[Principles of organization of emergency care to victims of traffic accidents at the stages of evacuation under conditions of a megapolis].

The article describes organizational grounds of the system of organization of emergency care to victims of traffic accidents (TA) under conditions of a megapolis at the stages of evacuation. The principles of rendering emergency medical care in TA are considered in detail. The succession of actions at each stage is stressed. Organization of trauma centers is recommended which will be able to render specialized medical care to the victims. Special attention should be paid to the conception of trauma disease. Correct organization of rendering specialized medical care to TA victims substantially reduces lethality.

[Hemodynamic parameters and saturation of the cerebral cortex blood with oxygen during extracorporeal circulation in heart surgery]. / Vliianie parametrov gemodinamiki na nasyshchenie kislorodom krovi kory golovnogo mozga vo vremia iskusstvennogo krovoobrashcheniia pri operatsiiakh na serdtse.

Sixty-three patients were intraoperatively examined during heart surgery with extracorporeal circulation (AEC). They were operated on for an affected heart-valve apparatus (AHVA) and ischemic heart disease (IHD). There was a perioperative monitoring of central hemodynamics, pressure in the bulb of superior jugular vein (BSJV) and electroencephalography (EEG). Regional oxygenation of the brain was made in real time by a INVOS3100 oximeter (SOMANETICS, USA). A maximal saturation of the cortex blood with oxygen at AEC was registered in patients with AHVA at an average pressure below 70 mm Hg, and in patients with IHD--at 85 mm Hg. An increased pressure in BSJV at a constant mean arterial pressure and at AEC is related with blood outflow from the venous collector of the brain.

[Problems of prehospital care for a severe combined trauma]. / Problemy dogospital'noi pomoshchi pri tiazheloi sochetannoi travme.

The authors have analyzed the strategy and results of treatment of 455 casualties at the prehospital stage. Main defects of giving help at the prehospital stage and ways to improve it are described.

[Organization and execution of the use of disinfectants, insecticides and rodenticides in the period of the eradication of the medical and sanitary consequences of a flood in Stavropol Territory in 2002]. / Organizatsiia i provedenie dezinfektsionnykh, dezinsektsionnykh, deratizatsionnykh rabot v period likvidatsii mediko-sanitarnykh posledstvii navodeniia v Stavropol'skom Krae v 2002 g.

Materials on the organization and execution of disinfection, disinfestations and deratization works at the period of the liquidation of the medico-sanitary consequences of the high flood in the Stavropol Territory in 2002 are presented. Timely and full-scope treatment, carried out in the course of these works, played a positive role in preventing epidemiological aggravations among the affected population.

[The assessment of microcirculation based on mathematical models of the hydrodynamics and oxygen transport in the microvessels (II)]. / Otsenka mikrotsirkuliatsii na osnove matematicheskikh modelei gidrodinamiki i transporta kisloroda v mikrososudakh (soobshchenie II).

Our previous communication No. 1 presents a mathematical definition of dynamic hematocrit and rate of erythrocyte movement, based on microvessel hemodynamics model. Now we offer a mathematical model of convective diffusion oxygen transfer in the erythrocytic cylinder-plasma system. Another definition of erythrocyte movement rate is offered and a solution of two equations which permitted its definition by measured parameters. A series of practical formulae for estimating microhemodynamics is derived, which can be used in clinical practice. The proposed model has been used in cardiosurgery department of Research Center of Surgery.

[Assessing the probability of hypoxic complications in cardiosurgery patients using statistical simulation of hypoxia]. / Otsenka veroiatnosti gipoksicheskikh oslozhnenii u kardiokhirurgicheskikh bol'nykh na osnove statisticheskoi modeli gipoksii.

The program is based on measuring the parameters determining the relationships between oxygen, blood acid-base, and blood and urine water-electrolyte balance in 150 patients after cardiopulmonary bypass surgery. Three degrees of homeostasis were distinguished: normal, hypoxic complications, and fatal hypoxic complications. The most informative laboratory tests reflecting the oxygen status and acid-base and water-electrolyte balance and indicating the presence and severity of hypoxic complications of homeostasis were selected. Graphic presentation of the probability scale predicting the hypoxic disorders helps more rapidly (than with the digital values) assess the severity of oxygen homeostasis disorders in patients. The PROGNOZ computer program may be used for the diagnosis and prediction of hypoxic disorders in intensive care units for cardiological and cardiosurgical patients.

