Frostbite: Overview and Classification
First, an overview of frostbite is caused by cold effects on the human body under certain conditions, causing local or even systemic damage. The degree of damage is directly related to the intensity of cold, wind speed, humidity, freezing time, and local and systemic conditions. Frostbite can occur in cold regions, regardless of peacetime, especially in wartime, due to hunger, fatigue, field operations, or longer fighting duration, and long-distance marching at night, cold equipment or shoes and socks. Frostbite often increases sharply and even occurs in batches, resulting in non-combat reductions and 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 suffered frostbite of about 120,000, the British army suffered 82,000 frostbite, Italian military suffered frostbite by nearly 300,000, and the German army suffered 13,000 frostbite. During the Second World War, the German army suffered 112,000 frostbite injuries and the American military suffered 90,000 frostbite. About half of the 50,000 wounded soldiers sent by the United States after the invasion of the Korean War were frostbite. According to the statistics of the North-east Military Region during the War to Resist US Aggression and Aid Korea, according to the statistics of the North-East Military Region’s anti-US aid and North Korea, the number of wounded casualties in 1951 accounted for 15.2% of the total (including 90.8% of cold injury of the lower limbs and 9.2% of the upper limbs), according to the participation in the war in the DPRK. In the second campaign (November 25th to December 24th, 1950), among the 44,000 wounded people in the three armed forces, frostbite accounted for nearly 30,000 (68%).
According to the nature of injury, frostbite can be divided into two types: frozen injury and non-freezing injury.
Local damage
Freezing injury
Frozen
Whole body frostbite
Frozen
frostbite
Non-freezing injury
Fight feet, soak feet (hands)
The difference between frozen and non-freezing damages is mainly determined by whether the temperature of the environment at the time of injury reaches below the freezing point of the tissue and whether the local tissue has frozen. Among the wounded people actually encountered, the most common is the local frostbite, which is commonly referred to as frostbite in the clinic. Sometimes minor local frostbite and frostbite are not easy to distinguish. In addition, there are also classified by injury, namely, systemic injuries (including freezing and freezing) and localized injuries (including frostbite, frostbite, pedicures, feet (hands), etc.).
Localized injuries occur most often in exposed parts of the body such as feet, hands, ears, and facial features. Among them, the foot is more common, according to statistics about half of the total number of frostbite. For example, among the wounded evacuees wounded by a certain division of the Volunteer Army during the period of the War to Resist US Aggression and Aid Korea, 97.3% of the limbs suffered from frostbite and 2.7% of the upper limbs, but they were also slightly different from usual during wartime. According to the statistic of the recent cold injury of the troops in a cold region, It accounts for 52.8% of the total, accounting for 11.7% (ears and nose) of 36.5% of face.
Second, freezing injury
(I) Frostbite (Local Frostbite)
[pathophysiological changes] can be divided into three phases:
1. Physiological adjustment stage: At the beginning of frostbite, in order to regulate the dynamic balance between heat production and heat dissipation, the human body mainly manifests as increased heat production and reduced heat dissipation. The main manifestation of increased heat production is increased muscle tension, followed by chills and increased metabolism. As the cold continues to increase, the metabolic activity of the liver also increases. The main manifestation of heat loss is skin vasoconstriction, reduced blood flow, and reduced skin temperature to reduce heat loss. If the cold lasts for a long time, the skin's blood vessels tend to expand briefly, causing the local blood flow to increase, the skin temperature to rise, and the circulation temporarily improving. However, in order to avoid heat loss, the body shrinks blood vessels. The contraction and expansion of these blood vessels are the body's response to cold. Of course, in order to maintain the central body temperature, the skin and limb blood vessels continue to shrink.
In short, at the beginning of freezing, all physiological functions tend to be hyperthyroidism, such as increased metabolism, rapid heartbeat, and alternating vasodilation of blood vessels. If the cold persists for a long time, it will inevitably appear to be inhibited, resulting in reduced metabolism, slower heartbeat, and lower body temperature. Since then, skin and acral blood vessels continue to contract, and skin and limb end tissue may freeze.
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