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Lecture notes, cheat sheets
Fundamentals of medical knowledge. Cheat sheet: briefly, the most important
Directory / Lecture notes, cheat sheets Table of contents
Accepted abbreviations Ministry of Health and Social Development of Russia - Ministry of Health and Social Development of the Russian Federation Russian Emergency Situations Ministry - Ministry of the Russian Federation for Civil Defense, Emergency Situations and Elimination of Consequences of Natural Disasters SARS - acute respiratory viral infections Unit abbreviations г - gram J - joule feces - calorie (off-system unit of heat amount) sq. m - square meter kg - kilogram л - liter min - minute ml - milliliter mmHg Art. - millimeter of mercury cm - centimeter ч - hour Abbreviations of prefixes for the formation of names of multiples and submultiples of physical measurements к - kilo... (103) М - Mega... (106) м - milli... (10-3) u - micro... (10-6) Topic 1. Health of school-age children 1.1. Anatomical and physiological features of preschool children This period of development of the child is characterized by his physical and mental maturation. Preschool children speak their native language well, use declensions and conjugations quite correctly. During this period, the individuality of the child is manifested, his emotions become more restrained. The main diseases of this period are diseases of the respiratory system (especially the upper respiratory tract), as well as infectious diseases, as children gradually enter society, begin to contact with a large number of people. At this age, physiological changes occur: at first, the growth of the child slows down to 4-6 cm per year, and later accelerates to 6-8 cm. Weight gain (in kilograms) looks like this: - at 4 years - 1,6; - at 5 years - about 2; - at 6 years old - 2,5. For this period of development of the child, the following anatomical and physiological features are characteristic. 1. There is a thickening of the skin, but the danger of hypothermia or overheating does not disappear. 2. Ossification of the skeletal system has not yet been completed. The skeleton of a child is similar in shape to the skeleton of an adult, but not yet so strong. At this age, diseases such as scoliosis appear, therefore, it is for this age that constant control over posture and distribution of the load on the body is very important. The ribs of the child take the same position as in adults; the chest becomes cylindrical. 3. The cardiovascular system is characterized by a decrease in heart rate (85-90 beats per minute by 7 years), a gradual increase in blood pressure (by 7 years - 104/67 mm Hg). 4. At the age of 6-7 years, growth accelerates - the so-called first physiological stretch, at the same time differences in the behavior of boys and girls appear. This is due to changes in the endocrine system of the child: the thyroid gland, adrenal glands, pituitary gland. There is also a "preparation" of the gonads for puberty. 5. At preschool age, the work of the child's immune system improves, so many diseases are easier than before. 6. The work of the nervous system at this age is characterized by the laying of the foundations of intelligence. Children willingly memorize verses, draw with enthusiasm, compose, rewriting the heard tales. It also lays down the basic norms of morality and morality. Children of this age are inquisitive: they constantly ask the question "why?". 1.2. Anatomical and physiological features of children of primary school age Primary school children include schoolchildren from 7 to 11 years old. During this period, the child's memory and coordination of movements improve. In connection with these physiological characteristics, the child has the opportunity to learn: writing, reading, counting. With the beginning of studies, some problems also arise: the child spends less time in the air, the child's daily regimen changes and is disrupted, including the diet. As a result, the likelihood of diseases such as infectious, allergic, cardiovascular, gastrointestinal increases. Also at this age, the likelihood and danger of childhood injuries are high. Among the anatomical and physiological features of children of primary school age are the following. 1. The growth rate stabilizes: the height of a child at 8 years old is 130 cm, at 11 years old - about 145 cm. 2. There are some accumulations of fat cells under the skin in the chest and abdomen, which, if not properly controlled, can lead to obesity. less dangerous hypothermia and overheating become, as the formation of sweat glands ends. 3. Increases in size and strengthens the muscular system of the child. Now the student becomes physically stronger and more efficient. More subtle work is subject to his fingers: writing, modeling. 4. The growth and strengthening of the bones continues, but the final ossification has not yet occurred, and therefore there is a danger of curvature of the spine due to incorrect posture when reading and writing. The chest is more and more actively involved in breathing, its volume increases. By the age of 11, differences in the structure of the skeleton of boys and girls begin to appear: the pelvis in girls is wider, there is a tendency to expand the hips. 5. The formation of the structure of the lung tissue is completed, the diameter of the airways (trachea, bronchi) increases. An increase in the mucous membrane ceases to pose a serious danger in diseases of the respiratory system. The respiratory rate decreases at 10 years to 20 times per minute. 