Kukhazikika kwa chilala, kumizidwa m'madzi ofunda, ndikuzimitsanso zoopsa¶

Frostbite ndi kuvulala kozizira kwambiri kwa chilengedwe komwe kumadziwika ndi mapangidwe a ayezi mkati mwa ma cell ndi ma extracellular spaces. Pamene thupi laumunthu losavala kapena losatsekeredwa mokwanira limakhala ndi kutentha kozizira kwambiri, njira zodzitetezera mthupi zimayambitsa kutsekeka kwamphamvu kwam'mimba. Kukazizira koopsa, magazi amapita ku zala, zala, mphuno, ndi m’makutu pang’onopang’ono mpaka kufika pang’onopang’ono poyerekezera ndi mmene amathira. Ngati kutentha kwa minofu kutsika pansi pa -0.55 °C (31.01 °F), madzi omwe ali mkati mwa minofu amaundana olimba, kung'amba maselo, kusokoneza mabedi a capillary, ndikuyambitsa necrosis ya minofu.

Thandizo loyamba la chisanu choopsa limafunikira ndondomeko zolondola, zovomerezeka zachipatala. Mankhwala olakwika a anthu, monga kupukuta miyendo ndi chipale chofewa, kuthira kutentha kwachitofu kochokera ku nkhuni, kapena kuyenda moumiriza mapazi omwe asungunuka kumene, kumawononga kwambiri ma cell ndikupangitsa kuti opareshoni adulidwe. Komanso, kuyambitsa kutenthetsanso mwachangu kumalo akutali komwe minofu yosungunuka imatha kuzizira panthawi yoyendetsa ndi vuto lalikulu lomwe limatsimikizira kufa kwathunthu kwa minofu. Kumvetsetsa momwe chisanu chachipatala chikuyendera, ndondomeko yomiza mofulumira m'madzi ofunda, kuchepetsa kupweteka kwa reperfusion, ndi kuopsa kwa refreeze kumateteza miyendo ndi kusunga kuyenda.

Chitani izi tsopano¶

1. Sungani wodwalayo pamalo ofunda, otetezedwa ndi mphepo nthawi yomweyo. Kutuluka mumphepo ndi chinyezi kumayimitsa kutentha kosalekeza ndikukhazikitsa kutentha kwapakati pathupi.
2. *Chiritsani systemic hypothermia musanalankhule ndi chisanu. Munthu sangathe kuchiritsa mabala oundana oundana pomwe kutentha kwapakati pa thupi kumakhalabe kupsinjika; kulunga thunthu la wodwalayo m’matumba ogona owuma, mabulangete, kapena zovala zofunda.
3. Unikani momwe zinthu zilili potuluka musanayese kusungunula miyendo yowundana. Ngati wodwala akuyenera kuyenda kupita kumalo otetezeka, kapena ngati pali kuthekera kuti minofu yosungunuka ingathe kuziziranso panthawi yoyendetsa, musasungunuke kumapeto kwake.
4. **Chotsani zovala zonyowa kwambiri, nsapato, ndi zodzikongoletsera. kudula zovala ndi kukameta ubweya ngati nsalu ndi mazira molunjika pa khungu.
5. Konzekerani kusamba m'madzi aukhondo pakati pa 37 °C ndi 40 °C (99 °F mpaka 104 °F). Ngati pobisalirapo n'kosatheka kuziziritsanso, mizani gawo lomwe laziziralo m'madzi osatentha kwambiri kwa mphindi 15 mpaka 30.
6. *Tetezani khungu losungunuka ndi mavalidwe otayirira, osabala komanso okweza. Pewani pakati pa zala zosungunuka kapena zala zala zala zala zonyela, pangani mabandeji osamatira omasuka, kwezani chiwalo pamwamba pamtima kuti muchepetse kutupa, ndipo tumizani kuchipatala mwachangu.

Biophysics ya kuzizira kwa minofu: ayezi wam'manja ndi mitsempha yamagazi¶

Frostbite si khungu lozizira chabe; ndizovuta, magawo awiri a pathophysiological ndondomeko yokhudzana ndi kuwonongeka kwa mapangidwe a ma cell omwe amatsatiridwa ndi kupita patsogolo kwa microvascular thrombosis.

flowchart TD
    A["Kuwonekera kwa Kuzizira Kwambiri (-0.55 °C / 31 °F)"] --> B["Kupweteka Kwambiri kwa Peripheral Vasoconstriction"]
    B --> C["Mapangidwe Owonjezera a Ice Crystal"]
    C --> D["Osmotic Dehydration: Madzi Amasiya Maselo"]
    D --> E["Intracellular Electrolyte Toxicity & Lysis"]
    E --> F{"Kodi Wodwala Angafike Pobisala Popanda Chiwopsezo Chowumitsidwanso?"}
    F -- No --> G["Khalani Ozizira; Splint & Pad; Choka Paphazi"]
    F -- Yes --> H["Kumizidwa M'madzi pa 37 °C mpaka 40 °C (99 °F mpaka 104 °F)"]
    H --> I["Kutenthetsanso kwa 15 mpaka 30 Min mpaka Distal Flushing"]
    I --> J["Padding Wosabala Pakati pa Digits; Kwezani Limb"]
    J --> K["Urgent Hospital Transport for Thrombolysis / Iloprost"]

Kuwonongeka kwachindunji kwa zomangamanga¶

Kutentha kwa minofu kutsika pansi pa kuzizira kwa seramu ya munthu (-0.55 °C / 31.01 °F), kuzizira kozizira kumawonekera:

Ice crystal nucleation imayambira m'malo amadzimadzi owonjezera omwe amakhala otsika kwambiri.

