In modern conditions of global epidemiological challenges, a systematic approach to engineering (design) and reengineering (redesign) of treatment and diagnostic processes in hospitals acquires a special role for the state healthcare system.

In this case, the focus of special attention to the management of hospitals is solving a task of organizing the treatment of patients with COVID-19 in the absence of proven clinical practice and dynamically modify the corresponding information flow, as well as the need for optimization of resource support and enhance its efficiency in the face of strong growth in the number of new cases and lack of standard solutions for the reorganization of hospitals, especially of non-infectious profile.

In the paradigm of the systemic approach, effective management of the treatment and diagnostic process is not possible without a deep analysis of all its elements: from the moment the patient is admitted to the hospital until the completion of the treatment process. The recency of COVID-19 and the lack of clinical practice for the treatment of these patients have predetermined the need to develop comprehensive standards of clinical processes and their automation. It is the way of organizing the process to achieve the target state of the patient that forms the requirements for infrastructure and resource provision.

The article presents the experience of the N.V. Sklifosovsky Research Institute for Emergency Medicine in organizational and informational support of the process of diagnosis and treatment of patients with COVID-19.

Relevance. Acute respiratory infection COVID-19 caused by the SARS-CoV-2 (2019-nCov) coronavirus is severe and extremely severe in 15—20% of cases, which is accompanied by the need for respiratory support. Hyperbaric oxygenation is recognized as an effective therapy for replenishing any form of oxygen debt.

Aim of study. To study the safety of HBO use in patients with COVID-19.

Material and metods. We examined 32 patients with the diagnosis “Coronavirus infection caused by the virus SARS-CoV-2” (10 — moderately severe patients (CT 1–2), 22 — patients in serious condition (CT 3–4), who received course of hyperbaric oxygenation (HBO). The procedures were carried out in a Sechrist 2800 chamber (USA) at a mode of 1.4–1.6 AT for no more than 60 minutes. In total, the patients received 141 HBO sessions. Before and after each HBO session, the subjective indicators of the patient’s condition were assessed and the blood oxygen saturation was measured.

Results. An algorithm for HBO course management was developed, which consists in using “soft” modes (up to 1.4 AT) during the first session, followed by pressure adjustment (not higher than 1.6 AT) during the course to achieve maximum therapeutic effect and comfort for the patient. Against the background of the HBO course, the patients showed an increase in blood oxygen saturation in patients in both surveyed groups, as well as positive dynamics in the form of a decrease in shortness of breath, an improvement in general well-being.

Conclusion. The inclusion of daily sessions (at least 4) of hyperbaric oxygenation in “soft” modes (1.4–1.6 ATA) in the complex therapy for COVID-19 has shown its safety and preliminary positive effect on the subjective state of the examined patients and the dynamics of blood oxygen saturation.

Abstract. In the context of the pandemic, when healthcare professionals are forced to work under extreme stress and an increased threat of infection, research on professional burnout and emotional maladjustment of medical workers is gaining particular relevance around the world.

Aim of study. To assess the severity of symptoms of depression and anxiety, professional burnout and emotional distress among the employees of the N.V. Sklifosovsky Research Institute for Emergency Medicine, providing care to patients with COVID-19 in the current period (July). To compare them with the indicators of a mixed sample of medical workers from different institutions and regions surveyed in the first months of the pandemic (March–April), and also to highlight the main factors of distress and protective factors.

Material and methods. The research methods were combined into a Google form, and participation in the research was anonymous. Of the 175 people who were sent questionnaires, filled out the form completely 120 people (69% samples), of which 43 men and 77 women, 54.2% were doctors of different specialties; 40% were nurses, the rest of the categories accounted for 5.8% of the sample. The mean age of the respondents was 36.1 years (from 21 to 61 years).

