Ama-Chilblains, i-pernio, nonyawo lomsele: ukunakekelwa okubandayo okungabandi¶

Ukulimala okubandayo okunganqamuki (i-NFCI) kumelela isigaba esisabalele, esibuhlungu, futhi esivame ukuwohloka kwezemvelo esihlukile kunesithwathwa sangempela. Nakuba isithwathwa sidinga amazinga okushisa angaphansi kweqhwa ukuze enze amakristalu eqhwa enyameni, ukulimala okungabandi kakhulu kukhula emazingeni okushisa angaphezu kwamaqhwa, ngokuvamile asukela phakathi kuka-0 °C no-15 °C (32 °F no-59 °F). Lapho isikhumba somuntu esingenalutho noma esingavamisile kahle sinomswakama ophikelelayo, izicathulo ezimanzi, kanye nokubanda okuqhubekayo phakathi namahora noma izinsuku, ukulimala okukhulu kwemizwa kwenzeka ngaphandle kwekristalu yeqhwa eyodwa.

Ukubonakaliswa komtholampilo okubili okuyinhloko kokulimala okunganqamuki amakhaza ama-chilblains (abuye aziwe ngokomtholampilo njenge-pernio noma i-perniosis) kanye nonyawo lomsele (unyawo lokucwiliswa). Ama-chilblain avela njengamanxeba esikhumba asendaweni, aluma kakhulu, ama-erythematous noma avuvukalayo ezinzwaneni, eminweni, ekhaleni, noma ezindlebeni, aqhutshwa i-microvascular vasospasm engajwayelekile lapho efudumala. I-Trench foot iyisimo se-neurovascular esijulile, esihlelekile esibangelwa ukucwiliswa isikhathi eside noma umswakama ngaphakathi kwamabhuzu aqinile, okubangela i-epidermal maceration, ukubhujiswa kwezinzwa ezizimele, ukuzwela okubandayo okungapheli, nobuhlungu obungapheli be-neuropathic. Ukuqonda i-pathophysiology ehlukile, isiteji somtholampilo, izinqubo zokomisa kahle, kanye nokuphikisana okuqinile ngokumelene nokufudumala kwamanzi ashisayo kuvikela iziguli ekukhubazekeni kwemithambo yegazi impilo yonke kanye nemithambo yegazi.

Yenza lokhu manje¶

1. Khipha izicathulo ezimanzi, amasokisi, nezingubo ezimanzi ngokushesha. Ukuqeda ukuthintana ngqo nendwangu emanzi kumisa ukupholisa okuhwamukayo okuqhubekayo futhi kumise ukubola kwe-epidermal okuqhubekayo.
2. Faka kabusha izingxenye ezithintekile kancane kancane ezingeni lokushisa elivamile legumbi. Vumela izitho ukuthi zifudumale zingenzi lutho emoyeni phakathi kuka-20 °C no-22 °C (68 °F kuya ku-72 °F); ungalokothi ucwilise ukulimala okubandayo okungabandi emanzini okugeza amanzi ashisayo.
3. Geza isikhumba ngobumnene ngokwedlulele usebenzisa insipho ethambile namanzi afudumele. Hlanza umjuluko onqwabelene, amagciwane, nokungcola ngaphandle kokukhuhla, njengoba izinyembezi zokungqubuzana ziba buthakathaka, isikhumba esigcwele amanzi.
4. Bamba isikhumba ngethawula elithambile nelihlanzekile. Vala umswakama ngobumnene; ungalokothi uhlikihle, uqhwebe, noma uhlikihle ngamandla izinzwane ezithintekile, amatheni, noma iminwe.
5. Phakamisa izinyawo noma izandla ngaphezu kweleveli yenhliziyo kancane. Ukugxilisa izitho zomzimba emicamelweni noma ezingubeni ezigoqiwe kunciphisa ukuhlangana kwegazi elidonsela phansi futhi kuqede i-edema ehlabayo ebuhlungu.
6. Yomisa isikhumba esingenalutho emoyeni ohlanzekile, owomile ngaphambi kokufaka amasokisi ewulu axegayo, ahlanzekile. Gcina izitho ezithintekile zichayeke emoyeni wegumbi elizungezayo okungenani imizuzu engama-30 kuya kwengama-60, uqiniseke ukuthi isikhumba somile ngokuphelele ngaphambi kokufaka izicathulo ezixegayo, ezingabambezeli.

I-Pathophysiology yokulimala okubandayo okungabandi: i-vasospasm kanye ne-maceration¶

Ukulimala okunganqamuki okubandayo kuyahluka ngokuyisisekelo kusukela kuqhwa ezinkambisweni zabo ze-biophysical, ubude besikhathi sokuchayeka, kanye ne-neurovascular sequelae yesikhathi eside.

flowchart TD
    A["Ukubamanzi Isikhathi Eside, Ukuchayeka Kubanda (0 °C ukuya ku-15 °C / 32 °F ukuya ku-59 °F)"] --> B["I-peripheral Arteriolar Vasoconstriction eqhubekayo"]
    B --> C["I-Capillary Endothelial Hypoxia & Ukuvuza Kwe-Fluid"]
    C --> D["I-Epidermal Hydration & Stratum Corneum Maceration"]
    D --> E{"Ukubonisa Isimo Sezempilo?"}
    E -- Superficial Inflammatory Papules --> F["Ama-Chilblains (Pernio): I-Microvascular Vasospasm"]
    E -- Deep Neurovascular Breakdown --> G["I-Trench Foot (Unyawo Lokucwiliswa): Inzwa kanye ne-Capillary Stasis"]
    F --> H["I-Gentle Passive Rewarming + Topical Corticosteroid"]
    G --> I["Ukomisa Umoya Opholile + Ukuphakama + Ukugwema Okuqinile Kwamanzi Ashisayo"]
    I --> J["Ukuphathwa Kwesikhathi Eside Se-Neuropathic Pain & Raynaud Phenomenon"]

Ukungasebenzi kahle kwe-Microvascular kanye nokwehluleka kokusabela kokuzingela¶

Ukusabela komzimba womuntu okujwayelekile ekuchayekeni kubanda kuwumjikelezo:

Lapho izinga lokushisa lesikhumba lehla, imicu yemisipha ebushelelezi yasendaweni kuma-arterioles e-cutaneous iyafinyela (i-vasoconstriction ebangelwa kubanda) ukuze kuvinjwe igazi elingaphakathi elifudumele ekulahlekelweni ukushisa esikhumbeni.

