Purpose. Conduct an analysis of projects of various inpatient emergency departments and identify optimal planning solutions. Methods. To analyze the projects of various inpatient emergency departments and search for optimal planning solutions, it is possible to use simulation modeling. This approach allows you to create a virtual model of the system and conduct many scenario tests in order to evaluate the efficiency and optimize the work of departments in various conditions. Using simulation modeling, three models of inpatient emergency departments of various sizes (1000, 1200 and 2500 m²) were created. The definition of functioning features was carried out with the same threshold value of the incoming flow of patients — 150 per day. In addition to the structural components of the departments, a “point of primary decision-making” was singled out. After the experiments, a comparison of the obtained statistical data was carried out. Results. As a result of the study, on the model of an inpatient emergency department with an area of 1200 m² and 2500 m², there were no queues in the process of work at the “point of primary decision making”. At the same time, on a model with a total area of 1000 m² with the same flow of patients, a queue was formed at the established “primary decision point”, waiting for 10 minutes of model time, which was due to the initial small area in the waiting room. Conclusion. Based on the data obtained, it was concluded that the optimal design solution for the creation of an inpatient emergency department is the department area of 1200 m².

The problems of the quality of diagnostics at the prehospital stage remain relevant. Diagnostic errors represent an urgent medical and social problem. The purpose of the study was to study the continuity in the provision of medical care to patients with acute surgical pathology of the abdominal organs in terms of the coincidence of the diagnoses of the emergency medical teams and the emergency hospital. The statistical data of the State Budgetary Institution St. Petersburg Research Institute of Emergency Medicine named after I. I. Dzhanelidze for the period 2015–2022, content analysis, statistical and analytical methods were used. Study results. Among patients with acute surgical pathology of the abdominal organs, a significant discrepancy in the diagnoses of prehospital and inpatient stages was revealed: “acute cholecystitis” in the diagnosis of emergency medical teams was confirmed by the hospital in 51.2% of cases, “ectopic pregnancy” — in 28.9% of cases, “acute appendicitis” — in 20.7% of cases, “acute pancreatitis” — in 6.7% of cases, “acute intestinal obstruction — in 5.7% of cases,” perforative ulcer” — in 3.1% of cases. 36.1% of patients received an unverified diagnosis of acute abdominal surgical pathology. Conclusion. Defects in the formulation, execution or coding of a diagnosis — an indicator of unsatisfactory qualifications of a medical worker and the quality of the organization of the medical and diagnostic process. It is the diagnosis, as an integral indicator of the clinical thinking of a doctor (paramedic), that is of exceptional importance, since it performs cognitive-logical, scientific, statistical and legal functions. However, reasonable overdiagnosis in the prehospital stage of emergency medical care is welcome, as underestimating the severity of the condition in conditions of limited diagnostic capacity and time deficit can have severe consequences for the patient.The tasks of clarifying the diagnosis, determining the indications for hospitalization and further tactics are designed to solve inpatient emergency departments with real medical and diagnostic, material and technical and personnel resources.

Purpose: to develop models of patients with severe hot liquid scald. Material and methods. Тhe analysis of scientific publications and own observations of the causes of hot liquids scald was carried out. Results. Based on the data obtained, four models of patients with severe hot liquids scald were formed: immersion injury (falling or prolonged stay in the bath), non-immersion injury (scalds in the shower or hot liquid splashing), cooking-related burns and a special type of immersion scald caused by communal incidence. According to the results of the study, 97% of patients with hot liquids scald corresponded to these four models. These models turned out to be homogeneous by gender, age, area, depth and localization of skin lesions, severity of the condition and other characteristics. Conclusion. Тhe use models of patients make it possible to form homogeneous groups of victims. Due to the homogeneity of these groups, it is possible to develop surgical treatment tactics for each of the formed models, which should improve the results of treatment of burned patients.

According to the Department of ambulance organization of the I. I. Dzhanelidze Research Institute of Joint Venture in the structure of the “acute abdomen” UGDB takes 4th place in 2021. Transcatheter arterial embolization (TAE) is an alternative to palliative surgical interventions when conservative treatment of ulcerative bleeding using endoscopic hemostasis methods is ineffective, especially in patients with a high risk of surgery and an unfavorable outcome. The aim of the work is to evaluate its role in improving the results of treatment of patients with UGDB who underwent TAE in an ambulance hospital in order to prevent recurrence of bleeding, to assess its role in improving the results of treatment of this category of patients. Materials and methods. The analysis of the results of treatment of 30 patients with UGDB who were on inpatient treatment at the I. I. Dzhanelidze Research Institute of SP from 2018 to 2021, the use of TAE is an alternative to open palliative surgery. As a result of the conducted examination, it was found that the use of endovascular hemostasis in order to prevent recurrence of bleeding in a group of somatically severe patients with UGDB is advisable.

The aim of the study was to improve the treatment results of acute abdominal surgical diseases during the COVID-19 pandemic. Material and methods. The object of the study was 200 patients who were randomized into 2 groups. The present study was retrospective, based on the analysis of the medical histories of patients hospitalized with clinical manifestations of acute abdominal pathology developed against the background of COVID-19. The present study was retrospective, based on the analysis of the medical histories of patients hospitalized with clinical manifestations of acute abdominal pathology developed against the background of COVID-19. Results. Cardiovascular and endocrinological background conditions were significantly less frequently recorded in the main group of patients. Perhaps the reason for this was that at the height of the pandemic, due to the excessive burden on the healthcare system, doctors did not pay enough attention to the presence of background conditions whuch could complicate the course of the main pathology. Patients in the comparison group were recruited in the post-pandemic period, when the functioning of the health system was normalized. Conclusion. The new SARS-CoV-2 virus will eventually line up with existing viruses and will periodically lead to COVID-19 outbreaks. A thorough analysis of acute abdominal surgical diseases during the COVID-19 pandemic leads to the correct tactics of surgical treatment with background and concomitant pathology. In this regard, the optimal planning of preventive and therapeutic measures requires the establishment of accurate diagnostics.

