Types and signs of frostbite. How to help with different degrees of frostbite. The course of cold injury is divided into two periods

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.

The reasons

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.

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.

clothing

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 the “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, 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 the 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 immediately place the limbs 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 clothing. 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 mainly used 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 whole 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 surgery

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.

It develops in remote areas of the body (feet, hands, tips of the ears) with reduced blood circulation.

With the general effect of cold (being in the cold or in an unheated room), low-temperature tissue damage may be accompanied by a general hypothermia of the body. If the cold acts locally (prolonged contact with a very cold surface at normal ambient temperature), signs of frostbite are not accompanied by symptoms of general hypothermia.

The development of frostbite is facilitated by: tight shoes and clothes, wet clothes, lack of physical activity in the cold, forced posture, alcohol intoxication, smoking, concomitant diseases accompanied by a deterioration in peripheral circulation (sugar, atherosclerosis, etc.).

In the place of hypothermia of the tissues, a spasm of the arteries occurs, as a result of which the surface layers no longer receive enough heat and nutrients, and the metabolic processes in them slow down. After a significant decrease in the temperature of the cells, the water in them turns into ice crystals, which leads to irreversible destruction and necrosis.

Frostbite degrees

As with burns, four degrees can be distinguished depending on the depth of tissue damage:

With mild frostbite, there is a change in skin color in a small area. Usually it takes on a whitish hue, and as it warms up, it becomes a bright red color. External manifestations are accompanied by itching, slight soreness, burning or numbness.
In the second degree, the depth of tissue damage increases, and therefore, blisters with transparent contents form in the altered areas.
The third degree of frostbite is characterized by damage to all layers of the skin, so the blisters are often filled with dark or bloody contents. After healing, defects and scars are often formed.
With the most severe degree of frostbite, necrosis of soft tissues, joints and even bones develops. The skin acquires a bluish or brownish tint, and subsequently turns black.

First Aid Principles

First aid for frostbite helps reduce tissue damage and speed up further recovery.

Basic steps to follow when providing first aid:

Stop the effect of cold on a person. Warming is best in a warm room, but during transportation it is necessary to minimize heat loss, for example, cover the victim with a warm blanket or clothing.
After moving to a warm room, the victim should be undressed, as it will take longer to warm up in clothes and shoes.
Try to warm the areas that are damaged to a greater extent. However, you can not do it quickly, for example, using heating pads or a hot bath.
Since there is a risk of general hypothermia, it is necessary to give the person hot tea or milk to drink.
If there are skin defects, they should be covered with a dry sterile napkin. The patch is not recommended, as the damaged epidermis may peel off along with the adhesive layer.
If a person falls into the water far from settlements in winter, he should be undressed, wiped dry and dressed in other clothes. If there is no spare clothing, then you need to dry the available things by the fire, while not allowing the victim to freeze.

After providing first aid for frostbite, it is advisable to consult a doctor, even if the victim's condition has improved and there are no external changes. Be sure to consult a doctor in the following situations:

A child or an elderly person has been exposed to cold. This is due to the peculiarities of their immune system.
There are signs of third and fourth degree frostbite.
Sensitivity in the affected limbs is not restored for a long time.
The area of the frostbite area is more than 1% (according to the "rule of the palm" 1% of the body surface is equal to the area of the palm of the victim).

What is forbidden to do with frostbite?

It should be remembered that some actions during hypothermia and frostbite can worsen the condition of the victim. In these situations, you cannot:

Give alcohol to drink. Despite the fact that a person experiences subjective improvement with alcohol intake, the degree of hypothermia is usually aggravated. This is due to the fact that under the influence of alcohol there is an expansion of peripheral vessels, and heat loss only intensifies.
Too quickly warm the patient or rub him, as these actions increase the area of necrosis due to mechanical damage and the spread of toxic substances.
Contrary to popular belief, it is not recommended to rub the skin with snow during frostbite.
Open blisters and treat them with an antiseptic, as this opens the entrance gate for infection.

If you provide the necessary first aid for frostbite in time, and then take the patient to the hospital, you can save the health, and sometimes the life of the victim.

Frostbite Prevention

To prevent hypothermia and cold damage to soft tissues, several rules should be observed:

do not drink alcohol in cold weather outside;
smoking also makes a person more vulnerable;
do not use tight shoes and light clothing, as a layer of air slows down cooling;
wear a hat, mittens and a scarf;
when going outside in winter, do not wear metal jewelry;
in frost, periodically examine the face, especially the tip of the nose, and limbs;
at the first sign of frostbite, try to return to a warm room;
do not wet the skin, as this increases heat loss.

