Frostbite
| Classification according to ICD-10 | |
|---|---|
| T33.- | Superficial frostbite |
| T34.- | Frostbite with tissue necrosis |
| T35.- | Frostbite involving multiple parts of the body and unspecified frostbite |
| ICD-10 online (WHO version 2019) | |
Under Frostbite ( Latin congelatio ) refers to damage to the tissue of living organisms by exposure to cold . It occurs particularly often on parts of the body that are exposed to the cold (auricle, nose), inadequately cold-protected limbs (fingers, toes) and, under certain circumstances, with general hypothermia . On the other hand, localized direct contact with extremely cold substances, such as dry ice or liquid nitrogen , in the case of inadequately insulating transport containers or technical accidents, as local cold damage, leads to symptoms that resemble a burn and are therefore referred to as cold burn .
Division into degrees of severity
The processes in frostbite wounds are similar to burn wounds , so the classification is almost the same. Frostbite is divided into three to four degrees depending on the severity:
- 1st degree frostbite (Congelatio erythematosa): numb and pale skin area, swelling of the skin area , pain
- 2nd degree frostbite (Congelatio bullosa): reddening or bluish-red skin color, swelling and blistering
- 3rd degree frostbite (congelatio gangrenosa): demarcation (demarcation of destroyed and healthy tissue) or almost painless death of the tissue
- 4th degree frostbite: icing and total tissue destruction
Symptoms
"Feeling cold" in hands and feet, feeling that shoes are too small, and blue-red spots are symptoms of frostbite. Frozen body parts are initially white-gray, soft and painful (like pinpricks), later they are numb and hard to the point of brittleness. The boundary between frozen and healthy body tissue is not clearly recognizable (see above demarcation).
In 2007 it was recognized for the first time why frostbite of the acra , i.e. the terminal parts of the body such as the tip of the nose, ears or fingers, can cause pain at all. Normally, action potentials generated by pain stimuli are triggered in nerve fibers by opening ion channels for sodium . However, below 10 ° C they stop working. Now a differently structured type of sodium channels has been discovered that can open below 10 ° C. This path seems to be inactive at normal temperature. Apparently it is an emergency system that reports to the organism that parts of the body are threatened with freezing.
Causes and occurrence
The main cause of frostbite, especially third degree, is improper clothing at long-term low temperatures below freezing point . During wartime, freezing is one of the leading causes of death in cold regions. In Germany today there is hardly any death from freezing to death.
Acute alcohol poisoning is conducive to frostbite . Alcohol increases and accelerates hypothermia because the blood vessels in the skin expand and the body dissipates more heat to the environment. The drunk feels subjectively warm. The affected person who underestimates and overestimates himself / herself due to the intoxication (duration, cold) is mostly no longer able to ask for help due to tiredness and drowsiness. The unconditional recommendation is derived from this experience to refrain from any alcohol consumption during organized winter aid campaigns and to avoid going it alone due to a lack of mutual help.
Mountaineers are a risk group for frostbite because they often and unexpectedly get into emergency situations without being able to take immediate countermeasures.
The wind chill effect poses its own danger . At higher wind speeds, even less low air temperatures or shorter exposure times are sufficient to lead to frostbite, as the heat flow from the body tissue to the outside increases with the wind speed. Bare skin areas such as the face are particularly affected. Wind-permeable items of clothing, such as a loosely knitted woolen hat or openings (sleeve openings, open pockets, wide jackets) allow air to flow close to the body. Windproof clothing should therefore fit tightly to the body with a rubber hem, especially at the edge, in order to keep the effect of the wind off. The wind chill effect is therefore of great importance for winter sports enthusiasts , snowmobilers (travel speed) and mountaineers ( mountain wind ). If it is not taken into account from the start and is paired with the numbness and thus insensitivity to pain of the affected areas of the skin, severe frostbite can easily occur.
therapy
The assessment of frostbite in the context of an emergency is difficult and usually only clearly possible after a few days, so in case of doubt, frostbite should always be assumed. Inpatient treatment is required from 2nd degree frostbite, which does not heal until 6 weeks at the earliest. The following measures should be taken as a first aider:
- Emergency services via the number 112 (in Europe) or other local emergency number alert
- Maintain the patient's body temperature , ideally raise it slowly, if necessary in a water bath. A rescue blanket or warm drinks support this process
- Dress the wounds with a sterile dressing, bandaging fingers and toes individually and not putting on a mittens
- Protect the damaged areas of the body from further exposure to the cold
- Further general measures in the context of first aid
- Do not thaw the affected areas quickly with hot water
- Do not apply mechanical loads, such as pressing or rubbing, to the injured areas
- Open tight clothing
In the case of rapid thawing, the oxygen demand of the tissue increases very quickly and the not yet fully functional vessels cannot yet supply the required oxygen, but the damage caused by the insufficient oxygen supply is less than the renewed toxic damage caused by slow thawing.
See also
Web links
Individual evidence
- ↑ Klaus-Jürgen Bauknecht, Joachim Boese-Landgraf: Wounds, wound healing, wound healing disorders, wound treatment, tetanus prophylaxis. In: Rudolf Häring, Hans Zilch (Hrsg.): Textbook surgery with revision course (Berlin 1986). 2nd, revised edition. Walter de Gruyter, Berlin / New York 1988, ISBN 3-11-011280-9 , pp. 7-17, here: pp. 8 f.
- ↑ Bild der Wissenschaft , 11/2007, p. 40. Original source not specified exactly (“Scientists from Erlangen”).
- ↑ Diseases of the circulatory system are the leading cause of death in 2006 . ( Memento of the original from February 6, 2012 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. Federal Statistical Office Germany; Retrieved December 26, 2007.
- ↑ Death from cold when intoxicated . In: Die Zeit , No. 6/2008.
- ↑ Medical aid training . 7th edition, March 2016 version. Austrian Red Cross General Secretariat, ISBN 978-3-902332-18-9
- ^ Fritsch: Dermatology & Venereology for Studies . Springer Verlag, Heidelberg 2009.