Pamene madzi amadzimadzi amtundu wa extracellular amasintha kukhala makristasi olimba a ayezi, madzi otsala osawuma osawuma amakhala hyperosmolar.

Izi zochititsa chidwi za osmotic gradient zimakoka madzi amadzimadzi kuchokera mkati mwa maselo oyandikana nawo kudzera mu nembanemba zam'manja, zomwe zimapangitsa kuchepa kwa madzi m'thupi.

Ma electrolyte a intracellular ndi ma enzymes amakwera kwambiri, kusokoneza kagayidwe kachakudya, kutulutsa mapuloteni, ndikugwa kwa nembanemba ya lipid bilayer.

Ngati kuzirala kuli kofulumira kapena kuwonetseredwa kwa nthawi yayitali, makhiristo a ayezi amalowa mkati mwa intracellular cytoplasm. Madzi oundanawa, okulirakulira, amakhala ngati ma scalpels ang'onoang'ono, omwe amadula ma cytoskeleton ndi nembanemba yama cell kuchokera mkati.

Microvascular thrombosis ndi kuwonongeka kwa reperfusion¶

Gawo lachiwiri la kuvulala kwa frostbite kumachitika pamene kufalikira kumayesa kubwerera kumalo owonongeka ozizira:

Minofu yozizira ikayamba kutenthedwa, ma arterioles omwe kale anali ophwanyidwa ndi ma venu amakula. Komabe, capillary endothelium yomwe ili ndi tinthu tating'onoting'ono tating'onoting'ono tawonongeka kale kuzizira.

Maselo owonongeka a endothelial amatupa, kusweka, ndikulira madzimadzi ozungulira mkati mwa interstitium, kumapanga edema yaikulu.

Mapulateleti a magazi ndi erythrocyte amamatira ku collagen yowonekera m'mphepete mwa makoma ovulala, ndikupanga microvascular thrombi (kutsekeka kwa magazi).

Maselo ofiira a magazi ophwanyidwa amatsekereza capillary lumen, chodabwitsa chotchedwa vascular stasis. Kuthamanga kwa magazi kumasiya, kulepheretsa minofu yapansi ya mpweya ndi glucose ngakhale kuti chiwalocho chatenthedwanso.

Mogwirizana ndi vascular stasis, reperfusion imatulutsa avalanche of inflammatory mediators: arachidonic acid, thromboxane A2, prostaglandins, ndi poizoni reactive oxygen free radicals. Thromboxane A2 imayambitsa kuphatikizika kwa mapulateleti am'deralo ndikukhazikika kwa vasospasm, kukulitsa ischemic necrosis mkati mwa minofu ndi mafupa.

Magawo azachipatala: chisanu cha digiri yoyamba mpaka digiri yachinayi necrosis¶

Kuzindikira bwino kuzama kwa kuzizira kwa minofu kumayang'anira chithandizo choyamba, ziyembekezo zakutsogolo, komanso kuthamangitsidwa. Mankhwala azachipatala amagawa kuvulala kozizira pogwiritsa ntchito magawo azikhalidwe a digirii zinayi komanso kachitidwe kamakono ka Cauchy ka magawo anayi.

Traditional Four-Degree Frostbite Staging:
--------------------------------------------------------------------------------
1st Degree (Frostnip):   Superficial; erythema, numbness; NO blisters or necrosis.
2nd Degree (Superficial): Clear bullae; partial dermal freeze; skin remains pliable.
3rd Degree (Deep):       Hemorrhagic (bloody) bullae; full-thickness dermal death.
4th Degree (Deep):       Muscle/bone frozen; mummification; dry gangrene; autoamputation.

Frostbite wa digiri yoyamba (frostnip)¶

Frostnip imayimira kuvulala kwachiphamaso, kosinthika kozizira komwe kumangopita ku epidermis:

Khungu limawoneka lotumbululuka, phula, kapena erythematous (lofiira), limodzi ndi dzanzi, kunjenjemera, kapena kuluma.

Palpation imasonyeza kuti minyewa yomwe ili pansi pa khungu imakhala yofewa, yolimba, komanso yokhazikika pamwamba pa fupa.

Makhiristo a ayezi amangopanga pakhungu kapena mkati mwa stratum corneum wosanjikiza kwambiri.

