[Diagnostics of pneumothorax with ultrasound].

The article deals with a method of pneumothorax diagnostics based on verification of four ultrasound sings--lung sliding absence, B-lines absence, lung pulse absence and lung point presence. Use of ultrasound allows to quickly diagnose a pneumothorax and to monitor the condition of pleural space. Introduction of the ultrasound methods into routine work ICU specialists can increase safety of patients.

[Clinical characteristics, diagnosis, and treatment of acute intoxication by baclofen].

For last few years in Russia and in the Armed Forces of RF is marked a growth of number of acute intoxications by GABA-agonists and by muscle relaxants, particularly by baclofen. Manifestations of intoxication by this specimen include cerebral and somatic-vegetal disorders, in grave cases of illness could evolve psychic excitement, delusions and coma. Treatment of baclofen intoxication compares of gastric lavage using a thick pathfinder, accompanied by insertion of adsorbent and apocathartic means, maintaining of impaired vital functions of body. Hereafter these injured patients should be hospitalized in a treatment institute, where exists a possibility of effectuating of reanimation and intensive care as well as extracorporal detoxication (hemosorption, hemodialysis).

[Some disputable issues of transfusion therapy in wounded patients].

On the basis of an analysis of the tactics of transfusion therapy in 272 wounded persons and victims with acute massive blood loss, the authors conclude that it is necessary to strictly follow the principle of individual directionality during blood transfusions. By taking into account the high risk of development of iatrogenic complications in the postshock periods of traumatic disease, it is expedient to do away with hemotransfusions in the advancing mode.

[Organization of anesthesiological and resuscitative care delivered to the wounded and patients in the large specialized hospital].

On the basis of an analysis of the specific features of organization of anesthesiological and resuscitative care, the authors formulate a number of points that are of great importance for the quality of work. They give the optimal recommendations for organizing the professional activities of physicians of intensive care units and consultants. The paper presents conceptual sketches of the training of anesthesiologists working in a specialized center are presented. The authors show it necessary to follow the principle in the gradation of anesthesiological and resuscitative care.

[Specifics of intensive therapy in abdominal gunshot wounds]. / Osobennosti intensivnoi terapii pri ognestrel'nykh raneniiakh zhivota.

Among the wounded admitted to the departments of anesthesiology, resuscitation and intensive therapy there were from 57.8 to 77.6% of gunshot injuries of the abdomen. Successful treatment of such patients is dependent not only on the timeliness and quality of surgical interventions but also on the correct choice of intensive therapy before and during operation and in the postoperative period. The temporizing strategy providing for expanding the list of the methods used as late as the symptoms of the unfavorable course of the postoperative period can not be considered sufficiently effective. Complex intensive therapy with a forestalling action on different links of the wound disease pathogenesis in most cases allows not only the elimination of organic and systemic impairments resulting from the wound but also is more effective for defensive compensatory mechanisms. Differentiation of the programs of treatment depending not only on the severity of the patient's state but also on the character of injuries of organs of the abdominal and retroperitoneal areas is of the leading significance.

[Anesthesiological aspects in determining indications and contraindications for surgical interventions in patients with severe wounds and injuries in the post shock period]. / Anesteziologicheskie aspekty v opredelenii pokazanii i protivopokazanii k vypolneniiu operativnykh vmeshatel'stv pri tiazhelykh raneniiakh i travmakh v postshokovom periode.

Approaches to validation of indications and contraindications for interventions in wounded patients and victims were developed on the basis of many-year experience. The desirability of intervention is determined primarily by strategic tasks which it solves. The operation is to be performed despite severe clinical condition if it removes the cause of critical state or creates conditions for preventing life-threatening complications of the traumatic disease. All the rest interventions can be postponed till complete or partial compensation of vital systems.

[Acute insufficiency of the gastrointestinal tract in patients with severe gunshot injury]. / Ostraia nedostatochnost' organov zheludochno-kishechnogo trakta pri tiazheloi ognestrel'noi travme.

Acute insufficiency of the gastrointestinal tract (GIT) in patients with severe gunshot injuries is an important link of pathogenesis of the polyorganic insufficiency syndrome. The character of the wound, the numerical score objective assessment of the injury severity and severity of the patient's state are considered to be criteria of early diagnosis of a risk of the development of acute insufficiency of GIT. The specific feature of "general" intensive therapy of acute insufficiency of GIT in severe gunshot traumas is the necessary application of regional anesthesia, sympatholytics, anticholinesterase agents and H2-blockers. Intensive "enteral" therapy of acute insufficiency of GIT in severe gunshot wounds includes the measures resulting in improvement of microcirculation, tissue respiration in organs of GIT, decompression of the stomach, local defense of mucosa, detoxication and early enteral balanced nutrition. The described method of treatment of wounded to the stomach used at specialized medical institutions resulted in 6.2 less lethality among this category of patients.

[Approaches to decreasing polypragmasy in intensive care of patients with severe injuries]. / Puti umen'sheniia polipragmazii pri intensivnoi terapii u postradavshikh s tiazheloi travmoi.

A total of 277 patients with grave combined injuries were treated. Polypragmasy involved all the trends of intensive care and was most often observed in infusion-transfusion and drug therapy. Three main approaches to decreasing polypragmasy in intensive care of victims with grave combined injuries consist in decreasing the volume of infusion-transfusion therapy, use of a limited number of antihypoxants, and early short courses of antibiotics.

[Anticipated intensive care in gunshot injuries of the abdomen]. / Operezhaiushchaia intensivnaia terapiia pri ognestrel'nykh raneniiakh zhivota.

Analysis of intensive care of 345 patients with gunshot wounds permitted the development of standard protocols of such care with consideration for the visceral injuries. In wounds to the large intestine, multiple-modality treatment including hyperbaric oxygenation, extracorporeal detoxication, and intraaortic infusion of drugs is recommended irrespective of the phase of peritonitis. In injuries to the small intestine, traditional intensive care (infusion therapy, partial parenteral nutrition, prolonged epidural blocking, and antibiotics) can be sufficient. However, in both cases these methods are to be used not after manifestation of signs of disorders in the abdominal cavity, but anticipate them, and the treatment is to be based on the general regularities in the course of traumatic disease in wounded patients. Such an approach can prevent the progress of peritonitis and improve the outcome of wound.