Particular attention should be paid to young children and the elderly, because their thermoregulation system usually does not work at full capacity. It is not advisable for them to stay outside in severe frosts for more than 20 minutes in a row.

With the onset of frost, the risk of frostbite increases - damage to body tissues caused by exposure to low temperatures. About 90% of cases of frostbite occur on the limbs, sometimes this leads to irreversible consequences: tissue necrosis and gangrene.

Causes of frostbite and their nature

Frostbite refers to cold injuries, their peculiarity is the likelihood of occurrence not only at sub-zero ambient temperatures, but also when a person stays outdoors for a long time at a temperature of +4..+8°C.

Changes in tissues occur not only under the influence of low air temperature, but also under the local action of ice, snow, cold metal products or water.

The development of frostbite begins with pathological changes in the blood vessels. Then there are circulatory disorders, which entail degenerative changes in the cells of the body; secondary tissue necrosis develops. Most often, the face, limbs (fingers), auricles are affected. Frostbite of other parts of the body is rare, usually with general freezing, when profound changes are observed in all tissues, blood circulation stops and anemia of the brain occurs.

Frostbite is promoted by:

General depletion of the body, vitamin deficiency.
Elderly age.
Vascular diseases and circulatory disorders.
Strong wind.
High humidity, damp clothes.
Alcohol intoxication.
Drowsiness.
Incorrectly chosen clothes and shoes.
Limb injuries.

Frostbite Symptoms

Symptoms differ depending on the period of frostbite:

Before warming (pre-reactive period)- at this time, a tingling, burning sensation is felt on the affected areas of the body. The feeling of cold is gradually replaced by loss of sensitivity. The skin at the site of frostbite becomes pale, with a bluish tint. Limbs stop moving, "stony".
After rewarming (reactive period)- the affected area becomes painful, edema develops. Subsequently, inflammation and signs of tissue death appear.

Immediately after warming the frostbitten area, it is impossible to determine the severity of the lesion, sometimes the picture becomes clear after a few days. There is a classification of frostbite, based on the depth of penetration of cold damage in the tissue.

Frostbite degrees

1st degree - there is a violation of blood circulation without tissue death. All violations are reversible. Patients feel pain, burning sensation in the affected area, then sensitivity to external stimuli disappears. After warming, the skin turns red, swelling appears. These phenomena disappear on their own after a few days, the skin peels off and then takes on a normal appearance.
2nd degree - tissue nutrition is disturbed, blisters appear with light contents inside, an infection may join. Tissue functions are restored in a week, sometimes it takes a longer time.
The 3rd degree of frostbite is characterized by the appearance of blisters with bloody filling. The epithelium completely dies, patients experience severe pain. Gangrene develops - the death of tissues with the spread of infection to large areas of the body. Dead tissue is torn off within two to three weeks, healing is slow, with the formation of scars and scars.
With the 4th degree of frostbite, necrosis occurs not only in soft tissues, but also in bones. The extremities are covered with blisters of dark color, pain is not felt, the fingers become black and mummified. Starting from the ninth day after frostbite, a granulation shaft appears - a line that delimits living and dead tissues. Rejection of dead areas and scarring occur slowly, within two months. This degree is characterized by frequent addition of erysipelas, sepsis, osteomyelitis.

First aid for frostbite

First aid to victims of frostbite falls on the pre-reactive period, that is, before warming up. It includes such activities:

Warming the patient, his affected limbs.
Restoration of blood circulation in frostbitten areas of the body.
Artificial respiration or the introduction of drugs to restore breathing (if necessary). If necessary, call an ambulance.
Protection against penetration of infection through the affected areas.
Inside - hot drinks (tea, coffee), heart remedies.
Taking foot baths with a gradual increase in temperature from +18°C to +37°C.
Light limb massage.
When signs of blood circulation appear (reddening of the skin, fever), massage and warming are stopped, the affected areas are wiped with alcohol and an aseptic dressing is applied.

What not to do with frostbite

You can not rub frostbitten areas with snow, as you can bring the infection through damaged skin; inefficient rubbing of oils and fats.

Also, warming the extremities too quickly should not be carried out because of the risk of shock. This is due to the fact that cold blood from a frostbitten limb, with a sharp warming, instantly enters the bloodstream, the temperature difference causes a drop in pressure and shock.

