13. Frostbite


We will discuss the impact of cold on the human body, go through the general hypothermia and local frostbite, & talk about first aid in these conditions. Each of us faces the effects of cold, which can manifest itself in the form of general hyperthermia or the local effects in frostbite. General hyperthermia is a condition in which the temperature of internal organs drop below 34 degrees Celsius. The general hyperthermia is facilitated by high humidity, damp clothes, strong wind, physical fatigue, mental trauma, past diseases, and different injuries.

General hypothermia has three degrees. Mild degree develops when the body temperature drops to 34-33 degrees. It is characterized by general fatigue, weakness, sleepiness. The movements are stiff, speech becomes slower, a person speaks syllables and the words separately. Victims feel thirst, and chills, their skin is a pale, marble color, goose skin appears.

Medium degree develops when the body temperature drops to 30-29 degrees Celsius. In this case, the victim’s consciousness is depressed. They look as meaningless, movements in the joints are sharply bound, breathing is slowed & superficial, pulse is weak & blood pressure is reduced. You can notice the pale cyanotic skin, which feels cold to the touch.

Severe hypothermia develops when the body temperature drops below 29 degrees. Consciousness is absent, limp, & cramps may be observed. Their rigidity makes it hard to straighten. The skin is pale, cyanotic, cold to the touch. Breathing is minimal, superficial intermittent. Pulse is irregular, blood pressure is reduced or is not determined. A severe decrease in body temperature. 25-22 degrees leads to the death in the victim.

Frostbite is a local damage to body tissues caused by cold. Frostbite most often occurs in cold wintertime at ambient temperature below minus 20 degrees Celsius. High humidity and strong winds also increase chances for frostbite even in temperatures around zero. Frostbite typically affects ears, nose, cheeks, insufficiently protected limbs, especially fingers and toes. Except for cold, other factors may contribute to the development of frostbite. They include, wet clothes and shoes, physical fatigue, hunger, prolonged immobile and uncomfortable position. Weakening of the body after the disease, legs sweating, chronic diseases of the lower limbs and cardiovascular system. Severe mechanical damage with a blood loss, smoking. These factors lead to long-term vascular spasms with microcirculation disorders, and further thrombosis.

There are two periods of frostbite flow. The latent pre-reactive period lasts the first 72 hours during which the depth of the damage cannot be determined. You can suspect frostbite due to local skin whitening. The reactive period comes to a few hours after warming. Typical signs are pain, swelling, hyperthermia, skin cyanosis, and bubbles.

There are four degrees of frostbite, so the treatment methods depends on each of them:

The first degree usually occurs when there is a short exposure to cold, and it is characterized by affected area, pallor and tingling. The frostbite affects the epidermis. The second degree occurs under prolonged exposure to cold. There is blushing, coldness and a slight loss of sensitivity in the initial period, like in all other frostbite degrees. Therefore, the most characteristic feature is forming bubbles filled with transparent content in the first days after cold exposure. The complete skin restoration takes one, two weeks. In third degree frostbite called exporter and temperature reduction in the tissue increases. Bubbles formed in the initial period are filled with blood. Damage in the deep tissues appears in 3-5 days after exposure developing gangrene. Although the tissues are intact, the victim suffers from excruciating pain.

The most severe is fourth-degree frostbite, which appears under prolonged exposure to cold. The temperature decrease in the tissues is the greatest. Mortification affects all layers of soft tissues, even the bones and joints. The damaged area is sharply cyanotic, sometimes marble color. Swelling develops immediately after heating and the rapidly increases. The skin temperature is much lower than in the surrounding tissues. Bubbles form in fewer frostbite areas where there is third, second degree. The absence of bubbles and the significantly developed swelling and loss of sensitivity indicates the terminal frostbite degree.

During the first aid for frostbite, it is necessary to eliminate the negative factor of cold. Move the victim to a warm room, change into dry, warm clothes, cover with a blanket, call an ambulance if needed. Start CPR if a person is unconscious and not breathing. Warming is the basis of the first aid. When warming the victim, remember the following rules: Warm the victim gradually. If the limbs are frostbitten, the most effective and safe is to immerse the victim in warm water. First, the water should be room temperature, after 20, 30 minutes, increase it by 5 degrees, and gradually for one, two hours bring it to body temperature 36 degrees. Then dry the damaged areas and apply a thermal insulated bandage. To put the insulating dressing first use a tissue, then a gauze layer, a thick layer of absorbent cotton, again a layer of gauze and on top of that rubberized fabric, and then fix it. Woolen blankets, fur things may also help with thermal insulation.

As we're told, the general warmth of the victim is essential. If he's conscious, give him a hot drink. At first-degree frostbite and limited damaged skin, the rescuer can warm the nose, ears, and fingers himself. Remember, it is strictly forbidden in frostbite to give the victim coffee or alcohol, which can aggravate the situation. Second, to rub the frostbitten surface with snow or stiff cloth. There is a high probability of injury and subsequent infection of the damaged skin. Third, to expose the frostbitten area to intense heat using a hot bath or water heater, etc. Fourth, rub the damaged skin with oil, fat, alcohol as this can complicate the disease. Fifth, to open the bubbles and remove necrotized tissue (the dead tissue).

Another common type is iron frostbite. The so-called iron frostbite is a cold injury resulting from warm skin contacting with an icy metal object. For example, it is not a fantasy when the children's tongues stick to a street fence or other metal structure. One careless movement, and the child’s tongue is literally stuck to the swing. Unfortunately, many parents being afraid, tear the tongue from the metal immediately. However, this will cause negative consequences. You can damage the child's mouth and tongue. Moreover, never heat the metal with a lighter. Such brutal methods can accidentally burn a child's face. If your child stuck his tongue to the metal, calm him down. Switch his attention and ask him to breath. Warm air will help release the tongue. However, do it actively so that the moisture does not freeze the tongue with even greater force. If the child is small, you can help yourself with breathing. It is also desirable to heat the metal with warm water to avoid serious injury. After that, the heated metal usually releases its victim.

There is there still possibility of tongue damage, mostly when it is quickly detached from the metal. In this case, wash the affected area with warm water, then treat it with antiseptic. See the doctor if you find a severely swollen and a deep tongue wound.

Let's summarize. Today you have learned the general hyperthermia, local frostbite, and factors affecting their development. You have particularly learned first aid rendering for these conditions.

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