Antithrombotic therapy is a cornerstone of acute coronary syndromes treatment, preventing coronary artery thrombosis development and progression. Early administration of P2Y12 receptor antagonists to patients with acute coronary syndromes (ACS) at the prehospital stage is a common practice and has been supported by the European and Russian Societies of Cardiology guidelines for many years despite the lack of definite evidence for its benefit. Recent clinical trials and registers on ACS treatment have shown no benefit and higher prevalence of bleeding related to the early start of P2Y12 receptor antagonists in NSTE-ACS patients. The latest European and Russian Societies of Cardiology guidelines do not recommend prehospital administration of P2Y12 receptor antagonists. The article highlights the antithrombotic therapy in acute coronary syndromes setting, recent ESC guidelines and its possible implementation in common practice.

Objective: substantiate the criteria for choosing a method for inter-hospital transportation of patients with severe trauma for the territorial system of medical support for the troops of the Western Military District.

Materials and methods. We studied 121 cases of inter-hospital transportation of patients with severe trauma in the territorial system of medical support for the troops of the Western Military District for the period 2015–2020. The time of inter-hospital transportation of patients by an ambulance car of class C and by helicopter was studied at various distances between medical organizations: up to 70 km, from 70 to 200 km, more than 200 km.

Results and discussion. At distances between medical organizations of more than 200 km, the average time of medical aviation evacuation of patients with severe injuries by helicopter was 176±35 minutes, and the average time of medical evacuation of patients in a class C ambulance was 290±43 minutes (p=0,04). When the distance between medical organizations is less than 200 km, the average time of medical aviation evacuation of patients with severe trauma by helicopter was 126±43 minutes, and the average time of medical evacuation of patients in a class C ambulance was 137±37 minutes (p=0,85).

Conclusions. The main factor in choosing a method for carrying out inter-hospital transportation of patients with severe trauma in the territorial system of medical support for the troops of the Western Military District is the distance between medical organizations. It is advisable to plan medical aviation evacuation of patients with severe trauma by helicopter when the distance between medical organizations is more than 200 km.

The article analyzes information about patients older than working age, delivered to the hospital for emergency indications, including emergency medical teams, for diseases of the circulatory system in the Russian Federation for 2010–2019. Over 10 years in the country, there has been an increase in the proportion of patients older than working age with diseases of the circulatory system, admitted on an emergency indications to the hospital, from 43,65 to 53,0%, including by emergency medical teams — from 47,2 to 49,1%.

Relevance. The development of methodological support for nursing services operating in the daily routines of a medical organization with increased preparedness in an emergency requires long-term scientific and methodological support and the development of practical recommendations on the organization of nursing services in emergency situations.

The goal — to analyze the organization of work of nurses and assess the quality of medical care at the Research Institute of Emergency Medicine. I. I. Dzhanelidze at the arrival of victims of the terrorist attack on April 3, 2017 in the St. Petersburg metro.

Materials and methods. The experience of organizing medical care upon admission of victims after a terrorist attack to the Scientific Research Institute of Emergency Care named after I. I. Dzhanelidze. During the study, the source of information was specially designed questionnaires (n=125 nurses). The main research methods: sociological, analytical, descriptive statistics.

Results and discussion. It was revealed that not all nurses received information about the arrival of victims after the terrorist attack by the warning system, almost every fifth nurse does not know what post she is assigned to in the event of an emergency, and almost every tenth nurse is not sure of her responsibilities in the attack. More than half of nurses believe that in emergency situations the number of nurses should be increased, since the lack of nursing staff reduces the quality of medical care for victims of the terrorist attack.

Conclusion. Identified problems require the development of universal protocols and action algorithms for organizing the work of the nursing staff of a multidisciplinary hospital during the provision of assistance with the admission of victims of emergency situations and terrorist attacks to improve the quality of medical care.

Purpose of the work: to assess the prevalence of myocardial infarction and COVID-19 in a «non-COVID» hospital.

Materials and methods: the first part of the work is monitoring data from June 2020 to May 2021, the second part is an analysis of monitoring from August 2017 to May 2021.

