Frostbite in children

Frostbite is tissue damage caused by exposure to low temperatures. Local damage can occur at temperatures both above and below the freezing point of water. The pathogenesis of frostbite is based on neurovascular reactions that lead to disruption of tissue metabolism, tissue anoxia, increased blood viscosity, increased thrombus formation, and cessation of blood circulation. Damage to vascular tissue is possible due to exposure of the extremities to cold for 1-2 hours.

Symptoms of frostbite in children

Frostbite can be superficial or deep. There are four degrees of frostbite severity:

• With first degree frostbite, paleness of the skin, loss of sensitivity, including the disappearance of the feeling of cold and discomfort in the damaged area are noted, and when it warms up, burning, pain, itching, redness and swelling of the soft tissues occur.
• In the second degree of frostbite, blisters of various sizes filled with yellowish liquid with a hemorrhagic tint form on the swollen skin of a pale-blue color, spreading to the fingertips. Pain and tactile sensitivity are absent for several hours.
• At the third degree of frostbite, total necrosis of the skin and underlying tissues develops. Blisters with hemorrhagic contents do not extend to the distal parts of the fingers. Capillary blood circulation is absent, general hypothermia develops. The tissues remain hard after warming.
• At the IV degree of frostbite, all tissue layers, including bones, are necrotized. The skin is purple, quickly covered with blisters filled with black liquid. The damaged area turns black and mummifies, dry gangrene develops, and in case of infection - wet gangrene. All types of sensitivity are absent. The limb's ability to move is preserved. Complications may develop - rhabdomyolysis with acute renal failure.

First aid for frostbite in children

Any rubbing of frostbitten areas of the body is unacceptable due to possible superficial damage and infection of the skin. It is necessary to wrap the injured child in a warm blanket, warm him with breath, body, and apply an aseptic and heat-insulating multilayer bandage to the affected limb. In a warm room, you can begin gradual, step-by-step warming in warm water, starting from 32-34 to 45 "C for 30-45 minutes. If the pain that occurs during warming quickly passes, the fingers take on a normal appearance, sensitivity is restored, then the limb is wiped dry and treated with a 33% ethanol solution. With grade II frostbite, blisters are not opened, treating the skin with ethanol (ethyl alcohol 96%). If the integrity of the blister wall is damaged, the exfoliated areas of the epidermis are removed, an aseptic bandage is applied.

If the fingers remain pale during warming and the pain increases, the victim must be urgently hospitalized. For pain relief, non-narcotic (50% sodium metamizole solution - analgin 10 mg per 1 kg of body weight) and narcotic analgesics [1-2% trimeperidine solution (promedol) or omnopon 0.1 ml per year of life] are administered intramuscularly. Pressure bandages are not applied, as this contributes to tissue destruction. The limbs are elevated, and the fingers are given a functionally advantageous position. Prednisolone 3-5 mg per 1 kg of body weight is administered intramuscularly or intravenously to prevent adrenal insufficiency.

In case of III-IV degree frostbite after anesthesia, remove blisters, make linear incisions on the skin if edema increases, apply wet-drying dressings with antiseptics. Necrectomy is performed if necrosis develops. Dextran (average molecular weight 30,000-40,000) is administered intravenously - rheopolyglucin or hydroxyethyl starch (refortan HEC) 10-20 ml per 1 kg of body weight per day in combination with pentophylline (trental) 0.6 mg per 1 kg of body weight per hour, or with xanthinol nicotinate (complamin) and with subcutaneous administration of sodium heparin 100-300 U per 1 kg of body weight per day in 4-6 doses. To prevent purulent complications, broad-spectrum antibiotics are used: inhibitor-protected penicillins, cephalosporins of the III-IV generation).

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