Ngezikhathi ezithile, isimiso sezinzwa esizimele siqala izikhathi ezimfushane ze-vasodilation, ezaziwa ngokuthi i-Lewis hunting reaction (i-cold-induced vasodilation), ephonsa igazi elifudumele emadijithini imizuzu emi-5 kuya kweyi-10 ukuze ilethe umoya-mpilo kanye nezakhamzimba ngaphambi kokubopha futhi.

Kubantu abathintekayo noma ngesikhathi sokuchayeka kubanda okumswakama okuqhubekayo, ukusabela kokuzingela kuyehluleka:

Ama-arterioles e-cutaneous ahlala evalelwe ku-vasospasm eqhubekayo, enamandla.

Ukugeleza kwegazi kwe-capillary kuyama, kuncishe i-endothelium yomkhumbi nezicubu ezizungezile umoya-mpilo.

Amaseli e-vascular endothelial athola ukuvuvukala kwe-hypoxic, kuyilapho amangqamuzana e-perivascular mast kanye neziphetho zemizwa yezinzwa ziba yi-hyper-sensitized.

Uma isicubu esibandisiwe sifudumala kabusha ngokushesha okukhulu, impendulo engavamile yokuvuvukala ivutha:

Ama-arterioles anwebeka kungazelelwe, kuyilapho ama-venule angezansi ahlala eminyene.

Lokhu kungezwani komfutho omangalisayo kuphoqa uketshezi, amangqamuzana egazi abomvu, nama-cytokine avuvukalayo ukuba aphumele ngaphandle ngezindonga ezilimele ze-capillary angene kudermis, akhiqize i-edema enzima, ukulunywa okukhulu, ama-papules avuvukalayo, kanye ne-microvascular thrombosis.

I-biophysics ye-epidermal maceration¶

Unyawo lomsele ludinga umswakama omude. Uma izinyawo zivalelwe ngaphakathi kwamabhuzu enjoloba angaphefumuli, ama-wader epulasitiki, noma amabhuzu esikhumba aswakeme, isikhumba sezinyawo sikhipha umjuluko ongakwazi ukuhwamuka:

Unyawo lomuntu onempilo luqukethe cishe izindlala zomjuluko ezingu-250,000, ezikwazi ukukhipha umswakama ofika ku-250 ml (ama-ounces angu-8.5) ngosuku ngaphansi kokuzikhandla okuphakathi komzimba.

Ivaleleke ngaphakathi kwezicathulo ezingangeneki, i-stratum corneum (ungqimba olungaphandle lwamaseli esikhumba afile, agcwele i-keratin) imunca amanzi njengesipontshi.

Isikhumba esivamile sinamanzi angamaphesenti angu-15 kuya kwangu-20; ngaphansi kokuchayeka komswakama okuqhubekayo, okuqukethwe kwamanzi kudlula amaphesenti angu-50, inqubo eyaziwa ngokuthi i-hyperhydration noma i-maceration.

Isikhumba esinamacembe siphenduka sibe mhlophe qwa, sivuvuke, sishwabane, futhi sibe mnandi kakhulu.

Amabhondi e-lipid e-intercellular ahlanganisa usimende ama-keratinocyte ayancibilika, okubangela ukuthi umgoqo wesikhumba ulahlekelwe amandla aso okuqina kwesakhiwo.

Ukunyakaza kwe-frictional ngaphakathi kwebhuthi kugunda i-epidermis ethambile kude ne-papillary dermis, evula imifantu emincane emema amagciwane ahlaselayo okukhunta namagciwane (afana ne-cellulitis, i-gangrene emanzi, nezilonda ezinyaweni).

Ama-Chilblains (pernio): isethulo somtholampilo kanye nokuphathwa¶

Ama-chilblain (i-pernio noma i-perniosis) amele izilonda zesikhumba ezivuthayo noma ezingapheli ezibangelwa ukusabela okungavamile kwemizwa emakhazeni aswakame angaqandi. Ngokuvamile zithinta izisebenzi zangaphandle, abaqwali bezintaba, abasebenzi bezempi, kanye nabantu abanezimo eziyisisekelo zokuzivikela komzimba noma ukujikeleza okungekuhle kwe-peripheral.

