The article highlights the modern understanding of etiology, epidemiology and pathogenesis of atrial fibrillation and flutter and their global burden as the most frequent form of supraventricular sustained tachyarrhythmia. The recent international and Russian national clinical guidelines on the treatment and prevention of atrial fibrillation are briefly discussed. The new antiarrhythmic drugs, presented in recent guidelines are also highlighted. The authors analyze their own experience in the treatment of paroxysmal atrial fibrillation with IC class drugs (propafenone) at the prehospital stage. 

In work it is provided that early and productive detection of АRDS at patients is justified to carry out on the basis of the following data having diagnostic value which are rational for using in the following sequence: emergence time (the acute beginning within the first 72 hours), a disturbing factor, IO and also results of a  computer tomography of bodies of a  thorax. It is revealed that the radiographic research of lungs can be used in diagnostics of АRDS at patients as an auxiliary method, in combination with abovementioned criteria. 

The purpose of the study is experimental testing of Russian medical devices for the elimination of tension and open pneumothorax.

Objectives of the research. Perform an analysis of the volume of therapeutic measures in the wounded and injured with open and tension pneumothorax. Conduct experimental testing of Russian samples to eliminate tension and open pneumothorax.

Materials and methods. A retrospective analysis of the medical histories of 232 patients with polytrauma admitted for treatment at the war surgery department of the Kirov Military Medical Academy in the period from 2015 to 2019. An experimental study was carried out on large biological objects (pigs) to evaluate the effectiveness of eliminating open and tension pneumothorax using products from the UD-02f (paramedic) kit.

Results. A retrospective analysis of the medical histories of 232 patients with polytrauma admitted for treatment at the clinic in the period from 2015 to 2019 was carried out. The incidence of tension pneumothorax was 11.6%. In 44.4% of cases, it was eliminated; in 55.6% of the ambulance teams, tension pneumothorax was not eliminated. Open pneumothorax was diagnosed in 21.1% of those admitted at the prehospital stage. In all cases, the elimination of open pneumothorax was carried out by applying an improvised sealing bandage to the chest. An experimental study of the effectiveness of the UD-02f set showed that the use of products included in this set allows to effectively eliminate the life-threatening consequences of wounds and chest injuries.

Conclusion. Open and tension pneumothorax are severe life-threatening consequences of chest injuries with a development rate of up to 12.1% and 11.6%, respectively. The inclusion of a set for eliminating tension and open pneumothorax disposable, sterile (paramedical) UD-02f, in the complete equipment and training of medical personnel in the procedure for its use, will allow timely and effective elimination of tension or open pneumothorax at the prehospital stage of emergency medical care. 

Out of all the cardiac manifestations of post-COVID syndrome, tachycardia has been studied to a lesser extent, while almost all patients complain of palpitations.

The purpose of the study is to reveal the incidence of post-COVID tachycardia syndrome in apparently healthy patients and to evaluate the effectiveness of ivabradine in this category of patients.

Materials and methods. 48 patients revealing no comorbid pathology were examined 12 or more weeks after COVID-19. Materials of instrumental research methods, functional tests, quality of life before and during treatment with ivabradine were studied.

Results. In all patients included in the study, against the background of an autonomic imbalance with a predominance of the activity of the sympathetic part and deterioration in quality of life, the syndrome of post-COVID tachycardia was diagnosed, and a positive effect of ivabradine on heart rate control was revealed.

Conclusion. Tachycardia can be considered a marker of post-COVID syndrome in patients who were apparently healthy before coronavirus infection; it can manifest itself in POTS, NST, or their combination, as well as be accompanied by other cardiac arrhythmias including PVC, SVE, non-sustained SVT, and persistent form of AF. Ivabradine is able to control heart rate and level the manifestations of post-COVID tachycardia syndrome. 

The article summarizes historical materials on the establishment of the Department of Emergency Medical Care and Injury Surgery in St. Petersburg on the basis of the First St. Petersburg State Medical University named after Academician I.P. Pavlov. The main stages of its development are presented, the scientific potential and contribution to the development of emergency and emergency medical care to the population of the city are shown. Since 2012, the staff of the Department, in cooperation with the St. Petersburg Research Institute of Emergency Medicine, has contributed to the study and solution of scientific, practical, organizational and methodological issues in the field of emergency medical care in the Russian Federation. 

The use of targeted arterial embolization in the treatment of bleeding ulcers was accompanied by technical success in 97.6% of cases, clinical success in 95% of cases, bleeding recurrence occurred in 5% of patients, while repeated arterial embolization was used to eliminate it in 2.5% of cases. Delayed operations were performed in 8.3% of patients, mortality was 6.5%, which allows us to recommend transcatheter arterial embolization for the treatment of patients with ulcerative gastroduodenal bleeding. 

