Celebrations on the occasion of the 90th anniversary of the N.V. Sklifosovsky Research Institute for Emergency Medicine and the 2nd Congress of emergency medicine doctors.

Resolution of the 2nd Congress of the emergency medicine doctors.

On the IV Congress Of Anesthesiologists And Emergency Uzbekistan And XI Republican Scientific And Practical Conference “Actual Problems Of Organization Emergency Medical Care: Questions Anesthesiology, Intensive Therapy In Critically Ill”.

I Russian congress with foreign participants “Emergency endoscopy”. Materials of conference. Part 4.

BACKGROUND. The appropriateness of the fibertracheobronchoscopy (FTBS) in patients with severe impaired consciousness, including with acute ischemic stroke (AIS), is still under debate. There is an ambiguous relation to FTBS performance.

MATERIAL AND METHODS. Study of cardiac index (CI), systemic vascular index-grained resistance (ISSS), heart rate (HR), systolic, diastolic, mean arterial blood pressure (SBP, DBP, BP Wed), extravascular lung water (EVLW), gas exchange (oxygenation index (RaO2 /FiO2 ), were held from 1 to 7 days of the acute period of stroke by 40 patients before and after FTBS.

RESULTS AND CONCLUSION. In both groups, SI, SBP, DBP, Wed Blood pressure, heart rate are increased. ISSS is decreased. Increased PaO2 /FiO2 , difference 27,61±4,9 mm pt.ct. Chronic and acute endobronchitis 1—2 degrees were revealed using endoscopy. Conducting FTBS reduced respiratory failure, PaO2 /FiO2 is increased. Heart failure is cause of deterioration after FTBS. Initially low C (less than 2,5 l/min/m2 ), high ISSS (3000 dyn·s·cm-5·m2 ) contraindication to FTBS. 

ABSTRACT. The development of new ideas to the ultrasound diagnostics of embologenic venous thrombosis on base of the collection of anatomical and structural functional ultrasound criteria of embologenic venous thrombus is discussed.

The investigations of 780 patients (800 lower limbs) were included in the current work. The presence of floating thrombi did not finish into PE (55,4% (302/545) cases). The analysis of frequency distribution of floating thrombi (n=545) in addition embologenic floating thrombi (n=302) in of inverior vein cava and comparative evaluation of unembologenic (n=243) and embologenic (n=302) floating thrombi from the form, the contour, structure of the thrombus and the counter, the mobility of the thrombus. The analysis of absolute and relative errors of the measuring of the length of the floating thrombus of iliac-femoral segment showed that the length of the floating thrombus is not reliable criterion of embologenic thrombus (n=177).

Ultrasound criteria of the embologenic floating thrombus and thrombi with fragmented surface were found. The detection of embologenic floating thrombi decreases the value of implanted cava-filters and thrombectomies. 

Study objective was to conduct a prospective observational study to assess the effect of pharmacointerventional tactics on the outcome of acute ST-elevation myocardial infarction (STEMI) in terms of mortality.

MATERIAL AND METHODS. The study included 405 patients with acute STEMI. The Thrombolysis in Myocardial Infarction (TIMI) Risk Score was used to assess the coronary circulation recovery in a major epicardial coronary artery (CA). Percutaneoous coronary interventions (PCIs) were undertaken either as initial interventions, or in a framework of pharmacointervantional treatment tactics.

RESULTS. Among 405 patients with STEMI, 154 (38%) underwent a thrombolytic therapy (TLT). Coronarography performed within 24 h from the onset of disease clinical symptoms demonstrated a completely occluded CA that had supplied blood to the area of present infarction in 73% of patients without previous TLT and in 74% of patients after TLT. TLT proved to be effective only in 36 % of patients. A successful revascularization, compared to that of inefficient, reduced the relative all-cause mortality risk and MI-caused mortality risk in the initially high-risk patients by 74% and 78 %, respectively.

concLusIons A timely myocardium revascularization using PCI is effective after successfully performed TLT. This proves the benefit of pharmacointerventional treatment tactics for the patients with STEMI in the cases when initial PCI appeared impossible for some reasons. 

