decreases, which leads to tissue necrosis.

Frostbite symptoms

To provide correct and timely assistance to the victim with frostbite, such skin lesions are divided according to severity. The lightest - 1 degree, is characterized by sensations of numbness, tingling, burning. The affected skin is pale, edematous and reddened with a purplish-red tint after warming. Such tissue damage usually recovers after 5-7 days, passing through the desquamation stage.

With 2 degrees of frostbite, blisters with transparent contents appear, after warming the skin, intense itching and sharp soreness of the affected skin appear. It may take up to 2 weeks for the skin to heal.

Grade 3 is characterized by damage to all layers of the skin by necrosis. The bubbles are filled with bloody contents. Healing takes a long time, more than a month, with the formation of scars.

At grade 4, all layers of soft tissues are exposed to necrosis. Skin lesions are manifested by severe, persistent edema and loss of sensitivity.

Symptoms of hypothermia

It should be noted that under the influence of low ambient temperatures, not only local damage to the skin in the form of frostbite is possible. Often there is a general hypothermia of the body, which is manifested by a decrease in the overall body temperature below 34 degrees, chills, a decrease in heart rate, respiratory rate, blood pressure, a violation of the general condition, sometimes there is even a violation of consciousness. The skin of the whole body is pale, cyanotic, with elements of "goosebumps".

Such a systemic damage to the body can also occur as a result of increased absorption of necrotic tissues from the focus of frostbite. In this regard, when the first symptoms of a violation of the general condition of the body appear, it is necessary to consult a specialist. Since when the body warms up, “oxygen debt of tissues” will appear, hypoxia will increase, and the violation of the general condition will progress. In a hospital, to determine the severity of the victim, the level of acid-base balance in the blood will be assessed.

First aid for frostbite

When the first clinical signs of frostbite appear, it is necessary to warm not only the injured limb in a warm room as soon as possible, but also the victim himself.

With the first degree of frostbite, the affected skin must be warmed with warm hands, light massage, and a sterile cotton-gauze bandage should be applied.

Herbal decoctions are considered safe folk remedies used for mild frostbite: oak bark, chamomile as compresses or general baths. For a warming compress, gauze is used, folded in 5-6 layers, moistened with a decoction of the above herbs at room temperature, applied to a frostbitten skin area, then a plastic film, a thick layer of gray cotton wool on top and bandaged for 6-8 hours. To create optimal sealing conditions, it is necessary to increase each subsequent layer in area. This procedure leads to the expansion of blood vessels and, accordingly, the warming of the skin.

The injured person must be given hot drinks, hot food. It is possible to take drugs from the group of non-steroidal anti-inflammatory drugs (analgin), from the group of salicylates (aspirin), from the group of antispasmodics (no-shpa, papaverine).

With a mild degree of general freezing of the body, manifested by a body temperature of 32-34 ° C, pale or moderately cyanotic skin, "goose bumps", chills, difficulty in speech, slowing of the pulse to 60-66 beats per minute and frostbite of the I-degree, warming of the body is possible in the following way. The victim is placed in a warm bath at an initial water temperature of 24 ° C, which is gradually raised to normal body temperature.

With a deeper skin lesion, II-IV degree, it is not recommended to rub the damaged skin, the frostbitten limb must be fixed with the help of improvised means, bandaged with sterile material, insulated and call an ambulance.

When the body is cooled, accompanied by a body temperature below 32, rare and shallow breathing, vomiting, convulsions, the victim is also recommended to be taken to the hospital as soon as possible.

Treatment for frostbite

In case of frostbite of the II degree, the covers of the bubbles are opened and removed according to all the rules of asepsis. The skin around the blisters is treated with alcoholic solutions of boric or salicylic acid. Dressings are applied with antibacterial ointments, drugs to stimulate regeneration processes: Dermazin, Levomikol. After 5-10 days, physiotherapeutic procedures are prescribed: electric light baths, ultraviolet irradiation starting with suberythemal doses, UHF therapy, darsonvalization method. Antibacterial drugs (penicillin) are prescribed intramuscularly to prevent secondary infection.

In case of frostbite of the III degree after removal of blisters and determination of the boundaries of skin necrosis, dressings with hypertonic NaCl solution are used. During the first week of treatment, dead tissue is removed. Physiotherapeutic methods of treatment are also used to improve wound healing. Sometimes a plaster cast is applied to limit the mobility of the limb.