6. In the cardiovascular system, the trend towards a decrease in heart rate continues (from 5 to 11 years old it decreases from 100 to 80 beats per minute) and an increase in blood pressure (110/70 mm Hg). 7. The digestive organs and digestive glands are well developed, actively functioning, the process of digestion practically does not differ from the digestion of adults. The frequency of bowel movements is 1-2 times a day. 8. The structure of the kidneys and other urinary organs is almost like in adults. The daily amount of urine gradually increases. 9. The body's defenses are well developed. Laboratory parameters of the immune system practically correspond to those of adults. 10. The development of the endocrine system is coming to an end. There are signs of puberty. In girls at the age of 9-10, the buttocks are rounded, the nipples of the mammary glands slightly rise, at the age of 10-11 the mammary gland swells. In boys, at the age of 10-11 years, the growth of the genital organs begins. 11. The development of the nervous system is characterized by the expansion of analytical capabilities, the child reflects on his actions and the actions of others. However, there are still many game elements in the behavior of children of primary school age; they are not yet capable of prolonged concentration. Some children, especially those who were brought up without peers, are closed, it is difficult to take root in a team, which can subsequently affect their mental type of character. 1.3. Anatomical and physiological features of children of senior school age Children of senior school age (from 12 to 18 years old) are otherwise referred to as youths, or teenagers. This period of a child's life is characterized by a sharp change in the work of the endocrine glands. For girls, this is a time of rapid puberty, for boys - the beginning of this process. This period is characterized by the completion of the formation of the child's personality. End physical changes in the body, resulting in a large mental and emotional stress. Against this background, teenage ailments are typical: dizziness and headaches caused by a reduced tone of the cerebral vessels - vegetovascular dystonia. Also typical for this age are diseases of the gastrointestinal tract: gastritis, duodenitis, peptic ulcer. Among the anatomical and physiological features of children of senior school age are the following. 1. The structure of the chest, pelvis and skeletal system as a whole is similar to their structure in adults. The ossification of the skeleton ends, therefore, incorrectly fused fractures, curvature of the spine, bones of the arms and legs after rickets, and other shortcomings are very difficult or even impossible to correct. 2. According to its characteristics, the cardiovascular system also approaches the structure of adults. The pulse rate is approximately 60-80 beats per minute, blood pressure is 120/70 mm Hg. Art. 3. Changes in the endocrine system continue. In this regard, the following physiological changes occur: - in girls: at the age of 12-13, there is an increase in the mammary glands, pigmentation of the nipples appears, menstruation begins; at 13-14 years old, hair growth begins in the armpits, menstruation is irregular; at the age of 14-15 there is a change in the shape of the buttocks and pelvis, which take on a shape characteristic of adult women; at the age of 15-16, acne appears due to the malfunction of the endocrine system during puberty, menstruation is regular; at the age of 16-18, the growth of the skeleton ends; - in boys: at the age of 11-12, the prostate gland increases, the growth of the larynx accelerates, after which the voice breaks; at the age of 12-13, the growth of the genital organs begins, hairline appears on the genitals; at the age of 13-14, the rate of growth and development of the genital organs increases, a seal appears in the peripapillary region, the voice begins to break; at the age of 14-15, the voice change is completed, facial hair appears, the first ejaculation is observed; at the age of 15-16, the maturation of germ cells - spermatozoa begins; at 16-17 years old, hair growth continues and even intensifies throughout the body, the end of sperm maturation occurs; at the age of 17-21, the growth of the skeleton stops. 4. The development of the nervous system is characterized by the formation and improvement of neuropsychic activity, the child is distracted from visual-figurative thinking and prefers abstract thinking. 1.4. Congenital childhood diseases and methods of their treatment Congenital diseases are called diseases that have passed to the child "by inheritance" from the parents, most of them are transmitted at the gene level. Let's list these diseases. Anemia This is a number of various pathological conditions, manifested by a decrease in the content of hemoglobin and (or) erythrocytes in the blood. Some forms of anemia are acquired. Anemia can be divided into groups according to the type of causes of the disease: - posthemorrhagic, caused by large blood loss; - hemolytic, caused by increased destruction of red blood cells; - anemia due to a violation of the formation of red blood cells. According to the characteristic size of red blood cells, anemia is divided into microcytic (with a decrease in size), normocytic (while maintaining a normal size), macrocytic (with an increase in the size of red blood cells). According to the degree of saturation of red blood cells with hemoglobin, anemias are hypochromic (low saturation), normochromic (normal saturation), hyperchromic (increased saturation of red blood cells with hemoglobin). According to the course of the disease, acute anemias are distinguished (they develop quickly, proceed with pronounced clinical signs) and chronic (they develop gradually, the signs can be minimally expressed at first). Anemia caused by a lack of certain substances (iron deficiency, protein deficiency) appear due to insufficient delivery of substances necessary for the synthesis of hemoglobin to the body. Among the congenital forms of anemia, the most significant are the following types. 