It would be a mistake to take alcohol in the cold, because heat is lost due to vasodilation and the result is the opposite effect.

After providing first aid and warming the patient, you can begin to treat frostbite.

Frostbite treatment

The choice of treatment method depends on the degree of frostbite, doctors recommend administering tetanus toxoid for prophylactic purposes in case of cold lesions of 2-4 degrees.

In case of frostbite of the 1st degree, the affected areas are wiped with a solution of tannin or boric alcohol. Physiotherapy is prescribed: darsonvalization, UHF therapy. Perhaps the use of ointments with antibiotics (levomekol, oflomelid).

With frostbite of the 2nd degree, the blisters that have appeared and the skin around them are treated with 70% ethyl alcohol. After opening the blisters, the epidermis is removed and an alcohol bandage is applied to the wound. For preventive purposes, the doctor may prescribe antibiotics.

Frostbite of the 3rd degree is accompanied by tissue necrosis, therefore, surgical treatment is performed - removal of dead areas (necrectomy). Bandages are applied with alcohol or hypertonic (10%) sodium chloride solution, antibiotics are prescribed.

With the 4th degree of frostbite, such surgical methods as necrectomy, necrotomy, amputation are used.

General treatment for all types of frostbite includes:

The use of sleeping pills and painkillers.
Vitamin therapy.
Enhanced nutrition.
Administration of antibiotics locally or orally.
Taking angioprotectors, anticoagulants and vasodilators to improve blood circulation and prevent blood clots.
The introduction of detoxification solutions to remove decay products from the blood.
In the recovery period - courses of magnetotherapy, UHF, electrophoresis.

For mild frostbite, you can use the following recipes:

Dilute a teaspoon of calendula tincture in 10 ml of water and apply as a compress.
From a decoction of potato peels, make baths for frostbitten hands or feet.
Apply pieces of aloe leaf to the affected areas.

Tip: during warming with frostbite, you need to drink a lot of hot, sweet liquid: a decoction of viburnum, chamomile, ginger; Regular tea will work too.

Often in winter there are injuries when curious kids taste frozen metal objects: the tongue instantly freezes to the piece of iron. Confused, the parents literally “with meat” tear off the child’s tongue from the metal, although it is enough to pour warm water on the stuck place. If a shallow wound forms on the tongue, it must be washed with hydrogen peroxide and a sterile bandage applied until the bleeding stops. Usually, small wounds on the tongue heal quickly; rinsing with decoctions of chamomile or calendula will help speed up the process. In case of severe injuries of the child, it is necessary to show the doctor.

Frostbite Prevention

In frosty weather, it is necessary to carefully prepare for going out, especially if you have to stand at a bus stop or somewhere else for a long time.

It is recommended to wear clothing consisting of several layers. It is good if the sweaters are woolen, creating an air gap.
Shoes should be one size larger to accommodate warm insoles and thick woolen socks.
It is necessary to remove metal jewelry before going out into the cold.
It is also recommended to eat tightly, food should be high-calorie to provide the body with energy.
You can not lubricate the face and hands with ordinary moisturizers, there are special protective compounds for application to the skin before going out into the cold.
In the cold, you need to move all the time, turn away from the wind, and at the first opportunity go into warm rooms (cafes, shops).

By following simple measures to prevent frostbite, you can protect yourself and your family from the unpleasant consequences of exposure to low temperatures. Knowing simple first aid methods for frostbite will help reduce the chance of complications in the event of an emergency.

The degrees of frostbite vary in symptoms. Each of them is characterized by certain symptoms and suitable treatment. What is frostbite and what to do when it occurs?

The concept of frostbite

Frostbite is damage to the skin that occurs as a result of exposure to low temperatures. The protruding parts of the body are most often affected - limbs, ears, nose, face skin. There are certain factors that can provoke the appearance of frostbite of varying degrees.

Factors:

vascular disease,
Intensive body heat transfer,
Injuries, weakened body, alcohol intoxication,
Violation of blood circulation.

People under the influence of alcohol suffer from frostbite quite often. At this moment, a person is poorly oriented in space. He has inhibited reactions to many stimuli, he may not feel discomfort in the freezing parts of the body.

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

signs

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

Symptoms:

The skin first becomes pale, then reddens,
There is a feeling of tingling and burning,
There is numbness of the skin,
There are painful sensations
The dermis may itch.

