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PERIODS AND DEGREE OF FROZEN

In the clinical course of frostbite, two periods are clearly distinguished: before warming up - pre-reactive (or latent) and after warming - reactive. Direct cell damage occurs during the reactive period. Consequently, only after an increase in the interstitial temperature and the completion of pathophysiological changes can one judge the degree of frostbite. The process of tissue death sometimes takes up to 5-7 days, after which it is possible to finally judge the frostbite depth.

The clinical picture of the pre-reactive period is quite poor in symptomatology. The earliest symptoms of developing frostbite are numbness, pinsy crawling, then pain and a feeling of stiffness in the affected limb. On examination, paleness of the skin, sometimes cyanosis, is noted; cold extremity to the touch; tactile and pain sensitivity is reduced; swelling, as a rule, no; sometimes there is no pulsation of the arteries on the feet.

The first sign of a reactive period is the appearance of tissue edema, followed by pain and changes in the skin corresponding to the depth of the lesion.

The classification of frostbite adopted in our country is based on the four-degree division proposed in 1940 by T.Ya.Ariev. It is based on the division of lesions into superficial (first and second degrees) and deep (third and fourth degrees).

FROZEN THE FIRST DEGREE develops with a brief exposure to cold. Pallor of the skin during warming is replaced by hyperemia. Tactile and pain sensitivity, as with burns, is preserved and even increased. Movement in the fingers of the hand and foot active. There is moderate edema within the boundaries of hyperemia. Sometimes there is cyanosis or marble coloration of the skin, which are more often with deeper lesions.

FROZEN SECOND DEGREE. The formation of bubbles filled with a clear liquid is most characteristic, as is the case with burns. Before the same skin is hyperemic, with a bluish tinge. Edema, as well as frostbite of the first degree, is insignificant. Bubbles usually form on the first day after injury; less likely to observe the appearance of bubbles during the second day. If the bubbles appear at a later date, and their contents have a dark color, this, as a rule, indicates a deeper lesion.
The healing of such frostbite occurs without the development of granulations and scar formation. Nails fall off, but then grow back.

THIRD DEATH THROTTLE Early blistering bubbles are filled with bloody contents, the bottom of bubbles is of a dark cherry or bluish color. Before their formation, the skin has a purple-bluish color and is cold to the touch, unlike damage of 1-2 degrees. Damaged areas are not sensitive to chemical (ethyl alcohol) and pain stimuli; tactile sensitivity can be maintained, but significantly reduced. With such a lesion, necrosis captures the entire dermis to the subcutaneous fat, as a result of which their healing occurs with the formation of coarse scars. Nails, as a rule, are not restored. The absence of bubbles in the presence of sharp edema and loss of all types of sensitivity within 48 hours or more is an unfavorable prognostic sign and indicates a fourth degree of frostbite.

FROZEN FOURTH DEGREE. The boundary of the lesion is at the level of bones and joints. In the first hours of the reactive period, the skin of the damaged area is sharply cyanotic, sometimes with a marble tinge. The temperature of the skin is significantly reduced. The development of edema begins 1-2 hours after the increase in interstitial temperature. Edema increases within 1-2 days and increases towards the proximal limb. Subsequently, mummification or wet gangrene of the fingers or limbs develops.

In the affected area with deep frostbite, four zones are distinguished from the periphery to the center:

1) total necrosis - all the tissues of this zone by the time of normalization of interstitial temperature are already necrotic;

2) irreversible degenerative processes - the tissues are in a necrobiotic state, and as a result of severe vascular disorders and toxemia, they are necrotic in the coming days after injury;

3) reversible degenerative processes - with timely and correct treatment, necrosis of the tissues of this zone can be prevented;

4) ascending pathological processes - in this zone, osteoporosis, neuritis, and endarteritis develop.
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PERIODS AND DEGREE OF FROZEN