1. Anemia Fanconi. It manifests itself in young children, more often boys are ill with it. Patients lag behind in physical and mental development. Possible violations of the development of the eyes, kidneys, hands, microcephaly (reducing the size of the head), an excessive amount of pigment in the skin, causing it to darken. At about 5 years old, insufficient formation of erythrocytes and platelets (pancytopenia) is detected, as a result of which bleeding appears, an increase in the size of the liver (the spleen and lymph nodes do not change in size), changes in other organs and tissues occur. 2. Familial hypoplastic anemia Estren-Dameshek. This disease is characterized by changes in the blood (insufficient number of red blood cells) without the development of organ defects. 3. Partial hypoplastic anemia of Josephs - Diamond-Blackfan. This type of anemia occurs in newborns. The disease develops gradually: pallor of the skin and mucous membranes, lethargy, appetite worsens; the content of hemoglobin and erythrocytes is reduced in the blood. Treatment. Red cell transfusion, removal of the spleen or embolization, drugs to stop bleeding. Bronchial asthma. This is a chronic disease characterized by acute attacks of suffocation caused by a deterioration in the patency of the bronchi due to their spasm, swelling of the mucous membrane and excessive mucus production. The disease can be caused by a hereditary predisposition, the presence of allergies in a child that causes swelling of the respiratory tract, and a violation of the hormonal balance in the body. Seizures in children can begin at the age of 2-5 years. They are caused by contact with an allergen, acute respiratory diseases, tonsillitis, physical and mental trauma, in some cases, preventive vaccinations and the introduction of gamma globulin can be the cause. Attacks of suffocation are often preceded by symptoms-harbingers: lethargy, excessive agitation of the child, irritability, capriciousness, the child may refuse to eat; the skin turns pale, the eyes shine unnaturally, the pupils dilate; there is an itching in the throat, sneezing, discharge from the nose of a watery nature, coughing, dry wheezing against the background of free uncomplicated breathing. This situation can last from several minutes to several days. Children of senior school age tolerate these symptoms more easily than younger students, since their airways are more open. Attacks cause lack of appetite, increased sweating, circles under the eyes. Gradually, breathing becomes freer, when coughing, a thick, viscous, whitish sputum is released. After some time, the condition improves, but the patient complains of constant malaise. Status asthma is a condition where the breathlessness does not go away after treatment. This state of the body, depending on the causes that caused it, can manifest itself in two ways. In the first case, it is the result of taking antibiotics, sulfonamides, enzymes, aspirin and other drugs and develops very quickly. The second option may be caused by improper treatment or taking an excessive dose of medication. In this case, all symptoms appear and increase gradually, over time. Asthmatic syndrome manifests itself in symptoms such as impaired breathing and cardiac activity, pathologies of the functions of the central nervous system, leading to agitation, delirium, convulsions, and loss of consciousness. Moreover, the younger the child, the more pronounced these symptoms. Treatment. It is carried out taking into account the individual and age characteristics of the child. At the first sign of an impending attack, the child needs to ensure peace in a clean, ventilated room, divert his attention. It is necessary to drip 2-3 drops of a 2% solution of ephedrine into the nose and carry out this procedure every 3-4 hours. Also, the child is given a drink containing aminophylline and ephedrine. You can not resort to warming procedures, as this can aggravate the situation. If the patient's condition worsens, he is injected subcutaneously with a 0,1% solution of adrenaline hydrochloride with a 5% solution of ephedrine hydrochloride. When treating children of senior school age, it is permissible to use some aerosol preparations - salbutamol (ventolin), alupent (asthmopent), but taking into account the individual characteristics of children. Medication must be continued for 5-7 days after the attacks, it is accompanied by massage and physiotherapy. Seizure prevention is the treatment of chronic infections and allergic conditions. Hydrocephalus. This disease is caused by the accumulation of fluid in the cavities of the brain and spinal canal. The disease appears when there is a violation of absorption or excessive formation of fluids in the cavities of the brain and a violation of its outflow with edema, tumors due to the inflammatory process. Hydrocephalus is manifested by signs of increased intracranial pressure: headache, nausea, vomiting, impaired certain functions (hearing, vision). Other symptoms are also possible. There are acute and chronic phases of the disease. The acute stage is characterized by the appearance of symptoms of the disease that caused hydrocephalus, i.e., the inflammatory process. The chronic stage is characterized by the manifestation of signs