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the general syndromes at a fire, minno-explosive trauma

Serious wounds are accompanied by the expressed hemorrhage and poyostupleniem in blood from the damaged tissues, and also from tissues, stradajuyoshchih from a hypoxia, products of a destruction of cells, microthrombuses, drops zhiyora, microemboluses getting property.

There is an embolization leyogochnyh vessels to development of a clinical picture of a thromboembolism of a pulmonary artery. The massive hemorrhage with disseminirovannym intravascular coagulation of blood causes microembolic processes, narusheyonija microcirculation and development of multiorgan insufficiency.

At a fire, minno-explosive trauma it is possible to observe sleyodujushchie the general syndromes:

— A traumatic shock;

— Purulent-rezorbtivnaja fever;

— A traumatosepsis;

— Traumatic attrition.

Traumatic shock — the reaction of an organism arising in reply to a trauma and characterised by oppression of vital signs. In a basis razyovitija a shock the nervously-reflex mechanism lays. Superstrong razdrazheyonie the central nervous system conducts to its excitation which are replaced by inhibition. At shock development the hemorrhage, cooling have great value. Acute vascular insufficiency develops. Clinically the shock is characterised by disturbances of consciousness of different degree (oglushennost, a sopor, a coma) and the central hemodynamic (a hypovolemia, a hypotension, tahiyokardija, centralisation of a circulation, microcirculation disturbance).

Allocate following degrees of a traumatic shock:

— Easy (I degree) — level of arterial pressure with firmness uderyozhivaetsja above 90 mm hg, the expressed tachycardia is not present, consciousness not nayorusheno or observe oglushennost;

— Average (II degree) — level of arterial pressure uderzhivayoetsja at level of 80 mm hg, a tachycardia (100-120 in a minute); observe oglushyonnost or a sopor;

— Serious (III degree) — level of arterial pressure below 80 mm hg, a sharp tachycardia (from above 120 in a minute); observe a sopor or to whom.

At easy and average degrees of a shock rest and anaesthesia are shown oxygen inhalation, prokainovye blockade. A hemotransfusion — only at krovopotere. The drop injection antishock liquid - is shown

stej — (Polyglucinum), solutions of a glucose and electrolytes. At a serious shock — intraarterial and intravenous introduction of components of blood, glucocorticoids in the big doses intravenously, high-molecular plasma substitutes, an oxygenotherapy, under indications — transfer on upravyoljaemoe breath, local prokainovaja blockade, anaesthesia.

Purulent-rezorbtivnaja fever as wound fever implication arises at any diapyetic wound owing to an absorption of products tkayonevogo disintegration, microbes, toxins. It serves as reaction of an organism to purulent-nekroticheskie processes in a wound. Its version — toksiko - rezorbtivnaja a fever arises to the expressed pyesis in inflammation focus. The clinical picture of this syndrome is characterised by a persistent fever, astenizatsiej, appetite depression, a complex vospalitelnoyodistroficheskih changes of internal organs. Gravity of its implications is proportional to expression of local purulent-nekroticheskogo process in a wound. The basic treatment — surgical. Wound sanation breaks gnojnoyorezorbtivnuju a fever.

A high-caloric food with bolyoshim quantity of fiber, parenteral introduction of the basic preparations is necessary.

Traumatosepsis — the general disease of an organism caused by a purulent wound fever, lost dependence on the local centre. At the heart of a sepsis lay deficiency of system of immunologic protection, generalizayotsija infections, occurrence of the secondary centres of an infection in parenchymatous organs. As originators the staphilococcus, a streptococcus, E. coli, a pyocyanic rod is more often serve. From purulent-rezorbtivnoj fever the sepsis differs a serious, malignant current, occurrence out of zayovisimosti from gravity of a local wound process, and wound sanation not obyoryvaet pathological process. The traumatosepsis can arise vsledyostvie attritions of protective forces of an organism at a long current gnojYono-rezorbtivnoj fevers and high virulentnosti a wound fever. The sepsis can proceed in the form of a hematosepsis with the steady bacteriemia expressed by an intoxication and in the form of a septicopyemia with set metayostaticheskih of abscesses. Clinical picture of a traumatosepsis harakteriyozuetsja gekticheskoj a fever, cold fits, sweats, development mielotoksi - cheskoj anemias, a leukocytosis with a deviation to the left. Observe sochetannuju a pathology of different organs and systems: a pneumonia, nephritises, colitises, endo - mio - and pericardites and others infektsionnoyovospalitelnye complications. From internal organs observe syndrome signs disseminirovannogo intravascular coagulation. In traumatosepsis treatment surgical sanation is necessary as usloyovie maintenance of effect of the further general treatment. Intravenously nayoznachajut the big doses of antibiotics (semisynthetic Penicillinums, cephalosporins, aminoglycosides, karbapenemy) taking into account flora sowed from blood and sensitivity to antibiotics. Spend gemotransfuyozii, introduction intravenously solutions of electrolytes, a glucose, plazmozame -
nitelej. Under indications enter antistaphylococcal plasma, spend a hemosorption, plazmaferez, hyperbaric oxygenation. The nutrition should be high-caloric, vitamin-rich and fibers. At development of an infectious-toxic shock introduction of the big doses gljukoyokortikoidov (300-600 mg of Prednisolonum a day) is shown.

Traumatic attrition — the serious dystrophic process arising at a long pyesis at wounded men. Traumatic isyotoshchenie develops at insufficient surgical activity or insufficient effective surgical treatment that promotes long conservation ranevogo is purulent-necrotic process. PaYOtogeneticheski it is bound to a long purulent-rezorbtivnoj fever, is more rare — with a traumatosepsis. Traumatic attrition is accompanied by a cachexia, a progressing atrophy of internal organs. Causes of death can be a deep cachexia, metastatic it is purulent-ihoroznye the centres, a nephritis, an amyloidosis, a pneumonia and others infectious oslozhneyonija. Deep albuminous insufficiency, a hypochromia anaemia, insufficiency of glands of internal secretion are characteristic. A current serious, usually irreversible. 2-4 months after wound develop in terms. At razvivyoshemsja attrition the operational risk increases. The persistent and long preparation for surgery is necessary with the help obshcheterapevticheskih meyoroprijaty (a hemotransfusion, an albuminous diet, parenteral and zondovoe a food, antibiotics, vitamins).

3.4.

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Scientific source the Therapeutic pathology at wounded and amazed: ucheb. - a method. The grant for students 5, 6 courses of all faculties of medical high schools, doctors of the general practice, therapists, surgeons / E. G.Malaeva [etc.]. — Gomel: GomGMU, 2016 . — 80 with.. 2016

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