Frostbite is under certain conditions due to the cold effect on the human body, causing local and even systemic damage. The degree of injury and the intensity of cold, wind speed, humidity, freezing time, and local and systemic state has a direct relationship. Frostbite can occur in cold areas regardless of the usual wartime, especially in wartime, due to hunger, fatigue, field work, or longer duration of the battle, as well as long-distance marching at night, insufficient cold-protection equipment or footwear discomfort, etc.. Frostbite tends to increase dramatically, and even occur in batches, resulting in non-combat attrition, which has a great impact on the combat effectiveness of the troops. According to incomplete statistics, during the first world war (1914 ~ 1918) the French army frostbite about 120,000 people, the British army frostbite 84,000 people, Italian army frostbite nearly 300,000 people, the German army frostbite 13,000 people. During the Second World War, the German army frostbite 112,000 people, the U.S. army frostbite 90,000 people. In the Korean War, about half of the 50,000 wounded evacuated by the United States invasion forces suffered from frostbite. My volunteer army in the anti-US aid to North Korea, according to the northeast military region anti-US aid to North Korea statistics: in 1951, frostbite injuries accounted for 15.2% of the total number of admissions (of which the lower extremities of frostbite accounted for 90.8%, the upper extremities accounted for 9.2%), according to the second campaign into the war in North Korea (November 25, 1950 ~ December 24), the three armies occurred in more than 44,000 wounded, frostbite accounted for nearly 30,000 (68%). 68 percent).
Based on the nature of the injury frostbite can be divided into two categories: frozen and non-frozen injuries.
Localized injuries
Freezing injuries
Freezing stiffness
Freezing injury of the whole body
Freezing death
Frostbite
Non-freezing injuries
Trench foot, immersion foot (hand)
The difference between freezing and non-freezing injuries mainly lies in the temperature of the environment at the time of the injury reaches below the freezing point of the tissues and the presence or absence of a history of freezing of the local tissues. In the actual encounter of the injured, localized frostbite is the most common, the clinical usually referred to frostbite, that is, such injuries. Sometimes minor localized frostbite is not easily distinguished from frostbite. In addition, there is also a classification of injury, that is, divided into systemic injury (including frostbite and frostbite) and localized injury (including frostbite, frostbite, trench foot, immersion foot (hand), etc.).
Localized injuries occur in exposed parts of the body, such as feet, hands, ears and face. Among them, the foot is particularly common, according to statistics about more than half of the total number of frostbite. For example, during the anti-American aid to North Korea, I volunteer a department of statistics of the evacuation of frostbite casualties, frostbite of the lower limbs accounted for 97.3%, the upper limbs accounted for 2.7%, but the usual and wartime are also slightly different, according to a cold area of the troops in recent years frostbite statistics, the foot accounted for 52.8%, the hand accounted for 36.5% of the face of the face of the 11.7% (ear and nose).
Two, freezing injury
(a) frostbite (local frostbite)
[Pathophysiological changes] can be divided into three phases:
1. physiological regulation stage: at the beginning of frostbite, the human body in order to regulate the dynamic balance between heat production and dissipation of heat, the main manifestation of the heat production and dissipation of heat to increase and decrease. The main manifestation of increased heat production is increased muscle tension, followed by chills, so that the metabolism increases. If chills continue to increase, hepatic metabolic activity is also enhanced. Decreased heat dissipation is mainly characterized by vasoconstriction of the skin blood vessels, which reduces blood flow and lowers the skin temperature in order to reduce heat dissipation. If the cold lasts for a longer period of time, skin blood vessels tend to dilate briefly, increasing local blood flow, skin temperature rises, and circulation is temporarily improved. But the body in order to avoid heat loss, blood vessels and then contract. This vasoconstriction and expansion of blood vessels, the body's cold to maintain the response. Finally, of course, the body's blood vessels in the skin and extremities continue to constrict in order to maintain central body temperature.