[Use of software "Aggregate state of the blood" in staged diagnosis and correction of disorders of blood coagulation and rheology]. / Ispol'zovanie algoritma "Agregatnoe sostoianie krovi" v poétapnoi diagnostike i korrektsii naryshenii svertovaniia i reologii krovi.

The "Aggregate State of the Blood" software was created at the National Research Center of Surgery in 1994. The software is intended for comprehensive assessment of the blood fluidity under different conditions of clotting, rheology, and acid-base balance and shows deviations of the detected values from the norm, predicting the risk of thrombotic and/or hemorrhagic complications. From 1994 to 1996, the program was used in more than 1000 patients subjected to cardiopulmonary bypass surgery with complicated and uneventful peri- and postoperative period. The operations were as follows: heart and liver transplantations (19 and 7 cases), intraaortic balloon counterpulsation (16), extracorporeal detoxication (10), acute myocardial infarction (9), etc. The results were compared with the data recorded in case histories of 255 patients who underwent similar operations in 1991-1994. The results of diagnosis and prediction were commented in the protocol for each case. The conclusions were used for therapy or prevention. The incidence of thrombotic and hemorrhagic complications and the DIC syndrome in 1995-1996, when the new software started to be used, was significantly lower than before. The best clinical results were attained in the patients examined before surgery (n = 92). In this group application of the program (and subsequent preventive treatment) helped improve the adaptive potential of the physiological systems maintaining the blood fluidity. This resulted in a lower postoperative blood loss and a lesser incidence of thrombotic and hemorrhagic complications and the DIC syndrome as against the reference group.

[Lomir in the treatment of arterial hypertension after angioplastic surgery]. / Lomir v lechenii arterial'noi gipertenzii posle angioplasticheskikh operatsii.

Isradipine (lomir) is a new highly selective arteriolar vasodilator of the dihydropyridine group, characterized by a slight cardiodepressive effect. The drug effect on the central hemodynamics and oxygen transport was studied after cardiovascular surgery. Arterial pressure and total peripheral vascular resistance were reliably reduced at the peak of the drug action, as was the left-ventricular stroke work and oxygen consumption. A tendency to increase of cardiac output and cardiac index was observed. Pulmonary vascular resistance and pressure in the pulmonary artery did not reliably change. The drug increased the intrapulmonary shunt.

[Prehospital care in traumatic shock]. / Dogospital'naia pomoshch' pri travmaticheskom shoke.

Clinical investigations performed in 735 patients have shown that in addition to the improvement of organisation of the medical aid and the universally recognized resuscitation measures for trauma shock, the prophylactics and treatment of intoxication, metabolic, immune and other disorders developing in the patients soon after trauma should be started as early as at the prehospital step.

[The use of the "internal autotransfusion" method in complex shock-control measures at the prehospital stage]. / Primenenie metoda "vnutrennei autotransfuzii" v komplekse protivoshokovykh mer na dogospital'nom étape.

Fifty-three patients with traumatic shock were injected 200-400 ml of a 10% solution of sodium chloride in combination with 100 ml of the 40% solution of glucose. The continuous, for 1-2 h, elevation of arterial pressure, increased minute blood circulation volume, cardiac index, stroke volume were noted. At the same time base deficiency in blood was growing. So, in the last 5 patients the infusion therapy at the prehospital stage was completed by injecting 200 ml of 3% sodium solution and the acid-base state in them was thus leveled. When using the "internal autotransfusion" lethality was reliably less than in patients who were treated by routine (polyglucon, gelatinole) infusion therapy.

[Computerized monitoring of patients in the intensive care and resuscitation unit]. / Komp'iuternyi monitoring u bol'nykh v otdelenii intensivnoi terapii i reanimatsii.