ABSTRACT. In blunt trauma, the structural features of the splenic parenchyma usually predispose to a significant intra-abdominal bleeding, so the excision of the damaged spleen is considered a main treatment technique in a majority of cases. However, a number of recent clinical studies have proved the necessity of a differentiated approach to making the treatment decisions and demonstrated the possibility of spleen salvage in certain cases.

The most debatable issue is the management tactics in splenic injury associated with the formation of subcapsular hematoma. It is necessary to emphasize that the conservative treatment of such splenic injury implies a persisting risk of double-stage splenic rupture with following intra-abdominal bleeding.

The Sklifosovsky Research Institute traditionally deals with injury management in all aspects and has gained a wide experience in splenic injury treatment that makes possible to demonstrate the choice of treatment tactics with regard to the splenic injury severity, and patient’s condition. A conservative management of spleen injury is reasonable only in stable patients and requires an additional use of instrumental diagnostic techniques. Morphological studies suggest that reparation processes around the splenic hematoma arise early enough and proceed, as a rule, with no signs of a purulent inflammation. 

ABSTRACT. The authors have offered an advanced comprehensive methodology of in-hospital rehabilitation for patients operated on for humerus fractures. A versatile exercise therapy has been implemented. High-tech methods of rehabilitation were used, including the electric stimulation, intermittent pneumocompression, passive and active mechanotherapy. The present comprehensive methodology makes the exercise therapy more effective, ultimately leading to an earlier limb functional recovery. 

Nowadays treatment methods of severe traumatic brain injury - state of the problem in the neurosurgery department of the Sklifosovsky Research Institute for Emergency Medicine.

Surgery of traumatic brain injury (TBI) is the principal direction of research activities in the neurosurgery department of the Sklifosovsky Research Institute for Emergency Medicine.

With a view to produce an unified approach in treatment patients with TBI, in the neurosurgery department brain injury practical classifications have been designed. Using neurological examination and CT data they allow to diagnose and determine a severity of TBI.

The conducted at the department researches allowed to clarify the indications to surgery and nonoperative treatment in patients with posterior cranial fossa injury and small intracranial hematomas. For the first time in Russia there was organized and carried out the randomized trial which was dedicated to the choice of surgery (decompressive craniectomy or craniotomy) in severe TBI. There were identified risk factors of adverse outcomes in patients with severe TBI.

There was worked out and embedded in daily practice the new original minimally invasive method of TBI surgery — the puncture aspiration and local fibrinolysis of traumatic intracranial hematomas. In surgery of subacute and chronic hematomas as well as in surgery of traumatic intracranial hematomas which are located in functionally significant regions of the brain, the endoscopy is being used actively. This method allows to reduce damages of surgical approach and keep its radicality. At the present time the researches is being conducted which are dedicated to surgery of acute brain herniation syndrome. Using original tools the minimally traumatic methods of tentorium and falx cerebri incisions were designed as well as the decompressive craniectomy in combination with lower medial temporal resection were developed.

Application of new technologies in diagnosis and treatment in patients with TBI as well as introduction in routine practice new types of surgery allowed to decrease noticeably postoperative mortality in operated patients with severe TBI. 

ABSTRACT. The paper presents the modern principles of intensive care of patients with subarachnoid hemorrhage after cerebral aneurysms ruptures focusing on neuromonitoring, mechanical ventilation, intracranial pressure and hemodynamic correction, calcium antagonists prescription, hyperbaric oxygen therapy, nutritional support, thromboembolic complications prevention and infection complications management. 

Questions of personnel deficiency in an emergency medical service in the Russian Federation are considered. 

Alexandr N. Konovalov. To the 80-th anniversary of the birth.

ARCMA “Zashita”. To the 20-th anniversary of the foundation.

Emergency Children’s Surgery and Traumatology Research Institute. To the 10-th anniversary of the foundation.

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