In short, at the beginning of the cold, all physiological functions tend to hyperactivity, such as metabolic increase, heart rate accelerated, the vasculature of the vasoconstriction alternately. If the cold lasts too long, inhibition is bound to occur, thus metabolism decreases, heart rate slows down, resulting in a decrease in central body temperature. Thereafter there is persistent contraction of blood vessels in the skin and limb ends, and freezing of the skin and limb end tissues may occur.
2. Tissue freezing stage: when the tissue temperature drops below the freezing point (skin freezing temperature is -50C), freezing will begin to occur. Freezing is divided into quick-freezing and slow-freezing.
Quick freezing: such as contact with very low temperature metal (such as cold areas placed outdoors in the metal part of the weapon) or liquid (such as liquid nitrogen), etc., can be immediately caused by contact with the part of the skin freezing. If you fail to get out of contact in time, the frozen tissue can be rapidly deepened, and in severe cases, the skin can be frozen in the cold solid, forcibly detached, which can cause avulsion injuries.
Slow freezing: common frostbite pathogenesis belongs to the slow freezing, first of all, the extracellular fluid water to form crystals (ice nuclei), with the extension of time, the ice crystals gradually increase. (Fast freezing not only the extracellular fluid freezes, at the same time the intracellular fluid also freezes, but the formation of ice crystals is generally smaller than slow freezing). Therefore, the process of tissue damage by slow freezing is mainly related to the change of osmotic pressure outside the cell. When the external temperature is lower than the freezing point of the tissue, the water in the extracellular fluid to form ice crystals, electrolyte concentration (mainly sodium ions) and osmotic pressure increases, the intracellular fraction to the extracellular large amounts of exudate (it has been studied, the cell loss of up to 78% of the cell can be caused by cellular damage, and in frostbite, the degree of loss of water can be up to 85 to 90%), so that the tissue dehydration, protein denaturation, enzyme activity is reduced, cellular crumpling, and This results in the depletion and loss of intracellular energy metabolism substances, which decreases the respiration rate of cellular mitochondria and results in the accumulation of a large number of intermediate products. This is the main reason for the death of frozen tissue.
In addition, in the past, it was also believed that, due to the increasing size of the extracellular fluid ice crystals, the mechanical effect on the tissue cells, so that the intercellular bridge rupture or cell membrane rupture, the cell contents of the spillover, is also an important cause of cell death.
Since the damage is caused when the tissue is frozen, it is often referred to as a primary injury.
3. Re-warming and thawing stage
After re-warming, if the skin is frozen superficially, the local area will only show general inflammatory reaction without serious tissue necrosis, and it will be healed in 1~2 weeks. If the deep tissue freezing occurs, not only electrolyte disorders and metabolic disorders still exist, but also local microcirculation disorders. This is due to the temporary recovery of blood flow in the frozen area after rewarming, vasodilatation, while the freezing stage of the blood vessel wall has been damaged (endothelial cells are extremely sensitive to cold) or even rupture, so the permeability of the capillary tube and oozing increases, local edema and blisters, followed by slowing down of blood flow and blood stasis, blood formation and accumulation of blood, and even thrombus formation. Such changes after rewarming are called cryosoluble injury or secondary injury. According to experimental observation, 10 minutes after the tissue rewarming and thawing, the phenomenon of microcirculation occlusion can occur. 24 hours in the small arteries, small veins, there are obvious thrombus, 3 ~ 4 days into the development of diffuse thrombus formation, resulting in tissue necrosis. Therefore, it is believed that, under certain conditions, 40% of the frostbitten tissue is primary damage, 60% is due to secondary damage after the recovery of circulation, so the method of rewarming to reduce tissue damage has an important relationship.
[Clinical manifestations] The clinical manifestations of localized frostbite can be divided into the pre-reaction period (prodromal period), reaction period (inflammatory period) and reaction period (recovery period).
1. Pre-reaction stage refers to a stage after frostbite until the rewarming and thawing, and its main clinical manifestations are cold, pale, hard, numbness or loss of sensation in the frozen part. Due to the local freezing state, the scope and extent of the damage is often difficult to determine.
