Background. The chances of fatal outcome in out-of-hospital cardiac arrest are exceeding 90%. However, the early initiation of bystander cardiopulmonary resuscitation (CPR) substantially improves the probability of survival. The study was aimed to determine the extent of community CPR training, level of CPR knowledge, willingness and motivation to learn CPR among the population of the Crimea.

Materials and methods.The representative sample of adult residents of the Crimean Peninsula (n=384) has been surveyed by means of individual structured interview from November 2017 to January 2018. The results were analyzed with social statistics.

Results. According to the survey, 53% of respondents were previously trained in CPR. The training was performed mainly (82%) at work, school, college/technical school or university, or when acquiring a driver's license. The majority of females, people over 60, unemployed and retired, widowed and those with monthly income lower than 20,000 roubles are not trained. Of previously trained, 44% respondents attended a single CPR course, 72% were trained more than one year ago, 47% of participants had no previous training in CPR, mostly never thinking about the need to go for training. Being dependent from previous CPR training, the knowledge of CPR is generally poor: the proportions of correct answering as of the proper location and rate of chest compressions were 46% and 4%, respectively. Among the respondents, 56% expressed their willingness to attend CPR training. The main motivating factors to attend CPR training were awareness of importance of CPR training, potential health problems in relatives/friends and free-of-charge training.

Conclusion. The Crimean population is insufficiently and non-uniformly trained in CPR, has limited knowledge of CPR and low motivation to learn. In order to increase the commitment of the community to provide first aid in out-of-hospital cardiac arrest, mass CPR training programs should be implemented with active involvement of the least trained and motivated social strata.

Background. The relative availability of Phenazepam makes it a frequent cause of overdose, suicide and non-medical use. At the same time, it remains insufficiently studied in chemical and toxicological terms.

The aim of study. to create an accessible, rapid method for detecting Phenazepam in biological matrices of patients with acute poisoning.

Materials and methods. We used thin-layer chromatography (TLC), gas chromatography with a mass selective detector (GC-MS), high performance liquid chromatography with a tandem mass-selective detector (LC-MS/MS) and immunochromatographic analysis (ICA). The preparation of samples of intact urine with the addition of standard solutions of Phenazepam and real urine samples of patients with acute poisoning with Phenazepam was carried out using liquid-liquid extraction or precipitation of related components of the sample with acetonitrile. Hydrolysis and derivatization were also added in GC-MS analysis.

Results. The analysis of statistics of the Department of Acute Poisonings of the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2014-2016 showed that Phenazepam poisonings averaged 9.2% of the total number of admissions and mainly occurred as suicidal attempts. A technique has been developed for the detection of Phenazepam by TLC, which gives more objective results than ICA. For confirmatory analysis, it is advisable to use LC-MS/MS method for the native substance and GC-MS for the products of hydrolysis after derivatization. Compared to confirmatory methods, the developed TLC-screening technique is expressive, does not require the use of expensive high-tech equipment, difficult sample preparation, and makes it possible to reliably detect toxic and lethal concentrations of Phenazepam.

The aim of study: to investigate validity of respiratory insufficiency scale (RIS) in patients with acute lesions of nervous system.

Material and methods. The prospective observational study included neurocritical care patients (n=179), admitted to the resuscitation and intensive care unit with independent breathing and RIS score 1 and higher. Patients were assessed according to RIS every 12 hours during the the period of RICU stay until the beginning of artificial lung ventilation or transfer to a specialized department. The RIS score did not influence the physician's decision upon intubation. The treatment was performed in accordance with national and international recommendations.

Depending on the tracheal intubation and ALV, patients were divided into 3 groups. Group I (n=65): 0% tracheal intubation and ALV; Group II (n =54): 42,6% cases of intubation and ALV; Group III (n=60): 100% patients requiring intubation and ALV.

The statistical analysis was performed using Shapiro—Wilk test, Mann-Whitney test, Kruskal—Wallis test, Chi-squared test. The ROC analysis was carried out to determine the sensitivity and specificity of the RIS scale.

Results. Patients with RIS score 1 — 2 did not require intubation and ALV. Patients with RIS 5 or more required urgent intubation and ALV. In patients with RIS score 3—4 the need for intubation and ALV was unpredictable. If RIS score 4 was sustainig during several hours, or if increased from 3 to 4, a patient required intubation and initiation of ALV.

Conclusion. RIS helps objectify indications for intubation and ALV in patients with acute neural lesions.

Background. The improvement of treatment tactics for nosocomial pneumonia in patients with burn and inhalation trauma is a relevant issue due to the frequency of this complication, which develops at any stage of treatment and aggravates the course of the underlying disease.

Aim of study. To evaluate the effectiveness of extremely high frequency therapy (EHFT) in the complex treatment of pneumonia in patients with burn and inhalation injury.

Material and methods. The results of extremely high-frequency therapy (EHFT) was compared, studying 23 burn patients with complex EHFT and 30 patients without EHFT.

Results. EHFT reduces the signs of endogenous toxemia, as evidenced by a statistically significant decrease in elevated concentrations of dead leukocytes in venous blood from 147-10⁶/L (98; 363-10⁶/L) to 81.8-10⁶/L (72; 150-10⁶/L) (p=0.041, Wilcoxon test) on day 6-8 (after 5-6 procedures), whereas in the comparison group, on the contrary, an increase in the dead cells from 121-10⁶/L (66; 210-10⁶/L) up to 137.4-10⁶/L (116; 207-10⁶/L) was observed. When comparing this indicator in two groups on day 6-8 from the onset of pneumonia, a statistically significant difference was found (p=0.021, Mann-Whitney). The term of managing pneumonia in patients receiving EHFT was significantly shorter than in the comparison group, 18 (13; 23) versus 21 (18; 27) days (p=0.020, Mann-Whitney).

