The article is devoted to the history of the ambulance services’ establishment in Tver and Tver region. The stages of the development of the emergency medical care in the region are characterized, also the chronological order of various units is considered. 

In this article, we have considered this concept as a syndrome of emotional (professional) burnout, namely the medical workers of middle level. Also cited the results of the study on the basis of the Voronezh center of medicine of accidents. Next was presented the prevention and treatment of syndrome of professional burnout and the complex of psycho- corrective activities. 

Background. Emergency physicians often have difficulty providing vascular access to patients in critical condition. In these conditions, intraosseous access has an advantage over traditional peripheral vein catheterization. Currently, intraosseous access is not widely used at the stage of emergency medical care.

Aim. Analysis and generalization of current information on the use of the method of intraosseous access to emergency medicine.

Materials and methods. We have found publications in Russian and international search engines (PubMed, eLIBRARY, etc.) over the past 20 years. Publications reflected current issues of intraosseous access application. 74 articles were found and 30 were selected for review.

Results. Intraosseous access showed good results in patients with weakly expressed venous network at the stage of emergency medical care. The method has a simple technique of manipulation, does not have a large number of complications and contraindications. Doctors who have received training often use intraosseous access, taking into account the indications for use.

Conclusion. Intraosseous access has an advantage over peripheral intravenous access in patients in critical condition at the stages of emergency care. 

The article provides an overview and analysis of the regulatory legal acts of the Russian Federation that regulate the possibility of using video recording in the work of mobile ambulance and disaster medicine teams based on the example of our own experience of Antonius Medvision —  Ambulance LLC, an organization of a non-governmental healthcare system that provides emergency medical care outside a medical organization in the Kaluga and Moscow regions. 

The pandemic of a new coronavirus infection caused the need to reorganize the work of emergency medical services (EMS) due to the high contagiousness and mortality, multiple organ lesions, difficulties in diagnosis and the lack of protocols for providing medical care to patients at the prehospital stage.

The purpose and objectives of the study is to assess the activities of the ambulance service in the context of a new coronavirus infection in Krasnodar.

Materials and methods: data of the information base of the integrated automated system for managing the activities of the ambulance station SBIHC KEH of the Ministry of Health Care of the Krasnodar Region in Krasnodar.

Results. А differentiated approach and algorithm was developed for assessing the severity of the condition in patients with COVID-infection and ARVI, their routing and organization of treatment in Krasnodar.

Conclusion: an assessment of the work of the ambulance service in combination with the measures taken during the observation period will ultimately allow organizing high-quality medical care to the population. 

In 91 patients with increased blood pressure, the efficacy and safety of three combinations of antihypertensive drugs was clarified. It was proved that the use of hourly monitoring of changes in blood pressure immediately after the provision of emergency therapy with the help of sublingual use of combinations of antihypertensive drugs allows for objective control of the time of onset and duration of the preservation of the therapeutic effect and to assess the likelihood and severity of repeated increase and excessive decrease in blood pressure. It has been shown that combinations of antihypertensive drugs: captopril with furosemide, moxonidine with furosemide and moxonidine with nifedipine are not only highly effective, but also safe, and therefore can be used by a doctor or paramedic of emergency medical care to provide emergency therapy, even in elderly and senile patients with comorbid pathology. 

Relevance. Among the purposes and target indicators of the implemented National projects by the end of 2024 it should be noted increase in the expected duration of healthy life, increase in total coefficient of birth rate up to 1.7 on one woman which achievement is impossible without ensuring female health.

The purpose: the analysis of a flow of the patients of an obstetric and gynecologic profile coming to a versatile hospital of emergency medical service (2015–2019).

Methodology. Data of the versatile 800-bed hospital incorporating 60 beds for patients of an obstetric and gynecologic profile served as materials of a research. Statistical and analytical methods of a research are used.

Results. The analysis of the entering stream (36.4 thousand in 5 years) with the diagnosis on the “obstetrics and gynecology” profile (the diagnosis of the direction) showed that most of them —  50.6% (р<0.01) were directed by the medical organizations of emergency medical service, 36.3% —  the medical organizations of polyclinic link, 3.2% —  the medical organizations of stationary type, and 9.8% —  independently asked for medical care. 77.6% of patients arrived from 9:00 till 21:00, including 32.9% —  from 9:00 till 12:00; the condition of 94.3% is regarded as satisfactory (р<0.01), only 71.5% of patients came to specialized offices according to a direction profile. The average time of stay of patients in office was about 2 hours (121.2±117.0 min.).