Results. The data obtained on the indicators of mental distress are generally consistent with international data: 8.3% of the surveyed demonstrate symptoms of depression of moderate and severe severity according to the Beck’s Depression Scale; 6.7 % noted the presence of suicidal thoughts; 29.3% had symptoms of anxiety of moderate and high severity according to the Beck’s Anxiety Scale. And 35% had high level of emotional exhaustion according to the Maslach Burnout Inventory. Nevertheless, the data obtained indicate a greater mental well-being of employees of the N.V. Sklifosovsky Research Institute in comparison with a mixed sample of specialists surveyed in March - April. The limitations of such a comparison are indicated, which are associated with differences in organizational affiliation and the composition of specialists. Anxiety for family members (noted by 54.7%) and fear of infection (noted by 38.3%) were most often named as an important factor of distress in the entire sample of 120 people. The most significant protective factors (reducing the level of distress), noted by more than half of the employees, were information about the current situation and tasks from the management, support from family and colleagues, material incentives and the opportunity to take breaks for rest. Based on the data of the regression analysis, it is concluded that it is important to take measures for psychological relief, provide personnel with protective equipment, reduce the level of physical discomfort associated with the use of personal protective equipment and lack of sleep, explain to the staff the meaning of all measures and decisions taken, and collegial discussion of the organization of work. The quality of support from relatives, colleagues and administration helps maintain a sense of the importance of their profession and self-respect for themselves as a professional among medical personnel.

Introduction. Efficient organization of measures aimed at decreasing mortality from out-of-hospital cardiac arrest (OHCA) warrants a clear understanding of OHCA epidemiology and performance of the prehospital care system in such cases. The study was aimed at performing respective analysis and identifying the ways for improving prehospital management of OHCA in the Republic of Crimea.

Material and methods. Annual data from the Crimean OHCA and Resuscitation Registry for 2018 were utilized. All OHCA cases attended by emergency medical services (EMS) with attempted cardiopulmonary resuscitation (CPR) were included, regardless of cardiac arrest etiology or patients’ age (n=419). For ensuring conformity and comparability of the study results, data collection and analysis were executed in correspondence with the statements of the Utstein recommendations.

Results. The overall incidence of EMS-attended OHCA in the Republic of Crimea was 673.3 per 100,000 population per year, the incidence of OHCA with attempted CPR – 21.9 per 100,000 population per year, the proportion of CPR attempts out of all OHCA cases – 3.3%. Mean patient age was 66.9 years, and 52.7% were male. The etiology was cardiac in 42.5% cases. In 71.8% cases OHCA was witnessed by EMS, in 25.5% – by a bystander before EMS arrival. Bystanders initiated CPR in 5.7% cases. The initial rhythm was asystole in 80.4% of all cases. When excluding EMS-witnessed cases, the mean EMS response time was 13 min. 5.0% patients had a sustained return of spontaneous circulation at hospital admission. Survival was associated with lower EMS response time (p=0.027), administration of shock (p<0.001) and advanced airway management with endotracheal tube or laryngeal mask (p=0.047).

Conclusion. High incidence of OHCA, low rates of CPR commencement and low rates of survival from OHCA in the Republic of Crimea determine the necessity of implementing a comprehensive program to improve prehospital care in the region. Considering the critical relevance of early intervention in OHCA and the revealed low bystander CPR rate, the measures for involving community into the process of prehospital care should form the basis of this program.

Relevance. In current clinical practice, there is a need for research to find new diagnostic tests for the purpose of determining the patients with the highest risk of death from pneumonia. Surfactant proteins SP-A and SP-D play a key role in the pathogenesis of the response to microbial invasion of lung tissue, which participate in a cascade of reactions of both innate and adaptive immunity, and therefore proteins SP-A and SP-D may be considered as markers of the severity of community-acquired pneumonia (CAP).

Aim of study. To evaluate the associations of surfactant proteins SP-A and SP-D in blood plasma with the severity of CAP.

Material and methods. The study included 247 patients admitted to the therapeutic department. The group of patients with CAP (n=188) was divided into groups of severe (n=103) and non-severe (n=85) pneumonia. The comparison group (n=59) consisted of patients without acute and chronic diseases of the bronchi and lungs. The mean age (years, Me, 25th; 75th percentile) of patients was 55 (47; 68), 55 (47; 70), and 61 (37; 63) years, respectively. All patients underwent clinical, functional, diagnostic and laboratory studies (including determination of the content of SP-A and SP-D proteins by enzyme immunoassay).

