In the article the changes of the main indicators characterizing the work of emergency medical care in the Russian Federation for 2009–2018 are reflected. The problems and prospects for the development of emergency medical care in the country are noted.  

This article presents the first experience of computer modeling, performed as a result of the construction of the model of the emergency department (ED). A number of experiments were conducted aimed at determining the admissible flow of patients’ arrival per day for a given staffing table, determining the necessary conditions for the department’s readiness for mass one-stage entry, and conducting research in the context of expanding the job responsibilities of the doctor of the ED.  

Development of system of rendering an emergency medical service in a hospital inevitably brings up questions of its availability and quality. And, if the leading pathological syndrome which is a reason for hospitalization and posing threat for the patient’s life deserves priority attention, the accompanying pathology often remains in the shadow. Thus skin diseases often are epidemiologically dangerous as for the patients having this illness and for the patients surrounding them and the medical personnel which is carrying out medical process. The assessment of a current state of a problem of delivery of health care by the patient with dermatological pathology in a hospital of an emergency medical service was a research objective. By results of research — surgical activity at patients with skin diseases made 88,3% that is much higher than the average level of surgical activity on a hospital (33,9%), they needed large volume of the most various laboratory diagnostic testings. Skin diseases or are a serious illness and conduct to a treatment failure, or significantly make heavier a condition of patients with various diseases (the hospital lethality in this group by 4–5 times exceeded an average value). Development of new models and the principles of the organization of medical and diagnostic process, introduction of methods of express diagnostics is required; obvious is also a role of the dermatovenereologist that will allow to increase availability and quality of the help to patients with dermatovenerologichesky pathology in a hospital of an emergency medical service.  

The article presents an analysis of current data on emergency management of crises in patients with myasthenia gravis, which is supplemented by our own observations of 892 patients with myasthenia gravis. A follow-up study was conducted, which helped us to assess the frequency, nature and course of crises in patients with myasthenia gravis, taking into account the form of the disease, sex and age of patients. It was found that crises were observed in 154 (17.4%) patients, these conditions were significantly more often registered at the age of 20 to 40 and in the first three years of the disease. Myasthenic crises 149 (96.9%) prevailed among the crises and were registered mainly in patients with generalized and pharyngeal-facial myasthenia. Based on long-term follow-up of patients and assessment of the results of emergency management of myasthenic crises we have presented an optimal scheme for prescription of anticholinesterase medicines as a part of combined therapy of crises of varying severity.  

 

Ketoprofen («Ketonal») proved to be significantly efficient in pre-hospital care when administered intramuscularly at a dose of 100 mg to treat pain in the neck (n=31), thoracic spine (n=53), and lower back (n=50), according to a visual analogue scale (VAS). During the in-hospital and outpatient care (n=33), a continued use of Ketoprofen in multiple therapy (muscle relaxants and chondroprotective agents) for lower back pain significantly improved the quality of life (Roland–Morris questionnaire) and reduced the pain twice according to VAS. At the end of the 3-week treatment, the maximum deep body temperature (measured by microwave radiothermometry) decreased in the lower back but did not return to normal. High correlation coefficients between the deep and skin temperature did not return to normal after treatment. Stabilometric parameters remained ‘rigid’, except for patient’s overall equilibrium (R) that became reliably normal in all directions. The control methods used indicate the need for a longer therapy.  

 

In work terms of emergence and frequency of development of a hypothermia in patients with traumatic shock of varying severity at a prehospital stage are presented. It is revealed that all patients with traumatic shock have III severity, unlike patients with shock of I and II severity, decrease in body temperature is noted.  

The article describes the results of a retrospective analysis of the medical records of adolescent girls hospitalized urgently with uterine bleeding. In the group of patients with concomitant somatic pathology, that allowed to determine its influence on the risk of dysfunctional uterine bleeding in the puberty period.  

Introduced results of treatment of 430 patients with obstructive jaundice admitted to Republic research center of emergency medicine. Performed retrospective analyses of possible complications after percutaneous transhepatic interventions in such category of patients and how to treat and prevent from these complications in emergency hospitals.  

The results of operative treatment of 36 men aged 18 to 35 years old with testicular reabrupt who were treated in the Urology Clinic Alexander Hospital with 2012 to 2017 years. The indication for surgical treatment were to sudden pain in the groin area, absence or sharp decline in blood flow below the scene of the alleged perekruta in Doppler ultrasound Diagnostics. Eight patients completed orchiopexy, 28 ill-orhojepididimjektomija. In the next and distant time frames identified in these patients spermatologicheskie violations as singular and fixed testicle.  

The article provides an assessment of gender differences in patients with myocardial infarction. Early diagnosis and prognosis of the development of acute heart failure in case of myocardial rupture, cardiogenic shock and death from the first minutes of contact with the patient is a crucial point in the physician’s decision of the further management of the patient with MU. It has been shown that women have a higher risk of complications of myocardial infarction than men, despite the similar treatment.  

 

The article highlights the hypothesis of the inflammatory pathways in pathogenesis of atherothrombosis and the conception of residual inflammatory risk in coronary heart disease patients. Modern approach to the correction of inflammatory risk by immune-modulating therapy in acute coronary syndrome setting is discussed. The results of most significant randomized clinical trials dedicated to this problem are also highlighted.  

The problem of diagnostics and treatment of an acute appendicitis remains extremely actual and are of spe­cial interest for system of rendering an emergency medical service as it is connected with delivery of health care in the emergency form. The assessment of evolution of surgical tactics at an acute appendicitis was a research objective. The content analysis, legal, historical, analytical, statistical methods are used. Data of the monitor­ing of sharp surgical pathology of abdominal organs in St. Petersburg which is carried out by the St. Petersburg Scientific Research Institute of Emergency Medicine of I. I. Dzhanelidze, normative legal documents, domestic and foreign scientific literature became material for research. Medical and diagnostic tactics at an acute appendi­citis I evolved from conservative to active (quick) which dominates and now. Today it comes back to possibility of conservative treatment of its uncomplicated forms again. The stationary office of an emergency medical service allows to change routing of patients with an acute appendicitis, to provide possibility of inspection and dynamic supervision of patients within the first days from the beginning of a disease from the beginning of starting conser­vative therapy (single introduction of glucocorticoids and antibiotics).