There are two periods of frostbite.

Kinds:

Hidden. At this point, the disease practically does not manifest itself, there are no vivid symptoms. Soreness, pallor and coldness of the skin are noted.
Reactive period. Manifestations in this case depend on what degree of frostbite is diagnosed.

In a person with frostbite, first there is a violation of mobility, numbness, and a decrease in sensitivity. When thawed, a burning sensation occurs, gradually turning into pain. The skin changes color from pale to bright red. With severe frostbite, blackening of the dermis is subsequently noted.

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

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

Degrees:

The first degree is considered the easiest. Appears as a result of a person's stay in the cold for a short period of time. At grade 1, it is noted in adults and in children there is a blanching of the dermis. After warming, it becomes red (sometimes burgundy). After a certain time, peeling begins. The presence of mild pain, itching, tingling is noted. There may be swelling. At this degree, tissue death is not diagnosed. Proper therapy allows you to recover in about a week.
Frostbite of the 2nd degree is characterized by stronger painful sensations. There is itching, burning sensation, tingling, numbness stronger than in the first stage. Blisters form on the skin during frostbite, filled with a clear liquid. The recovery period at this degree lasts about a couple of weeks, scars and scars do not appear.
The third stage of frostbite is considered more dangerous. In this case, a person feels more severe manifestations of pain and burning. The limbs are numb. On the damaged areas, the appearance of blisters with blood contents is noted. Frostbite of the 3rd degree is characterized by a decrease in the overall body temperature, the death of the skin and nails. The recovery period is at least three weeks, scars and scars may occur in the affected areas.
The fourth degree of frostbite is considered the most severe.. The person feels severe numbness and pain in the affected areas. There is a death of soft tissues, bones and joints. The skin becomes blue, almost black. Blisters with bloody contents are formed. There is practically no sensitivity, body temperature can rise to 39 degrees. Frostbite of the limbs at grade 4 in most cases ends with gangrene and amputation.

The appropriate treatment is selected depending on the degree of frostbite.

Causes of frostbite

There are several reasons for this phenomenon.

List:

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

Very often, frostbite of varying degrees occurs due to the fact that people dress inappropriately for the weather, in thin, easily blown and wet things. There are a number of diseases that increase the risk of frostbite of any degree.

Diseases:

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

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

First aid

When frostbite of any degree occurs, a person needs.

First aid:

The victim must be moved to a warm, dry, calm place.
It is necessary to remove all cold clothes and shoes from him.
The patient is wrapped in a blanket, inside it is allowed to put heating pads with warm water.
The victim should be given a warm drink to drink. The exceptions are coffee and alcohol. It is better to choose tea, milk, fruit drinks.
You can not warm the damage under hot water, blow on them with a hairdryer, apply to the battery.
After the operation, the patient is allowed to take a warm bath. The water temperature is raised gradually.
After this procedure, the skin is wiped dry, put on warm dry clothes, wrapped in a blanket.
In the absence of blisters, it allows bandages to be made, in other cases it is necessary to contact a medical institution.

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

How not to freeze and prevention

If the person is outside. That in order to avoid frostbite, it is worth doing any exercises. You cannot stand in one place. You can do bends, swing on your feet, perform jumps. If there is any warm room nearby, then it is worth going into it and warming up.

It is worth remembering that with intense physical exercise, sweat appears on the skin, which will also cool and lower body temperature.

Prevention

To avoid frostbite, you should follow simple preventive rules.

Rules:

You need to dress according to the weather. All clothing should be tucked into each other. It is better to use natural fabrics. Mittens warm better than gloves, the sole should be at least one centimeter thick. Clothing should be true to size, not small.
Do not leave the house in severe frosts, drive a car.
You can not smoke in the cold, drink alcohol and drinks with caffeine.
Exposed areas of the skin can be lubricated with a greasy cream or lard, but not with moisturizing creams.
At the first sign of frostbite, you need to take cover in a warm room.
You should not let go in the cold some children and the elderly.
When hiking, in the mountains, you need to have extra clothes, a supply of food and water with you. If necessary, immediately call the rescuers.
No need to wear metal jewelry and give children toys with metal parts, they cool quickly.

Animals often suffer in severe frosts. There is no need to remain indifferent, if possible, it is worth helping the animal, feeding it, giving it the opportunity to warm up.

The degrees of frostbite differ in symptoms and possible consequences. It is worth remembering that even mild frostbite can lead to malfunctions in the body.