Chilblains (Pernio) Anatomical Distribution:
--------------------------------------------------------------------------------
Primary Sites:    Dorsal surfaces of toes, fingertips, heels, ears, nose.
Visual Appearance: Erythematous (bright red) to violaceous (purple) swollen papules.
Key Symptoms:     Intense itching, burning pain upon rewarming, localized edema.
Distinction:      Skin remains soft and pliable; NO hard wooden freezing.
--------------------------------------------------------------------------------

Izimpawu zomtholampilo kanye nezimpawu zama-chilblain¶

Ama-chilblain akhula phakathi kwamahora angu-2 kuya kwangu-14 ngemva kokuchayeka emoyeni omanzi, obandayo:

• Amaphuphu abomvu kuya ku-violaceous. Izilonda ziqala njengamabala abomvu ahlukene, avuvukele ashintshela ngokushesha abe nsomi noma izigaxana ezinodlame. Zivela kakhulu ezicini zomgogodla wezinzwane, izinhlangothi zezinyawo, izihloko zeminwe, ibhuloho lekhala, nezindlebe.
• Ukulunywa okukhulu (ukuluma) nobuhlungu obushisayo. Uphawu oluphawulekayo lwe-chilblain ukulunywa okubuhlungu okuba namandla kakhulu lapho umuntu engena egumbini elishisayo noma engena embhedeni ofudumele. Njengoba igazi ligelezela esicutshini se-vasospastic, ukulunywa kuphenduka imizwa eshisayo ejulile.
• Amabhamuza kanye nezilonda ezimeni ezimbi kakhulu. Ku-pernio enzima noma ephindaphindayo, i-edema yendawo eqinile iphakamisa i-epidermis, yakhe amabhamuza amancane, aqinile. Uma kusetshenziswa ukungqubuzana, lawa mabhamuza ayagqabuka, ashiye izilonda ze-erythematous ezingajulile, ezibuhlungu, eziphola kancane ezithambekele ekuthelelekeni kwesibili kwe-staphylococcal.

Usizo lokuqala nokunakekelwa kwezokwelapha kwama-chilblain¶

Ukuphatha ama-chilblain kugxile ekudambiseni impendulo engavamile ye-neurovascular nokuvikela isikhumba esisengozini:

1. Khuthaza kabusha isikhumba ungenzi lutho. Ngena endlini ungene egumbini elifudumele kahle (20 °C ukuya ku-22 °C / 68 °F ukuya ku-72 °F). Vumela isikhumba sifudumale ngokwemvelo. Ungalokothi ubeke ama-chilblain eduze kwerediyetha, isifudumezi sikagesi, noma iziko elivulekile, futhi ungalokothi uwacwilise emanzini ashisayo, njengoba ama-heat spikes ashubisa kakhulu ukulunywa kanye ne-edema evuthayo.
2. Gwema konke ukunwaya nokuklwebhana. Ukunwaya ama-chilblain kudabula i-epidermis ezacile phezu kwama-papules, okuholela ezilonda ezivulekile kanye nekoloni yamagciwane. Gcina izinzipho zimfushane futhi ufake imbobo kakotini noma uvolo oxekethile.
3. Faka isicelo se-topical corticosteroid cream. Ukusebenzisa i-topical corticosteroid enamandla amaphakathi (efana nephesenti elingu-1 le-hydrocortisone noma i-triamcinolone acetonide engu-0.1%) kabili ngosuku kunciphisa ukuvuvukala kwe-capillary, kunciphisa i-edema, futhi kuqede ukulunywa.
4. Vikela ukungqubuzana ngaphakathi ezicathulweni. Uma isiguli kufanele sigqoke izicathulo, gcoba ibhandishi lebhandishi le-hydrocolloid noma umkhono wozwane wejeli we-silicone phezu kwezilonda ukuze uvimbele amaqhuqhuva ngokumelene nokuhlikihlwa ngomshini.
5. Ukwelashwa okuhlelekile kwezifo ezingelapheki noma eziphikisayo. Ezimweni ezinzima, eziphindaphindayo zasebusika, odokotela bangase banikeze oral calcium channel blockers (njenge-nifedipine, 20 mg kuya ku-60 mg nsuku zonke). I-Nifedipine ikhulula imisipha ebushelelezi ye-vascular, inwebe ama-arterioles angaphakathi, futhi isheshise ukuxazululwa kwezilonda ezingapheli ze-violaceous.

Unyawo lomsele (unyawo lokucwiliswa): izigaba ezine zomtholampilo¶

I-trench foot (unyawo lokucwiliswa) yisimo somtholampilo esiyingozi kakhulu kunama-chilblain. Imele ukuchotshozwa kwe-neurovascular okuhlangene kanye nokulimala kwe-ischemic okuthinta izicubu ezijulile ezinyaweni. Okokuqala okwaqashelwa ngezinga elikhulu phakathi kwamasosha emi emiseleni egcwele amanzi phakathi neMpi Yezwe I, unyawo lomsele luhlala luyingozi njalo phakathi kwamasosha esimanje, abaqwali, abantu abangenazindlu, nabasinde ezinhlekeleleni abavaleleke ezikhukhuleni.

Unyawo lwe-trench luqhubekela phambili ngezigaba ezine ezihlukene zomzimba, ngasinye sidinga usizo oluthile lokuqala kanye nokuphathwa komtholampilo.

flowchart TD
    A["Isigaba 1: I-Pre-Hyperemic (Ischemic)"] -->|Slow Passive Room Air Warming| B["Isigaba 2: I-hyperemic (I-Reperfusion Inflammatory)"]
    B -->|Elevation, Bed Rest, Pain Management| C["Isigaba 3: I-Post-Hyperemic (I-Chronic Neuropathic)"]
    C -->|Long-Term Nerve Recovery: 6 to 24 Months| D["Isigaba 4: I-Permanent Sequelae / Raynaud / Autonomic"]

Isigaba 1: Isigaba sangaphambi kwe-hyperemic (ischemic).¶

Isigaba sangaphambi kwe-hyperemic senzeka phakathi nesigaba sokuchayeka esibandayo, esimanzi kanye nokuhlenga ngokushesha okulandelayo:

Unyawo luyabanda, luvuvukele, luphaphathekile, lumhlophe, noma lumpunga.