of hydrocephalus itself. Hydrocephalus is called congenital if the disease developed in the womb. In this case, the child is born with a large head, which, with the development of the disease, increases more and more over time (the head takes the form of a ball). Children with this disease lag behind both in physical development (poorly and late holding their heads, walking, weak) and in mental development. With the closure of the fontanelles, the child develops symptoms that indicate a violation of the outflow of cerebrospinal fluid. Treatment. It is carried out only in a hospital by using drugs that reduce intracranial pressure and removing excess fluids, sometimes the causes of impaired fluid outflow are removed surgically. Further, the children are observed by neuropathologists. Congenital malnutrition. This disease is a congenital eating disorder, as a result of which the child does not receive enough nutrients. The disease may be due to a violation of the course of pregnancy against the background of impaired blood supply to the placenta or intrauterine infection of the fetus; illness of the mother during pregnancy, her malnutrition, as well as smoking and drinking alcohol; by other harmful factors. There are three stages of the disease: - I degree: subcutaneous tissue narrows in all parts of the body, except for the face. There is an 11-20% lack of body weight. The child's growth and mental development do not slow down. Characterized by lack of appetite and sleep disturbance. Excretory processes are normal. The skin is pale, muscle tone and tissue elasticity are below normal; - II degree: the subcutaneous tissue continues to thin out on the whole body, on the stomach and chest it almost disappears. The child begins to lag behind in physical and mental development, weakness, lethargy, low mobility appear. Face coloring (earthy shade), muscle tone and tissue elasticity deteriorate sharply. Often manifestations of signs of beriberi, rickets. The chair is broken; - III degree: extreme exhaustion of the child is manifested. Virtually disappears subcutaneous tissue. The child does not gain weight, and sometimes even loses weight. The developmental disorder of the child progresses, his face becomes covered with wrinkles. The color changes, the moisture of the mucous membranes disappears. All muscles are extremely weakened, breathing difficulties and disruption of the cardiovascular system may occur. Urination is rare, there is little urine, constipation and other stool disorders appear. There is no immunity. Treatment. In the treatment of congenital malnutrition, it is necessary to take into account the causes of the onset of the disease and its degree. The treatment is reduced to the elimination of the causes of the disease, the care and proper nutrition of the child (in the absence of mother's milk, artificial feeding is used, in severe cases - intravenous: nutrients are dripped), the treatment of disease complications (infectious diseases, metabolic pathologies), the treatment of beriberi, massage, physiotherapy exercises. Further proper care of the child, regular walks in the fresh air, and physical activity are recommended. Prevention of malnutrition is a healthy lifestyle of a pregnant woman: proper nutrition and daily routine, rejection of bad habits. It is also necessary to monitor the development of the fetus in order to timely detect symptoms of the disease. 1.5. Acquired childhood diseases and their treatment Acquired diseases are called diseases caused by certain causes after the birth of a child, as a result of his contact with the external environment. Let's list these diseases. Acquired hypoplastic anemia. This type of anemia appears when the hematopoietic function of the bone marrow is impaired. The cause of the disease can be the use of certain drugs, pathology of the immune system, exposure to ionizing radiation, chronic infectious diseases. The main manifestations of the disease: pallor of the skin, bleeding of the mucous membranes, frequent bleeding. Infectious complications can also be observed - pneumonia, inflammation of the middle ear, pyelitis, inflammation of the mucous membranes and rectum. The internal organs do not increase, with the exception of the liver. Treatment. RBC transfusion, hormone therapy. If necessary, blocking of the blood vessels of a part or the whole spleen is used, leaving this organ in place, rarely - bone marrow transplantation. Hemostatic drugs are used. Preventive measures include constant monitoring of the state of the blood during long-term treatment, avoidance of other harmful factors. Anorexia. The disease is manifested by a violation or lack of appetite, even if the body needs food. Violation is caused by improper activity of the food center. The cause of the disease is excessive emotional arousal, mental illness, endocrine system disorders, intoxication, metabolic disorders, diseases of the digestive system, irregular monotonous nutrition, the use of drugs with an unpleasant taste that disrupt the functions of the gastrointestinal tract or act on the central nervous system. The prolonged course of the disease leads to a decrease in immunity, the resistance of the child's body. Treatment. First of all, the elimination of the cause that caused anorexia, or minimizing it. Drugs that increase appetite, vitamins, hormones are used, in severe cases - intravenous administration of nutrient solutions. Of particular note is neuropsychic anorexia. This disease is caused by the conscious refusal of the child to eat. This disorder is more common in girls during adolescence, when they think they are too fat. Conscious restriction