Frostbites in children

Frostbite - damage to tissues when exposed to low temperatures. Local damage can occur at a temperature both above and below the freezing point of water. At the heart of the pathogenesis of frostbite are neurovascular reactions, leading to a disruption of tissue metabolism, tissue anoxia, increased blood viscosity, increased thrombosis and cessation of circulation. Damage to the tissues of the vascular bed is possible due to the effects of cold on the limbs for 1-2 hours.

Symptoms of frostbite in children

Frostbites can be superficial and deep. There are four degrees of severity of frostbite:

• At the first degree of frostbite, blanching of the skin, loss of sensation, including the disappearance of a feeling of cold and discomfort in the damaged area, and when it warms up, burning, pain, itching, redness and swelling of soft tissues occur.
• At the second degree of frostbite on the edematous skin of pale cyanotic color, bubbles of various sizes are formed, filled with a yellowish liquid with a hemorrhagic tinge extending to the fingertips. Pain and tactile sensitivity are absent for several hours.
• At the III degree of frostbite, total necrosis of the skin and underlying tissues develops. Bubbles with hemorrhagic contents do not spread to the distal parts of the fingers. There is no capillary circulation, and general hypothermia develops. Fabrics after heating remain solid.
• At the fourth degree of frostbite, all layers of tissues, including bones, become necrotic. The skin is crimson, quickly covered with bubbles, filled with a liquid of black color. The damaged area turns black and mummified, dry develops, and in case of infection, wet gangrene. There are no all kinds of sensitivity. The ability of the limb to move remains. Perhaps the development of complications - rhabdomyolysis with acute renal failure.

Emergency help with frostbite in children

Any rubbing of frost-bitten 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 it with breathing, body, and apply an aseptic and thermo-insulating multilayer bandage to the affected limb. In a warm room, you can start a gradual, step-by-step warming in warm water, ranging from 32-34 to 45 "C for 30-45 min. If the pain that occurs when warming, quickly passes, the fingers take the usual form, the sensitivity is restored, then the limb is wiped dry and treated with a 33% solution of ethanol.With the second degree of frostbite, bubbles are not opened by treating the skin with ethanol (ethyl alcohol 9%). If the integrity of the wall of the bladder is broken, the exfoliated parts of the epidermis are removed, an aseptic bandage is applied.

If the fingers remain pale when warming, the pain increases, then the patient must be urgently hospitalized. For analgesia intramuscularly injected non-narcotic (50% solution metamizole sodium - analgin 10 mg per 1 kg body weight) and narcotic analgesics [1-2% solution of trimesperin (promedol) or omnopon 0.1 ml per year of life]. Pressing dressings do not impose, as it promotes tissue destruction. The limbs are elevated, and the fingers of the hand are functionally advantageous. Intramuscularly or intravenously, prednisalone 3-5 mg per 1 kg of body weight is administered to prevent adrenal insufficiency.

At the III-IV degree of frostbite after anesthesia, the blisters are removed, as the edema increases, linear incisions are made on the skin, wet-drying bandages are applied with antiseptics. With the development of necrosis, a necrectomy is performed. Intravenously injected dextran (compare the molar mass of 30 000-40 000) - reopolyglucin or hydroxyethyl starch (HES rep) 10-20 ml per 1 kg of body weight per day in combination with pentokiphylline (trental) 0.6 mg per 1 kg of body weight per hour, or with xanthinol nicotinate (complamine)] and with subcutaneous administration of heparin sodium 100-300 units per 1 kg of body weight per day in 4-6 receptions. To prevent purulent complications, antibiotics of a wide spectrum of action are used: inhibitor-protected penicillins, cephalosporins of III-IV generation).

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