2. The reaction period includes the stage after rewarming and rethawing. The extent and degree of frostbite damage is gradually apparent with rewarming. Since the 1970s, the severity of frostbite has been unified into a three-degree classification. Its clinical manifestations are as follows:
One degree Damage in the epidermis. Local skin redness, swelling, the main symptom is tingling, burning pain, usually can be healed in a short period of time (about 1 week). Sometimes in weeks or months still have localized excessive sweating and cold feeling and other sequelae. Although the damage mechanism of first-degree frostbite and frostbite is different, the clinical manifestations and treatment are basically the same.
The second degree damage to the dermis. There is local congestion and edema, rewarming 12 to 24 hours after the formation of plasma blisters. The blisters are mostly clear yellow, transparent, the bottom of the blisters is bright red, local pain is more intense, but the sensation is slow, to the pinprick, cold, hot sensation disappeared. If there is no concomitant infection, the edema is reduced after 4 to 5 days, the blisters gradually dry and form scabs, and the scabs start to come off and heal after 2 to 3 weeks.
Third-degree damage to the entire skin, subcutaneous tissue and even muscle, bone . There are significant edema and blisters, blister fluid is mostly bloody, bright red or coffee color, the bottom of the blister is gray or dirty color. The skin is greenish purple, grayish white, pale white or even purple-black, and the nail beds of fingers (toes) are grayish black. If there is no secondary infection, the local area becomes dry and shrinks, presenting dry necrosis; secondary infection, the necrotic tissue produces foul-smelling secretion, presenting wet necrosis. The time for dry necrosis to appear as a demarcation line usually takes 1 to 2 months. From the complete detachment of necrotic tissue, the emergence of healthy granulation and epithelial formation, it often takes more than 2 to 3 months.
Table 1-20 Identification of second- and third-degree frostbite after rewarming
Identification Contents Second-degree Third-degree
Skin color Red or purplish red Superficial purplish, pale, or purplish-black
Blisters Mostly clear yellow, plasma Mostly red or coffee-colored
Blister bottoms Bright red Grayish white or dirty
Oozing matter Fewer More
Sensation and pain sensitivity, deep sensation exists, shallow and deep sensation is retarded or lost
Skin temperature is increased or normally decreased
3. The late reaction refers to the stage of the formation of granulation wounds after the healing of the first and second degrees of frostbite, and the third degree of frostbite after the detachment of necrotic tissues. This period can appear: ① plasma skin local cold, sensory loss or sensitivity; ② cold sensitivity, cold season skin pale or purple; ③ pain sensitivity, the limbs can not hold the weight and so on. These manifestations are due to the sympathetic nerve or peripheral nerve injury caused by dysfunction.
[First aid and metallurgy]
1. First aid and treatment principles:
①Rapidly get out of the cold environment to prevent further freezing;
②Rapidly rewarming the body as soon as possible;
③The local application of frostbite cream;
④Improve the local microcirculation;
⑤Anti-shock, anti-infection and warmth;
⑥Apply internal medication to activate the body and keep the body warm.
7, the second and third degree of frostbite can not be distinguished according to the third degree of frostbite treatment;
8 frostbite surgical treatment, should minimize the disability, maximize the retention of the ability to survive the limb function.
2. Rapid rewarming: as soon as possible to make the casualty out of the cold environment, such as conditions, should be immediately warm water rapid rewarming, rewarming in the warmth of the conditions of adequate evacuation. If there are no conditions for rapid rewarming, the casualty should be evacuated as soon as possible, and attention should be paid to keeping warm and preventing trauma during the evacuation. Rapid rewarming in warm water should be carried out immediately after arriving at the medical unit. Especially for the treatment of the second, third, degree burns are still in a frozen state, rapid rewarming is the effect of the total significant and critical measures.
Specific method: the frozen limbs immersed in 420C (should not be too high) warm water, to the frozen area of the skin to red, especially the finger (toe) nail bed red, tissue softening until, time should not be too long. For facial frostbite, a towel can be moistened with 420C warm water for localized hot compresses. In the absence of warm water, the frozen limb can be immediately placed on its own or the rescuer's warm body parts, such as armpits, abdomen or chest, in order to achieve the purpose of rewarming.