Isikhumba sizwakala sicwebezela futhi sigcwele amanzi, sibonisa ukugoqa kwe-maceration okujulile, okumhlophe, okucijile eduze kwendawo yesitshalo naphakathi kwezinzwane.

I-peripheral arterial pulses (i-dorsalis pedis kanye ne-posterior tibial) ibuthakathaka ngendlela engavamile noma ayibambeki ngokuphelele ngenxa ye-arteriolar spasm enamandla.

Ukuzwa kunciphe kakhulu. Isiguli sichaza unyawo njengokuzizwa sisinda, ufile, noma njengokuthi "ukuhamba ngezikhonkwane zokhuni." Ukuzwa okuthintekayo, ukuthinta ukukhanya, nokuphendula ngokuphinifa akukho ngokuphelele ezinzwaneni zonkana kanye nengaphambili elikude.

Ukulimala phakathi nalesi sigaba kugxile ekuvuvukeni kwamangqamuzana e-endothelial, i-microvascular stasis, kanye nokuwohloka kwe-axonal kwasekuqaleni kuma-peripheral sensory and autonomic nerve fibers.

Isigaba 2: Isigaba se-hyperemic (reperfusion yokuvuvukala).¶

Isiteji se-hyperemic siqala amahora ngemva kokuba unyawo lususwe emakhazeni futhi lufudumale ekamelweni lokushisa. Imele ukusabela kokuvuvukala okuqhumayo okuthatha izinsuku ezimbalwa kuya emavikini ambalwa:

Unyawo lushintsha lube umkhawulo obomvu oshisa kakhulu, owomile, obophayo. Ama-peripheral pulses agcwala, abophe, futhi ashintshe kakhulu.

I-edema enkulu iqala, okwenza unyawo, iqakala, nomlenze ongezansi zivuvukale kuze kube kabili umthamo wazo ovamile.

Amabhamuza amakhulu, aqinile agcwele uketshezi olune-serous noma olopha kakhulu aphakamisa isikhumba esimacerated. Izindawo zesikhumba esikha phezulu ziyahlehla, ziveze i-dermis eluhlaza, ekhalayo.

Ubuhlungu obukhulu, obubuhlungu buqala ukungena. Iziguli zichaza ubuhlungu obukhulu, obushisayo, obuhlabayo kanye nokuzwa ukushaqeka kukagesi okungazelelwe (ama-paresthesias wokudubula) afinyelela emazingeni ahlabayo, ikakhulukazi ebusuku.

Ubuhlungu phakathi nalesi sigaba bubangelwa ukuvuvukala kwamakhemikhali okucasulayo okuvuselela izinzwa zezinzwa kanye ne-acute reperfusion hyperemia enwebeka imibhede yezicubu ze-ischemic.

Isiteji sesi-3: Isigaba se-post-hyperemic¶

Isigaba se-post-hyperemic siqala njengoba ukuvuvukala okunamandla kanye ne-hyperemia ebophayo kuncipha, ngokuvamile ehlala kusukela ezinyangeni ezimbili kuya kweziyi-12:

Ukuvuvukala nokubabomvu kuyaphela kancane kancane, futhi amabhamuza ome abe uqweqwe oluqinile.

Nokho, unyawo luhlala lungavamile. Isikhumba siyabanda, siphaphatheke, futhi sizwele kakhulu ekushintsheni kwezinga lokushisa.

I-Hyperhidrosis (ukujuluka ngokweqile, okubandayo) iqala ngenxa yokonakala kwemithambo yemizwa yozwela ebangela izindlala zokujuluka ngokungalawuleki.

Iziguli zihlushwa ubuhlungu obungapheli, obungalawuleki be-neuropathic, obubonakala nge-allodynia (ubuhlungu obubangelwa izisusa ezingenabuhlungu, njengokuxubha amashidi ombhede ezinzwaneni) nokungabekezelelani amakhaza. Ukuhamba ngisho nebanga elifushane kubangela ubuhlungu obujulile, obubuhlungu bethambo kanye nokukhathala okukhulu.

Isigaba 4: Ukulandelana okungapheli okungapheli¶

Ezimweni ezimbi kakhulu zonyawo lomsele lapho ukuchayeka kudlule amahora angama-48 kuye kwangama-72, ukukhubazeka okungapheli kwesakhiwo nokusebenza kuhlala impilo yonke:

Ukulahlekelwa okukhulu kwe-peripheral unmyelinated kanye ne-myelinated nerve axon kuholela ku-sensory neuropathy engapheli kanye nokuba ndikindiki.

Isenzakalo se-Raynaud yesibili senzeka, lapho ukuchayeka kancane emoyeni opholile kubangela ukuqubuka kwe-digital blanching kungazelelwe, okubuhlungu kanye ne-cyanosis.

Iziguli zithola i-osteoarthritis ngaphambi kwesikhathi emalungeni amancanyana onyawo, i-muscular atrophy emisipheni yonyawo lwangaphakathi (okubangela izinzwane zesando nokukhubazeka kwe-pes cavus), kanye ne-hyperhidrosis eqhubekayo okwandisa amathuba okuba sengozini yokutheleleka kwesikhunta kanye namagciwane.

Ukomisa okuthambile kanye nephrothokholi yokufudumala izinga lokushisa kwegumbi¶

Ukuphathwa komtholampilo kokulimala okubandayo okungashisi kuhluke ngokuphelele ku-frostbite. Ngenkathi isithwathwa sifuna ukufudumeza ngokushesha, okunamandla endaweni yokugeza engu-37 °C kuya ku-40 °C (99 °F kuya ku-104 °F) ukuze kuncibilike amakristalu eqhwa ngokushesha, ukushisisa okusheshayo kokulimala okubandayo okunganqamuki kuvinjwe ngokuqinile.

