SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : FROSTBITE (CONGELATIO) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. Influence of low temperature (below 0 ° , about 0 ° , sometimes even above 0 ° ). Favor: physical factors (humidity, humidity service, the wind, the duration of low temperature), biological (age, anemia, exhaustion, lack of activity, General circulatory disorder, abnormalities of the nervous system), local circulatory disorder (tight shoes). The impact of freezing on the body depends on exogenous and endogenous factors, duration of cooling.
The pathogenesis. Form of frostbite:
1) the total freezing - profound changes in all tissues due to the gradual cessation of circulatory and coming anemia of the brain;
2) perniosis is a chronic inflammation of the skin, often as a result of repeated lung frostbite (chronic form frostbite);
3) trench-foot (gangrene from moisture) long - term exposure is not particularly low temperatures (usually above 0 ° ) under the action of moisture, the stillness, the obstruction of blood circulation and the accession of infection;
4) frostbite (often in the fingers, feet, hands, nose, ears, skin, cheeks).
There are four degrees of frostbite:
first degree - circulatory disorders (spasm, then paralysis of the capillaries) without the presence of necrosis, inflammatory process (congestive hyperemia, exudation with edema and infiltration of the skin).
The second degree of necrosis of the superficial layers of the skin to germ layer with the advent of serosanguineous exudate, the Stripping of the epidermis in the form of bubbles.
Third degree - the mortification of the soft tissues at different depths: the necrosis is due to circulatory disorders, gangrene develops gradually wet or dry. There are three stages of the process: a) necrosis and the presence of bubbles, b) resorption of necrotic and granulation development, scarring, and epithelialization.
Fourth degree - mortification in all tissues of the limb segment, including bone. Fast mummification or reactive edema and wet gangrene. In a further rejection of the tissue; stage are the same.
The severity of the process is dependent on the prevalence of necrosis and inflammatory-degenerative focal or systemic change (disseminated necrosis Girgolu). Between tissues peripheral areas, cooled to limits that are not compatible with life, and viable tissues of the Central areas there is a zone of demarcation, which marked degenerative and necrotic processes. Changes in the frostbite develops primarily in the blood vessels of the affected tissues, then there are changes in the blood (hemolysis); metabolic disorders.
Symptoms. The total freezing: begins with feelings of chills, lethargy, fatigue, somnolence, somnolence, breaking into euphoria and sleep; members grow numb, breathing and cardiac activity are weak, comes anemia of the brain and death from paralysis of the heart. At temperatures below 20 ° in the rectum to return the victim to life fails, perniosis: on fingers and toes, tip of nose, skin brushes, sometimes hip and thigh appears bright or slightly bluish redness, swelling, accompanied by a burning sensation and slight pain. Trench foot: I stage - painful hyperesthesia of the feet, especially the toes, and swelling, II stage - bubbles and hemorrhage, stage III - drying bubbles, the development of scabs, granulation and gangrene. Frostbite: first degree - blanching of the skin, loss of sensitivity, by warming the burning and pain, the skin becomes bluish-red, painful, swollen. Second degree - the same changes also appear on the skin blisters with serous-hemorrhagic and turbid contents. Third degree - originally the same changes as in the preceding degrees, but more common. Fabric insensitive, blue-purple color gradually spreads herself with demarcation. Fourth degree - limb cyanotic, pale, insensitive (no pain, heat and deep muscle sensitivity), cool to the touch, covered with hemorrhagic blisters. The demarcation scheduled for 9 - 17-th day. Appears reactive edema develops wet gangrene (accession infection) or mummification.
For. There are directiony period (pallor, lowering the temperature, discomfort to the development of edema and reactive period. Frostbite first and second degree - the process is reversible, ending with full recovery of fabrics with a slight blueness and their sensitivity to cold. Frostbite third and fourth degree - the process is only partially reversible.
Tetanus, gas gangrene, cellulitis, septic arthritis, erysipelas, septicaemia, the development of venous ulcers.
The degree frostbite is revealed gradually, as well as the prevalence of morbidity.
Prevention of oznoblenie and frostbite in the production, life and in a field environment consists of hardening, i.e. to accustom to walking without warm clothes at moderate cold, wiping cold water, etc. are important measures for protecting clothes from moisture, drying it, especially socks, stockings and shoes, and a well-fitting leg and especially free shoes impermeable to water.
The treatment of common freezing: warm, artificial respiration, the introduction under the skin camphor, caffeine, ephedrine, when signs of life - a warm drink (tea, coffee, alcohol), wraps. Oznoblenie: dry heat, warm baths, protection from re-cooling,fat dressings (goose and pork fat). Trench foot: restorative treatment, removing shoes, removing bubbles, headbands.
Treatment for frostbite in coreactive period: the warming of the patient, restoring blood flow in warm baths with washing soap and a gentle massage. When restoring circulation (the teaching of the skin, warming) the massage is stopped, the skin is treated with alcohol, aseptic insulated dressing. Ointment dressings and greased for frostbite of all degrees, except the first, is undesirable. Massage is best done in sterile gloves using vodka and alcohol, not vaseline.
Treatment of frostbite in the reactive period - tetanus serum (1 500 AE). First degree: protection from the cold, rubbing alcohol, ultraviolet irradiation, topical dressings. Other degrees: after skin treatment and bubbles alcohol remove them completely, fibrin clots gently dried, impose aseptic warming bandage. In the stage of ossification when frostbite third and fourth degree cut dead tissue multiple slits (necrotomy) for drying fabrics and create a scab or excised dead tissue (necrectomy). Systematic physiotherapy for drying fabrics (ultraviolet irradiation, sollux), when dry tissue and scab formation - public methods of treatment. In the stage of development of granulation and epithelization - ointment dressing. When the fourth degree frostbite when the formation of a dry scab or clear demarcation - amputation.