Results. In the group of patients with severe pneumonia unlike mild pneumonia, and group of comparison higher levels of proteins SP-A and SP-D were observed. Correlation analysis described below revealed statistically significant connection: protein SP-D — direct relation with leukocyte levels (r=0.320, p<0.0001), erythrocyte sedimentation rate (r=0.331, p<0.0001), inverse relation with blood oxygen saturation (r=-0.407, p<0.0001), for SP-A protein — direct relation with body temperature (r=0.355, p<0.0001), erythrocyte sedimentation rate (r=0.369, p<0.0001) in the blood C-reactive protein (r=0.446, p<0.0001), SP-D (r=0.357, p<0.0001), and also relation with the duration of clinical symptoms (r=0.528, p<0.0001) and blood oxygen saturation (r=-0.401, p<0.0001). When conducting ROCanalysis for the surfactant protein SP-A, the area under the ROC- curve was 0.70, the optimal sensitivity for severe pneumonia was 68%, the specificity was 69% at the SP-A level in blood plasma equal to 42.9 ng/ml. When performing ROC analysis for the surfactant protein SP-D, the area under the ROC curve was 0.64 for severe pneumonia, the optimal sensitivity was 62%, and the specificity was 62% at the SP-D content in blood plasma equal to 319.2 ng/ml.

Conclusion. According to the results of this study, the SP-A and SP-D proteins are associated with clinical and laboratory signs that reflect the severity of CAP. Thus, SP-A and SP-D are new laboratory markers of CAP severity.

Relevance. For the acute phase of cerebral insufficiency (ACI) analysis of energy demand at rest (REE) using indirect calorimetry method is effective to evaluate the level of hypermetabolism and selection of optimal nutritional support. In patients with chronic impairment of consciousness (CIC) the reasonability of such an approach is shown, but in this category of patients the influence of rehabilitation measures on energy demand is not taken into account. Verticalization is a routine method of prevention and treatment of immobilization syndrome in patients with ACI and its consequences today.

Aim of study. To determine the effect of the verticalization procedure on the turntable on the dynamics of REE index in patients with unresponsive wakefulness syndrome (UWS).

Material and methods. A prospective, comparative, non-randomized study was conducted in 136 patients in the neuro-intensive care unit of the Brain Institute Clinic. The REE index was determined using the method of indirect calorimetry without load and during verticalization in 75 patients with UWS and in 51 patients of the intensive care unit, who also underwent ACI, but were clearly conscious.

Results. In patients with clear consciousness during verticalization REE increased by an average of 300 kcal (20%) from the initial values. The energy value of verticalization was about 5 kcal/kg. On the contrary, in the group of patients with UWS, the verticalization procedure practically did not increase the energy consumption, and the energy value of verticalization slightly exceeded 1 kcal/kg.

Conclusion. Patients with UWS have a special metabolic status, probably due to a decrease in the functional activity of the brain. This can be confirmed using indirect calorimetry.

Abstract. The use of endoscopic transsphenoidal access is an effective and safe method for the surgical treatment of pituitary adenomas (PA). In endoscopic transsphenoidal surgeries, there is a need to control intracranial pressure (ICP) for reposition and expansion of the tumor capsule. Currently, the main method for reducing ICP in transsphenoidal surgery is installation of an external lumbar drainage, which is associated with a number of complications.

Aim of study. To improve the results of surgical treatment of patients with hypertension using hypertonic saline solution (HSS).

Material and methods. The study included 89 patients, who were devided into two groups: Group A — control group (n=25), where the lumbar drainage was installed for invasive intraoperative measurement of the dynamics of ICP parameters at the main stages of the operation (HSS was not administered in these patients); Group B — study group (n=64), where the efficacy of non­invasive regulation of the tumor capsule position using intravenous HSS was assessed, in addition, lumbar drainage was installed in 25 patients of group B, as well as in group A, for invasive measurement of ICP (the dynamics of ICP changes at the main stages of the operation was measured), and the dynamics of changes in the electrolyte composition of the plasma during the first days after the administration of the HSS was monitored as well.

Results. In Group B, there was a more significant decrease in ICP in the course of HSS (on average by 22.49 mm Hg) compared to Group A, where the decrease in ICP was 14.23–8,46 mm Hg (from 13.62±1.36 mm Hg, p<0.05). After intravenous administration of HSS, the plasma composition changed as expected (the concentrations of Na+ and Cl­ increased on average to 150±0.71 mmol/L and 118.3±1.06 mmol/L, respectively, which slightly exceeded the average statistical norm, K + slightly decreased within the average statistical norm), during the first day there was a normalization of the above laboratory parameters .
This technique was used to obtain patent No. 2669924 “A method for regulating the position of a tumor capsule in endoscopic transsphenoidal surgery of pituitary adenoma”.