Palibe matuza omwe amatuluka, ndipo palibe kutayika kwa minofu kosatha. Akatenthedwanso, malowa amakhala hyperemic (ofiira kwambiri), otentha, ndi kutupa, kuthetsa kwathunthu mkati mwa masiku angapo ndi kupukuta kowoneka ngati kutentha kwa dzuwa.

Frostbite wa digiri yachiwiri (wapamwamba kwambiri makulidwe a dermal)¶

Frostbite yachiwiri imaphatikizapo kuzizira kwa epidermis yonse ndi zigawo zapamwamba za dermis:

Malo omwe akhudzidwawo amamva kuzizira, dzanzi, ndi kuuma pokhudza, ngakhale zozama zakuya zimasunthabe.

Pasanathe maola 12 mpaka 24 munthu atayambanso kutenthedwa, matuza aakulu, olimba, odzaza ndi madzimadzi ooneka ngati udzu (clear bullae) amatuluka.

Matuza owoneka bwinowa akuwonetsa kuti maukonde amkati a capillary amakhalabe akugwira ntchito pang'ono ndipo akutulutsa madzi a m'magazi mu danga la subepidermal.

Pansi pa chithuza chong'ambika chowoneka bwino chimawoneka pinki, chonyowa, ndipo chimakhala ndi kumveka bwino. Frostbite yachiwiri nthawi zambiri imachiritsa pakadutsa milungu iwiri kapena inayi popanda kuchitidwa opaleshoni yaying'ono, ngakhale kuti odwala nthawi zambiri amavutika ndi kuzizira kwanthawi yayitali komanso kumva kuwawa kwa neuropathic.

Frostbite yachitatu (kuzizira kwa minofu yakuya)¶

Frostbite yachitatu imayimira kuwonongeka kwathunthu kwa khungu ndi mafuta a subcutaneous:

Mphuno yachisanu imakhala yamatabwa, yolimba, komanso yosasunthika. Pakusungunuka koyamba, khungu limawoneka ngati laling'ono, lofiirira kapena lotuwa.

Mkati mwa maola 24 mpaka 48, matuza akuda, otaya magazi odzaza ndi madzi ofiirira kapena amagazi amayamba.

Matuza a hemorrhagic ndi chizindikiro chachipatala chowopsa chosonyeza kuti dermal vascular plexus yakuya yaphwanyidwa ndikusweka, kumatuluka magazi m'magulu akufa.

Pansi pa chithuza chothyoka chokhetsa magazi ndi chakuda, chowuma, komanso chosasunthika poyesa kuyezetsa pinprick. Kuvulala kwa digiri yachitatu kumasiya kutumphuka kwakuda, kolimba (eschar) komwe kumagwira kwa milungu ingapo, kumafuna kudulidwa opareshoni kapena kumezanitsa khungu.

Frostbite yachinayi (deep structural necrosis)¶

Frostbite yachinayi imaphatikizapo kuzizira kwathunthu ndi ischemic necrosis yomwe imafalikira pakhungu, mafuta ocheperako, minofu yamimba, tendons, periosteum, ndi fupa:

Mapeto ake ndi oundana olimba, akuwoneka ngati chipika chozizira, chokhazikika, chonga mwala chomwe sichingasunthidwe kapena kulowetsedwa ndi kukakamizidwa.

Pambuyo pakuwothanso, minofuyo imakhala yozizira, yopanda magazi, komanso yamtundu wa cyanotic kapena yakuda.

Matuza nthawi zambiri kulibe kapena aang'ono kwambiri ndipo amataya magazi m'mphepete mwa proximal, chifukwa microcirculation imawonongeka kotheratu kotero kuti palibe madzi a m'magazi omwe angapopedwe kuti apange chithuza.

Pakatha milungu ingapo, malekezero a munthu wakufayo amadulidwa mouma. Minofu yakuda, yofotayo imapanga fupa lolimba, lopindika lomwe limasiyana momveka bwino ndi minofu yathanzi, ndipo pamapeto pake amachitidwa opaleshoni kapena kudzicheka modzidzimutsa.

Ndondomeko yomiza mwachangu m'madzi ofunda¶

Muyezo wagolide wosungunula minyewa yachisanu ndikuwothanso mwachangu m'madzi ofunda. Kupangidwa kudzera mu kafukufuku wambiri wazachipatala ndi mabungwe azachipatala ndi Wilderness Medical Society (WMS), protocol iyi imasunga kuchuluka kwa minofu yomwe imatha kupulumutsidwa.

Kuwothanso pang'onopang'ono (monga kulola kuti minofu isungunuke ndi kutentha kwa chipinda) kumatalikitsa gawo lowopsa lomwe madzi oundana amasungunuka ndikuundananso, ndikuwonjezera kuwonongeka kwa ma cell. Kumizidwa mwachangu m'madzi osambira kumachepetsa nthawi yosinthira yowonongayi.

