[Clinical manifestations] The clinical manifestations of local frostbite can be divided into pre-reaction period (precursor period), reaction period (inflammation period) and late reaction period (recovery period).
1. The pre-reaction period refers to the period from frostbite to rewarming before melting. Its main clinical manifestations are cold, pale, hard, numb, or loss of frozen parts. Because the local is in a frozen state, the extent and degree of damage are often difficult to determine.
2. The reaction period includes rewarming and rewarming. The extent and extent of frostbite damage gradually became evident with rewarming. Since the 1970s, China has changed the severity of frostbite into a three-degree classification. Its clinical manifestations are as follows:
Once damaged in the epidermis. The redness and swelling of the local skin, the main symptoms are tingling, burning, and can generally heal in the short term (about 1 week). Sometimes there are still some residual symptoms such as excessive sweating and cold sensation in weeks or months. Although the injury mechanism of frostbite and frostbite is different, the clinical manifestations and treatment are basically the same.
Second degree damage to the dermis. With local congestion and edema, serous blisters developed 12-24 hours after rewarming. Most of the sputum is clear yellow, transparent, and the bottom of the clam is bright red. The local pain is more dramatic, but it is dull, and the feeling of acupuncture, cold and heat disappears. If there is no concurrent infection, the edema will be reduced after 4 to 5 days. The blisters will gradually dry and form ecdysis. After 2 to 3 weeks, the blister will start to heal.
Three degrees of damage to the entire skin, subcutaneous tissue and even muscle, bone. There are significant edema and blisters. The sputum is mostly bloody. It is bright red or brown. The bottom is gray or dirty. The skin is bluish-purple, gray-white, pale-white, or even purple-black, and the nail bed is gray-black. If there is no secondary infection, localized dryness, shrinkage, dry necrosis, secondary infection, necrotic tissue produces odor secretions, showing wet necrosis. The time when the dry necrosis occurs is generally 1 to 2 months. It takes 2 to 3 months or more for the complete loss of necrotic tissue, the appearance of healthy granulation, and the formation of epithelium.
Table 1-20 Identification of the second and third frostbite after rewarming
The second and third degree of authentication
Skin color red or purple, purple, pale, or purple black
The blister is mostly clear yellow, and the grout is mostly red or brown
The bottom is bright red or dirty
Less exudate
Feeling hyperalgesia, feeling deeply deep, feeling dull or lost
Skin temperature increased or decreased normally
3. The late reaction period refers to the stage of formation of granulation wounds after the first and second degrees of frostbite healed, and after the third degree frostbite was shed. This period can occur:
1 Pulp chills in the skin, feeling diminished or sensitive;
2 sensitive to cold, cold or pale skin appears purple;
3 sensitive to pain, limbs can not be heavy and so on. These manifestations are caused by dysfunctions of sympathetic nerves or peripheral nerves after injury.
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