The rescue is strictly prohibited fire, snow rubbing, cold water immersion or pounding the affected area.
3. Improvement of local microcirculation The initial stage of third-degree frostbite can be applied to low molecular weight (molecular weight of 40,000 or less) dextrose anhydride, intravenous drip, day by day, 500 to 1,000 milliliters of medication, maintenance of 7 to 10 days, in order to reduce the viscosity of the blood, improve microcirculation. Anticoagulants (e.g., heparin) or vasodilators (opioid, benzylaminazoline, etc.) may also be used if necessary.
4. Local treatment
(1) local medication: immediately after the rewarming of the local coated with frostbite ointment, can be properly coated thicker, between the fingers (toes) need to be coated with sterile dressings and bandages, change the medication 1 to 2 times a day, the area of a small first and second-degree frostbite, may not be wrapped, but pay attention to keep warm.
The frostbite creams available are furacilin cream: furacilin, cortisone cream: furacilin, dextrose anhydride cream, etc., and their formulas and preparations are as follows:
Table 1-21
*Thin Gong Ying extract 1 ml is equivalent to the raw medicine 4 grams
The base formulations are identical
Oil phase Base: 17g of stearic acid, 25g of liquid paraffin, 2g of lanolin.
Aqueous phase matrix: 2 g of triethanolamine, 5 g of glycerol (medicinal), 0.1 g of methylparaben, 48-49 ml of distilled water.
Method of preparation: hand furacilin placed in the milk bowl into a fine powder, add glycerol ground into a paste, and then add 2 to 3 ml of distilled water, research and standby. Heat the oil phase in a water bath until all dissolved, continue to heat to 750 C. After the water phase is heated and dissolved in a water bath to 750 C, slowly add 750 C to the oil phase, stirring while pouring and adding furacillin glycerin paste. Continue grinding to form a cream.
(2) Treatment of blisters Blister fluid should be withdrawn under aseptic conditions, or if the blister is large, it may be drained by a low incision.
(3) Treatment of infected wounds and necrotic scabs, infected wounds should be drained in time to prevent accumulation of pus under the scabs, and necrotic scabs should be nibbled off in time.
(4) timely removal of necrotic scab treatment, granulation wounds fresh as soon as possible after the implantation of skin to eliminate the trauma. Early skin necrosis after the formation of dry scabs, for the deep tissue viability situation, often not easy to judge, sometimes it seems that the limb has been necrotic, but after the removal of the scabs to reveal the granulation trauma (indicating that the deep tissues are not necrotic), after skin grafting healed. Therefore, the frostbite amputation should take a cautious attitude, generally recognize its own separation of detachment, try to retain the viable tissue, if necessary, can be carried out arteriography, in order to understand the blood circulation of the limb.
5 Chinese medicine treatment: should focus on warming the meridians and collaterals, activating blood circulation and removing blood stasis. Formulas:
Boswellia serrata 9 grams of myrrh 9 grams
Peach kernel 9 grams of Salvia miltiorrhiza 30 grams
Angelica Sinensis 6 grams of Maodongqing 30 grams
Scutellaria baicalensis 15 grams of rhubarb 4.5 grams
Glycyrrhiza glabra 6 grams of Astragali 15 grams
Double Flower 15 grams of forsythia 15 grams
*** Decocted as a single dose, the second day of service, served for 7 to 14 doses. The patient's condition can also be based on the patient's condition with the addition or subtraction of evidence.
6. Prevention of infection Severe frostbite should be oral or injection of antimicrobial agents: routine tetanus prophylaxis.