Kuwongolera bwino kutentha: 37 °C mpaka 40 °C (99 °F mpaka 104 °F)¶

Kutentha kwamadzi pakuwothanso kuyenera kuyang'aniridwa mosamalitsa:

Zenera la achire ndi 37 °C mpaka 40 °C (99 °F mpaka 104 °F). M'chipululu mulibe choyezera choyezera kutentha, madzi ayenera kumva kutentha mpaka kukhudza chigongono chosavulala, mofanana ndi madzi osambira omasuka a ana.

Musapitirire 40 °C (104 °F). Minofu yolumidwa ndi chipale chofewa yachita dzanzi ndipo simatha kumva kuyaka. Kuyika dzanja kapena phazi lozizira m'madzi otentha kuposa 40 ° C kumapangitsa kuti pakhale kutentha koopsa komanso kuyaka kwa mapuloteni oundana pamwamba pa kuvulala kozizira.

Osatenthetsanso m'madzi ozizira kuposa 37 °C (99 °F), chifukwa kutentha kwapang'onopang'ono kumatalikitsa kulimbikira kwa ayezi ndikuchedwetsa kubwereza kwa microvascular.

+-----------------------------------------------------------+
|             WATER BATH REWARMING SPECIFICATIONS           |
|                                                           |
|  [.] TARGET TEMPERATURE: 37 °C to 40 °C (99 °F to 104 °F) |
|  [.] DURATION: 15 to 30 minutes continuous immersion      |
|  [.] ADD WARM WATER CONTINUOUSLY to maintain target range |
|  [.] AGITATE GENTLY; never rub tissue against basin walls |
|                                                           |
|  STOP IMMERSION WHEN:                                     |
|  - Distal skin turns soft and pliable to touch            |
|  - Red or purple flushing appears at tips of digits       |
+-----------------------------------------------------------+

Pang'ono ndi pang'ono kusamba madzi¶

Tsatirani izi posamba posambitsa madzi ofunda:

1. Tetezani chidebe choyenera. Gwiritsani ntchito beseni loyera, mphika, kapena mphika waukulu wokwanira kuti muzitha kuzizira popanda khungu kukhudza mbali kapena pansi pa chidebecho.
2. Sakanizani madzi ndi kutentha komwe mukufuna. Sakanizani madzi otentha ndi ozizira mpaka thermometer itsimikizire kutentha kwa 38 °C (100.4 °F). Ngati alipo, onjezani sopo kapena mankhwala a chlorhexidine m'madzi kuti muchepetse kuchuluka kwa mabala a bakiteriya.
3. Chotsani zodzikongoletsera zonse ndi zovala. Chotsani mphete, zibangili, kapena masokosi otsala. Kutupa kumayamba nthawi yomweyo pakuwothanso; mphete zachitsulo zomwe zasiyidwa pa zala zidzakhala ngati ma tourniquets olimba, zomwe zimapangitsa kuti pakhale chilonda cha digito.
4. Miwirini malekezero oundana. Mitseni mwendo womwe wakhudzidwa kwathunthu m'madzi. onetsetsani kuti zala kapena zala zikuyandama momasuka ndipo zisapume ndi chitsulo cholimba kapena pulasitiki pansi pa mphikawo.
5. Onetsetsani ndikuwonjezera kutentha kwa madzi nthawi zonse. Mnofu woundana umatenga kutentha mwachangu, kuziziritsa madzi osamba. Yang'anani kutentha kwa madzi mphindi zisanu zilizonse. Onjezerani madzi otentha pang'ono mumtsuko kutali ndi khungu la wodwalayo, ndikuzungulira madziwo pang'onopang'ono kuti asunge kutentha kofanana pakati pa 37 °C ndi 40 °C.
6. Bweretsani kwa mphindi 15 mpaka 30. Pitirizani kumizidwa mpaka nsonga zakutali za manambala zitakhala zofewa, zofewa, ndikuwonetsa zizindikiro za erythema (yofiira kapena yofiirira). Osafupikitsa kusamba ngati minofu imakhala yolimba komanso yotumbululuka.
7. Chotsani modekha ndi mpweya wouma. Kwezani malekezero kunja kwa bafa mosamala kwambiri. Osapukuta kapena kupaka khungu ndi thaulo. Lolani nthambi kuti ziume kapena zichotse chinyezi ndi zopyapyala, zosamatira zopyapyala.

Chiwopsezo chosungunula-kuzizira: chifukwa chiyani mapazi oundana amayenda, mapazi osungunuka amafa¶

Imodzi mwa mfundo zotsutsa komanso zofunika kwambiri pamankhwala adzidzidzi ozizira ndi kuletsa kusungunuka m'munda pamene kuzizira kuli kotheka.

Fufuzani ndi kupulumutsa ogwira ntchito ndi madokotala a m'chipululu mobwerezabwereza amakumana ndi zochitika zomvetsa chisoni zomwe anthu omwe ali ndi zolinga zabwino amatsitsimutsa mnzake mapazi oundana mkati mwa hema kapena chipale chofewa, kuti azindikire kuti wodwalayo sangathenso kuyenda, phwando silingatulutsidwe ndi helikopita chifukwa cha nyengo, ndipo mapazi osungunuka amaundana molimbanso pa ulendo wotsatira.

