Background. Acute hemorrhage remains the leading cause of death on the operating room in emergency surgery. However, the correlation of the central hemodynamics, oxygen balance and homeostasis in such victims during emergency surgical treatment with the outcomes of surgical treatment has not yet been evaluated.

Material and methods. We examined 100 patients with acute massive blood loss, who had emergency surgery. We determined heart rate, arterial pressure by direct and indirect methods, central venous pressure, oxygen saturation of blood, cardiac index, systemic vascular resistance, gas and acid-base contents of arterial and venous blood, oxygen consumption, oxygen delivery, oxygen extraction ratio according to generally accepted formulas. Two groups of patients were formed of 50 people, depending on the oxygen balance (Group 1 - subcompensation, Group 2 - decompensation).

Results. At the time of admission to the operating room and after the surgery, the indicators of systemic hemodynamics in patients of both groups did not differ statistically significantly. In the Group 2, at the time of admission to the operating room, there were statistically significantly higher VO₂ (195 (158, 256) ml/(min-m²) and 112.5 (86; 145.3) ml/(min-m²)), ERO2 (50 (45.1, 60) % and 25.1 (19.6, 33.2) %) and low SvO₂ (54.4 (48.5, 67.5) % and 75.1 (67,8; 83) %) (p<0.001 for all indicators). In the Group 2, there were increased values of ERO₂ and VO₂ (p=0.001) at the end of the operation compared to the Group 1, although the glucose and lactate levels did not differ statistically significantly between the groups. The course of the postoperative period was complicated in 9 (18%) patients of the Group 1 and 2 (4%) patients died. The course of the postoperative period of patients in the Group 2 was complicated in 9 (18%) patients and 7 (14%) patients died.

Conclusion . Circulatory insufficiency persisted in patients who had severe oxygen deficiency disorders, despite management of bleeding, replenishment of blood loss, intraoperative intensive therapy, indicating the depletion of the compensatory mechanisms of the oxygen transport system. This was confirmed by a higher mortality rate among the victims of this group.

Aim of study. A comparative analysis of the early outcomes of simultaneous and staged methods of revascularization in patients with a combined coronary and carotid artery stenosis.

Materials and methods. The study included 45 patients with combined carotid and coronary artery stenosis, operated at the Republican Research Centre of Emergency Medicine in 2014-2018. Patients were divided into two groups: “simultaneous”, 20 patients (simultaneous interventions on the carotid and coronary arteries were performed) and “staged”, 25 patients (carotid and coronary artery stenoses were operated in a staged manner). In all cases, surgical intervention was performed on the beating heart.

Results. According to the results of work in the postoperative period, the incidence of neurological complications in the group of staged interventions and in the group of simultaneous interventions was 4.0% vs 5.0%, respectively. In the group of staged interventions, no deaths were observed, whereas in the group of simultaneous interventions, one lethal outcome was observed (5%) associated with pulmonary complications.

Background. The pressure in brain sinuses (BSP) is used to monitor the effectiveness of various methods of prevention and treatment of venous air embolism (VAE) during surgeries in patients in the sitting position. A simpler and more approachable way is to measure the pressure in the superior bulb of the jugular vein (JBP), which accurately reflects the BSP. The dependence of the frequency and severity of VAE in JBP, however, has not been investigated, and the data on the effect of various methods of prevention and treatment of VAE on JBP are either insufficient or contradictory. The study was aimed to determine the dynamics of the JBP when bringing the patient to a sitting position, its relation with the severity of the VAE and to assess the effect of right atrium pressure (RAP), positive end expiratory pressure (PEEP) and decreased minute pulmonary ventilation (MPV) on it.

Material and methods. The prospective study included 66 people who underwent intracranial surgery in a sitting position. In addition to the standard monitoring under general anesthesia with artificial lung ventilation, the superior bulb of the jugular vein and the right atrium were catheterized, and the esophagus was intubated with transesophageal echocardiography sensor. JBP was measured in a supine and sitting position and examined in relationship to RAP. In patients with JBP<0 mm Hg, its dynamics was evaluated at PEEP<0 cm H20 and MPV with end-tidal carbon dioxide (etCO₂)=44 mm Hg, PEEP=15 cm H₂0 and MPV with etCO₂=36 mm Hg. The Tuebingen scale (Tuebingen VAE) was used to determine the severity of VAE.

Results. After bringing the patient to the sitting position the JBP significantly (W=2137.5; p<0.001) decreased by an average of 8 mm Hg, while in 11 (16.7%; 95% CI: 8.6-27, 8) cases it remained positive. No correlation was found between the RAP and JBP in the supine position (Z =-0.08225; p=0.9344) and in the sitting position (Z=1.2272, p=0.2198). The VAE frequency was 51% (95% CI 38.8-64). In patients with JBP <0 mm Hg, the frequency and severity of VAE was significantly higher than with JBP≥1 mm Hg (chi-square=4.37; df=1; p=0.036 and Z=2.47, p=0.015, respectively). Significant changes of JBP when PEEP 15 cm H₂O and MPV with etCO₂=36 mm Hg were not found (Z = -0.9784, p=0.3964 and Z=-1.3324, p=0.2305 respectively).

