The results of the analysis of the medical and statistical characteristics of patients who applied for emergency and urgent indications to the burn center of the State Budgetary Institution “St. I. I. Dzhanelidze”, based on the results of 2019–2021. It was revealed that out of 4465 patients, 790 (17.8%) were admitted with injuries requiring immediate hospitalization in the intensive care unit for burns. 2232 victims (50%) after examination in an inpatient emergency department were referred to specialized general departments of the burn center, in 1443 cases (32.2%) injuries were recorded that did not require inpatient treatment, assistance was provided on an outpatient basis. Most of the patients applied for burn injuries — 3825 (85.7%), ICD10 codes: T310-T319.

An important task of the health system is to improve the quality of medical care, the quality of professional training of surgeons. The purpose of the study: based on the analysis of the literature, to determine the main components of the educational process within the framework of continuous education of doctors of surgical specialties, necessary for adequate professional development and improvement of the quality of medical care for specialized patients. Results of the study. An analysis of the system of professional training of surgeons was carried out, its shortcomings were noted. Knowledge, practical skills, experience, medical thinking, logic and intuition are the most important components of a highly professional doctor, surgeon. The world experience of training specialists is presented. Conclusion. Today in Russia, a new modern system of postgraduate education of doctors of surgical specialties is being formed within the framework of the system of continuing medical education. In order to achieve better results, organizational approaches to vocational education should be reviewed.

In work it is presented that application of infusional therapy for patients with heavy traumatic shock at a prehospital stage is not only pathogenetic expedient, but also authentically reasonable component of antishock treatment. It is revealed that the most effective option of volemichesky compensation at patients with heavy traumatic shock at pre-hospital and hospital stages of treatment is application sterofundin isotonic and 4% the modified gelatin.

The objective. To substantiate the use of the Estimated Continuous Cardiac Output technology for the assessment and correction of the volemic status in obese patients during routine hernia repair of the anterior abdominal wall under spinal anesthesia. Subjects and methods. The study included 40 patients who underwent hernia repair of the anterior abdominal wall under spinal anesthesia. Inclusion criteria: body mass index of more than 30–40 kg/m^2, physical status according to ASA II or III, no history of indications of diabetes mellitus, myocardial infarction, stroke, malignant neoplasm. Exclusion criteria: refusal of the patient, contraindications to spinal anesthesia. The patients were randomly divided into 2 groups of 20 people. Patients of both groups were comparable in age, gender, and physical status. Group 1 patients underwent preoperative evaluation, as well as monitoring of the effectiveness of correction of volemic status using EsCCO technology. Intraoperative infusion therapy was prescribed to patients of group 2 based on the doctor’s experience, blood pressure, heart rate and formulas for calculating the infusion load. Statistical analysis of the data obtained was performed using MS Excel, Statistica 10. To test the hypothesis of the normality of the distribution of a random variable, the Shapiro-Wilk test was used. Under conditions of normal distribution of quantitative indicators, descriptive statistics were used for statistical data analysis: mean value (M); standard deviation (SD); 95% confidence interval of standard deviation (C1). The Student’s t-test was used to analyze the differences between quantitative characteristics. The differences were considered significant at p<0.05. Results. The greatest decrease in systolic blood pressure by 4 minutes (from 122.8 to 117.5 mm Hg, by 4.3%) was revealed among group 1A patients, by 2 minutes (from 120.6 to 115.4 mm Hg, by 4.3%) among group 2 patients by 4 minutes (from 123.4 to 107.2 mm Hg, by 13.1%) from spinal anesthesia. The most pronounced change in heart rate relative to baseline data among group 1A and group 1B patients was noted at 2 minutes after intrathecal administration of bupivacaine (from 72.4 to 76.2, by 5% and from 74.6 to 78.4, by 4.8%, respectively) with a gradual return to parameters that are close to the baseline, and among patients in group 2, a sharp jump in heart rate from 73.8 to 83.3 (by 11.4%) was noted at 2 minutes. Heart rate continued to increase and by 6 minutes reached an average of 86.0, which is 14% higher than the original value. In all three groups of the study, the greatest deviation from the baseline was found at 6 minutes after the administration of bupivacaine with a further gradual return to slightly larger parameters than the base[1]line. Significant changes in SI were detected at 6 minutes from the execution of the neuroaxial block among all patients of this study. For group 1A, they ranged from 3.89 to 5.25 l/min/m² (by 27.6%), for group 1B patients from 3.88 to 5.1 l/min/m² (by 23.9%) and for group 2 from 3.84 to 5.45 l/min/m² (by 29.5%). Conclusion. The Estimated Continuous Cardiac Output technology can be effectively used to assess and correct the volemic status in obese patients when performing elective hernia repair of the anterior abdominal wall under spinal anesthesia.

A case of intubation-tracheal anesthesia in a patient with Duchenne-Becker myopathy due to the need for surgical intervention for acute calculous cholecystitis is described. The methodology of the performed anesthesia is described in detail, as well as the methods of anesthetic support of operations in patients with myopathy, myasthenia gravis and myotonic muscular dystrophy.

The work includes 30 patients with thermal burns of I–II degree, the area of which amounted to 15–20%, living in Saratov for the period from 2011 to 2021. All injuries were obtained in everyday conditions by ingesting hot liquid on various parts of the body. The average age was 28±5 years. There were 19 men (63,3%), 11 women (36,7%) people. Anti-shock measures were carried out for all victims, including the introduction of polyglucin infusion therapy, the imposition of aseptic bandages, and pain relief. The first group (main) included patients who were given narcotic analgesics as pain relief, the second (comparison) included victims who were given non-drug analgesics as pain relief. Based on the results obtained, it was concluded that the use of narcotic analgesics at the prehospital stage leads to the early cessation of pain syndrome, the prevention of the development of traumatic shock and improves the results of treatment of such victims.

Objective: to establish the reasons that impede the provision of ambulance in case of traffic accidents in the Republic of Khakassia and to outline ways to solve them. Materials and methods. Official statistical forms, information materials and electronic databases of the State Budgetary Institution of Health of the Republic of Khakassia “Republican Medical Information and Analytical Center” of the Ministry of Health of the Republic of Khakassia (RMIAC) and the Department of State Road Safety Inspectorate of the Ministry of Internal Affairs for the Republic of Khakassia (UGIBDD) were used. Results. An analysis of the causes that impede the provision of ambulance in case of traffic accidents in the Republic of Khakassia is carried out. Of course, persons injured as a result of transport accidents that occurred on the territory of a large city have a better chance of the timely arrival of the ambulance team than those injured as a result of a traffic accident on highways remote from large cities. Conclusion. It is necessary to continue this study for the scientific substantiation of ways to eliminate the causes that impede the provision of ambulance in case of road acci[1]dents in the Republic of Khakassia.

The review of foreign literature highlights some principles of ensuring the patency of the patient‘s respiratory tract with subsequent artificial ventilation during resuscitation by an ambulance team.

There is described the casuistic case of the death of the 67-year-old woman from hemotamponade of the pericardial cavity due to non-perforating injury to the posterior wall of the left heart ventricle with the fish bone that has perforated the anterior wall of the esophagus. It is also reported about the presence in literature of the single publication of the case of such perforation of the left heart atrium with its thrombosis and thromboembolic complications and of few rare cases of such perforation complicated with aortal pseudoaneurism, hemophtisis, and lung abscess. The peculiarity of this and published in the literature cases is that most of such perforations are asymptomatic, and their clinical manifestations appear already at the stage of development of complications.