in food leads to physiological and mental disorders. Girls also use various medications that adversely affect their fragile body. This type of anorexia is treated with the help of psychotherapy. Bronchitis. Bronchitis is called inflammation of the bronchi against the background of damage to their mucous membranes. In medicine, acute and chronic bronchitis are distinguished. Typically, children get acute bronchitis, which is often a manifestation or complication of respiratory infections, less often occurs before the onset of measles and whooping cough. Acute bronchitis is more common in children suffering from chronic diseases of the upper respiratory tract. The peak incidence occurs in spring and autumn. Symptoms of the onset of the disease are cough and rhinitis, a gradual increase in temperature. After 1-2 days, sputum discharge, nocturnal cough appear. Treatment. A sick child must be provided with warmth and rest, give hot drinks (tea with linden, honey, raspberries). Antibiotics, antipyretics and sulfonamides are used if the temperature rises above 39 ° C or if there is a threat of infectious diseases. Inhalation is indicated to thin the sputum. In the absence of elevated temperature, banks, mustard plasters are placed, hot wraps are used. Chronic bronchitis in children is more rare. It appears as a disease of the nasopharynx, against the background of diseases of the cardiovascular system (congestion in the lungs), pathology of gland secretion. The predisposition to chronic bronchitis increases in children suffering from congenital immunodeficiency, impaired bronchial function, and malformations of the lungs. In chronic bronchitis, pathology of bronchial patency may not be observed, and then cough, dry and wet rales become its symptoms. The main direction of treatment of chronic bronchitis is to increase the body's resistance. More vitamins are included in the child's diet; in severe cases, antibiotics and sulfonamides are used, and physiotherapeutic procedures are used. In the absence or improper treatment of chronic bronchitis can lead to the development of pneumonia, in some cases - bronchial asthma. Prevention of chronic bronchitis - proper nutrition, timely and proper treatment of infectious and inflammatory diseases of the upper respiratory tract. Stomach ache. The appearance of pain in the epigastric region signals diseases of the abdominal organs or other internal organs. The causes of such pain can be varied, up to signs of pneumonia, so it is very important to pay attention to the child's complaints. Among the main factors for the occurrence of pain in the abdomen, deformation of the intestinal walls, an increase in the lumen in it, intestinal spasms can be distinguished; inflammation in the abdominal cavity; lack of oxygen or abnormal location of the intestines; displacement of the position of internal organs; infectious diseases; violation of the chair; pancreatitis, inflammation of the pancreas and gallbladder; peptic ulcers of the digestive system; various forms of gastritis, inflammation of appendicitis; angina, diabetes, etc. Treatment. If abdominal pain occurs, the child needs a doctor's examination and further examination: blood and urine tests, etc. Before the final diagnosis, it is not recommended to carry out drug treatment, as well as warming up diseased organs. Treatment in hospital or outpatient treatment should be monitored by tests. It is also useful for abdominal pain to examine the digestive organs, abdominal cavity, excretory system using ultrasound methods. Hemorrhagic diathesis. Hemorrhagic diathesis is a disease accompanied by increased bleeding, which can occur on its own or be the result of injuries, surgical interventions. Acquired hemorrhagic diathesis can be a complication of other diseases or the result of an overdose of heparin (which reduces blood clotting), aspirin. According to the types of hemorrhages, there are such types of hemorrhagic diathesis as hemorrhage into the joints, bruising on the skin, bleeding from the nose, gums. Treatment. The main focus of treatment is to reduce vascular permeability, as well as improve blood clotting. Calcium preparations, ascorbic acid are used, sometimes they resort to transfusion of platelet mass. After completion of treatment, a blood test is mandatory. If the disease is incurable, treatment and blood tests are carried out regularly. In order to prevent this disease, it is necessary to organize a full and regular nutrition of the child, monitor the presence of vitamins in food, timely and correctly treat colds and infectious diseases. Worm diseases. This type of infectious disease is caused by a whole group of parasites of helminths (worms): ascaris, pinworms, echinococci, etc. Parasite eggs enter the child's body orally: with water, dust, food. Echinococcus is infected through dirty hands after contact with animals. Some insects can also be carriers of parasites. Therefore, the main measure for the prevention of this type of disease is the observance of a set of sanitary and hygienic rules: washing hands before eating, washing fruits and vegetables, timely destruction of insects, etc. Ascariasis. The first signs of ascariasis are skin rashes, liver enlargement, some changes in the composition of the blood, possibly the development of bronchitis, pneumonia. In the future, there are malaise, headache and other types of pain, nausea, irritability, sleep disturbance and appetite. In the absence of treatment, violation of the integrity of the intestines with the development of peritonitis, appendicitis, intestinal obstruction is possible. When ascaris penetrates into other internal