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

The clinical picture of the pre-active period is rather poor in symptoms. The earliest symptoms of developing frostbite are numbness, paresthesia such as "crawling crawling," then pain and stiffness appear in the affected limb. On examination, paleness of the skin is noted, sometimes cyanosis; the extremity to the touch is cold; tactile and pain sensitivity reduced; edema, as a rule, no; sometimes there is no pulsation of the arteries on the feet.

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

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

FROSTENING OF THE FIRST DEGREE develops with a short exposure to cold. Pale skin on warming is replaced by hyperemia. Tactile and pain sensitivity, as well as with burns, are preserved and even raised. Movements in the fingers and feet are active. There is moderate edema in the borders of hyperemia. Sometimes there is a cyanotic or marbling color of the skin, which is more common with deeper lesions.

FROST SECOND DEGREES. The most characteristic is the formation of bubbles filled with a clear liquid, as in burns. Up to the same skin integuments are hyperemic, with a cyanotic shade. Edema, as well as with frostbite of the first degree, is insignificant. Bubbles usually form in the first day after injury; It is less common to observe the appearance of bubbles during the second day. If the bubbles arose at a later date, and their contents have a dark color, then, as a rule, it indicates a deeper defeat.
Healing of such frostbite occurs without the development of granulations and the formation of scars. Nails fall off, but then grow back.

FROST DEFECTS THIRD DEGREES Early bleeding bubbles are filled with bloody contents, the bottom of blisters of dark cherry or bluish color. Before their formation, the skin is crimson-cyanotic in color and cold to the touch, in contrast to the 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 this defeat, necrosis seizes the entire dermis to the subcutaneous fat, so that their healing takes place with the formation of coarse scars. Nails, as a rule, are not restored. The absence of blisters in the presence of sharp edema and loss of all sensitivities within 48 hours or more is an unfavorable prognostic sign and indicates a fourth degree of frostbite.

FROSTENING OF THE FOURTH DEGREES. The border of the lesion is at the level of bones and joints. In the first hours of the reactive period, the skin of the injured area is sharply cyanotic, sometimes with a marble shade. The temperature of the skin is significantly reduced. The development of edema begins 1-2 hours after the increase in the interstitial temperature. Edema builds up within 1-2 days and increases toward proximal limb sections. In the future, mummification or moist 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 tissues of this zone are necrotic at the time of normalization of the interstitial temperature;

2) irreversible degenerative processes - tissues are in a necrobiotic state, and as a result of pronounced vascular disorders and toxemia necrotic within the next few days after trauma;

3) reversible degenerative processes - with timely proper treatment, tissue necrosis of this zone can be prevented;

4) ascending pathological processes - in this zone, osteoporosis, neuritis, and endarteritis develop in the future.
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    On the question of the tactics of providing first aid and treating frostbites in the pre-active period, there are two points of view. The first, the older, theory of "forced warming" is based on the fact that the earlier it will be possible to stop the effect of the damaging factor (cold) on the tissue, the better the treatment results will be. The second, more modern, concept of "warming from within" comes from
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  3. Advanced atrioventricular blockade of the second degree and blockade of the third degree of type A1
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  4. Advanced atrioventricular blockade of the second degree and blockade of the third degree of type B
    Advanced AV blockade II degree and AV blockade III degree 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 the recording of transmembrane potentials in the atrial fiber adjacent to the AV node (II), and also in the NH region of the AV node (NH)
  5. Ear conch of frostbite
    Cause Prolonged exposure to low temperature in the ear. Symptoms Symptoms of mild frostbite of the auricle are redness, the formation of vascular spots. The skin is very sensitive and painful to touch. The next degree of frostbite of the auricle is the middle one. It is characterized by swelling of the auricle and the formation of blisters. Symptoms III
  6. Frostbites
    Clinical characteristics of frostbite. Frostbite - damage to tissues caused by exposure to negative or low positive temperatures, in which there is a perversion of neurovascular reactions, impaired blood circulation, impaired tissue metabolism, edema development, secondary necrosis of tissues. Degree frostbite I degree - pallor or cyanosis of the skin, marbling of the vascular
  7. Frostbite
    Frostbite is the response of the body to local effects of low ambient temperatures. Predisposing factors Meteorological conditions - low air temperature, - high humidity, - wind. Mechanical obstruction 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. At the heart of the pathogenesis is a prolonged vascular spasm with subsequent thrombosis, which leads to trophic and necrotic disorders in the tissues. Contributing to adverse physical factors: wind, moist air, the duration of exposure to cold, poor body protection clothing,
  9. Frostbites
    This is tissue damage caused by exposure to low temperatures. With the weakening of the body (illness, trauma, prolonged exposure to wind and cold) frostbite can occur even at a temperature of +3 ... + 7 ° С. The distal parts of the extremities, ears and nose are more susceptible to frostbite. Degree frostbite I degree - skin lesions in the form of various circulatory disorders. The skin is pale,
  10. Frostbites
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  11. Frostbites
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  12. Frostbite of the auricles
    Frostbite of the auricles develops under the influence of low temperature. After the reflex spasm of the peripheral cutaneous vessels, their paralytic expansion occurs, stagnant hyperemia occurs with the release of the liquid part of the blood into the affected tissues, which leads to edema, the appearance of blisters and necrosis. There are 4 degrees of frostbite. I degree - there comes a temporary reversible disorder
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