What kind of injury?Tissue damage can occur not only at high temperatures but also at low temperatures. Damage to the skin and subcutaneous tissue caused by extreme cold is called frostbite, which is a physicochemical injury to the skin similar to a burn. Frostbite usually occurs when tissue is frozen due to prolonged exposure to low temperatures in cold regions, and then thaws, causing damage to the tissue. In such cases, damage usually extends not only to the skin, but also to deeper tissues such as subcutaneous tissue and blood vessels. Frostbite can occur on any part of the body, but the hands, feet, nose, and ears are particularly susceptible to damage. How symptoms manifestWhen tissues are exposed to cold, the first thing that happens is that blood vessels constrict. When the skin temperature drops to 25°C, the tissues become cyanotic (dark purple) because of the lack of oxygen they need. When the skin temperature drops to 15°C, the skin turns pink. At this point, tissue damage begins, and frostbite occurs when the skin temperature drops to -4°C. This is the state in which the water in the tissue freezes and turns into a sorbet-like substance. Symptoms begin with a pins-and-needles sensation, followed by numbness, and as the injury progresses it becomes white, cold, hard, and numb. If the damage is limited to the skin and subcutaneous tissue, the body can fully recover. However, if the blood vessels are damaged, the damage becomes irreversible. How to provide first aidImmerse the injury in lukewarm (not hot) water for 15 to 30 minutes, adding more warm water to maintain the temperature. Cover the ears, nose, cheeks, etc. with a warm cloth. Do not rub or move the injury to warm it. As you apply heat, you will experience a burning pain and the area will begin to swell and discolor, so once the skin has softened and returned to its natural color, you no longer need to apply heat. In the case of frostbite, the whole body is usually cold and hypothermia occurs. It is necessary to check whether the person has hypothermia, first move them to a warm place away from the cold, remove all precious metals and wet clothing, and warm the whole body. Junichi Sasaki Frostbite |
どんな外傷か高温の場合でなくても、低温でも組織の傷害は起こります。極端な寒冷による皮膚や皮下組織の傷害を凍傷と呼びますが、凍傷も熱傷に似た皮膚の物理化学的傷害であるといえます。 通常、凍傷は寒冷地などで長時間低温にさらされることにより組織が凍結し、さらに解凍することにより組織の傷害が起こります。このような場合には、皮膚ばかりでなく皮下組織や血管などの深部組織にも傷害が及ぶのが普通です。凍傷は体のどの部位にも生じますが、とくに手、足、鼻、耳が傷害を受けやすい部位です。 症状の現れ方組織が冷気にさらされると、まず血管が収縮します。皮膚の温度が25℃にまで下がると、組織の活動に必要な酸素が不足するため、チアノーゼ(暗紫色)状態になります。皮膚の温度が15℃にまで下がると、逆にピンク色になります。 このころより組織の傷害が始まり、皮膚の温度がマイナス4℃になると凍傷が起こります。これは組織の水分が氷結し、シャーベット状になった状態といえます。 自覚症状は、ピンか針で突つかれたような感覚から始まり、その後しびれを感じるようになり、さらに進むと白色で冷たく硬くなり、感覚がなくなります。この状態で傷害部を温めると、 傷害が皮膚とその皮下組織にとどまっていれば、完全に元の状態に回復することができます。しかし、血管が傷害を受けてしまうと傷害は不可逆的なものになり、 応急処置はどうするか傷害部をぬるま湯(決して熱くないように)に浸して、15~30分ほど温め、温かいお湯を注ぎ足してお湯の温度を保つようにします。耳、鼻、頬などは温かい布であてがうようにします。また、傷害部をこすったり、動かして温めるようなことは行わないようにします。 温めているうちに、焼けるような痛みとはれや変色が始まるので、皮膚が軟らかくなり血色がもどったら、温める必要はありません。 凍傷の場合には、通常は全身も冷えて低体温の状態になっています。低体温かどうかを必ず確認して、まず寒気を避けて暖かい場所に移し、貴金属類や濡れた衣類はすべて取り除き、全身を温めるなどの処置が必要になります。 佐々木 淳一 凍傷
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