Frostbite IV degree excision of dead tissue, amputation of limbs.

In the treatment of chronic dermatitis caused by prolonged exposure to low temperatures on the skin, general strengthening and vitamin teas and agents that improve peripheral circulation are used. A patient with frostbite in the diet needs to strengthen the protein-vitamin ingredients. Of the physiotherapeutic procedures, ultraviolet irradiation in suberythemal doses is of the greatest importance.

The outcome and prognosis of frostbite directly depends on the degree of tissue damage. With mild frostbite, after the restoration of damaged skin, it is necessary to treat it with care. Re-frostbite on previously affected skin can occur much more quickly. The result of severe frostbite can be not only the loss of a limb, but a fatal outcome.

As mentioned above, there are a lot of factors that increase the possibility of frostbite in the cold season, so you need to take the issue of preparing to go out into the street in such a difficult period for the body very seriously.

Frostbite consultation:

1. Is it true that excessive sweating of the feet is the cause of frostbite?
Sweating of the feet leads to an increase in the moisture content of clothing and footwear in contact with the skin and thereby reduces their thermal insulation properties.

2. Why are older people and children most susceptible to frostbite?
The blood supply to the limbs directly depends on the amount of blood supplied to the tissues through the vessels. Elderly people are characterized not only by obliterating diseases of the extremities, but also by various systemic diseases of blood vessels and capillaries. All this is a fundamental predisposing factor for getting skin lesions in the cold season. By the way, smokers, precisely because of the constant spasm of peripheral vessels, are also more prone to frostbite of the limbs than others. The child's body has not yet fully formed the mechanism of thermoregulation, therefore, it is not ready to give an appropriate response to any hypothermia.

3. Which skin conditions increase the risk of frostbite?
All diseases as a result of which the blood supply to tissues is disturbed predispose to the development of frostbite. As an example, various systemic connective tissue diseases, cicatricial atrophies can be cited.

4. Why is a weakened body more prone to frostbite?
In an organism that has recently undergone physical overwork, mental trauma, colds and various other injuries, all metabolic processes are reduced, blood supply to tissues is limited and, accordingly, less heat is produced, much needed in the cold season.

5. Why do drunk people often get skin lesions from the cold?
This is due to the fact that due to the expansion of peripheral vessels with alcohol, the body loses more heat. Such a person does not feel the beginning symptoms of skin lesions due to a reduced threshold of sensitivity under the influence of the alcohol factor. Often, an aggravating factor is prolonged immobility and squeezing of the limbs, as a result of which the blood supply to the underlying tissues is disturbed and their ischemia (bleeding). In such tissues, massive cell death occurs, ending in the formation of necrosis.

6. Why is it impossible to rub frostbitten skin with snow in the cold?
The vessels in such skin are very fragile and can easily be damaged when rubbed with snow, which will aggravate the picture of the lesion. Mechanical injuries caused by snow, scratches are an additional factor for infection of the affected skin.

7. Is it recommended to rub frostbitten skin with alcohol solutions, oils, fats?
This approach is not acceptable for deep forms of damage: II-IV degree. To the untrained eye, it is often difficult to differentiate the severity of frostbite.

8. Why is it impossible to warm a frostbitten limb near an open fire, battery, heater? The sensitivity of such affected tissues is reduced. A case of additional skin damage is possible, but already in the form of a thermal burn.

9. How to dress in cold weather to avoid frostbite?
It is necessary to dress in such a way that the layers of clothing do not fit tightly to each other and leave layers of air between them, which perfectly retain heat. Outerwear must be waterproof and windproof. Shoes should also be loose and dry. With excessive sweating of the feet, the use of warm insoles and woolen socks on the bare foot is recommended, as they absorb excess moisture and leave the feet dry.

10. Why is it not recommended to wear rings on your fingers during frosts?
Firstly, rings on the fingers often disrupt normal blood flow, which is very important in frosty conditions. Secondly, the metal cools faster in the cold to low temperatures, and thus is a potential cooling factor.

11. What to do when "freezing" the skin, mucous membranes to frozen iron objects?
It is necessary to pour warm, but not hot water on the stuck place, the metal will warm up and break its “contact” with the skin. These wounds are usually not deep. It is necessary to stop the bleeding and disinfect such damage with hydrogen peroxide. Then you can apply "Olazol", "Dermazin" and other products that are successfully used to treat weeping surfaces. You still need to see a doctor with this kind of damage.

Dermatologist Kuklina T.P.