organs, their inflammation, abscesses are possible, when ascaris enters the respiratory organs, disturbances in their activity and asphyxia (cessation of breathing). Treatment: drug therapy (mintezol, vermox, piperazine preparations). Enterobiasis. This disease is caused by pinworms. Its first symptoms are a violation of the frequency and type of stool, abdominal pain, perianal itching, against which inflammation of the skin is possible. The diagnosis is made based on the results of scraping from the anus. Treatment is reduced to compliance with the rules of hygiene. Drug treatment is used only in severe cases (combanthrin, mebendazole, piperazine). An antipruritic ointment is used. The main preventive measures: compliance with sanitary and hygienic rules, as well as regular medical examination of children. Dermatomyositis. This disease, which affects the muscles and skin, usually occurs in girls. One of the main causes of the disease is a latent malignant tumor. The main symptoms of the disease are muscle pain, especially in the muscles of the limbs, neck, weakness, decreased activity, muscle atrophy is possible. Symptoms of the onset of the disease are swelling of the muscles of the larynx, intercostal muscles and diaphragm, resulting in respiratory and voice disorders. The skin swells and turns red in the area of the joints and on the face. The main means of recognition - laboratory clinical studies. Treatment: long-term drug therapy with the use of hormonal drugs. When treating with hormones, constant medical supervision is necessary, since an overdose of hormonal drugs is dangerous. Diathesis exudative-catarrhal. This disease is caused by inflammation of the skin. The cause of its occurrence is a metabolic disorder with intolerance to certain foods. Usually children of the first year of life get sick with diathesis, but the disease may also persist in the future. Treatment: exclusion from the diet of foods that caused this condition. In severe cases of the disease, anti-inflammatory baths and other drugs are used. Prevention is the proper nutrition of a pregnant woman and children of the first years of life. Nasal bleeding. Usually, bleeding occurs in case of trauma to the nose or damage to the nasal mucosa as a result of diseases, mainly infectious. Bleeding also opens due to an increase in blood pressure, in diseases of certain organs or blood. In addition, bleeding occurs even in the absence of diseases, when there are sharp changes in weather conditions (atmospheric pressure, humidity, temperature). The appearance of blood in the nose does not always indicate nosebleeds. Sometimes, with nosebleeds, blood enters the throat, and vice versa, with bleeding of the digestive organs, blood can enter the nose. Treatment. With nosebleeds, the child must be kept calm. In this case, the upper body and head should be raised. Otherwise, blood entering the throat may interfere with breathing. To stop bleeding, cotton wool or gauze moistened with a solution of hydrogen peroxide is placed in the nasal passage, and a cold compress is placed on the bridge of the nose (sometimes on the back of the head). If bleeding often recurs in the absence of injury, this may indicate the presence of a serious illness or a general weakening of the body. Croup Croup is a reduction in the lumen of the larynx as a result of spasm, while wheezing or hoarseness of the voice, difficulty breathing and a deep cough appear. True croup is a consequence of an infectious disease - diphtheria, false croup occurs with other types of respiratory diseases. In both cases, there is a contraction of the muscles of the larynx due to its swelling and inflammation, so the air that has entered during inhalation causes irritation of the larynx. Inflammatory processes also affect the vocal cords, resulting in changes in the voice. With true croup, all symptoms increase at lightning speed, loss of voice is possible. After 7-10 days, serious breathing difficulties appear, the skin turns blue, the body weakens, cardiac activity is disturbed, and if left untreated, death is possible. False croup is characterized by sudden onset of symptoms, cough usually occurs at night. The voice is rarely lost. Possible recurrence of seizures. Treatment. At the first manifestation of symptoms of croup, you should immediately consult a doctor. At the same time, the child must be provided with free access to oxygen, peace and warm drink, soda inhalation is possible. After an attack, the child should be under the supervision of a doctor, as repeated attacks are possible. Laryngospasm. This disease is a sudden attack of suffocation caused by a spasm of the muscles of the larynx. It is observed in case of metabolic disorders, lack of vitamins, salts of some chemical elements. It can also occur if the child breathes air containing irritants. Laryngospasm is manifested by difficulty in breathing, blanching of the skin, tension of the muscles involved in breathing. Seizures can last from a few moments to tens of minutes. In the most severe manifestations, convulsive movements of the limbs, foam from the mouth, and cardiac arrest are observed. In the absence of the necessary assistance, a fatal outcome is possible. Treatment. The child must be provided with free access to oxygen, rest, give a drink. One way to stop an attack is to induce a gag reflex. After an attack, constant medical supervision is necessary. Children who have had an attack of laryngospasm are recommended to take frequent walks in the fresh air, the use of preparations containing calcium and vitamins, and hardening. Bed-wetting. There are many reasons for the condition in