What method can treat frostbite caused by snow?

1. First aid and treatment principles: ① Get out of the cold environment quickly to prevent further frostbite; (2) Take the time to quickly rewarming as soon as possible; ③ Local application of chilblain cream; ④ improving local microcirculation; ⑤ Anti-shock, anti-infection and warm keeping; ⑥ Use oral drugs such as promoting blood circulation and removing blood stasis; ⑦ If the second and third degree frostbite cannot be distinguished, it shall be treated as third degree frostbite; The surgical treatment of frostbite should minimize disability and maximize limb function. 2. Rapid rewarming: After getting the wounded out of the cold environment as soon as possible, warm water should be used for rewarming immediately if possible, and after rewarming, they should be evacuated with full warmth. If there is no rapid rewarming condition, evacuate as soon as possible, and keep warm during evacuation to prevent trauma. After arriving at the medical unit, warm water should be used to rewarming immediately. Especially for the treatment of second-degree, third-degree and third-degree burns that are still frozen, rapid rewarming is the key measure and the effect is obvious. Specific methods: Soak the frozen limbs in 420C (not too high) warm water until the skin in the frozen parts turns red, especially the nail bed flushes and the tissues become soft. Not too long. For facial frostbite, a towel can be soaked in 420℃ warm water for local hot compress. In the absence of warm water, the frozen limbs can be immediately placed on the warm body of themselves or rescuers, such as armpits, abdomen or chest, in order to achieve the purpose of rewarming. It is forbidden to roast with fire, rub with snow, soak in cold water or pat the affected area hard during the treatment. 3. Improve local microcirculation In the early stage of third-degree frostbite, low molecular weight dextran (below 40,000) can be applied intravenously at a dose of 500 ~ 1000ml per day for 7 ~ 10 days to reduce blood viscosity and improve microcirculation. Anticoagulant (such as heparin) or vasodilator (papaverine, benzylamine oxazoline, etc. ) can also be used when necessary. 4. Local treatment (1) Local medication: immediately after rewarming, apply external ointment for chilblain between fingers (toes), which can be appropriately thickened, and wrap it with sterile dressing, and change the dressing 1 ~ 2 times a day. For the first-degree and second-degree frostbite with small area, it is not necessary to wrap it, but attention should be paid to keeping warm. Available frostbite creams include nitrofurazone cream, cortisone cream, nitrofurazone cream, dextran cream, etc. The formula and preparation method are as follows: table 1-2 1 * bogongying extract 1 ml is equivalent to 4 grams of crude drugs, and the matrix formula is exactly the same as that of the oil-phase matrix: 17 grams of stearic acid and liquid paraffin 20. Aqueous matrix: 2g triethanolamine, 5g glycerol (medicinal), 0. 1g methyl paraben, 48-49ml distilled water. Preparation method: put furacilin into a mortar and grind it into fine powder, add glycerol and grind it into paste, then add 2 ~ 3 ml distilled water and grind it evenly for later use. Heat the oil phase in a water bath until it is completely dissolved, and continue to heat it to 750 C. After the water phase is heated and dissolved in a water bath to 750 C, it is slowly added to the oil phase at 750 C, and stirred while pouring, and nitrofurazone glycerin paste is added. Keep grinding the cream. (2) The blister fluid should be extracted under aseptic conditions. If the blister is large, it can also be drained through a lower incision. (3) Treatment of infected wound and necrotic scab skin. Infected wounds should be drained in time to prevent pus from accumulating under the scab, and necrotic scab skin should be eaten in time. (4) timely excision of necrotic scab skin, skin grafting as soon as possible after granulation wound is fresh to eliminate the wound. It is often difficult to judge the viability of deep tissues after early skin necrosis forms dry scab. Sometimes it seems that the limbs are necrotic, but the granulation wound is exposed after scabbing (indicating that the deep tissue is not necrotic), and it is cured after skin grafting. Therefore, amputation after frostbite should be cautious. It is generally believed that it will separate and fall off on its own, and try to keep viable tissue. If necessary, arteriography should be done to understand the blood circulation at the end of the limb. 5 Chinese medicine treatment: review meridians, promote blood circulation and remove blood stasis. Prescription: 9 grams of frankincense, 9 grams of myrrh, 9 grams of peach kernel, 30 grams of angelica, 6 grams of Ilex pubescens, 30 grams of Scutellaria baicalensis, 4.5 grams of rhubarb 15, 4.5 grams of licorice, 6 grams of astragalus, 0.5 grams of forsythia suspensa 15, 15 * * decocted twice a day. 6. In order to prevent infection and severe frostbite, antibiotics should be taken orally or injected: tetanus preventive injection should be carried out routinely. (2) Frostbite (systemic frostbite) [Pathogenic factors] Frostbite, also known as systemic frostbite, is due to the long-term exposure of the body to cold environment, which leads to the decline of systemic metabolic function, a large loss of heat, inability to maintain body temperature, and finally coma and systemic frostbite. In the early stage of human cold, on the