Purpose. To evaluate the predictive value of the parameters of respiratory support for newborn patients with respiratory insufficiency in assessing non-transportability.

Materials and methods. The observational, cohort, retrospective study included data from 284 trips of the transport team to ventilated newborns from August 1, 2017  to December 31, 2018, a subgroup of transportable patients (n=244) and newborns recognized as untransportable due to the presence of respiratory insufficiency (n=40) was identified. The assessment and comparison of anamnesis, the status at the time of arrival of the transport team, intensive care, the parameters of respiratory support and its correction, monitored parameters, as well as assessments on scales — KSHONN, NTISS and TRIPS.

Results. Тhe calculated respiratory parameters have a high predictive value for the non-transportability of newborns: the AUC ROC for the mean airway pressure is 0.858 [0.785–0.931], for the saturation index of oxygenation — 0.931 [0.893–0.970], for the SpO₂/FiO₂ ratio —  0.937 [0.901–0.973]. These indicators demonstrate significantly higher values of AUC ROC in comparison with the KSHONN scales (AUC=0.812 (0.742–0.882)), NTISS (AUC=0.848 (0.793–0.904)), TRIPS (AUC=0.802 (0.726–0.879)) scales. The high predictor value of the mean airway pressure and the saturation index of oxygenation for nontransportability remains high regardless of the need for catecholamine infusion.

Conclusion. Mean airway pressure, saturation oxygenation index and SpO₂/FiO₂ ratio demonstrate a high predictive value for the patient’s non-transportability, exceeding the accuracy of the scales (KSHONN, NTISS, TRIPS).

The average number of incoming calls determining the amount of load on the Valdai emergency care station (ECS) in the Novgorod region is estimated. Calculations of the required number of brigades were carried out, 3 models of the functioning of the ECS were proposed. Possible financing schemes for the work of the ECS have been identified. A comparison of the necessary costs for staff remuneration with two possible financing schemes was carried out. The proposals on the organization of the work of the ECS are formulated. 

Purpose: to assess the role of left ventricular (LV) isovolumic relaxation time (IVRT) as a predictor of adverse outcome in acute decompensated heart failure (ADHF) against the background of intermediate ejection fraction (EF) of the left ventricle.

Materials and methods. The study included 121 patients aged 37  to 85 years (mean age 67.2±2.5 years) with ADHF against the background of LV ЕF; 78 — male, 43 are fermale. In all patients, the time between the end of blood flow in the outflow tract and the beginning of blood flow in the inflow tract was determined, i.e., LV IVRT. According to this parameter, the whole group was divided into 3 samples: with an average LV IVRT (70–100 ms — 54 patients), increased (more than 100 ms — 15 patients) — or reduced LV IVRT (less than 70 ms — 52 patients).

Results. The mean LV IVRT in group 1 was 87.5±6.4 ms, in group 2–106.4±9.7 ms, in group 3–55.3±4.1 ms. Hospital mortality (HM) in the entire sample was 5.3%, long-term (24 months) (LM) — 39.6%. The obtained results were subjected to correlation analysis: HM was characterized by a connection with LV IVRT (r= –0.295, p<0.05), but the dependence was inversely proportional. For LM, the correlation coefficient with LV IVRT was 0.519, p><0.05, which is typical for an average connection strength. Conclusions: 1. The value of IVRT in patients with midrange LV EF correlated negatively with the levels of both in-hospital and long-term mortality: low numbers of IVRT statistically significantly predicted an increase in mortality from all causes, while a decrease in mortality was observed at high values of IVRT. 2. In patients who are hospitalized for ADHF against the background of mid-range LV EF, it is advisable to determine the LV IVRT to assess the immediate and long-term prognosis of the disease. Keywords: heart failure, acute decompensation, time of isovolumetric relaxation of the left ventricle, prognosis> ˂ 0.05), but the dependence was inversely proportional. For LM, the correlation coefficient with LV IVRT was 0.519, p ˂ 0.05, which is typical for an average connection strength.

Conclusions: 1. The value of IVRT in patients with midrange LV EF correlated negatively with the levels of both in-hospital and long-term mortality: low numbers of IVRT statistically significantly predicted an increase in mortality from all causes, while a decrease in mortality was observed at high values of IVRT. 2. In patients who are hospitalized for ADHF against the background of mid-range LV EF, it is advisable to determine the LV IVRT to assess the immediate and long-term prognosis of the disease.