(2) Frozen stiffness (frostbite)
[Pathogenesis] Frozen stiffness, also known as frostbite, is caused by prolonged exposure of the body to the cold environment, resulting in the lowering of the body's metabolism, the loss of a large number of calories, the body temperature can not be maintained, and finally the consciousness of the coma, the whole body is frozen stiff. At the beginning of the human body by the cold, on the one hand, with the enhancement of metabolism to produce heat, so muscle contraction, heartbeat accelerated, blood pressure, respiration increased; on the other hand, peripheral vascular contraction, reduce heat dissipation. If you continue to freeze, heat dissipation more than heat production, body temperature began to fall, to 32 0C or less, chills no longer occur, metabolism is gradually reduced, blood pressure, pulse, respiration also began to decline; to 30 0C or less, into a coma state of total body stiffness. If not rescued in time, will eventually lead to death.
Freezing often occurs in a sudden drop in temperature or encountered a blizzard, especially thin clothing, hunger, fatigue, lost, drunkenness and other accidents are likely to occur, usually rare. But our country is a vast country, in the high mountain snow operation of the exploration team or scouts, in the frigid region of the pilot in distress, in the ocean by the storm of the accidental attack of the sailors, fishermen and so on may occur freezing stiffness.
[Pathophysiology] The pathological process of the body's response to cold is divided into two aspects of function compensation and function failure, the main manifestations are as follows:
1. Nervous system: body temperature in 340C can be amnesia, less than 320C when the sense of touch, loss of pain, and then the loss of consciousness, the pupil dilation or narrowing.
2. Circulatory system: after the drop of body temperature, the water in the blood is moved to the tissue space from the blood vessels, the blood is concentrated, the viscosity increases, more than half of the peripheral small blood vessels stops at 20 0C, the pulmonary circulation and the external peripheral resistance increases; coronary artery blood flow at 19 0C is 25% of the normal, the cardiac output decreases, the heart rate slows down, the conduction block occurs, and ventricular fibrillation can occur.
3. Respiratory system: respiratory center is inhibited, respiration becomes shallow and slow, respiration at 290C is 50% less than normal, respiratory depression further aggravates hypoxia, acidosis and circulatory failure.
4. Kidney: Due to renal vasospasm, renal blood flow decreases, and tight glomerular filtration rate decreases. Renal blood flow decreases by more than half and glomerular filtration rate decreases by 1/3 at a body temperature of 270 C. If prolonged, it leads to metabolic acidosis, azotemia and acute renal failure.
[Clinical manifestations and diagnosis]The casualty's skin is pale and cold, sometimes there is edema in the face and surrounding tissues, confusion or coma, muscle tonus, fine tremor visible on electromyography and electrocardiogram, pupil light reflex is sluggish or absent, bradycardia, arrhythmia, undetectable in the lowering of blood pressure, atrial and ventricular fibrillation may occur, and in severe cases, cardiac arrest. Respiration is slow and shallow, and in severe cases, one or two weak breaths are occasionally seen.
If there is a history of freezing, the diagnosis can be made by measuring the anus and performing an electrocardiogram. It is not necessary to perform too many tests. However, it should be noted that a normal thermometer is not suitable (only up to 350C). A thermometer can be inserted into the anus, at least 5 centimeters.
Generally speaking, the rectal temperature of 28 ~ 300C or more, more can be resuscitated, 250C or so is the risk of death. Xinjiang Military Region General Hospital revived a case of severe freezing. Anal temperature of only 220C patients. Foreign countries also have a center body temperature of 180C and can be resuscitated individual case reports.
[First aid and treatment] The key is to quickly restore the patient's central body temperature and prevent complications.
Rapidly and steadily move the patient into a warm environment, take off clothes, shoes and socks, take full-body warming measures, covered with quilts or blankets, and hot water bags, kettles, heating (note that cushions, clothes or blankets, do not put directly on the skin in order to prevent scalding) to put the armpits and groin, the conditions of the electric blanket wrapped in the torso to open up the infrared and short-wave heating, etc., but also available in warm water, will be submerged in a 40 ~ 420C warm bathtub, and the patient will be able to recover from the illness. 420C warm bath, water temperature from 34 ~ 350C, 5 ~ 10 minutes to raise the water temperature to 420C, to be anal temperature rose to 340C, with regular breathing into the heartbeat, stop heating.