Tsoka la biophysics la refreezing¶

Kuziziritsanso minofu yosungunuka ndikowopsa padziko lonse lapansi:

Panthawi yoziziritsa koyamba, makhiristo oundana amapangidwa makamaka m'malo a extracellular. Ma cell ena amakhalabe ndi moyo, ndipo capillary structural integrity imasungidwa pang'ono.

Chiwalocho chikasungunuka, edema yayikulu imasefukira m'matumbo. Mipata yowonjezera imakula ndi exudate yotupa, ndipo ma microvessels amakula.

Chiwalocho chikaundana kachiwiri, kuchuluka kwa madzimadzi mkati mwa minyewa yotupayo kumapanga tinthu tambirimbiri ta ayezi. Mipangidwe ya ayezi yomwe ikukulirakuliraku imang'amba nembanemba iliyonse ya cell, kuphwanya ma capillaries omwe angotsegulidwa kumene, ndikudula ulusi wa minofu.

Kuzizira kumayambitsa thrombosis yathunthu, yosasinthika. Kafukufuku wachipatala amatsimikizira kuti minofu yomwe imasungunuka kuti isungunuke imadwala 100 peresenti ya full-thickness necrosis, zomwe zimachititsa kuti adulidwe kwambiri.

Initial Freeze: Extracellular ice forms; partial tissue survival possible.
      |
Rapid Thawing:  Tissues flood with fluid; capillaries reopen; massive edema.
      |
REFREEZING:     Massive ice shards shred engorged cells and crush microvessels.
      |
Result:         100% Full-Thickness Gangrene; Amputation Guaranteed.

Protocol yoyenda-pa-chisanu-yozizira¶

Ngati munthu yemwe ali ndi mapazi oundana atsekeredwa kudera lakutali lachipululu, ndipo kupulumutsidwa sikungathe kufika pamalopo:

Munthu amatha kuyenda pa mapazi oundana kwa maola ambiri kapena masiku angapo kuti akafike pamalo otetezeka. Pamene kuyenda ndi mapazi oundana kumayambitsa kuwonongeka kwa makina ndi kuvulala kwapang'onopang'ono, kutayika kwathunthu kwa minofu kumakhala kochepa kwambiri poyerekeza ndi chiwonongeko choopsa chomwe chimabwera chifukwa cha thaw-refreeze cycle.

Osachotsa nsapato za odwala. Nsapato yachisanu imagwira ntchito ngati chingwe cholimba, kuteteza phazi lachisanu kuti lisawonongeke.

Osayika mapaketi otentha kapena madzi ofunda. Sungani phazi lozizira mpaka wodwalayo ali mkati mwa galimoto yotentha, chipatala, kapena malo osungiramo mapiri okhazikika kumene kutentha kosalekeza kumatsimikiziridwa.

Pitirizani kunja kwa nsapato kuti musagwedezeke, limbitsani wodwalayo ndi mitengo yoyenda, ndipo yendani pang'onopang'ono kumutu wapafupi kapena malo ochotsamo.

Wodwalayo akafika pamalo otetezeka kumene kutentha kumatsimikiziridwa, nthawi yomweyo perekani ndondomeko yomiza m'madzi ofunda mofulumira.

Kusamalira ululu wobwerezabwereza komanso kuwongolera matuza¶

Kuwotha moto wovulala wachisanu ndizochitika zowawa kwambiri. Magazi akamabwereranso m'mitsempha ya ischemic ndi minofu, odwala amamva kupweteka kwambiri, kuyaka, ndi mphamvu zamagetsi zomwe nthawi zambiri zimafotokozedwa ngati zowawa.

Kuwongolera koyenera kwa ululu ndi chisamaliro cha matuza ndizofunikira kwambiri pakuwongolera pambuyo pakutha.

Pharmacological pain control¶

Othandizira oyamba ndi othandizira azachipatala ayenera kuyembekezera kupweteka kwambiri ndikuyambitsa njira zochepetsera ululu msanga:

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) ndiye njira yayikulu yochizira matenda achisanu. Ibuprofen imakondedwa chifukwa imagwira ntchito ngati systemic inhibitor ya cyclooxygenase pathway:

Ibuprofen imalepheretsa kaphatikizidwe ka thromboxane A2 ndi prostaglandins, oyimira pakati pa biochemical omwe amachititsa kuphatikizika kwa mapulateleti, kutsekeka kwa microvascular, ndi vasoconstriction.

Perekani ibuprofen (nthawi zambiri 400 mg mpaka 800 mg pakamwa maola 8 aliwonse mwa akuluakulu, molingana ndi ndondomeko zachipatala zakumaloko komanso kulolerana kwa odwala).

Acetaminophen (paracetamol) ikhoza kuwonjezeredwa kuphatikiziro lapakati la analgesic synergy, kusinthana ndi ibuprofen.

M'zipatala zachipatala, ma analgesics a opioid (morphine, fentanyl, kapena hydromorphone) nthawi zambiri amafunika kuti athetse ululu wopweteka kwambiri panthawi yosamba.