which there is involuntary urination during sleep. Among them, the abnormal development of the urinary tract, inflammatory diseases of the urinary system, the weakened condition of the child after a serious illness. Bedwetting can also be a symptom of laryngospasm or an epileptic seizure, this is indicated by the presence of other symptoms (irritability, anxiety). Also, the causes of involuntary urination include dementia, paralysis of the sphincter of the bladder, hereditary diseases, stress experienced by the child. Treatment. In the presence of this condition, you should consult a doctor for examination and accurate diagnosis, since bedwetting can be a harbinger of serious illness in a child. Pyelitis. Pyelonephritis. These are diseases in which inflammation of the kidneys and renal pelvis is observed. Often these diseases occur in parallel. The causes of pyelonephritis are the entry of pathogenic microbes into the renal tissue through the urethra and bladder or the transfer of microbes through the blood vessels from the foci of inflammation in the body. Pyelonephritis can be acute and chronic. Symptoms of acute pyelonephritis are fever, sweating, pain in the lower back at the location of the kidneys, nausea, vomiting, muscle pain; urine contains an excessive number of leukocytes and microbes. Chronic pyelonephritis can be asymptomatic for several years, is detected only in the study of urine. The disease can be manifested by malaise, headache, a slight increase in body temperature. During periods of exacerbation, all signs of acute pyelonephritis appear. If left untreated, the kidney tissue is damaged, the urinary excretion mechanism is disrupted. Treatment. In acute pyelonephritis, inpatient or outpatient treatment is carried out under the supervision of a doctor. Untreated acute pyelonephritis can become chronic. In the chronic form of the disease, children are constantly under the supervision of a doctor who prescribes a certain diet and regimen. It is recommended to limit salt intake. Pleurisy. Most often, pleurisy, i.e., inflammation of the serous membrane of the lungs (pleura), is a complication of pneumonia or allergic and infectious diseases of the respiratory tract. Rarely there are cases of pleurisy on the background of rheumatism and tuberculosis. Pleurisy can be divided into dry and exudative. Dry pleurisy is characterized by swelling of the pleura, the formation of thickening and irregularities on it. With exudative pleurisy, an accumulation of fluid in the pleural cavity is formed. The fluid can be bloody, purulent, etc. Also, pleurisy can be unilateral and bilateral. Initially, the disease is manifested by pain in the chest, especially when inhaling or coughing. Later, weakness appears, body temperature rises. If the patient is laid on his side, the pain subsides. Further development of the disease leads to a change in the color of the skin and mucous membranes (pallor or blue), as well as respiratory failure. Treatment. Dry pleurisy is cured in a few days, exudative - in about a few weeks. It is possible to recognize the disease only in a medical institution, where X-rays and other tests are carried out for this. Next, an analysis of the pleural fluid (if any) is made and treatment is prescribed. It is carried out mainly in a hospital. During treatment, a certain regimen and diet are prescribed. Sometimes surgery is used. After recovery, the child is periodically examined. Flat feet. This is a change in the shape of the foot, caused by the flattening of its arches. Flat feet can be transverse, longitudinal, combining both forms. Transverse flatfoot is characterized by a flattening of the transverse arch of the foot, while its anterior section rests on the heads of all five metatarsal bones, and not on the first and fifth, as is normal. Longitudinal flatfoot is characterized by a flattening of the longitudinal arch of the foot, in this case the foot is in contact with the floor almost the entire area of the sole. The causes of acquired flat feet are overweight, underdevelopment of the muscular-ligamentous apparatus of the foot, improper shoes, various types of injuries and paralysis of the lower extremities. With flat feet, there is a rapid fatigue of the child when walking, pain in the lower extremities, and edema may appear at the end of the day. Flat-footed children have a special gait: they walk with their toes wide apart, slightly bending their joints, and waving their arms when walking. They often wear out the inside of the shoes. As measures for the prevention of flat feet, one can name the correct selection of shoes, monitoring the correct posture of the child, playing sports, walking barefoot on the ground and sand. Treatment. In case of flat feet, you should consult an orthopedist. The treatment includes a complex of general and special gymnastics, other methods of physiotherapy. Warm baths and massages are also recommended. In severe cases of flat feet, orthopedic shoes or surgery are used. Pneumonia. Pneumonia is an inflammatory disease of the lungs that occurs on its own or against the background of other diseases. Pneumonia is caused by bacteria and viruses. The likelihood of pneumonia increases with hypothermia, moral or physical fatigue, and other manifestations of a decrease in immunity and body resistance. There is no generally accepted classification of pneumonia, however, acute and chronic pneumonia, lobar and focal pneumonia, and bronchopneumonia are conventionally distinguished. Acute pneumonia develops quickly, within a few days. The disease proceeds rapidly, is cured completely in a period of several days to several weeks. The