Conclusion. The use of HSS is a safe non­invasive technique for expansion of the tumor capsule during operations to remove pituitary adenomas using transsphenoidal endoscopic access. It should be noted that this method is most appropriate in situations not associated with the risk of developing intraoperative liquorrhea.

The aim of the study is the comparative analysis of the long-term results of treatment of extra-articular fractures of the long bones in HIV-infected and non-HIV-infected patients.

Material and methods. In the presented study, a comparative analysis of the results of surgical treatment of 90 HIV-infected and 112 HIV-uninfected patients with extra-articular fractures of the long bones of the extremities aged from 23 to 54 years was performed.

Results. HIV-infected patients are mainly characterized by non-infectious complications from the postoperative wound (formation of seromas, hematomas, dehiscence of the edges of wounds, delayed healing), aseptic loosening and migration of fixators, and delayed consolidation of fractures. The presence of statistically significant relationships between the factors characterizing the course of HIV infection (stage of the disease, the number of CD4 + lymphocytes, the ratio of CD4/CD8 + lymphocytes, viral load) and the risk of postoperative complications was revealed.

Conclusion. Thus, the use of standard algorithms for determining the tactics and method of treatment of extra-articular fractures of the long bones of the extremities in HIV-infected patients leads to a significant number of unsatisfactory treatment results (up to 31.1%). For HIV-infected patients, the most typical complications are postoperative wounds, impaired fracture consolidation processes and aseptic loosening of metal fixators, which can lead to the development of infectious complications without proper attention. Expansion of research in this area with an increase in the number of observed contingents will make it possible to develop a scientifically based scale for predicting the development of possible postoperative complications in this category of patients.

Introduction. The number of patients with severe ischemic left ventricular dysfunction (ILVD), who undergo coronary artery bypass, increasing each year. ILVD is an established risk factor for mortality in patients after myocardial revascularization during the early and late postoperative periods.

Aim of study. To evaluate the early results of surgical myocardial revascularization in patients with coronary artery disease (CAD) and severe ILVD.

Material and methods. The study included 149 patients with coronary artery disease with severe left ventricular dysfunction (ejection fraction (EF) ≤39%), operated from January 2002 to December 2018. different variables were assessed (pre- and postoperative), including LV ejection fraction and end systolic volume index (ESVI).

Results. The average age of the patients was 59.36±8.97 years (from 30 to 78 years), 93% of the patients were men. In 28 patients (19%), ILVD developed against the background of myocardial infarction (MI) and in 121 (81%) due to ischemic cardiomyopathy (ICMP) with a history of myocardial infarction. The mean EF before surgery was 36.64±3.17 (from 21 to 39%). In the postoperative period, there was an increase in EF, which averaged 44.92±4.92 (from 36 to 59%) (p value <0.001). The mean LV ESVI before surgery was 60.23±11.52 ml/m². In the immediate postoperative period ESVI decreased to 46.26±12.40 ml/m² (the value of p<0.001). The average number of bypass coronary arteries in one patient was 3.9±0.87. There was also a decrease in the degree of mitral regurgitation in most patients after coronary artery bypass grafting (CABG) (p value <0.001). Hospital mortality was 2% (3 patients).

Conclusion. Coronary artery bypass grafting in patients with severe ischemic left ventricular dysfunction can be performed with low mortality. Surgical myocardial revascularization can be considered a safe and effective operation for patients with coronary artery disease with a satisfactory condition of the distal coronary arteries, low ejection fraction, and with a predominance of viable myocardium.

Background. Acute kidney injury following cardiac surgery remains a common and serious complication.

Aim of study. To identify risk factors for the development and morphological features of acute renal injury, to assess the use of renal replacement therapy in patients after cardiac surgery.

Material and methods. The study involved 66 patients who were treated in the Department of Cardiac Resuscitation of the N.V. Sklifosovsky Research Institute for Emergency Medicine from 2009 to 2018. Of these, 45 men (68.2%) and 21 women (31.8%). The mean age of the patients was 56.3±13.2 years. Clinical and anatomical analysis of material from 19 deceased patients was carried out. Depending on the use of methods of renal replacement therapy, patients were divided into two groups: Group 1 included 23 patients with acute renal injury requiring the use of renal replacement therapy; Group 2 included 43 patients where methods of renal replacement therapy were not used.