one hand, it is to enhance metabolism to generate heat, so muscles contract, heart beats faster, blood pressure rises, and breathing times increase; On the other hand, peripheral blood vessels contract and heat dissipation decreases. If it continues to be frozen, the heat dissipation will exceed the heat production, the body temperature will begin to drop below 32°c, chills will no longer occur, metabolism will gradually decline, and blood pressure, pulse and breathing will also begin to decline. Drop below 30 degrees Celsius, go into a coma, and feel stiff all over. If not rescued in time, it will eventually lead to death. Freezing often happens when the temperature drops suddenly or when there is a snowstorm, especially when clothes are thin, hungry, tired, lost and drunk. It is rare to see at ordinary times. However, China is a vast country. Explorers or scouts working in high mountains and snow, pilots in distress in cold areas, sailors and fishermen accidentally attacked by snowstorms in the ocean may all freeze to death. [Pathophysiology] The pathological process of the body's response to cold can be divided into two aspects: functional compensation and functional failure, and the main manifestations are: 1. Nervous system: amnesia may occur when the body temperature is 340℃, and when it is lower than 320℃, the sense of touch and pain will be lost, and then the consciousness will be lost, and the pupils will be dilated or narrowed. 2. Circulatory system: After the body temperature drops, the water in the blood moves from the blood vessels to the interstitial space, and the blood is concentrated and the viscosity increases. At 20℃, the blood flow of more than half of the peripheral small vessels stopped, and the pulmonary circulation and peripheral resistance increased. 19 0C, coronary blood flow is 25% of normal, cardiac output decreases, heart rate slows down, conduction block occurs, and ventricular fibrillation may occur. 3. Respiratory system: the respiratory center is inhibited, and breathing becomes shallow and slow. At 290℃, the number of breaths is reduced by 50% compared with normal time. After respiratory depression, hypoxia, acidosis and circulatory failure are further aggravated. 4. Due to renal vasospasm, renal blood flow decreases, and the filtration rate of compact globules decreases. At 270C, the renal blood flow decreased by more than half, and the glomerular filtration rate decreased 1/3. If it lasts too long, it will lead to metabolic acidosis, azotemia and acute renal failure. 【 Clinical manifestations and diagnosis 】 The injured person's skin is pale and cold, sometimes his face and surrounding tissues have edema, confusion or coma, muscle rigidity, slight tremor in electromyography and electrocardiogram, bradycardia and arrhythmia, undetectable drop in blood pressure, atrial and ventricular fibrillation, and severe cardiac arrest. Breathing is slow and shallow, and occasionally one or two weak breaths can be seen in severe cases. If you have a history of cold, you can diagnose it by measuring anal temperature and electrocardiogram. Don't need too many tests. However, it should be noted that ordinary thermometers are not applicable (only 350C can be measured). You can insert the thermometer into the anus, at least 5 cm or more. Generally speaking, when the rectal temperature is above 28 ~ 300℃, it can be revived, and there is a danger of death at around 250℃ ... The General Hospital of Xinjiang Military Region rescued a case of severe frostbite. Patients whose anal temperature is only 220℃, and some cases abroad reported that the central body temperature 180℃ was cured. [First aid and treatment] The key is to quickly restore the patient's central body temperature and prevent complications. Move the patient into a warm environment quickly and smoothly, take off his clothes, shoes and socks, take measures to keep him warm, cover him with a quilt or blanket, heat him with a thermos and kettle (be careful to separate him with a cushion, clothes or blanket, and don't put him directly on the skin to prevent burns), put him under his armpit and groin, wrap his body with an electric blanket, and absorb heat with infrared rays and short waves. , also use warm water to immerse the patient in the hot tub of 340C ~ 420C, and the water temperature is from. If the patient is conscious, warm drinks or a small amount of wine can be given, and heated 10% glucose water can be dripped intravenously (the infusion tube can be extended to 5 ~ 6 meters and soaked in a water bath at 38 ~ 400℃), which is helpful to improve circulation. In addition to body surface rewarming, central rewarming can also be used, especially for those with severe frostbite. Extracorporeal circulation blood warming and peritoneal dialysis can be used. Peritoneal dialysis can be performed in a general hospital. Dialysis solution heated to 49 ~ 540℃ can be hung at a height of 3 ~ 4 feet and pumped into abdominal cavity through a catheter kept warm in a water bath at 430℃, and peritoneal dialysis can be performed for about 20 ~ 30 minutes each time, and continuous dialysis can be performed for 5 ~ 6 times. It can increase anal temperature by 2.9 ~ 3.60℃ per hour, which is helpful to improve heart and kidney function. Other treatments include correcting arrhythmia and acidosis, and paying attention to the prevention and treatment of complications (pneumonia, cardiac and renal insufficiency, brain and pulmonary edema). If there is local frostbite, the frozen person should be rescued first, and then treated according to the principle of frostbite. 