Conclusion. Development of stationary offices of emergency medical service gives the chance of sorting of the arriving patients according to weight of a state and needs in specialized medical and diagnostic actions. The diagnosis only of 71.5% of the arriving patients corresponds to a direction profile. The share of patients (for 50.2%), capable to ask independently for medical care grows. Every fifth patient who is almost arriving in the emergency order receives adequate (necessary and sufficient) the volume of medical care in office of emergency medical service. 

A study was conducted in 149 patients with diagnoses of thoracoabdominal trauma. In order to objectify the severity of the patients’ condition, a visual analog scale was used. To assess the state of the function of the autonomic nervous system in patients of the comparison group and the main group after the therapy, an analysis of heart rate variability was performed during the day. The combined use of dalargin, a narcotic analgesic and a non-steroidal anti-inflammatory drug, provided good analgesia, neurovegetative protection, when examined in the emergency room, the victims of the main group were in contact, which contributed to a more thorough collection of complaints, anamnesis and examination of the patient. 

The article describes the application of methods and methods of reconstructive surgery of iatrogenic false aneurysms of the left femoral artery. Experience shows the optimality of the choice and method of surgical treatment of iatrogenic aneurysms of the femoral artery by restoring prosthetic arteries. The article presents a clinical case of surgical treatment of iatrogenic aneurysm of the left femoral artery resulting from a puncture of the left femoral artery. The elimination of the aneurysm was accompanied by plastic surgery of the defect (5–6 cm) of the left femoral artery by applying prosthetics to the vessels. The rationale for the choice of surgical intervention is given. 

The article analyzes the results of treatment of patients with peptic ulcer bleeding in two clinics. One of the main reasons for the adverse outcomes of treatment is rebleeding. Early identification of patients with a high risk of rebleeding will allow timely preventive measures to be taken and avoid the development of severe complications, which ultimately will reduce mortality. The use of endoscopic hemostasis in patients with ulcerative bleeding in routine practice can reduce the number of operations, total and postoperative mortality.

Aim of study. Identify the features and offer the best tactics for the surgical treatment of vascular injuries in traumatic shock.

Material and methods. The clinic has 36 patients with hemorrhagic and traumatic shock. Of them: 33 men (91.6%), women 3 (8.3%). We found, among those admitted to the clinic, 36 patients with hemorrhagic and traumatic shock. So, in 5 patients, the condition was extremely serious. The use of angiography and MSCT is of great importance for the early diagnosis of traumatic vascular damage.

Results. We have performed 36 different operations for patients with shock after vascular injury: vessel ligature —  19; lateral suture —  5. Of them: at the same time imposed side seam venous vessels; сircular suture —  4; autovenous shunting —  3; prosthetics —  4: primary amputation —  1 and 7 patients with epineural suture. Along with this, severe shock, massive tissue damage and irreversible ischemia were indications for limb amputation in 1 (2,7%) patients with vascular damage. Arrosive bleeding was observed, only in one patient. In 24 (94,4%) patients, wound healing was primary, in 2 (5,5%) patients, wounds healed by secondary intention.

Conclusions. The high efficiency of timely application of reconstructive- restorative operations —  autovenous shunting and vascular prosthetics after stabilization of hemodynamic parameters depends on the degree of traumatic and hemorrhagic shock. 

The aim of the study is to improve the organization and provision of surgical care to civilians with gunshot wounds to the chest in the context of armed conflict on the example of the Chechen campaign.

Materials and methods. The work is based on the analysis of medical care provided to 106 wounded with gunshot wounds to the chest from the civilian population in the period from 1991 to 2000. Medical care was provided on the basis of the surgical hospital of the city hospital No. 9 in Grozny.

Results and discussion. Found that providing medical care to wounded with gunshot wounds of the chest when massive flow in terms of actual hostilities rendered by the forces and means of civil hospitals, has a certain specificity. It is due to the fact that in such conditions, in contrast to military medical organizations, there are no stages of evacuation, often the wounded are delivered by non-specialized and unsuitable vehicles on destroyed roads, while they are not given or given insufficient pre-medical care. In such conditions, the workload of medical personnel of civil medical institutions associated with the provision of medical care increases. In this regard, in our opinion, it is necessary to develop measures aimed at improving the algorithm aimed at minimizing various errors that occur in civilian medical institutions during the mass admission of wounded. 

This article is about of two cases of successful cardiopulmonary resuscitation (CPR) and using therapeutic hypothermia as a important part of treatment of post-resuscitation disease. Current evidence supports that induction of therapeutic hypothermia in selected patients after cardiac arrest can improve neurological outcome. It is hoped that by summarizing the current state of knowledge on the subject and highlighting issues on clinical management will enable more patients to benefit from the therapy.