Ukubeka unyawo lomsele noma i-chilblain emanzini ashisayo kubangela ukuphindaphindeka okungazelelwe, okukhulu okukhuphula ukubhujiswa okuncane kwemithambo yegazi, kubangele ubuhlungu obungabekezeleleki bemizwa, kusheshise amabhamuza, futhi kubangele ukushuba okugcwele kwezicubu.

Isinyathelo ngesinyathelo ukufudumala nokunakekelwa okubandayo okungashisi¶

Landela le nqubo yomtholampilo lapho uphatha i-trench foot noma ama-chilblain:

1. Ukushintshela endaweni yokukhosela eyomile, epholile. Hambisa isiguli egumbini elingaphakathi noma etendeni eligcinwe endaweni evamile, izinga lokushisa elikhululekile: 20 °C kuya ku-22 °C (68 °F kuya ku-72 °F).
2. Susa zonke izicathulo nezingubo ezimanzi ngokucophelela. Khumula amabhuzu ngokuphelele. Ungalokothi ukhumule noma ugeqe amabhuzu ezinyaweni ezigcwele amanzi. Sika amasokisi amanzi ngezikele zamabhandishi uma enamathela esikhumbeni esithambile, esimacered.
3. Hlanza ngobumnene ngensipho ye-antiseptic. Geza izinyawo noma izandla usebenzisa amanzi ayisivivi (acishe abe ngu-25 °C kuya ku-30 ​​°C / 77 °F kuya ku-86 °F) kanye nensipho ethambile, engenaphunga elibulala amagciwane. Ungakhuhli noma usebenzise izindwangu zokugeza ezinezindwangu ezimahhadlahhadla.
4. I-Blot yome ngokuphelele ngamathawula athambile. Gcoba kancane isikhumba ngamathawula kakotini ahlanzekile, athambile noma ama-microfiber. Qaphela ngokucophelela izikhala phakathi kwezinzwane (izikhala zewebhu), lapho umswakama oboshiwe uzala ama-maceration kanye nama-pathogens we-fungal. Ungalokothi uhlikihle isikhumba emuva naphambili.
5. Veza izinyawo endaweni yokomisa umoya. Gcina izinyawo ezingenalutho zivezwe emoyeni ohlanzekile, ojikelezayo wegumbi okungenani imizuzu engama-30 kuya kwengama-60. Ukuchayeka emoyeni kuvumela i-stratum corneum egcwele amanzi ukuthi ikhiphe amanzi emzimbeni, iqinise, futhi ibuyisele izakhiwo zayo zemvelo zokuvimbela ukuzivikela.
6. Phakamisa imikhawulo engezansi. Phakamisa imilenze phezulu emicamelweni noma ezikhwameni zokulala ezigoqiwe ukuze izinyawo ziphumule ngo-15 cm kuya ku-30 ​​cm (amayintshi angu-6 ukuya kwangu-12) ngaphezu kwezinga lenhliziyo. Ukuphakama kunciphisa ingcindezi ye-hydrostatic venous, kunciphisa i-edema yokuvuvukala, futhi kunciphisa ubuhlungu bokushaywa.
7. Gcoba uvolo omile oxekethile, onganciphisi noma amasokisi okwenziwa. Uma isikhumba sesomile kahle futhi siqinile, gqoka amasokisi ahlanzekile, omile, axegayo enziwe ngoboya be-merino noma uboya bokwenziwa obusezingeni eliphezulu. Ungalokothi usebenzise amasokisi okucindezela aqinile, anwebekayo, akhawulela i-microvascular perfusion.
8. Gcina ukuphumula okuphelele kombhede ngesikhathi se-hyperemia yeSigaba 2. Ungalokothi uvumele isiguli esine-hyperemic, unyawo lomsele olunamabhamuza ukuthi luhambe noma luthwale isisindo ezinyaweni zaso. Ukuhamba kuchoboza ama-capillary e-plantar angasebenzi futhi kubangela ukulimala okukhulu kwe-dermal shear.

+-----------------------------------------------------------+
|          NON-FREEZING COLD CARE SAFETY RULES              |
|                                                           |
|  [.] REWARM SLOWLY at room temperature (20 °C to 22 °C)   |
|  [.] PAT DRY GENTLY; never scrub or massage softened skin |
|  [.] AIR-DRY BARE FEET for 30 to 60 minutes               |
|  [.] ELEVATE FEET above heart level to control swelling   |
|  [.] NEVER USE HOT WATER BATHS; hot water causes necrosis |
|  [.] STRICT BED REST during acute hyperemic swelling      |
+-----------------------------------------------------------+

Izinqubo zokuvimbela: isiyalo sonyawo kanye nokuphathwa kwegiya¶

Ukulimala okungamaqhwa okunganqamuki kungavinjelwa ngokuphelele ngenhlanzeko yomuntu siqu eqinile, ukulawulwa komswakama okunolaka, kanye nezinqubo ezilandelwayo zamagiya. Izinsizakalo zezempi emhlabeni wonke zenze izinqubo ezibanzi zokusebenza kwesimo sezulu esibandayo eziklanyelwe ukuqeda unyawo lwemisele enkundleni.