The purpose of the study. To analyze the structure of the incoming flow in conditions of conducting large-scale military operations at the stage of emergency specialized surgical care and to determine the predictors of an unfavorable outcome in patients with severe combined wounds. Materials and methods. A retrospective cohort study of medical data was performed in seriously wounded during a special military operation who were admitted to the department of anesthesiology, intensive care and intensive care of a level 3 military medical organization with severe combined wounds and trauma in 45 seriously wounded. Depending on the outcome of treatment, the seriously injured and injured were divided into 2 groups: survivors (n=30, 66.6%) and deceased (n=15, 33.4%) within a 30-day period from the moment of injury. Results. In the structure of seriously injured people in need of resuscitation, gunshot wounds predominate 84.5% (fragmentation — 95.4%, bullet — 4.6%), surgical diseases account for 7.2% of cases, closed trauma occurs in 5.1% of cases, thermal lesions — 3.2%. Combined and multiple wounds were diagnosed in 96.2% of cases. Upon admission, the predictors of death are hypothermia (p-value=0.011), the time elapsed from injury to qualified surgical care (p-value=0.035), the severity of the condition on the APACHE II scale (p-value=0.047). During treatment at the stage of emergency specialized surgical care, the predictors of death are the laboratory assessment of total bilirubin (p-value=0.006), the SOFA scale (p-value=0.015), an increase in creatinine levels (p-value=0.018), the appearance of metabolic acidosis (p=0.022), an increase in the dose of norepinephrine (p-value=0.015).value=0.033), as well as an increase in potassium levels (p-value=0.041). Conclusion. The result of the study showed a high frequency of combined injuries admitted to the OARIT. The predictors of an unfavorable outcome at admission were hypothermia; the time elapsed from the moment of injury to the provision of qualified surgical care; the severity of the condition on the APACHE II scale. And during intensive therapy, the predictors were: an assessment on the SOFA scale, an increase in creatinine levels, total bilirubin, potassium levels and metabolic acidosis.

The XXIV Congress of Pediatricians of Russia with international participation “Actual problems of Pediatrics”, held on March 3–5 of this year, highlighted a number of features of the modern development of pediatric science and practice. This refers to the situation of demographic decline, a three-year unfavorable epidemiological situation, negative trends in the formation of the health of the child population, a shortage of pediatric personnel during the implementation of the 2nd stage of the program “Decade of Childhood 2021–2027”. This set of reasons creates certain risks in the correct diagnosis of diseases and the conduct of adequate medical measures, including the provision of emergency and emergency care. These trends are the reasons for the increase in the volume of both planned and emergency medical care. This article presents an analysis of the morbidity and disability of children in St. Petersburg in the period 2019–2022, analyzes the structure of emergency calls to children. Along with the dynamics of morbidity and disability, a real picture of the growth of emergency medical care for children is given. The ways of stabilization and improvement of the current situation are proposed.

Acute dissection of aortic refers to cardiovascular catastrophes accompanied by a high level of fatal complications and deaths. In the vast majority of cases, middle-aged and elderly men with a burdened history of arterial hypertension and atherosclerosis suffer from this ailment. However, in addition to these diseases, this pathology can occur with rheumatism, inflammatory vascular diseases and connective tissue diseases. The polysymptomicity of the disease provides a high probability of meeting with this pathology of doctors of any specialization. Focusing on the clinical manifestations of the disease, taking into account laboratory (activation of prothrombotic and fibrinolytic mechanisms of the hemostasis system) and instrumental data will direct to timely recognition of pathology and diagnosis, which will determine the tactics of management and prognosis of the patient’s life. The disease in question is an absolute indication for surgical treatment, therefore conservative therapy will be aimed only at stabilizing hemodynamic parameters and preparing for surgical treatment of the patient. A clinical case of dissection of an aortic aneurysm, which occurred under the masks of acute coronary syndrome and acute abdomen, is presented. This case demonstrates the importance of assessing clinical symptoms and the dynamics of their development in the diagnosis of acute aortic dissection for doctors of both therapeutic and surgical profiles.

This article is devoted to neurocirculatory dystonia with an analysis of a clinical case and the search for the cause of the development of the disease. The patient presented for clinical analysis was observed for a long time by doctors of various profiles, who prescribed her a variety of therapy depending on the symptoms. At the same time, almost no specialist suspected the neurotic nature of the disease in order to refer the patient to the appropriate specialist. This situation is quite typical for patients with neurocirculatory dystonia. Often patients with neurotic disorders turn to therapists, cardiologists and gastroenterologists due to the fact that the symptoms mimic a variety of pathologies of internal organs. Patients actively seek help from a doctor and are ready for various studies, they have a “rich experience” in communicating with doctors of various specialties, they endure numerous, often repeated examinations, they are prescribed a variety of medications. Thus, patients become dependent on permanent diagnostic studies and frequently changing medical prescriptions.

The review of foreign medical periodicals presents some aspects of the application of extracorporeal membrane oxygenation during resuscitation in patients with out-of-hospital cardiac arrest.