Conclusion. EHFT reduced intensity of endogenous toxicosis and inflammation, approaching pneumonia relief for 3 days.

The article presents the current state of hyperhydration issue in burn patients as a result of excess volume of infusion therapy during the acute period of burn disease. We report the data on the pathogenesis of burn disease and standard formulas for determining the volume of infusion therapy in case of burn shock, mechanisms and clinical manifestations of hyperhydration in burn patients and modern methods of its management. Since the danger of hyperhydration persists even after a shock in an acute period of burn disease, a method is proposed for determining the baseline volume of infusion therapy in the post-shock period. The developed algorithm is effective for prevention of hyperhydration in burn patients and covered by an invention patent.

Intracranial hypertension (ICH) is a frequent and serious complication that occurs in pa-tients with severe traumatic brain injury (TBI) and nontraumatic brain damage. Persistent ICH significantly worsens the prognosis of the disease course and increases the risk of adverse outcomes. In this regard, one of the main tasks of intensive care of patients with intracranial bleeding (ICB) is diagnosis and timely management of ICH. The gold standard is invasive intracranial pressure (ICP) monitoring. The advantages of direct measurement of ICP include accuracy and continuity of registration. The disadvantages are the invasiveness of the method, high cost, the risk of developing infectious and hemorrhagic complications and possible dislocation of sensors. It is necessary to search for a method of non-invasive assessment of the level of ICH most correlated with the data of direct measurement of ICP. Ultrasonography of the optic nerve structures can be such an alternative cheap way to assess ICP. Its advantages are the possibility of repeated dynamic use, no need for surgical intervention, simplicity and high accuracy of measurement. However, the results obtained with ultrasound vary, since this method is operator dependent and requires precise adherence to the technique of the study. When the optic nerve ultrasound is performed, a contact gel for ultrasound examinations is applied to the anterolateral surface of the closed upper eyelid, and a scanning plane is displayed behind the eyeball for visualization in the central part of the ultrasound image of the optic nerve, lens and retina. To visualize the vertical course of the ophthalmic artery (and the vertical course of the optic nerve), the color flow Doppler mode is used. The study includes measuring the diameter of the optic nerve and the optic nerve sheath diameter (ONSD). There is subarachnoid space with cerebrospinal fluid between the optic nerve and its sheath. With an increase in intracranial pressure, the expansion of this space occurs, ONSD grows as well. This article contains an analysis of the literature describing the anatomy of the optic nerve and various ultrasound techniques, as well as data from various authors on the threshold value of the optic nerve sheath diameter.

The article summarizes years of the authors experience in the diagnosis and treatment of acute poisonings with ethyl alcohol and presents data on the epidemiology of poisoning with ethyl alcohol, as well as modern terminology and systematization of poisoning with alcohols in accordance with the international classification of diseases ICD 10.

We analyzed the pharmacokinetics and pharmacodynamics of ethyl alcohol in its toxic effects.

The original clinical classification of alcoholic coma, confirmed by electrophysiological studies of the brain is given in the article. We also determined the involvement of deep structures of the brain in the pathogenesis of acute alcohol poisoning.

The emergency therapeutic measures in acute alcohol intoxication and its complications, primarily related to accelerated detoxification of the body by forced diuresis are reported. The importance of effective correction of acid-base blood disorders and prevention of acute renal failure is emphasized.

The article might provide a more accurate diagnosis of acute alcohol poisoning, accompanied by the development of alcoholic coma, and to improve the quality of treatment of this disease in the intensive care and toxicology departments.

We present the management features for the refractory epileptic status in a patient after surgical treatment of unruptured cerebral aneurysm and no epileptic prehistory. The role of continuous electroencephalographic monitoring in adjusting the rate of drugs administration for general anesthesia in the treatment of this condition is also described.

We report the successful surgical treatment of a giant true thrombosed aneurysm of the left ventricle.

A 59-year-old male patient Z. was admitted with severe heart failure and chronic thrombosed aneurysm of the left ventricle, formed after acute extensive myocardial infarction, despite successful installation of a stent into the anterior descending artery in the acute period. Echocardiography revealed a significant increase in the volume of the left ventricular cavity, a significant decrease in the contractile function of the left ventricular myocardium (ejection fraction 32-36%), a giant left ventricular aneurysm (9x6 cm) with a parietal lining thrombus in the aneurysm cavity. Coronary angiography showed an aneurysmal dilatation of the circumflex branch of more than 6 mm, hemodynamically significant stenosis of two coronary arteries. According to the scintigraphy, the myocardium beyond the scar tissue was viable. The patient underwent resection of a left ventricular aneurysm, endoventricular plasty (Dor procedure), coronary artery bypass surgery of the circumflex artery and obtuse marginal branch of the left coronary artery.

The patient was discharged in satisfactory condition on day 14 after surgery. At follow-up 6 months after surgery, an increase in the ejection fraction to 3941% was noted.

The authors report a rare clinical case of extensive retropharyngeal hematoma, associated with undiagnosed injury of the cervical spine with a gradual involvement of the spinal cord into the traumatic disease.