Isistimu yokuzungezisa yamasokisi amathathu¶

Ukulawulwa komswakama wezinyawo kudinga ukujikeleza okusebenzayo, kwansuku zonke kwamasokisi:

Izisebenzi zangaphandle, abaqwali bezintaba, nabaqwala izintaba ebusika kumele baphathe okungenani amapheya amathathu oboya obuminyene kakhulu noma amasokisi okwenziwa afaka umswakama:

• Ibhangqa 1: Igqokwa ezinyaweni ngaphakathi kwamabhuzu phakathi nokuhamba okusebenzayo noma emsebenzini.
• Ipheya 2: Ipheya ehlanzekile, eyomile amathambo egcinwe ngaphakathi kwesikhwama esomile esingangeni manzi, ebekelwe ukulala ekamu.
• Ibhangqa 3: Ipheya eyisipele yomiswa ngaphakathi kwejazi lakho ngokumelene nokushisa komzimba wakho noma ilenga ephaketheni lakho.

Ungalokothi ugqoke amasokisi afanayo amahora angaphezu kwangu-12 okunyakaza okuqhubekayo okusebenzayo. Shintsha ube amasokisi amasha, omile emini. Susa ipheya emanzi, khipha umjuluko, futhi uyibeke ngaphakathi kwezingubo zakho zangaphakathi lapho ukushisa komzimba wakho kuzokomisa khona ntambama.

Ukuhlanzeka kwezinyawo kanye nezithiyo zomswakama¶

Ukunakekelwa ngokomzimba kwansuku zonke kwezinyawo kuvimbela umgoqo wesikhumba ekubhidlikeni:

Geza futhi womise izinyawo nsuku zonke. Njalo kusihlwa, geza izinyawo kahle ngamanzi ahlanzekile, womise ngokucophelela phakathi kwazo zonke izinzwane, futhi uvumele izinyawo ezingenalutho ukuba zome emoyeni okungenani imizuzu engu-30 ngaphambi kokufaka amasokisi omile.

Faka izimpushana ezinyaweni ezimunca umswakama. Ukuthela uthuli ezinyaweni ngempushana ye-talc engeyona imithi noma i-foot powder equkethe i-zinc oxide, i-aluminium chlorohydrate, noma i-cornstarch kumunca umjuluko osebenzayo futhi kugcine isikhumba somile.

Sebenzisa ama-antiperspirant sprays noma ama-roll-ons. Ukusebenzisa i-aluminum chloride antiperspirant yamandla omtholampilo ematheni ezinyawo kanye ngosuku izinsuku ezintathu kuya kweziyisihlanu ngaphambi kohambo lwesimo sezulu esibandayo kunciphisa ukujuluka konyawo ngamaphesenti angaphezu kwangu-50, kuvimbele i-epidermal maceration.

I-Barrier creams kanye ne-petrolatum. Ezimweni ezibandayo ezimanzi kakhulu lapho amabhuzu azocwiliswa khona nakanjani, ukusebenzisa i-coating encane ye-dimethicone-based barrier cream noma i-petroleum jelly yezokwelapha (petrolatum) ezinzwaneni nasezinyaweni kudala umgoqo we-hydrophobic ovimbela amanzi angaphandle ukuthi angangeni ku-stratum corneum.

Ukulinganisa okufanelekile kwezicathulo nokukhetha ibhuthi¶

Omakhenikha bezicathulo badlala indima enkulu ekulimaleni okungashisi amakhaza:

Ungalokothi ugqoke amabhuzu aqinile. Amabhuzu alingana kahle esimweni sezulu esifudumele abe yingozi emakhazeni. Ukugqoka amasokisi asebusika aminyene ngaphakathi kwamabhuzu aqinile kucindezela i-dorsal pedis artery, kuminyanisa i-microcirculation, futhi kusheshise i-ischemia yezicubu.

Amabhuzu asebusika anosayizi ingxenye eyodwa kuya koyedwa ubukhulu obukhulu kunezicathulo zomgwaqo ezijwayelekile. Lokhu kudala indawo evulekile yomoya ofile ezungeze unyawo, kuvumela ukugeleza kwegazi okungakhawulelwe kwe-capillary, futhi kuvumela indawo yamasokisi ewulu aqinile ngaphandle kokubopha.

Khetha amabhuzu e-membrane aphefumulayo, angangeni manzi esimweni sezulu esibandayo (njenge-Gore-Tex noma i-eVent). Ngamanzi aqhubekayo, amile noma ama-slush, sebenzisa amabhuzu e-pac anezingqimba ezimbili anama-liner azwakalayo asuswayo noma okwenziwa.

Omisa amalayini ebhuthi ebusuku. Ungalokothi ulale namalayini ebhuthi amanzi ngaphakathi kwamabhuzu afriziwe. Khipha olayini abazizwayo noma bovolo kumagobolondo ebhuthi bese ulala nawo ngaphakathi kwesikhwama sakho sokulala ngokumelene nomzimba wakho ukuze uqinisekise ukuthi izicathulo zomile, ezifudumele ngakusasa ekuseni.

Imihlahlandlela yomtholampilo yamazwe ngamazwe kanye namazinga abandayo omsebenzi¶

Ukulimala okubandayo okunganqamuki kungaphansi kwezindinganiso ezisemthethweni zokuxilonga, izimfundiso zezempi yezempi, kanye nemithetho yezempilo yasemsebenzini ezindaweni zonke zomhlaba.

I-United States: I-DoD, i-OSHA, namazinga omsebenzi e-NIOSH¶

E-United States, ukulimala okunganqamuki okubandayo kulawulwa ngaphansi kwamazinga okusebenza ezempi oMnyango Wezokuvikela (DoD) kanye nemihlahlandlela Yokuphepha Emsebenzini Nokuphathwa Kwezempilo (OSHA):

I-US Army Public Health Centre iphoqelela i-Technical Bulletin Medical 505 (TB MED 505: Prevention and Management of Cold-Weather Injuries), isungula ukuhlolwa okuqinile kwezinyawo zansuku zonke okuyisibopho, izimiso zokushintsha amasokisi, kanye nezikhathi zokuma eziphezulu kakhulu ezindaweni ezimanzi.