Results. Hospital mortality in Group 1 was lower (34.8 and 41.9%, respectively), however, the differences were statistically insignificant (p=0.372). To identify the factors in the development of acute renal damage, a stepwise regression analysis was performed by constructing a regression model of Cox proportional hazards. Age, history of chronic kidney disease, serum creatinine level on the first day after surgery, severity of the condition according to the APACHE-II scale, increased lactate level on day 2 of the postoperative period, decreased urine output on the first day after surgery were statistically significant.

Conclusion. Risk factors for the development of ARI after cardiac surgery under cardiopulmonary bypass are advanced age, CKD in history, the severity of the patient’s condition, assessed by the APACHE-II scale, increased serum creatinine on the first day after surgery, increased lactate on day 2 of the postoperative period, a decreased diuresis on day 1 after surgery. The use of RRT in patients after surgery under the conditions of AC was accompanied by a tendency to improve treatment results: in-hospital mortality in the group of patients who underwent RRT was 34.8% versus 41.9% in the group without RRT methods. Morphological and functional features of renal failure in patients with ARI were preceding chronic renal pathological processes of different etiology, mainly affecting the glomeruli, vessels and stroma, as well as acute pathological processes aggravating ARI (dyscirculatory disorder, degenerative changes, necrosis and necrobiosis tubular epithelium).

Relevance. One of the key components of the accelerated recovery protocols (ARP), in addition to minimizing the surgical approach, is an adequate postoperative analgesia. Despite this, applied postoperative analgesia combinations are not devoid of drawbacks, such as lack of effective postoperative analgesia and the presence of side effect. The use of a pharmacogenetic approach to analgesic therapy for the purpose of its personalization may increase the effectiveness and safety of the use of analgesics. In particular, the presence of an inactive CYP2D6*4 allele , in which the conversion of tramadol to its active metabolite is reduced, contributes to the insufficient efficacy of the drug. As for non-steroidal anti-inflammatory drugs, the presence of CYP2C9*2/*3 polymorphisms leads to a decrease in drug metabolism and a longer half-life, resulting in the increase of the clinical effect and the risk of adverse reactions. Thus, genotyping of patients with the determination of the presence of specific genetic factors can rationalize the postoperative analgesia.

Aim of study. Evaluation of the possible association of polymorphisms of the CYP2D6 and CYP2C9 genes with the clinical efficacy of tramadol and ketorolac in relation to postoperative pain.

Material and methods. This observational clinical study involved 107 patients with uncomplicated acute calculous cholecystitis who underwent videolaparoscopic cholecystectomy and perioperative treatment according to ARP. All patients underwent whole blood sampling followed by real-time polymerase chain reaction genotyping. Analgesic efficacy was assessed using a visual analog scale (VAS) and McGill Pain Questionnaire.

Results. In CYP2D64* carriers pain was higher than that of wild-type carriers, according to VAS and McGill Pain Questionnaire in all investigated periods. In carriers of CYP2C9*2, the pain syndrome was lower than in carriers of the wild type at all intervals studied. In carriers of CYP2C9*3 pain was lower only after 2 and 6 hours, also according to McGill Pain Questionnaire.

Conclusion. 1. The presence of the polymorphic marker CYP2D6*4 may reduce the efficacy of postoperative tramadol analgesia compared with wild type. 2. The presence of the polymorphic marker CYP2C9*2 and CYP2C9*3 may increase the efficacy of ketorolac pain relief compared to wild type.

Relevance. Increased intra-abdominal pressure (IAP) in patients with severe acute pancreatitis (AP) is one of the triggers for the development of a functional organ failure, which leads to death. In this case, the favorable outcome of treatment of patients with severe AP is largely determined by early diagnosis and timely elimination of intra-abdominal hypertension (IAH). At the same time, there is no unified and agreed opinion on the principles and specific methods of eliminating the IAH syndrome in patients with severe AP today, which greatly complicates the choice of treatment strategy and tactics.

Aim of study. To assess the role and clinical significance of IAP monitoring in patients with severe AP with various manifestations of organ dysfunction and, offer a set of therapeutic measures aimed at resolving intra-abdominal hypertension.