Ndondomeko zamakono zoyendetsera matuza¶

Matuza amawonekera mkati mwa maola 6 mpaka 24 atawothanso, kuwoneka ngati bullae wowoneka bwino kapena mdima wakuda wa hemorrhagic bulla. Kusamalira bwino matuzawa kumateteza matenda obwera m'mabala:

Siyani matuza owoneka bwino ngati kuli kotheka. Denga la matuza limapangidwa ndi stratum corneum yakufa yomwe imapanga chovala chosabala, chowotcha. Madzi owoneka bwino a blister ali ndi zinthu zochiritsa zomwe zimathandizira kuyambiranso kwa dermal re-epithelialization.

Ngati chithuza chowoneka bwino chikuvutitsidwa kwambiri ndikuwopseza kuphulika panthawi yoyendetsa, akatswiri azachipatala amatha kutulutsa madziwa pansi pamikhalidwe yovuta kwambiri pogwiritsa ntchito singano yosabala, ndikusiya khungu lachithuza losalala pabedi la bala.

Osachotsa kapena kukhetsa matuza otaya magazi m'munda. Matuza a hemorrhagic amawonetsa kuchuluka kwa dermal necrosis. Kuchotsa denga la matuza kumavumbula tsinde lopunduka, lakuya la dermal molunjika ku kuipitsidwa ndi bakiteriya, kutembenuza bala louma la ischemic kukhala chowopsa, chonyowa chotupa.

Ikani gel osakaniza aloe vera ngati alipo. Aloe vera wangwiro ndi mdani wogwira mtima wa thromboxane. Kupaka aloe vera pakhungu losungunuka, losasunthika pakatha maola 6 aliwonse kumachepetsa dermal ischemia ndikuwongolera kupulumutsa kwa minofu.

Manga malekezero momasuka muzovala zazikulu zosabala. Ikani zopyapyala zopyapyala zopyapyala pakati pa chala chilichonse kapena chala chilichonse kuti muteteze maceration, kulungani phazi lonse kapena dzanja lonse ndi chopyapyala chopyapyala, ndikutsekereza chiwalocho ndi mphira wopepuka.

Njira zapadziko lonse lapansi zochizira chimfine ndi zipatala¶

Chithandizo cha chisanu choopsa chapita patsogolo kwambiri pazaka makumi awiri zapitazi. Zipatala zapadera zowotcha ndi zipatala zovulala mozizira tsopano zikugwiritsa ntchito njira zotsogola za mitsempha zomwe zimapulumutsa miyendo yomwe idayenera kudulidwa.

Njira zotsogola zachipatala: thrombolytics ndi prostacyclin analogues¶

Wodwala yemwe ali ndi chimfine choopsa kwambiri akafika kuchipatala chapadera mkati mwa maola 24 mpaka 72 atavulala, chithandizo chapamwamba chimayambika:

Mtsempha kapena intra-arterial minofu plasminogen activator (tPA). Ngati angiography kapena multispectral laser Doppler imaging imatsimikizira kusakhalapo kwa magazi m'mitsempha yakutali ya digito, madokotala amapereka tPA yoyendetsedwa ndi catheter mwachindunji m'mitsempha yamagazi. tPA imasungunula mitsempha yamagazi ya microvascular, kubwezeretsanso kutulutsa kwa capillary ku manambala a ischemic ndikuchepetsa kwambiri kudulidwa.

Ma analogi a Prostacyclin (Iloprost). Iloprost imagwiritsidwa ntchito kwambiri ku Europe ndi Canada, ndikuvomerezedwa ndi FDA ku United States, iloprost ndi analogi ya prostacyclin yoyendetsedwa ndi kulowetsedwa m'mitsempha. Imapangitsa vasodilation yamphamvu, imalepheretsa kuphatikizika kwa mapulateleti, ndikukonzanso makoma owonongeka a cell endothelial, ndikusunga manambala mpaka maola 72 mutatenthetsanso.

Hyperbaric oxygen therapy (HBOT). M'malo osankhidwa achipatala, odwala amalandira 100 peresenti ya okosijeni mkati mwa chipinda chopanikizika cha hyperbaric pa 2.0 mpaka 2.5 atmospheres. HBOT imadzaza minyewa ya ischemic ndi okosijeni wosungunuka, imathandizira kuphulika kwa bala, komanso imachepetsa edema yobwezeretsanso.

Kuchedwetsa kudulidwa kwa opaleshoni (mfundo yodikira). Opaleshoni yamakono yachisanu imatsatira lamulo lokhazikika lokhazikika: "Frostbite mu Januwale, kudula mu July." Eschar yakufa, yakuda imaloledwa kuti iume, kuyimitsa, ndikudula malire mwachilengedwe kwa miyezi iwiri kapena isanu ndi umodzi. Kudula mafupa ochita opaleshoni nthawi isanakwane kumadula minofu yomwe imawoneka yakufa pamwamba koma imakhala yotheka, ndikupangitsanso ma capillaries m'mizere yozama.