Imihlahlandlela ye-OSHA yengcindezi ebandayo idinga abaqashi kwezolimo, ezokwakha, nezimboni zasolwandle ukuthi banikeze izindawo zokuphumula ezifudumele, ezomile, baphoqelele izinguquko zezicathulo, futhi baqaphe abasebenzi ngezimpawu zokuqala zama-chilblain nonyawo lokucwiliswa.

Ukuhlolwa kwezokwelapha kanye nokuthunyelwa kwezimo eziphuthumayo kulo lonke elase-United States kufinyelelwa ngokushayela ku-911.

I-United Kingdom: Umnyango Wezokuvikela kanye nesiqondiso somtholampilo se-NHS¶

I-United Kingdom ibambe indikimba yocwaningo lomtholampilo olumayelana nokulimala okungamakhaza okunganqamuki, okuqhutshwa ulwazi lwezempi yaseBrithani Empini yase-Falklands kanye nezivivinyo zokuqeqeshwa zaseNyakatho Yurophu:

UMnyango Wezokuvikela wase-UK (i-MoD) usebenzisa i-Joint Service Publication 539 (JSP 539: Ukulimala Kwesimo Sezulu Embuthweni Ohlomile), uhlukanisa i-NFCI njengengozi yezempi ebikwayo. Imithetho elandelwayo yezempi yaseBrithani igunyaza ukuthi noma yiliphi ilungu lenkonzo elibonisa izinyawo ezindikindiki, eziphaphathekile ngemva kokuchayeka emakhazeni amanzi libekwe esivimbelweni somsebenzi ngokushesha, lihlinzekwe ngokufudumeza izinga lokushisa kwegumbi, futhi lihlolwe izikhulu zezokwelapha.

I-National Health Service (NHS) ihlinzeka ngemitholampilo yesifunda yokushisa eyisipesheli esebenzisa i-infrared thermography kanye nokuhlolwa kwezinzwa ezishisayo ukuze kulinganise ukulimala okuhlala njalo kwenzwa ye-autonomic nokuphatha ubuhlungu obungapheli be-post-NFCI neuropathic. Izinsizakalo eziphuthumayo kulo lonke elase-UK zifinyelelwa nge-999 noma i-112.

ECanada: Amabutho aseCanada kanye Nesikhungo SaseCanada Sezempilo Yomsebenzi¶

E-Canada, ukulimala okubandayo kugadwa ngaphansi kwemihlahlandlela Yezokuvikela Kazwelonke kanye ne-Canadian Center for Occupational Health and Safety (CCOHS):

Imiyalo ye-Canadian Forces Health Services igcizelela ukuhlonza insimu esheshayo ye-pernio kanye nonyawo lokucwiliswa phakathi nokusebenza kwe-sub-arctic kanye nogu.

Amakhodi ezempilo omsebenzi agunyaza ukuthi abasebenzi abachayeke endaweni ebandayo, emanzi bathole izicathulo ezishisayo ezingangeni manzi ezinamasoli angakwazi ukubhoboza kanye nezindwangu ezivikelayo ezingamubi ezithobela i-CSA Standard Z195. Usizo oluphuthumayo lufinyelelwa e-Canada yonkana ngokudayela ku-911.

I-Australia: Umsebenzi Ophephile E-Australia kanye nemfundiso yezwe eliphezulu lezempi¶

E-Australia, ukulimala okunganqamuki okubandayo kwenganyelwe i-Safe Work Australia kanye ne-Australian Defence Force (ADF):

Abasebenzi bezolimo ezifundeni eziseningizimu nobusika obumanzi (i-Tasmania, Victoria) kanye namasosha asebenza ezindaweni zokuqeqeshwa kwe-High Country bangaphansi kokuhlolwa kwengozi yokucindezeleka okubandayo emsebenzini.

Amakhodi wokuzijwayeza we-Safe Work Australia adinga abaqashi ukuba banikeze ama-gumboot angangeni manzi, amasokisi ashisayo, namakamelo okomisa afudumele kubasebenzi basezimbonini ezimanzi, ezibandayo kanye nezindawo ezingaphandle. Ezimweni eziphuthumayo, abantu base-Australia bashayela u-000.

Imibuzo evame ukubuzwa¶

Ungakwazi yini ukuthola unyawo lomsele uma izinga lokushisa lingabandi?¶

Yebo. I-trench foot ayidingi amazinga okushisa abandayo. Ikhula ngaphansi kwezimo zokuswakama okungabandi kakhulu ngokuvamile kusukela ku-0 °C kuya ku-15 °C (32 °F kuya ku-59 °F). Lapho izinyawo zihlala zivalelwe ngaphakathi zimanzi, amabhuzu amabhuzu aswakeme amahora angu-12 noma ngaphezulu, ukucinana kwethambo legazi okunganqamukiyo, ukuntuleka komoya-mpilo kwezicubu, kanye nokonakala kwesikhumba kubangela ukulimala okujulile kwemithambo yegazi nezicubu ngaphandle kokuba kube neqhwa enyameni.

Kungani amanzi ashisayo eyingozi kumuntu one-trench foot noma ama-chilblain?¶

Ukufaka amakhaza angewona amaqhwa emanzini ashisayo kubangela ukuvuleka okuzumayo, okukhulu kwemithambo yegazi ezicutshini esezivele zilinyazwe yi-capillary. Lokhu kuqubuka okungazelelwe kwegazi kubangela ukuvuvukala okunamandla, kusheshise amabhamuza, kukhiqize izinhlungu zemithambo-luvo, futhi kungabangela i-tissue necrosis. Izingozi ezingabandi ezibandayo kufanele zihlale zifudunyezwa kancane kancane endaweni yokushisa evamile.