Material and methods. The current study included 199 patients with severe AP, divided into two groups depending on the chosen treatment strategy. Group I included 107 patients where the diagnosis and treatment of the disease corresponded to generally accepted standards. Group II included 92 patients, where, in order to objectify the severity and prognosis of the course of AP, along with standard studies, IAP and APACHE II scale indicators were additionally monitored during treatment, and the severity of organ dysfunctions was assessed. In these patients the choice of medical tactics, including the use of conservative and surgical interventions, was made on a differentiated basis, based on the severity of the disease and the dynamics of the IAH.

Results. The role and significance of IAP monitoring and APACHE II scale indicators in the treatment of patients with severe AP were determined. The use of a differentiated approach to the choice of treatment strategies for patients with AP considering the severity of the disease and severity of IAH syndrome results in reduced hospital mortality by 10.3% and reduced postoperative mortality by 11.4%.

Conclusion. Monitoring of intra-abdominal pressure and APACHE II scale indices in conjunction with standard clinical and laboratory parameters allows patients to be clearly stratified according to the severity of acute pancreatitis, which helps optimize the choice of treatment tactics, including methods and timing of surgery, as well as the use of a set of effective therapeutic measures aimed at eliminating intra-abdominal hypertension.

Relevance. The article is devoted to one of the most difficult and controversial problems in the treatment of intra-abdominal infection, the prediction and diagnosis of tertiary peritonitis. The technique of peritoneal laser Doppler flowmetry (PLDF) makes it possible to assess the degree of visceral microcirculation disorders in various diseases of the abdominal organs.

Aim of study. To identify early, trigger indicators of peritoneal microcirculation in tertiary peritonitis, obtained by the PLDF method.

Material and methods. A retrospective analysis of the results of treatment of 48 patients operated on for secondary diffuse purulent peritonitis in the clinic of general surgery of the Astrakhan State Medical University in the period from 2015 to 2019 was carried out. All patients were divided into two equal groups: the main group with subsequently developed tertiary peritonitis, and the comparison group with arrested peritonitis. The study of peritoneal microcirculation was performed at the time of laparotomy, after debridement, 24 and 48 hours later. A total of 768 scans were performed. Evaluation was carried out using the APACHE II scales , abdominal index and SOFA scale. Spearman’s rank correlation test was one of the main statistical methods.

Results. Twenty-four hours after the primary operation, the values of the percentage of microcirculation, standard deviation and coefficient of variation showed a direct correlation with the development of tertiary peritonitis. According to Spearman’s criterion, the closeness of the relationship according to these indicators was: r=0.71, r=0.55, r=0.63, respectively, at p≤0.05. After 48 hours, all the studied values of microcirculation made it possible to diagnose tertiary peritonitis. The data obtained correlated with the data obtained by the systems for assessing the severity of the patient’s condition.

Conclusion. 1. The generally accepted scales for assessing the severity of patients’ condition (APACHE II, abdominal index and SOFA) used in patients with diffuse purulent peritonitis do not allow predicting the risk of tertiary peritonitis 24 hours after surgery. The data obtained as a result of the scoring on the above scales becomes representative 48 hours after the initial intervention. 2. The percentage of microcirculation, standard deviation and coefficient of variation can be used as early screening indicators of peritonetal laser Doppler flowmetry to predict tertiary peritonitis 24 hours after primary surgery. 3. The whole range of indicators of peritoneal laser Doppler flowmetry allows the degree of impairment of the tissue microcirculation in patients with peritonitis to be objectively assessed even 48 hours after the initial operation and to be diagnostic criteria of tertiary peritonitis.

Relevance. Most of the victims of road accidents die prior to the arrival of medical staff, therefore, providing first aid to injured people in the first minutes after receiving injuries is very important for saving human life and health. Timely and skillful provision of first aid to victims of road accidents prevents further deterioration of the state of the human body and can positively affect the entire process of its further treatment and rehabilitation.

Aim of study. To characterize the delivery of first aid to victims of road traffic accidents at the present stage and to outline possible ways for its improvement.