Monitoring-computed systems were used during the therapeutic-diagnostic process at the resuscitation department of the All-Union Surgery Research Center in more than 1,000 patients who underwent operations on the heart, coronary arteries, bronchi, trachea, and esophagus. The main importance is attached to examination of the cardiorespiratory system. More than 90 derived parameters characterizing intracardiac hemodynamics, ventricular contractility, and oxygen transport are calculated according to special programs. For evaluation of the function of the lungs in an automated regimen, 32 parameters characterizing lung ventilation, gas exchange in the lungs, mechanism of respiration, and metabolism are calculated. Monitoring-computed care makes it possible to appraise the patient's condition in a given situation, the transient nature of changes in the physiological systems of the organism under the effect of therapy, and helps in choice of the optimal regimens of artificial lung ventilation and the methods of treatment. Computed appraisal of hemodynamics by means of the algorithm of the nearest point was found to be correct in 93% of cases. Storage of the results in the computer memory ensures an operative approach to information on any of the patients.

[The status of the renin-angiotensin-aldosterone system in patients in the early period following aortocoronary bypass surgery]. / Sostoianie renin-angiotenzin-al'dosteronovoi sistemy u bol'nykh v rannie sroke posle operatsii aortokoronarnogo shuntirovaniia.

The state of renin-angiotensin-aldosterone system has been studied in 43 patients after aortocoronary bypass surgery. Renin activity, angiotensin II and aldosterone content have been studied, using radioimmunoassay, in comparison with hemodynamic findings and water-electrolyte balance parameters. The study was performed in patients with uncomplicated postoperative period and in patients with acute circulation disturbances just after surgery and 3, 6, 18 and 48 hours after surgical intervention. It has been shown that in uncomplicated postoperative period there is a 6-8-fold increase in plasma renin content and a 1.5-2-fold increase in aldosterone concentration. Despite an increase in aldosterone activity clinical signs of hyperaldosteronism became evident by the 18-48th hour postoperatively. A persistent increase in renin-angiotensin-aldosterone system activity in patients with acute circulation disturbances is considered as a compensatory body reaction directed at stabilization of the circulating blood volume and heart performance.

[Dynamics of the level of plasma vasopressin and its role in the regulation of water-electrolyte metabolism in patients following aortocoronary bypass]. / Dinamika urovnia plazmennogo vazopressina i ego rol' v reguliasii vodno-élekrolitnogo obmena u bol'nykh posle aortokoronarnogo shuntirovaniia.

Changes in plasma vasopressin, K+, Na levels, osmolality in blood and urine samples, as well as hemodynamic parameters, cardiac output and circulating blood volume including, have been assessed in 38 patients 3, 6, 18 and 48 hours after aortocoronary bypass surgery. It has been found that vasopressin blood level in the postoperative period is considerably (5-7 times) higher than physiological hormone level. The main reasons for vasopressin blood level increase are surgical stress, increase in blood plasma osmolality, hypokalemia, a drop of the arterial blood pressure and central venous pressure elevation. Despite a high vasopressin level and its pronounced impact on the renal excretory function, the first postoperative hours are marked by polyuria, mediated mainly by osmotic diuresis due to infusions of high amounts of osmotically active substances.

[Use of sympathomimetic agents in the treatment of acute circulatory insufficiency in the immediate postoperative period of heart surgery patients]. / Primenenie simpatomimeticheskikh sredstv dlia lecheniia ostroi nedostatochnosti krovoobrashcheniia v blizhaishem posleoperatsionnom periode u kardiokhirurgicheskikh bol'nykh.

Sympathomimetic agents: isoproterenol (novodrin), dopamine, noradrenalin, adrenalin were used in 137 patients with acute circulatory insufficiency. Their hemodynamic effects were assessed, using catheterization of heart chambers and radiocardiography, and studies of circulating blood oxygen transport, acid-base state and metabolic product levels. A differential approach to sympathomimetic treatment has been developed. Isoproterenol is primarily indicated in those cases where myocardial failure is combined with decreased heart rate, conductivity disorders and markedly increased total peripheral resistance. Dopamine is more justified in cases where increasing the heart rate is more desirable, and there are signs of renal failure and heart rhythm disorders. The possibility of dopamine-induced pulmonary hypertension and pO2 fall should not be dismissed. Correct choice of an agent or a combination of agents makes it possible to control the patient's condition through action on various hemodynamic mechanisms that determine the magnitude of cardiac output.