Ngingawubona kanjani umehluko phakathi kwe-chilblain ne-frostbite?¶

Ama-chilblain avela emazingeni okushisa angaphezu kwamakhaza futhi abonakala njengamaqhubu avuvukele, alumayo, abomvu-nsomi ezinzwaneni, eminweni, noma ezindlebeni ahlala ethambile futhi ethambile uma uwathinta. I-Frostbite yenzeka emazingeni okushisa angaphansi kweqhwa futhi ihilela ukuqanda kwezicubu kwangempela, okubangela isikhumba ukuthi sizwe i-waxy, siqine, futhi sibe ngokhuni, okulandelwa ukuba ndikindiki okuphelele namabhamuza amakhulu agcwele uketshezi lapho incibilika.

Kuthatha isikhathi esingakanani ukuthi unyawo lomsele luphole ngokuphelele?¶

Amacala athambile abanjwe ekuqaleni kwesigaba sangaphambi kwe-hyperemic angaxazululeka phakathi nezinsuku ezimbalwa zokuphumula okomile, okufudumele. Kodwa-ke, unyawo lomsele olulingene ukuya kolubi olungene ezigabeni ze-hyperemic kanye namabhamuza ngokuvamile ludinga izinyanga ezimbili kuya kweziyishumi nambili ukuze ziphole. Ezimweni ezimbi kakhulu lapho kucekelwa phansi imizwa kanye ne-capillary, iziguli ziba nokulimala okungapheli kwemizwa, ukuzwela okubandayo, nobuhlungu obungapheli impilo yonke.

Iyiphi indlela engcono kakhulu yokomisa izinyawo ezigcwele amanzi, eziqinile ensimini?¶

Susa amabhuzu namasokisi amanzi ngokushesha, geza izinyawo ngobumnene ngensipho ethambile namanzi asivivi ngaphandle kokukhuhla, bese uzimbambatha zome ngethawula elihlanzekile. Vumela izinyawo ezingenalutho ukuba zome emoyeni endaweni yokushisa yegumbi okungenani imizuzu engama-30 ukuya kwengama-60 ukuze isikhumba esithambile sikwazi ukuqina. Phakamisa izinyawo ukuze unciphise ukuvuvuka, futhi ufake amasokisi ewulu axegayo, omile uma omile ngokuphelele.

Isitifiketi sosizo lokuqala¶

Ukubona nokwelapha ukulimala okungashisi amakhaza okufana nama-chilblain kanye ne-trench foot kudinga ulwazi olusebenzayo lomuthi wemvelo, isayensi yokuvimbela isikhumba, nokunakekelwa kwamanxeba okuthambile. Ukufunda ukwehlukanisa ukuhlukumezeka okunganqamuki nesithwathwa esijulile, ukugwema amaphutha ayingozi okushisa ngokushesha, nokusebenzisa ukomisa ngendlela efanele kwenkambu kungavimbela ukukhubazeka okungapheli kwemithambo yegazi kubasebenzi bangaphandle, abaqwali bezintaba, nabasinde enhlekeleleni.

Sikhuthaza kakhulu wonke umuntu osebenza ngaphandle, obamba iqhaza kwezokungcebeleka kwasebusika, noma ohola amaqembu angaphandle ukuthi aqedele isitifiketi esigunyaziwe e-wilderness first aid (WFA) noma usizo lokuqala olujwayelekile kanye nokuvuselela i-cardiopulmonary (CPR). Abahlinzeki abaziwayo njenge-American Red Cross, i-St John Ambulance, i-British Red Cross, kanye ne-Canadian Red Cross banikeza ukuqeqeshwa okuphelele ekuvimbeleni ukulimala okubandayo kwemvelo, ukuphathwa kwe-maceration, kanye nosizo lokuqala lokuhlukumezeka.

Imithombo ihloliwe¶

• I-Wilderness Medical Society (WMS, United States): Izinkombandlela Zomtholampilo Zokuvinjelwa Nokwelashwa Kokulimala Okungabandi Okubandayo.
• Isikhungo Sezempilo Somphakathi sase-U.S. Army (United States): I-Technical Bulletin Medical 505: Ukuvimbela Nokuphathwa Kokulimala Kwesimo Sezulu.
• UMnyango Wezokuvikela wase-UK (e-United Kingdom): Ukushicilelwa Kwenkonzo Ehlanganyelwe 539: Ukulimala Kwesimo Sezulu Embuthweni Wezempi: Ukulimala Okungabandi Okubandayo.
• Isevisi Yezempilo Kazwelonke (NHS, United Kingdom): Isiqondiso Somtholampilo Ku-Chilblains (Pernio) kanye Nokulimala Okungapheli Okushisayo.
• Isikhungo SaseCanada Sezempilo Nokuphepha Emsebenzini (CCOHS, Canada): I-Cold Weather Workers Safety and Immersion Foot Guidance.
• I-Safe Work Australia (Australia): Ukuphatha Izingozi Zokusebenza Ezimeni Zesimo Sezulu Ezidlulele: I-Cold Stress.

Iziqondiso ezihlobene¶

• I-Hypothermia kanye nokwelashwa okuphuthumayo kwe-frostbite
• Isiteji se-Frostbite, ukucwiliswa kwamanzi afudumele, kanye nezingozi zokumisa kabusha
• Ukuqashelwa ukushaqeka nokuphatha ekuhlukumezekeni
• Iziphepho zasebusika kanye nezinqubo zokusinda ze-blizzard ezimbi kakhulu
• Izinombolo zesimo esiphuthumayo ngezwe