Introduction. Early bystander cardiopulmonary resuscitation (CPR) is a critical factor in out-of-hospital cardiac arrest survival, and the readiness of bystanders to provide the first aid is known to be positively influenced by effective training. It is recommended to use alternative teaching methods in order to increase the accessibility of CPR training. The study was carried out to assess the effectiveness of the blended approach to resuscitation training, where classroom training hours are partially substituted with remote learning.

Material and methods. This prospective randomized study was conducted in November-December 2018. Nursing students and nonmedical university students underwent classroom training (1 hour of lecture, 3 hours of hands-on training) or blended training (1 hour of on-line course, 3 hours of hands-on training) in basic CPR with automated external defibrillation (AED). CPR knowledge and willingness to attempt resuscitation were evaluated before and after the training, and resuscitation skills were assessed as well after training in a simulation scenario. CPR quality measures were registered using the skills checklist when analyzing video recordings, and automatically by means of the Resusci Anne QCPR manikin.

Results. The training and the study assessments were completed by 94 participants: 55 - classroom training, 39 - blended training. The mean age was 19 years and 17 years, respectively, 24% and 31% were male. Whereas there were more participants with previous training in CPR in the classroom training group (36% vs. 13%; p<0.05), the baseline levels of knowledge and readiness to perform resuscitation on a stranger were generally comparable between the groups. After the training, there was an increase in willingness to perform resuscitation (from 3.6 to 4.4 points in both groups) and improvement in self-perceived CPR knowledge (from 2.4 to 4.0 points in the classroom training group and from 2.6 to 4.3 in the blended training group). The assessment of the CPR quality in the simulation scenario revealed no significant differences between groups, excepting higher rate of chest compressions in the blended training group (116.0 vs. 109.4, р<0.01).

Conclusion. The suggested method of blended training in basic CPR with AED is no less efficient than traditional classroom training, and it can be recommended for increasing access to high-quality training in first aid.

The aim of the study is to specify tactics of surgical treatment of cerebellar infarction (CI).

Material and methods. The results of treatment of 80 patients with CI were studied. According to the clinical course of stroke, the patients were divided into 2 groups. The group of malicious cerebellar infarction included 55 patients (69%) (Group I), the group cerebellar infarction with benign course included 25 patients (31%) (Group II). Patients of Group I were divided into subgroups, in one of them surgical treatment was performed (surgical subgroup), and in the another one, only conservative (conservative subgroup) treatment was performed. In the surgical subgroup, 16 patients underwent isolated ventriculostomy, 5 - posterior fossa decompression (PFD), 18 - combination of ventriculostomy and PFD. The criteria of efficacy of surgery were recovery of consciousness and/or IV ventricle and the quadrigeminal cistern configurations. Results of treatment were assessed according to the Glasgow Outcome Scale.

Results. Malicious cerebellar infarctions occurred more frequently in patients with volume of ischemia exceeding 20 cm³ in the first day of the disease. The threshold value of mass effect, which may cause further a malocious cerebellar infarction, in the first day of the disease was score 3 according to the M. Jauss scale. In group of patients with malicious cerebellar infarction, surgical treatment reduced the mortality rate of occlusion and dislocation syndrome by 35.8%. The most effective type of intervention was a combination of decompressive trepanation of the posterior cranial fossa and external ventricular drainage. Combined ventriculostomy and PFD were 34 % more effective than just ventriculostomy, and 38 % more effective than just PFD.

Conclusion. Patients with cerebellar infarction of more than 20 cm3 and signs of a mass effect in the posterior cranial fossa score 3 or higher according to M. Jauss scale, are prone to developing a malicious course of the disease. After the development of clinical manifestations of occlusive and dislocation syndrome, they need surgical treatment.

In the surgical treatment of malignant cerebellar infarction, ventriculostomy with PFD are advisable, as each operation separately does not always provide a necessary effect in decompensation of dislocation syndrome.

In this review, we have summarized the latest evidence, indications, and methods of fecal microbiota transplantation (FMT), and analyzed the prospects and therapeutic potentials of this procedure. In recent years, FMT has attracted great interest, especially due to the global Clostridium difficile infection (CDI). FMT is now recommended as alternative therapy for recurrent CDI when standard treatment with antibiotics fails. It involves putting suspended biomaterial with intestinal microorganisms of a healthy donor into the intestine of a patient. Although the exact mechanism of action is not entirely clear, it is believed to restore the composition and function of the intestinal microbiota in diseased patients. The efficacy varies depending on the route of administration, quality and volume of donor biomaterial, and treatment before the procedure.

The analysis of domestic and foreign sources of literature showed that the problem of diagnosis and treatment of inhalation injury still remains relevant as 20-30 years ago. It is known that inhalation injury causes both local and systemic disorders. Existing diagnostic methods do not allow the extent of these disorders to be accurately determined. This, in turn, leads to the absence of clear criteria for the severity of inhalation injury and treatment algorithms.

