[Principles of intensive care during the acute period of severe craniocerebral trauma in children]. / Printsipy intensivnoi terapii v ostrom periode tiazheloi cherepno-mozgovoi travmy u detei.

Prospective analysis of the course of severe craniocerebral injury (CCI) in 37 children showed that the results of treatment depended on methods of intensive care. In children the outcome of CCI depends primarily on adequacy of maintaining effective cerebral bloodflow during the acute period of CCI irrespective of the terms and etiological factors of coma. Adequate cerebral perfusion pressure is attained with osmodiuretics, saluretics, and hemodynamic therapy. Hyperventilation is justified in cases with coma developing within 2 h after the injury; it should not lead to long (more than 1 h) decrease of PaCO2 below 28 mm Hg. The authors emphasize that every delayed decrease of consciousness after the injury should be thoroughly analyzed in order to rule out intracranial complications (epi/subdural and intracerebrai hematomas) in no more than 6 h, which is the maximal time allowed for decision making. Use of unapproved medical methods and drugs in children during acute period of severe CCI is ineffective and even hazardous, because it distracts the physician's attention to negligible details of treatment; in addition many of such drugs have side effects.

[Organization of inpatient care on mass admission of children with burns suffered in a train crash]. / Organizatsiia lechebnoi pomoshchi v usloviiakh statsionara pri massovom postuplenii obozhennykh detei, postradavshchikh v zheleznodorozhnoi katastrofe.

The article discusses some experience in organizing medical care for children injured during the crash in Bashkiria in June, 1989. Twenty-eight children with extensive Degrees II--IIIa, IVb burns were treated in the burn department of Children's Clinical Hospital No. 9, Moscow; 24 of them were discharged in a satisfactory condition, 4 children with a burn of more than 50% of body surface died. Simultaneous admission of the injured during a crash creates organizational, therapeutic, and psychological difficulties. The authors consider it necessary to create a special reserve of equipment, instruments, and drugs in the leading therapeutic centers, to train some of the general surgeons in problems of treatment of burn injuries, and engage, without fail, a psychoneurologist in the treatment.