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"description": " \r\n\r\nОбморожение характеризуется повреждением кожного покрова и тканей при воздействии на них низкой температуры, возникает также при непосредственном контакте с предметом, охлажденным до сверхнизкой температуры (контактные отморожения) и длительном периодическом охлаждении в условиях высокой влажности воздуха.",
"etiology": "<p> </p>\r\n<p>К отморожению на морозе приводят: </p>\r\n<ul>\r\n<li>тесная и влажная одежда и обувь; </li>\r\n<li>физическое переутомление; </li>\r\n<li>голод; </li>\r\n<li>вынужденное длительное неподвижное и неудобное положение; </li>\r\n<li>предшествующая холодовая травма; </li>\r\n<li>ослабление организма в результате перенесённых заболеваний; </li>\r\n<li>потливость ног; </li>\r\n<li>хронические заболевания сосудов нижних конечностей и сердечно-сосудистой системы; </li>\r\n<li>тяжёлые механические повреждения с кровопотерей. </li>\r\n</ul>\r\n<p>При употреблении алкоголя происходит расширение периферических сосудов, что характеризуется усиленной потерей тепла, в то время как в норме при действии холода происходит их сужение. Достаточно часто тяжёлые отморожения, приводящие к ампутации конечностей, происходят именно в состоянии сильного алкогольного опьянения, по причинам скорее не физиологического свойства, а в первую очередь из-за неспособности нетрезвого человека своевременно принять меры против замерзания; в случае же тяжёлого опьянения пропадает способность нормально передвигаться, осознание опасности исчезает, и человек может просто заснуть на морозе, что нередко приводит и к смертельному исходу. </p>",
"pathogenesis": "<p>Воздействие низких температур вызывает стойкий спазм сосудов. Скорость кровотока уменьшается, вязкость крови увеличивается. Форменные элементы «забивают» мелкие сосуды, образуются тромбы. Таким образом, патологические изменения при отморожении возникают не только в результате непосредственного воздействия холода, но и вследствие реакции со стороны сосудов. </p>\r\n<p>Местные расстройства кровообращения провоцируют нарушения со стороны вегетативной нервной системы, регулирующей деятельность всех внутренних органов. В результате развиваются воспалительные изменения в удаленных от места отморожения органах (дыхательных путях, костях, периферических нервах и желудочно-кишечном тракте).</p>",
"diagnostics": "<p>Пострадавший указывает на длительное пребывание в условиях низкой температуры воздуха. Дифференциальный диагноз отморожение проводится с гангреной пальцев стоп при диабетической ангиопатии или облитерирующем эндартериите. <br class=\"SCXW17836495\" /> </p>",
"treatment": "<p>При обморожении пальцев, ушных раковин или других частей тела следует принять следующие меры: </p>\r\n<ul>\r\n<li>Укрыться от холода. </li>\r\n<li>Согреть руки, спрятав их в подмышках. Если обморожением затронуты нос, уши или участки лица, согреть эти места, прикрыв их руками в сухих тёплых перчатках. </li>\r\n<li>Не тереть поврежденные места. Никогда не растирать обмороженные участки кожи снегом. </li>\r\n<li>Если есть риск повторного обморожения, не допускайте оттаивания уже пострадавших участков. Если они уже оттаяли, укутайте их так, чтобы они не могли вновь замерзнуть. </li>\r\n<li>Если при согревании обмороженных участков чувствительность в них не восстанавливается, обратитесь за неотложной медицинской помощью. Если профессиональная помощь в ближайшее время недоступна, согревайте сильно обмороженные кисти или стопы в теплой (не горячей!) воде. Другие пострадавшие участки (нос, щеки, ушные раковины) можно согревать, приложив к ним теплые ладони или подогретые куски ткани. </li>\r\n</ul>",
"prevention": "<ol>\r\n<li>Одежда должна соответствовать температуре, быть сухой и подходящего размера. </li>\r\n<li>При отсутствии теплой одежды утеплиться можно при помощи обычной бумаги или лоскутов ткани, скомканных и помещенных между слоями одежды. </li>\r\n<li>Не стойте на месте, двигайтесь. Человеческий организм в сутки способен истратить более шести тысяч калорий, большая часть которых расходуется на теплообразование. </li>\r\n<li>Не носите тесной обуви. Подошва должна быть не менее сантиметра толщиной; </li>\r\n<li>По возможности найдите внешний источник тепла, разведите огонь. </li>\r\n<li>Прием пищи должен быть своевременен. В рационе питания доля жиров и углеводов должна быть увеличена. Источниками жира могут послужить, например, сало, подсолнечное масло, мясо; источниками углеводов – мучные изделия, рис, картофель. </li>\r\n<li>Людям с нарушенным кровообращением необходима более теплая одежда. </li>\r\n<li>Не используйте алкоголь с целью согревания. Алкоголь дает лишь короткий временный эффект, после чего следует усугубление замерзания. </li>\r\n</ol>",
"clinical_picture": "<p>Скрытый (дореактивный) период отморожения развивается в первые часы после травмы и сопровождается скудной клинической симптоматикой. Возможны незначительные боли, покалывание, нарушение чувствительности. Кожа в области отморожения холодная, бледная. </p>\r\n<p>После согревания тканей начинается реактивный период отморожения, проявления которого зависят от степени повреждения тканей и вызываемых основной патологией осложнений. </p>\r\n<p>Поверхностное отморожение возникает при воздействии холода в течение недолгого времени. К признакам отморожения относится изменение цвета кожи. Пораженный участок становится бледным, появляется чувство покалывания с последующим онемением. После согревания он краснеет, иногда до багрово-красного цвета, что сопровождается отеком. Могут быть боли разной интенсивности. Через 5-7 суток после отморожения нередко бывает небольшое шелушение пострадавшей кожи. Выздоровление наступает на 6-7 сутки после поражения. </p>",
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