If the patient's consciousness exists, warm drinks or a small amount of wine can be given, and intravenous drip of warmed 10% glucose water (the infusion tube can be lengthened to 5-6 meters and immersed in a 38-400C water bath) can help improve circulation.
In addition to body surface rewarming, the center rewarming method can also be used, especially those severely frozen casualties. Extracorporeal blood warming and peritoneal dialysis can be used. Peritoneal dialysis in general hospitals can be carried out, can be heated to 49 ~ 540C dialysis fluid suspended in 3 ~ 4 feet in height, through the catheter insulated in a 430C water bath, into the abdominal cavity, peritoneal dialysis, each time about 20 ~ 30 minutes, can be continuous dialysis for 5 ~ 6 times. Every hour can make the anal temperature rise 2.9 ~ 3.60C, help to improve cardiac and renal function.
Other treatments, including correction of heart rhythm disorders and acidosis, attention to complications (pneumonia, cardiac and renal insufficiency, cerebral and pulmonary edema) prevention and treatment. If accompanied by local frostbite, should be first rescue frostbite, and then according to the principles of frostbite treatment.
Three, non-freezing injuries
(I) frostbite Frostbite is a non-freezing local tissue injury that occurs in a cold and wet environment. Frostbite is a non-freezing localized tissue injury that occurs in a cold and wet environment. Frostbite occurs when the temperature is above freezing (0-100C). Frostbite occurs mostly on the fingers, backs of hands, toes, heels, and ear galleries. Localized erythema, diffuse edema, and the appearance of varying sizes of nodules, abnormal sensation, burning itch, swelling and pain, and sometimes blisters. The blisters burst to form superficial ulcers, oozing plasma, and can be infected with pus.
Treatment of basically the same, second, degree frostbite. Daily available 420C warm water immersion, each 20 minutes, dry with a towel; room temperature is maintained at 150C or more, and pay attention to local warmth, can also be used with massage or diathermy, generally one week can be healed. If there is an ulcerated infection, local application of frostbite cream. China's folk prescription, such as chili pepper rods can be pepper decoction soak the affected area, according to reports the effect is better.
(2) trench foot wartime standing for a long time in the wet and cold trenches caused by a foot injury.
(3) Water-soaked foot or water-soaked hand A localized injury caused by prolonged immersion of the hand and foot in cold water.
(4) air-raid trench foot The Second World War, many old and frail people, squatting or curled up for too long in the air-raid trench (hole), affecting the blood circulation of the lower limbs, the local blood accumulation of foot injuries that occurred.
The pathophysiological changes of these three injuries, there are many **** the same point. Frozen temperature are above the freezing point of the tissue, the injury site is extensive, in addition to skin damage and vascular changes, there is also a wide range of inflammatory reactions, especially muscle and nerve damage and degeneration. Clinical manifestations: in the pre-reaction period, due to vasoconstriction and spasm, the pulsation of blood vessels is weakened or disappeared, the foot starts to be flushed and then turns pale, and the frozen person's foot is heavy and uncomfortable, followed by numbness and pain, especially the arch of the foot and the bottom of the foot is more prominent. Symptoms are more obvious in the reaction period, first of all, extreme dilatation of blood vessels, congestion and edema, localized heat and arterial pulsation, or blisters and oozing phenomenon. Secondly, the sensory nerves are disturbed and the foot is painful, which is aggravated by movement or unprotected position. Late reaction, foot edema subside, but very sensitive to cold, and easy to sweat, activity edema can appear again, and pain, affecting the lasting standing, serious cases can sometimes be left foot muscle atrophy, osteoporosis.
The above three kinds of damage, early treatment can prevent infection and reduce local tissue damage, treatment methods and frostbite local therapy is similar, can refer to carry out.