Research results. According to the data obtained, the peak of the combination of myocardial infarction with COVID-19 lagged behind the total pool of COVID-19 patients by a month, while there was a decrease in the overall incidence of unstable angina pectoris and an increase in the number of patients with myocardial infarction. Obviously, people were slow to seek medical attention. This led to an increase in the time from the onset of symptoms to hospital admission, a later initiation of treatment, and an increase in the incidence of thrombosis in COVID-19 survivors.

Conclusions. In patients, myocardial infarction predominated in the structure of acute coronary syndrome in patients, which is associated, on the one hand, with an increase in the time from the onset of symptoms to admission to the hospital and an increased risk of thrombosis in persons who have undergone COVID-19.

We studied the possibilities of urgent monitoring of blood pressure and an objective assessment of its results at the pre-hospital stage. Of the 105 patients included in the study, 6 were excluded for technical reasons and 8 due to additional antihypertensive drugs. For emergency antihypertensive therapy, two-component combinations were used: captopril+furosemide, moxonidine+furosemide, moxonidine+nifedipine (if there was no intolerance to any of the studied drugs, they were prescribed using random numbers), blood pressure monitoring was simultaneously started, which lasted for a day. The stability of the antihypertensive effect, the frequency of excessive lowering of blood pressure in relation to its target value was evaluated. It was shown that the use of blood pressure monitoring techniques from the first minutes of sublingual use of various combinations of antihypertensive agents allows objectively assessing and documenting the safety of the effect of emergency therapy.

The work demonstrates the possibility of effective and safe medical cardioversion in patients with atrial flutter at the pre-hospital stage.

Post-traumatic brain edema is integral pathophysiological process in patients with severe traumatic brain injury, leading to increase of intracranial pressure (ICP). Intracranial hypertension (ICH), in turn, increases the number of deaths in this group of patients. The most important task in the treatment of victims in the early postoperative period after the removal of traumatic intracranial hematomas is correction of ICH syndrome.

Purpose of the study. To evaluate the effect of the systemic angioprotector use on the treatment outcomes of patients with traumatic intracranial hematomas in the early postoperative period.

Materials and methods. The study included 50 patients with traumatic intracranial hematomas. Group I — the main group (with the use of systemic angioprotector, n=24), group II — the comparison group (without the use of the medication, n=26). The effectiveness of treatment was compared — according to the following criteria: survival in the postoperative period (14 days), level of consciousness (at admission and average value during the day throughout the treatment), course of neurological status: meningeal signs, cranial nerve function, motor sphere, response to pain stimuli, autonomic system disorders (at admission and every day throughout the treatment), monitoring of ICP (before removal of the hematoma and average value throughout the measurement), changes in the multispiral computed tomogram of the head (at admission, on the 3^rd, 7^th, 14^th day).

Results. The study found that the mortality rate in the main group of patients with intracranial hematomas in the early postoperative period decreased by 21.5%. The average value of ICP for the entire period of measurement in group I is 15.0±7.6, in group II 17.3±8.4 mm Hg. The average value of points of the Glasgow com scale on the 14th day in group I is 9.2±1.9, in group II 7.5±0.7 points. The duration of intraventricular monitoring of ICP was less in the first group — 4.3±1.2 days, compared to the second group — 6.2±1.5 days.

Conclusion. The use of systemic angioprotector in the complex treatment can reduce intracranial pressure (ICP) in patients with traumatic intracranial hematomas in the early postoperative period and improve intermediate outcomes.

Objective: to evaluate the blood clotting system based on laboratory data in adolescent girls with uterine bleeding of the puberty period (MCPP). The study included 151 girls from 9 to 17 years old, of which 101 patients with MСPP and 50 patients with somatic pathology who do not suffer from MСPP. All patients underwent laboratory tests of blood coagulation parameters. The results of the study revealed lower values of the prothrombin index (PTI) and a tendency of compensatory increase in fibrinogen levels with a decrease in Duke bleeding time in the period of acute uterine bleeding in patients of the main group. In patients with MСPP, the threshold values of the blood clotting system parameters for the occurrence of uterine bleeding were determined, these are the level of PTI≤71.25%, fibrinogen ≤4.45 g/l, bleeding time according to Duque <2.38 min (p<0,05 according to the criterion χ2). The analysis of the obtained results indicates the presence of signs of insufficiency of the vascular-platelet hemostasis link in girls with MCPP.