Kusamutsidwa kumunda, zoyendera, komanso kusiyana kopanda kuzizira kozizira¶

Kuyendera kotetezeka kuchokera kumalo ozizira kumafunikira kukhala tcheru mosalekeza motsutsana ndi chipongwe chaching'ono cha chilengedwe.

Ma protocol ndi immobilization¶

Paulendo wopita ku chipatala, wodwalayo ayenera kuthandizidwa mosamala kwambiri:

Kwezani malekezero osungunuka pamwamba pa mlingo wa mtima. Edema ya post-thaw imafika pamtunda wa maola 24 mpaka 48. Kukwezera mwendo kumachepetsa kuthamanga kwa interstitial capillary hydrostatic, kumachepetsa kutupa, komanso kumachepetsa kugunda kowawa.

Dulani nthambi momasuka. Gwiritsani ntchito chingwe chopindika cha SAM kapena chingwe cholimba kuti musasunthe dzanja kapena bondo. Izi zimalepheretsa kupindika kapena kugundana mwangozi panthawi yamayendedwe m'malo ovuta.

Sungani wodwalayo kutentha ndi madzi. Perekani madzi a m'kamwa ofunda, okoma ngati wodwalayo akudziwa, ali tcheru, ndipo amatha kumeza popanda kutsamwitsidwa. Pewani caffeine, yomwe imayambitsa vasoconstriction ya zotumphukira.

Tetezani kuziziritsa kwa convective mu ma ambulansi ndi ndege. Ma aircrafts mkati mwa ma helikoputala othamangitsidwa kapena magalimoto onyamula amatha kuziziritsa minofu yotenthedwa. onetsetsani kuti wodwalayo wasindikizidwa mkati mwa thumba la zotengera zotenthetsera.

Post-Thaw Care Checklist:
- [ ] Extremity elevated strictly above heart level.
- [ ] Dry sterile gauze placed between each individual toe or finger.
- [ ] Bulky, loose outer dressing applied; NO tight circumferential tape.
- [ ] Limb immobilized with a padded splint to prevent movement trauma.
- [ ] Patient receiving oral ibuprofen for thromboxane inhibition.
- [ ] Whole-body warmth maintained; patient shielded from vehicle drafts.

Kusiyanitsa chisanu ndi kuvulala kosazizira kozizira¶

Othandizira oyamba nthawi zambiri amasokoneza chisanu ndi kuvulala kosazizira kozizira (NFCI), monga phazi la ngalande (phazi lomiza) ndi chilblains (pernio):

Frostbite imafuna kuzizira kwenikweni (pansi pa 0 °C / 32 °F) ndipo imaphatikizapo mapangidwe a ayezi mkati mwa minofu.

Phazi la ngalande limapezeka m'malo onyowa, osazizira kuyambira 0 °C mpaka 15 °C (32 °F mpaka 59 °F) chifukwa cha kusasunthika kwa nthawi yayitali mu nsapato zonyowa kwa maola 12 kapena masiku angapo. Palibe mawonekedwe a ayezi; chovulalacho chimayamba chifukwa cha kusakhazikika kwa capillary constriction, endothelial hypoxia, ndi neurovascular maceration.

Chilblains (pernio) amayimira zotupa zapakhungu za vasospastic zomwe zimachitika pambuyo pozizira kwambiri, mpweya wonyowa pamwamba pa kuzizira, zomwe zimawoneka ngati zoyabwa kwambiri, zopweteka zofiira kapena zofiirira pazala kapena zala.

Kuchiza phazi la ngalande ndi madzi otentha a 40 °C (104 °F) sikuloledwa, chifukwa kutentha kwachangu kumawonjezera kupweteka kwa mitsempha ndikuwonjezera kuwonongeka kwa minofu. Zovulala zozizira zosazizira ziyenera kutenthedwa pang'onopang'ono kutentha, kutsukidwa modekha ndi antiseptic, ndi kuumitsa bwino.

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi ndipaka matalala pa zala zolumidwa ndi chisanu kuti zitenthetse?¶

Ayi. Kupaka chipale chofewa ndi chipale chofewa ndi nthano yoopsa kwambiri chifukwa chipale chofewa chimatentha komanso kuzizira kwambiri. Kupaka minofu ya dzanzi kumapangitsa kuti madzi oundana ang'ambe kupyola m'maselo osalimba ndikuchotsa zigawo zoteteza. Osapaka, kusisita, kapena kumenya mbama khungu lomwe lalumidwa ndi chisanu. Chitani minofu mofatsa kwambiri ndikuitenthetsa mumsamba wofunda wamadzi ofunda.

Kodi ndiyenera kuchita chiyani ngati wovulala ndi chisanu akuyenda kuti akapulumutse anthu?¶

Ngati munthu amene ali ndi mapazi oundana ayenera kuyenda kupita kumalo otetezeka, musayese kusungunula mapazi ake. Kuyenda pa mapazi oundana kumakhala kowawa ndipo kumayambitsa microtrauma, koma kuyenda pamapazi omwe angosungunuka kumene kumaphwanya ma capillaries otupa, kumayambitsa kupweteka kwambiri, ndipo kumabweretsa chiwonongeko chakupha ngati mapazi amaundananso pakuyenda. Valani nsapato, tulukani mozizira, ndipo yambitsani kutenthetsa madzi ofunda pokhapokha ngati nyumba yokhazikika yamkati yafika.