Material and methods. To achieve this goal, an analysis was made of the results of domestic and foreign scientific research and regulatory legal acts on the issue of providing first aid to victims of road accidents. The literature search was carried out in specialized scientific search engines eLibrary, PubMed, Scopus using the keywords: first aid, prehospital stage, road traffic injuries, road traffic accidents. For the analysis, scientific articles published between 1980 and 2020 were selected. Resources with outdated or inaccurate information were excluded, some scientific papers were found by links to articles. The state of the problem of providing first aid to victims of road traffic injuries, for the most part, reflects scientific publications over the past ten years.

Abstract. In connection with the growth of resistance of pathogens of pyoinflammatory infections (PII) to antibiotics, physicians began to use bacteriophages, which are widespread where there are homologous bacteria. They are also found in the human body, possibly protecting against PII. It was found that mortality in patients with bacteriophages was lower than in patients without homologous endogenous bacteriophages. The most common were mild bacteriophages, which “protected” patients from infection, although it is believed that only virulent bacteriophages may do this.

Aim of study. To study the effect of virulent and moderate endogenous bacteriophages on the course of pyoinflammatory infections in intensive care units (ICU) patients.

Material and methods. The study included 33 patients with positive blood culture who were treated in the ICU. Of these, 12 (36.4%) had endogenous bacteriophages (10 men, 2 women).
We isolated 16 strains of various bacteria. Bacteriological blood tests were performed using an automatic blood culture analyzer Bactec-9050. Identification of isolated microorganisms was carried out using an automatic microbiological analyzer WalkAway 40. Traditional virological methods on the basis of LLC SPC MicroMir were used for work with bacteriophages.

Results and discussion. From 16 positive blood cultures, the following were isolated: Klebsiella pneumoniaе — in 7 samples, Acinetobacter spр. — in 4 samples, Staphylococcus spp. — in 2 samples, and one strain in each sample: Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecalis. Endogenous phages were isolated in 36.4% of patients, which were detected in all blood cultures. The exception was K. pneumoniae strains, for which in 42.9% of cases (3 cases out of 7) bacteriophages were absent.
Out of 12 patients with isolated bacteriophages, 6 had positive treatment outcomes.
Of 14 blood samples, 11 moderate bacteriophages were isolated, which amounted to 78.6%, virulent — 21.4%. Despite this, the protective effect of bacteriophages was noted.

Conclusion. 1. All blood cultures contained homologous bacteriophages, except K. pneumoniaе strains, which had no endogenous bacteriophages in 42.9% of cases. 2. Most of the isolated endogenous bacteriophages (78.6%) were moderate. 3. In the absence of homologous bacteriophages in the blood of ICU patients, the likelihood of death increases (66.7%) compared to patients with bacteriophages (33.3%).

The basis of optimized conventional system of surveillance and control for catheter-related bloodstream infections (CRBI) was priority in detection and risk assessment an infectious complication of puncture catheterization that substantially justified with inclusion of two main components as an addition to the existing system: monitoring of puncture catheterization, which allows to obtain and analyze data on risk factors for infections associated with the catheterization procedure and subsequent manipulations of the device, standardize approaches to working with a venous catheter and improve the diagnosis of CRBI; assessment of ensuring the epidemiological safety of medical care for catheterized patients. Epidemiological efficiency risk-based surveillance, primarily determined to reduce the incidence of CRBI by 1.8 times compared to initially defined real incidence: 12.5‰ (95% CI — CI 11,8–13 2) vs 22.8‰ (95% CI 21,1–24,5) catheterized patients, p=0.0001.

Background. Severe open injuries of the lower extremities in most cases are the result of high-energy trauma, because the foot and ankle are damaged as a result of automobile accidents almost in every fourth victim. According to the literature, the percentage of infectious complications after surgical debridement of open injuries of the foot is 43–67.9% and shows no tendency to decrease.

Material and methods. We performed 32 operations with the use of free revascularized grafts in patients aged from 16 to 70 years with extensive posttraumatic defects of the foot between 2010 and 2018.

Results. As a result, 30 (93.7%) out of 32 grafts provided foot support ability provided during the post-operative period. When replacing large defects (more than 80 cm²) of soft tissues supporting surface of the foot we used free musculocutaneous flap of the latissimus dorsi, fasciocutaneous flaps were used for defects of the dorsum of the foot (less than 80 cm²). Long-term results were assessed using the Foot and ankle ability Measure (FAAM) questionnaire.