3. Non-frostbite (1) Frostbite occurs in a cold and humid environment, and it is a local tissue injury that is not frostbite. The temperature of frostbite is mostly above freezing point (0 ~ 100℃). The most common parts are fingers, back of hand, toes, heels and ear gallery. Erythema, diffuse edema, nodules of different sizes, paresthesia, burning pain, swelling and pain, and sometimes blisters appear locally. Superficial ulcer is formed after the blister ruptures, and serous fluid oozes out, which can cause infection and suppuration. The treatment is basically the same, second and third degree frostbite. Soak in 420℃ warm water for 20 minutes every day and dry with a towel. Keep the room temperature above 150C, and keep warm locally. You can also use massage or diathermy therapy, which can be cured in a week. If there is ulceration infection, apply chilblain cream locally. Domestic remedies, such as soaking the affected area with pepper stalks and pepper soup, are reported to have better effects. (2) A foot injury caused by standing in a wet and cold trench for a long time in wartime. (3) local injury caused by soaking feet or hands and feet in cold water for a long time. (4) The bomb shelter was full during World War II. Many elderly and infirm people crouch or curl up in air-raid shelters for too long, which affects the blood circulation of lower limbs, causing local congestion and hurting their feet. The pathophysiological changes of these three kinds of injuries have many similarities. The freezing temperature is above the freezing point of tissue, and the injured parts are extensive. In addition to skin injury and vascular changes, there are a wide range of inflammatory reactions, especially muscle and nerve injury and degeneration. Clinical manifestations: At the initial stage of the reaction, due to vasospasm, the pulse of blood vessels is weakened or disappeared, and the feet turn pale after flushing, and the feet of those who are frozen are heavy and uncomfortable, and then numb and painful, especially in the arch and sole of the foot. The symptoms in the reaction period are more obvious. First of all, the blood vessels are extremely dilated, hyperemia and edema, local fever, obvious pulse of arteries, occasional blisters and oozing blood. Secondly, sensory nerve disorder, foot pain, activity or vertical position are aggravated. In the late stage of reaction, the edema of the foot subsided, but it was very sensitive to cold and easy to sweat. Edema appeared again during activities, which was very painful and affected standing for a long time. In severe cases, it sometimes leads to muscle atrophy and osteoporosis in the left foot. For the above three kinds of injuries, early treatment can prevent infection and reduce local tissue damage. The treatment method is similar to the local treatment of chilblain and can be used for reference. Four. Prevention of Frostbite Most frostbite can be prevented. The main preventive measures are: (1) Do a good job in anti-freezing publicity and education, improve ideological understanding, strengthen exercise, enhance physical fitness, and improve cold tolerance; (1) Organize cold tolerance exercises in a planned and step-by-step manner, such as organizing troops to climb mountains, ski, run, etc. , and insist on washing hands, face, feet and bath with cold water (from hot weather). (2) Grasp the law of frostbite and the key points of antifreeze, such as the weather prone to frostbite, mainly cold days and windy days, especially the weather with sudden temperature change; Frozen parts, mainly exposed parts of the body and limbs, such as hands, feet, ears, nose, face and so on. Soldiers are prone to frostbite when they are on duty alone, especially when they are on duty or when they are performing emergency tasks. Master the above rules and take corresponding measures to prove that frostbite can be reduced or prevented. (3) Strengthen administrative management and make material guarantee. Implement anti-freezing and warm-keeping measures, and maintain doors, windows, stoves, fire walls and straw mats before winter. Clothes should be warm and airtight, moderately elastic, and shoes and socks should not be too tight. (4) Actively improve the diet, reasonably arrange the eating time, the interval should not be too long, pay attention to the quality, and ensure hot food. ⑤ Pay attention to cold and warmth when transporting the wounded. Never bake with fire, and don't immediately wipe the frozen parts with snow. (2) Soldiers or individuals should do "seven diligence" and "six noes" in anti-freezing, that is, often carry out cold-resistant exercise; Always prepare cold-proof supplies; Bake shoes, socks and insoles, especially those with sweaty feet; Always exercise your hands and feet and rub your forehead; Always iron your feet with hot water; Often supervise each other; Frequently exchange anti-freezing experience. Don't wear wet and tight shoes and socks; Don't stay still for a long time; Don't go out alone without preparation; Don't touch the metal with low temperature with your bare hands; Do not soak the frostbitten parts with fire, snow rubbing or cold water; Don't drink. The troops stationed in the cold-proof areas for a long time have summed up many effective anti-freezing experiences over the years. As long as we take these measures and experiences seriously and practice them bravely, we can realize freedom of movement in the cold.