Ndi kutentha kotani komwe kumatenthetsanso chisanu m'madzi?¶

Madzi osamba ayenera kusamalidwa bwino pakati pa 37 °C ndi 40 °C (99 °F mpaka 104 °F). Madzi otentha kuposa 40 ° C amawotcha ndikuwotcha minofu ya dzanzi, pomwe madzi ozizira kuposa 37 ° C sangasungunuke minofu mwachangu kuti aletse kuwonongeka kwa ayezi. Yang'anirani madzi mosalekeza ndi thermometer, ndikuwonjezera madzi ofunda pang'ono kuti asunge kutentha koyenera kwa mphindi 15 mpaka 30.

Kodi nditulutse matuza akulu odzaza madzimadzi omwe amapangidwa nditatha kusungunuka?¶

Ayi. Osatulutsa, kukhetsa, kapena kusenda matuza achisanu m'munda. Matuza osawoneka bwino amakhala ngati mabandeji osabala omwe amateteza dermis yaiwisi, yotulukanso pansi. Matuza amdima kapena amagazi amawonetsa kuwonongeka kwa minofu yakuya ndipo sayenera kutsegulidwa, chifukwa kuwaswa kumalola mabakiteriya owopsa kuti alowe m'minyewa ya devitalized ndikuyambitsa matenda oopsa.

Chifukwa chiyani ibuprofen imalangizidwa makamaka pachisanu?¶

Ibuprofen ikulimbikitsidwa chifukwa ndi mankhwala osagwiritsa ntchito steroidal odana ndi kutupa omwe amalepheretsa kupanga thromboxane A2 ndi prostaglandins. Mankhwalawa amachititsa kuti magazi aziyenda kwambiri komanso kutsekeka kwa magazi m'mitsempha yotenthedwanso. Kutenga ibuprofen koyambirira kumachepetsa kutsekeka kwa ma microvascular, kumachepetsa ululu wowawa, komanso kumathandizira kupulumutsa zala ndi zala zomwe zili pachiwopsezo.

Chitsimikizo cha thandizo loyamba¶

Kuwongolera zoopsa zozizira zachilengedwe kumafuna maphunziro othandiza, ozikidwa pa umboni omwe amapitilira chidziwitso chabodza. Kuzindikira kusintha kosawoneka bwino kuchokera ku chipale chofewa kupita ku kuzizira kwambiri, kudziwa kutenthetsa madzi osamba mwachangu, ndikupereka kugawanika koyenera kungatanthauze kusiyana pakati pa kuchira kwathunthu ndi kudulidwa kosintha moyo.

Timalimbikitsa kwambiri onse okonda panja, oyenda m'nyengo yozizira, ndi okwera mapiri kuti amalize maphunziro ovomerezeka ku wilderness first aid (WFA) kapena thandizo loyamba lokhazikika ndi kutsitsimula mtima kwamtima (CPR). Othandizira odziwika monga American Red Cross, Canadian Red Cross, St John Ambulance, ndi British Red Cross amapereka maphunziro apadera a chipululu komanso zachilengedwe. Chitsimikizo chimawonetsetsa kuti muli ndi luso lothandizira, kukhazikika m'malingaliro, komanso chidziwitso chachipatala chofunikira kuti muzitha kuyendetsa bwino pakagwa mwadzidzidzi.

Magwero afufuzidwa¶

• Wilderness Medical Society (WMS, United States): Malangizo Othandizira Pachipatala Popewa ndi Kuchiza Frostbite.
• American Burn Association (ABA, United States): Malangizo Othandizira Kuvulala kwa Frostbite M'malo Owotcha Mwapadera.
• Canadian Association of Emergency Physicians (CAEP, Canada): Management of Severe Frostbite mu Dipatimenti Yowopsa.
• Bungwe la British Mountaineering Council (BMC, United Kingdom): Frostbite Clinical Guidelines, Recognition, and Field Management.
• International Commission for Mountain Emergency Medicine (ICAR-MEDCOM): Pamalo Chithandizo cha Frostbite ku Mountain Rescues.
• European Wilderness Medical Society (EU): Ulamuliro wa Zovulala Zozizira Mwangozi ndi Njira Zowonjezereka Zowonjezereka.

Maupangiri ogwirizana¶

• Hypothermia ndi frostbite chithandizo chadzidzidzi
• Kuzindikira modabwitsa ndi kasamalidwe mu zoopsa
• Mkuntho wa dzinja komanso njira zopulumutsira mvula yamkuntho
• Thandizo loyamba lamagetsi ndi magetsi oyaka kwambiri
• Nambala zadzidzidzi malinga ndi dziko