Conclusion. Primary early replacement of tissue defects on the foot with free revascularized autografts is the method of choice for solving this problem, as it allows you to maintain the supporting function of the foot and is often alternative method to amputation.

The article describes the experience of using allografts in surgery of the main arteries of the lower limbs. The urgency of using bioprostheses is briefly shown. The management of patients with infectious complications remains an unsolved problem in vascular surgery. Reconstructive vascular surgery is often repeated. Operations are often performed in the presence of extensive necrosis and trophic ulcers. The autovein is not always available for reconstruction of the main artery , which is why the issue of choosing a material for repeated reconstruction remains relevant. The medical literature has shown the tendency of xenoprostheses to aneurysmal transformation in the postoperative period. There is not a lot of information in the world and domestic sources on the use of arterial allografts. The lack of clear indications and contraindications for use, optimal preservation periods, the choice of the necessary preservatives and a suitable medium do not allow the widespread use of allografts in practical surgery if there is access to the technology of vascular collection, conservation and transplantation. The problem of using allografts requires further study. In this regard, the experience of using allografts in two non­standard clinical situations is presented. It was concluded that it is possible to effectively use freshly prepared arterial allografts from a postmortem donor during reconstruction in patients with critical ischemia of the lower extremities in the absence of a suitable autovein and the impossibility of using a synthetic prosthesis.

Clinical observation of closed abdominal trauma and isolated gallbladder injury is discussed. The frequency of occurrence and risk factors for the development of gallbladder injury are presented.

We report a case of emergency extra- intracranial microanastomosis in a patient with acute thrombosis of the internal carotid artery, formed on the first day after classical carotid endarterectomy using a temporary by-pass under conditions of contralateral occlusion. The causes of the complication are analyzed. A set of instrumental examinations was demonstrated, including multispiral computed tomography with angiography of the brain and extracranial arteries, as well as multispiral computed tomography with the study of parameters of cerebral perfusion after acetazolamide. The main stages of surgical correction, the dynamics of clinical indicators are presented. The conclusion was made about the effectiveness and safety of the chosen revascularization strategy.

This work provides information concerning the insufficiently studied period in the history of Sheremetev Hospital and Sklifosovsky Institute for Emergency Medicine in 1916–1925. The data of Russian historical and medical literature were used, some archival documents were introduced into scientific circulation, which explain the reasons for the significant reduction in the activities of the Sheremetev Hospital and the Hospice House in 1916, the closure of the hospital and the House in 1917, as well as the circumstances of the resumption of the Sheremetev Hospital in 1919, organization of the Moscow City Ambulance Station in 1919 and N.V. Sklifosovsky Institute for Emergency Medicine in 1923.

The creation of the organizational foundations of clinical toxicology began after its separation in the first half of the 20th century from forensic medicine, pharmacology, and military and industrial toxicology. In this, the research started in the therapeutic clinic of the N.V. Sklifosovsky Research Institute for Emergency Medicine is important, which led to the opening of the country’s first toxicological department at the Institute and made it possible to resolve acute poisoning (AP) issues at a new level. The obvious successes achieved in this direction by the employees of the department served as a prerequisite for the creation of Republican and All-Union AP treatment centers on the basis of the N.V. Sklifosovsky Institute, where employees began actively work on the preparation of relevant regulatory documents and the organization of toxicological centers (departments) in the regions. As a result, by the end of the twentieth century, the foundation of the toxicological service was created in the Russian Federation — a network of 44 centers (departments) for AP treatment in 41 regions, which today provide specialized assistance to the population of 50% of the territory of the Russian Federation and serves as the basis for the implementation of advanced achievements in this area.

An outstanding role in the formation of clinical toxicology as a new direction in clinical medicine and the creation of a scientific school of clinical toxicologists belongs to E.A. Luzhnikov, member of RAS.

Creation of the organizational foundations of urgent clinical toxicology and its formation as an independent scientific and practical direction in medicine, in which a significant contribution belongs to the staff of N.V. Sklifosovsky Research Institute for Emergency Medicine, are closely related to scientific and practical achievements in this area, the prompt response of specialists to the toxicological situation in the country, as well as adoption of the experience gained in the course of organizational and information and advisory activities. At the same time, timely preparation and publication of legal and regulatory documents regulating practical work in this area are of particular importance.