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frostbite(chilblains), injury to the tissue caused by exposure to cold, usually affecting the extremities of the body, such as the hands, feet, ears, or nose. Extreme cold causes the small blood vessels in the extremities to constrict. The blood circulates more slowly and stagnation results. Eventually the body fluids may freeze. The condition is aggravated by tight clothing, physical inactivity, and dampness. Severe frostbite that is not treated may result in gangrene; amputation of the affected part may be necessary. See first aidfirst aid,
immediate and temporary treatment of a victim of sudden illness or injury while awaiting the arrival of medical aid. Proper early measures may be instrumental in saving life and ensuring a better and more rapid recovery.
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(also called congelation), damage to body tissues as a result of cold. Frostbite usually affects the lower extremities; less frequently, it affects the upper extremities, the nose, and the ears. It can develop at such relatively mild freezing temperatures as –3° to – 5°C. It can even set in at nonfreezing temperatures; this usually occurs when the body’s resistance is decreased by such factors as starvation, intoxication, or loss of blood from a wound. Wind and increased humidity promote the development of frostbite.
The body reacts to cold with a reflex spasm of the peripheral blood vessels. The cold also acts directly on the tissues, lowering the temperature of the tissues and disrupting local metabolism. The changes that develop in the tissues depend on the intensity of the cold and on the duration of exposure. Four degrees of frostbite are distinguished. In cases of first-degree frostbite, the affected area first reddens and then becomes white and numb. Occasionally, these symptoms are accompanied by a tingling sensation. After being thawed out, the affected area of the skin reddens and swells; slight pain and a burning sensation are noticeable. Within two to three days all symptoms disappear completely.
Second-degree frostbite is characterized by more serious disorders of blood circulation, although any changes in the blood vessels are still reversible. The skin is markedly pale, becoming purple upon thawing, and edema extends beyond the frozen areas. Blisters filled with clear or bloody fluid appear.
Third-degree frostbite develops as a result of intense cold or prolonged exposure to cold. Blood circulation is severely disrupted, and the skin becomes blue-purple (occasionally, black) after thawing. The blisters are filled with a bloody dark brown fluid. The affected area is completely numb during the first days after freezing; subsequently, severe pain arises. In fourth-degree frostbite, necrosis extends through the soft tissues to the bones.
First aid for frostbite is directed toward the most rapid restoration of blood circulation in the affected area. First- or second-degree frostbite in the hands or feet is treated by heating the frozen part in warm water (18°–20°C), lightly massaging the area, and then slowly increasing the water temperature to 37°–38°C. Massage is not recommended when blisters are present. Rubbing with alcohol and applying a dry, sterile bandage while the patient is given hot tea and a small quantity of alcohol to drink are also helpful. To prevent infection in second-, third-, or fourth-degree frostbite, tetanus antitoxin, antibiotics, and other substances are administered. In cases of extensive third- and fourth-degree frostbite, the affected area is covered with sterile cloths and bound, but not tightly, after which the patient is transported to surgery.
Frostbite can be avoided by wearing warm, loose clothing and comfortable, waterproof footwear equipped with insoles. Measures should be taken to prevent foot perspiration, and hot food should be eaten at regular intervals. Protective greasy cream should be applied to the face, ears, and lips.
REFERENCEAr’ev, T. Ia. Ozhogi i otmorozheniia. Leningrad, 1971.
D. A. VELIKORETSKII