Four, frostbite prevention
Most of the frostbite is preventable, the main preventive measures are as follows:
(a) do a good job of anti-freezing publicity and education, improve the ideological understanding, strengthen the exercise, strengthen the physical fitness, and improve the ability to withstand the cold:
(1) a planned step-by-step organization of cold exercise, such as organizing the troops to climb the mountain, skiing, running, etc., and adhere to the cold water to wash their hands, wash their faces, feet and bath (should be from the hot days). and scrub bath (should start from the hot days). ② grasp the law of frostbite, seize the focus of frostbite, such as frostbite prone to weather, mainly cold and windy days, especially the sudden change in temperature; easy to freeze parts, mainly exposed parts of the body and limbs, such as hands, feet, ears, nose, face, etc.; prone to frostbite time, more often than not in the warrior alone on duty, especially in the guard post tend to stand still, or to carry out urgent tasks such as the detachment. Grasp the above rules, take appropriate measures, practice has proved to be able to reduce or prevent the occurrence of frostbite. ③ Strengthen the administration and management, and do a good job of material assurance. Implement measures to prevent freezing and keep warm, and repair doors, windows, stoves, fire walls, and grass mats before winter. Clothing should be warm and impermeable to the wind, and loose and tight, shoes and socks should not be too tight. (4) Actively improve the food, rationalize the time of eating and drinking, not too long interval, pay attention to the quality, and make sure to eat hot food. ⑤ Pay attention to preventing cold and keeping warm during the transportation of the wounded. Do not use fire or snow to rub the frozen parts immediately.
(2) soldiers or personal frost should be "seven diligent" "six do not" that is: diligent cold exercise; diligent preparation of cold items; baked shoes and socks, insoles, especially "sweaty feet" should pay more attention to; "sweaty feet" should be more attention to; the wounded on the way to transport the warmth. The "sweaty feet" should pay more attention to; diligently moving hands and feet, rubbing the forehead surface; diligently use hot water to scald the feet; diligently supervise each other; diligently exchange anti-freezing experience. Don't wear wet, too tight shoes and socks; don't stay still for a long time; don't go out alone when you are unprepared; don't touch metal with bare hands at very low temperatures; don't bake on fire, rub in snow or soak frozen parts in cold water; and don't drink alcohol.
Long stationed in the cold area of the troops, over the years have summed up a lot of effective anti-freezing experience, as long as these measures and experience to pay serious attention to the courage to practice, you can get in the cold when the freedom of action.
Fifth, frostbite graded treatment
(a) first aid battalion:
1. quickly move the casualty into a warm environment, take off (or cut off) wet and frozen clothes and shoes and socks (such as clothes and shoes and socks frozen in the skin, should not be forcibly removed, you can be right to the process of rewarming slowly removed).
2. As soon as possible when possible, use 40 ~ 420C warm water to implement rapid thawing and rewarming, until the tissue is softened, the skin, the nail bed turns red until. Apply frostbite cream for aseptic bandaging. Prohibit the use of cold water immersion, snow rubbing, fire baking.
3. The pain of the injury can be taken orally or injected painkillers.
4. Rapid evacuation under warm conditions.
(2) The regiment's rescue
1. Rapid rewarming of the wounded who have not been rewarmed (those who have been rewarmed should not be rewarmed).
2. After rewarming, apply frostbite cream externally, once or twice a day, with aseptic bandages.
3. Intravenous infusion of low molecular dextrose anhydride, 500 milliliters each time, 1 to 2 times a day, for 1 week.
4. Serious frostbite should be prevented from infection. Apply antimicrobial agents (penicillin 1.6 million units per day, streptozotocin one gram per day), or oral sulfonamides.
(3) division ambulance or first-line field hospital:
1. on the whole body frostbite (frostbite) or severe (deep) frostbite, the implementation of complementary treatments such as those who have not been rewarmed should still grasp the rewarming; anti-convulsive, anti-infectious, prevention of complications, etc.; in 24 to 48 hours after the evacuation.
2. Mild frostbite can take care of their own life can be discretionary stay treatment.
3. For the severely injured who cannot be evacuated for a while, they should be treated in strict accordance with the measures of early treatment.
(4) Specialized hospitals or rear hospitals
To complete the final treatment of frostbite casualties, active treatment of trauma, timely removal of necrotic tissues, early implantation of skin to eliminate trauma. %A