Nonspecific infectious lesions of the spine are relatively rare, difficult to diagnose and severe diseases of the spine. The urgency of treating nonspecific infectious spinal diseases is explained by an increase in the frequency of these diseases, new antibiotic-resistant strains of microorganisms, and the severity of the course and unsatisfactory treatment outcomes. In this review, we describe spondylodiscitis and epiduritis in detail. On the basis of literature data, we thoroughly studied and described etiology, clinical pattern and diagnosis of these diseases. We thoroughly covered modern laboratory and radiologic methods for the diagnosis of spondylodiscitis and epiduritis, such as spondylography, computed tomography, magnetic resonance imaging, scintigraphy, positron emission tomography of the spine and biopsy and described modern methods of conservative and surgical treatment. The particular attention is paid to the technique of surgical treatment of spondylodiscitis and epiduritis.

Background. The term “burnout” was originally developed by the psychologist Herbert Freudenberg (Germany, USA) in the seventies of the last century. Then another psychologist, Christina Maslach was a co-author of the Maslach Burnout Inventory, which was adapted to different professions and translated into different languages. According to Russian scientist professor Victor V Boyko “the emotional burnout is a form of professional distortion of an individual ...”. Anesthesiology and resuscitation are certainly among the most stressful medical disciplines, daily exposing doctors to high responsibility associated with life-threatening scenarios of patients. Therefore, burnout detection is important because it is related to the safety and quality of medical care, as well as to the life and health of intensive care specialists.

Aim of study Anonymous, blind observational study of the frequency and dynamics of burnout, depression, situational and personal anxiety of anesthesiologists and resuscitation doctors and nurses of anesthesiology and intensive care departments.

Material and methods. The study included 64 specialists of anesthesiology and intensive care departments (41 doctors and 23 nurses). Maslach Burnout Inventory (MBI) for Medical Personnel, Purpose in life test (Crumbaugh & Maholick, 1964), “Burnout” questionnaire of V. V. Boyko, Toronto Alexithymia Scale (TAS), Spielberger State-Trait Anxiety Inventory (STAI) in the adaptation by Y L. Khanin, Assessment of depression (HADS), and a series of general questions (gender, age, profession, working experience, marital status, number of working hours per week, how much do I love my job, how much I would like to love my job, somatic complaints, etc.).

Results. According to MBI, 65.9% of examined doctors and 43.5% of nurses have high rates of certain burnout, which confirms the relevance of the studied problem. Of these, 12.19% of doctors and 8.7% of nurses have high rates of all three sub-scales of burnout syndrome. Depression, personal and situational anxiety have a positive correlation with burnout.

Conclusion. According to the literature, burnout leads to a steady decrease in work productivity, destructive behavior, emergence of a variety of psychosomatic disorders, and a sense of meaninglessness of existence, despair, suicidal thoughts and committed suicides at the final stage of burnout. It is necessary to conduct regular testing of intensive care specialists to detect burnout, depression and anxiety. When the burnout is identified, it is necessary to perform psychological interventions.

Seat belt syndrome is a triad of symptoms: body belt marks (hemorrhages, ecchymosis, abrasions on the abdominal wall), intra-abdominal trauma and spinal fractures in the thoracic and lumbar spine. The abdominal mark of a safety belt implies a complex diagnostic algorithm to exclude injury to the intraabdominal organs and the abdominal wall. The clinical picture of damage is not specific, which leads to errors in diagnosis or delays at the beginning of the examination protocol. A dynamic examination of the patient (ultrasound, CT, X-ray) is necessary. The damage to the abdominal wall with a seat belt, which entailed the development of septic complications, require long-term general and local treatment, additional diagnostic methods and surgical interventions.

We report the experience of sanitary aviation evacuation of a patient with severe respiratory failure on the background of community-acquired pneumonia using mask non-invasive ventilation. The use of this method of ventilation of the lungs made it possible to avoid undesirable consequences arising from the transfer of the patient to artificial ventilation of the lungs and to transport him safely to a specialized medical institution in order to continue treatment. The described method of preparing a patient with respiratory failure before aviation transportation has shown its effectiveness during the flight and may be recommended for use by airmobile crews when carrying out long-distance evacuation

The authors report a clinical observation of the removal of a large foreign body (a dental prosthesis with a sharp metal pin) of the left inferior bronchus with combined use of rigid and flexible bronchoscopy. A foreign body was detected two years later by chance during examination for complications. It is noted that the combination of rigid and flexible bronchoscopy allows good visualization of the surgical intervention to be performed and additional damage to the bronchi and trachea to be avoided while removing a foreign body.

The article presents unforeseen difficulties in organizing the deployment of the emergency room, dressing rooms, resuscitation units and operating rooms in the hospital of Maralik, which received victims of the earthquake.

We considered options for sorting the victims, depending on the severity of the condition, the urgency in the implementation of resuscitation and surgical interventions. We also paid attention with the psychological state of victims and determined the procedure for transporting victims to specialized hospitals of the other cities of Armenia and our country.

The creation of a state system of medical, social and ecological protection in the country from possible natural disasters and man-made disasters is an actual issue.