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PERIODS AND DEGREES OF FREEZING

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

The clinical picture of the pre-reactive period is rather poor in symptoms. The earliest symptoms of developing frostbite are numbness, paresthesia such as "crawling creeps," then pain and a feeling of stiffness in the affected limb appear. On examination, pallor of the skin, sometimes cyanosis, is noted; limb to the touch cold; tactile and pain sensitivity are reduced; edema, as a rule, is not; sometimes there is no pulsation of 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 frostbites accepted in our country is based on a four-degree division, proposed in 1940 by T. Ya. Aryev. It is based on the division of lesions into superficial (first and second degree) and deep (third and fourth degree).

FROZEN FIRST DEGREE develops with a short exposure to cold. Pallor of the skin during warming is replaced by hyperemia. Tactile and pain sensitivity, as with burns, saved and even increased. The movements in the fingers and feet are active. There is moderate edema within the boundaries of hyperemia. Sometimes cyanosis or marbled color of the skin is observed, which is more often with deeper lesions.

FREEZING SECOND DEGREE. The most characteristic is the formation of blisters filled with a clear liquid, as with burns. Prior to this, the skin is hyperemic, with a bluish tint. Edema, as well as during frostbite of the first degree, is insignificant. Bubbles usually form on the first day after an injury; less often, the appearance of bubbles during the second day can be observed. If the bubbles arose at a later date, and their contents have a dark color, then this usually indicates a deeper lesion.
The healing of such frostbite occurs without the development of granulation and scarring. Nails fall off, but then grow back.

FROZENING THE THIRD DEGREE The bubbles that appear early are filled with bloody contents, the bottom of the bubbles is dark cherry or bluish in color. Before their formation, the skin has a crimson-cyanotic color and is cold to the touch, in contrast to damage of 1-2 degrees. Damaged areas are not sensitive to chemical (ethyl alcohol) and pain irritants; tactile sensitivity can be maintained, but significantly reduced. With such a lesion, necrosis captures the entire dermis to subcutaneous fat, as a result of which their healing occurs with the formation of rough scars. Nails, as a rule, are not restored. The absence of bubbles in the presence of a 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.

Frostbite FOURTH DEGREE. The border of the lesion passes 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 tint. The temperature of the skin is significantly reduced. The development of edema begins 1-2 hours after an increase in interstitial temperature. Swelling increases within 1-2 days and increases towards the proximal extremities. 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 tissues of this zone by the time normalization of interstitial temperature is already necrotic;

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

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, endarteritis subsequently develop.
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PERIODS AND DEGREES OF FREEZING

  1. FIRST AID MEASURES AND TREATMENT OF FREEZERS IN THE PREACTIVE 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" is based on the fact that the sooner it is possible to stop the action of a damaging factor (cold) on the tissue, the better the treatment results. The second, more modern, concept of "warming from the inside" comes from
  2. The severity of traumatic disorders (concussion, bruising, compression). Symptoms of an acute period. First aid for head injury.
    TBI - mechanical damage to the skull or intracranial formations with impaired functional unity and morphological integrity of the brain. Open TBI - with damage to the bones of the skull, aponeurosis (connective tissue, hair grows on the cat) and scalp. Closed head injury - 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 block of the third degree of type A1
    1 According to the authors' classification, type A denotes a variant of AV blockade with a normal form of the QRS complex, and type B indicates a variant of AV blockade with an expanded QRS complex. - Note. translator. The term “advanced grade II AV block” is used when more than two consecutive supraventricular impulses are blocked [9]. Although to distinguish this option from the blockade of the AV blockade III degree
  4. Advanced atrioventricular block of the second degree and block of the third degree of type B
    Advanced AV block II degree and AV block 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 registration of transmembrane potentials in the atrial fiber adjacent to the AV node (II), as well as in the region of the NH AV node (NH)
  5. Auricle 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 painfully sensitive to touch. The next degree of frostbite of the auricle is medium. It is characterized by swelling of the auricle and the formation of blisters. Symptoms III
  6. Frostbite
    Clinical characteristics of frostbite Frostbite is tissue damage that occurs when exposed to negative or low positive temperatures, in which there is a distortion of neurovascular reactions, circulatory disorders, tissue metabolism, development of edema, secondary tissue necrosis. Degree of frostbite I degree - pallor or blueness of the skin, marbling of the vascular
  7. Frostbite
    Frostbite is the body's response to local exposure to low ambient temperatures. Predisposing factors Meteorological conditions - low air temperature, - high humidity, - wind. Mechanical obstruction of blood circulation - tight shoes, clothes. Decreased local tissue resistance - vascular disease,
  8. Frostbite
    Frostbite - tissue damage when exposed to low temperatures, mainly when exposed to atmospheric air. The pathogenesis is based on a prolonged vascular spasm followed by thrombosis, which leads to trophic and necrotic disorders in the tissues. Contributing unfavorable physical factors: wind, humid air, duration of exposure to cold, poor body protection with clothing,
  9. Frostbite
    This is tissue damage resulting from 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 ° С. Distal extremities, ears, nose are more prone to frostbite. Degree of frostbite I degree - skin lesion in the form of various circulatory disorders. The skin is pale
  10. Frostbite
    noses are quite common, there are four degrees of frostbite: • When swelling and blueness of the skin is noted after thawing; • blistering; • 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, for this, careful rubbing of the skin of the nose with alcohol, vodka,
  11. Frostbite
    Frostbite is damage caused by local overcooling of body tissues. The development of frostbite is promoted by: moist air and wind; alcohol intoxication, which removes the sensitivity of the skin to cold, 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 - pale skin,
  12. Frostbite
    Frostbite of the auricles develops under the influence of low temperature. After a reflex spasm of the peripheral skin vessels, their paralytic expansion occurs, congestive 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 - a temporary reversible disorder occurs
  13. Frostbite
    Frostbite is a condition of the body that occurs in response to low temperatures and is characterized by tissue damage of varying depths. Frostbite is promoted by adverse environmental factors (wind, low temperatures, insufficient body protection by clothes, etc.), as well as the state of the child's body (weakness and poor resistance as a result of illness, insufficient
  14. The concept of frostbite, their classification and first aid
    Frostbite - damage to body tissues due to exposure to low temperatures. Frostbite is promoted by humidity, increased wind, exhaustion, vitamin deficiency, tissue compression, anemia. In the development of frostbite, pre-reactive and reactive periods are distinguished. In the pre-reactive period (under the influence of cold), microcirculation is disturbed, accompanied by vasospasm. Sharp
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