  1. RENDERING FIRST AID AND TREATMENT OF FROZEN IN THE DOREACTIVE PERIOD
    On the issue of tactics of first aid and treatment of frostbite in the pre-reactive period, there are two points of view. The first, older, theory of "forced warming up" is based on the fact that the sooner it is possible to stop the effect of the damaging factor (cold) on the fabric, the better the results of treatment will be. The second, more modern, concept of "warming from the inside" comes from
  2. The severity of traumatic disorders (concussion, bruise, compression). Symptoms of the acute period. First aid for TBI.
    TBI - mechanical damage to the skull or intracranial formations in violation of the functional unity and morphological integrity of the brain. Open CCT - with the defeat of the bones of the skull, aponeuroses (connection of tissues, on the cat. Hair grows) and the skin of the head. Closed TBI - no damage to the bones of the skull and its soft tissues. Signs of TBI:? Loss of consciousness
  3. Advanced atrioventricular block of the second degree and blockade of the third degree of type A1
    1 According to the classification of the authors, type A denotes a variant of AV-blockade with the normal form of the QRS complex, and type B - a variant of AV-blockade with an extended QRS complex. - Note. translator. The term “advanced AV block II degree” is used in cases when more than two consecutive supraventricular impulses are blocked [9]. Although to distinguish this variant of the blockade from the AV blockade of the third degree
  4. Advanced atrioventricular block of the second degree and blockade of the third degree of type B
    Advanced grade II AV-blockade and Grade III AV-blockade can also be determined in the presence of wide QRS complexes [33]. The experimental record shown in fig. 1.15, was obtained a few minutes after the recording shown in fig. 1.12. In fig. 1.15 registration of transmembrane potentials in the atrial fiber adjacent to the AV node (II), as well as in the NH region of the AV node (NH)
  5. Auricle frostbite
    Cause Prolonged exposure to low temperature on the ear. Symptoms Symptoms of mild frostbite of the auricle are redness, the formation of vascular spots. The skin is very sensitive and painfully reacts to touch. The next degree of frostbite of the auricle is average. It is characterized by swelling of the auricle and the formation of blisters. Symptoms III
  6. Frostbite
    Clinical characteristics of frostbite Frostbite - tissue damage that occurs when exposed to negative or low positive temperatures, at which there is a perversion of neurovascular reactions, circulatory disorders, impaired tissue metabolism, the development of edema, secondary tissue necrosis. Degree of frostbite I degree - pallor or cyanosis of the skin, marbling of the vascular
  7. Frostbite
    Frostbite - the body's response to local exposure to low ambient temperatures. Predisposing factors. Meteorological conditions - low air temperature, - high humidity, - wind. Mechanical impairment of blood circulation - tight shoes, clothing. Decrease in local tissue resistance - vascular diseases,
  8. Frostbite
    Frostbite - tissue damage when exposed to low temperatures, mainly due to atmospheric air. The basis of pathogenesis is a long vascular spasm with subsequent thrombosis, which leads to trophic and necrotic disorders in the tissues. Contributing adverse physical factors: wind, humid air, duration of exposure to cold, poor body protection by clothing,
  9. Frostbite
    These are tissue damage as a result of exposure to low temperatures. With the weakening of the body (illness, injury, prolonged exposure to wind and cold) frostbite can occur even at a temperature of +3 ... + 7 ° C. Distal extremities, ears, nose are more susceptible to frostbite. Degree of frostbite I degree - skin lesion in the form of various circulatory disorders. The skin is pale,
  10. Frostbite
    the nose is quite common, there are four degrees of frostbite: • When after thawing there is swelling and blueness of the skin; • Bubble formation; • Necrosis of the skin and subcutaneous fat; • Necrosis of the skin and cartilage. First aid and treatment: it is necessary to restore blood circulation as soon as possible. To do this, wipe the skin of the nose with alcohol, vodka,
  11. Frostbite
    Frostbite is damage caused by local hypothermia of body tissues. Contribute to the development of frostbite: humid air and wind; alcohol intoxication, which removes the sensitivity of the skin to cold, which increases heat loss due to the expansion of skin vessels; violation of local blood circulation with tight clothes and shoes. There are four degrees of frostbite: I - skin is pale,
  12. Frostbite of auricles
    Frostbite of the ears develops under the influence of low temperature. After reflex spasm of peripheral skin vessels, their paralytic expansion occurs, congestive hyperemia occurs with the release of liquid blood into the affected tissues, leading to edema, blistering and necrosis. There are 4 degrees of frostbite. I degree - temporary reversible disorder occurs
  13. Frostbite
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  14. The concept of frostbite, their classification and first aid
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