disease begins with an increase in body temperature, chills, cough, pain in the side when inhaling is possible, breathing quickens, in severe cases it is difficult. Chronic pneumonia is a consequence of acute pneumonia or other infectious diseases of the upper respiratory tract (sinusitis, SARS, etc.). A predisposition to chronic pneumonia is observed in weakened children, who often suffer from colds and infectious diseases. Chronic pneumonia proceeds in waves and is characterized by periods of attenuation and exacerbation of the process. In cases of exacerbation, symptoms of acute pneumonia are observed, only they proceed more slowly. Frequent and prolonged attacks of the disease can lead to sclerosis of the lung tissue (pneumosclerosis) and expansion of the bronchi - bronchiectasis. In this case, a violation of gas exchange in the body and, as a result, a violation of the functions of the cardiovascular system is possible. Treatment. For the treatment of pneumonia, antibacterial drugs are used, as well as warming agents (jars, mustard plasters, compresses), massages, and physiotherapy. It is important to ventilate the room where the patient is located as best as possible, change bed and underwear in a timely manner, and observe hygiene standards. The most important way to cure a child is a healthy lifestyle: proper nutrition, daily routine, sports. Prevention of pneumonia is to maintain the immunity and protective functions of the child's body. toxic syndrome. This is a painful condition caused by exposure to toxic substances on the body, in which there are metabolic disorders and functions of various organs and systems, primarily the central nervous and cardiovascular systems. The clinical picture is determined mainly by the underlying disease and the form of the toxic syndrome. Neurotoxicosis (toxic syndrome caused by damage to the central nervous system) begins acutely and is manifested by excitation, followed by depression of consciousness, convulsions. There is also an increase in temperature up to 39-40 ° C, shortness of breath. Rarely, redness appears on the skin, and with prolonged exposure to toxic substances, the skin turns pale, acquires an earthy hue. Perhaps the appearance of liver failure, acute renal failure, acute coronary (heart) failure and other conditions of extreme severity. Gradually, dehydration develops. Treatment: immediate hospitalization. The hospital is taking measures to eliminate dehydration, convulsions, disruption of the vital systems of the body. Sjögren's disease. A systemic chronic autoimmune disease characterized by lesions of the mucous membranes, primarily the mouth and eyes, in which the patient is disturbed by the sensation of sand and a foreign body in the eyes, itching of the eyelids, accumulation of white discharge in the corners of the eyes. Then there is a fear of light, damage to the cornea of the eye. The salivary glands are also affected, which leads to the development of dryness of the mucous membranes of the mouth, the appearance of diseases of the teeth and gums. Treatment: hospitalization. The hospital uses drugs that reduce the immune response of the body, anti-inflammatory drugs, eye drops, antibiotics and vitamins. Topic 2. The main signs of a violation of the child's health 2.1. Physiological health criteria Health is the general well-being of the body, which includes the following aspects: the absence of disease, a certain level of physical fitness, preparedness, and the functional state of the body. There are many criteria for assessing the level of health of the body. These criteria are determined by various indicators. Let's present some of them. Vital capacity (VC) is a value that consists of several components: tidal volume, inspiratory reserve volume, and expiratory reserve volume. Tidal volume is the volume of air that a person inhales and exhales during quiet breathing. Inspiratory reserve volume is the volume of air that can be removed from the lungs during maximum exhalation. Residual volume is the volume of air that remains in the lungs after maximum exhalation. The vital capacity of the lungs in children changes with age, according to this indicator, one can judge the correct development of the child's respiratory system. Normal vital capacity of the lungs (in liters) is equal to: - at the age of 7 in boys - 1,4; girls - 1,3; - at the age of 8 in boys - 1,5; girls - 1,3; - at the age of 9 in boys - 1,7; girls - 1,5; - at the age of 10 in boys - 2,0; girls - 1,7; - at the age of 11 in boys - 2,1; girls - 1,8; - at the age of 12 in boys - 2,2; girls - 2,0; - at the age of 13 in boys - 2,3; girls - 2,3; - at the age of 14 in boys - 2,8; girls - 2,5; - at the age of 15 in boys - 3,3; girls - 2,7; - at the age of 16 in boys - 3,8; girls - 2,8. In the future, the vital capacity of the lungs changes slightly. Pulmonary ventilation, or respiratory minute volume (MOD), is the amount of air passing through the respiratory system in 1 minute. MOD is determined by multiplying the volume of respiration by the respiration rate. Normally, the pulmonary ventilation of an adult is 30-50 liters. Pulse rate - the number of pulse beats in 1 minute. Pulse is a periodic jerky contraction of the walls of the arteries during the movement of blood at the time of contraction of the heart. The pulse of a healthy person is normally 60-90 beats per minute. The norm of the pulse rate depends on the age of the person (in newborns, the pulse is 120-140 beats per minute), his psychological state (with nervous stress, the pulse quickens), physical overstrain, the position of the human body, ambient temperature, and eating. Normally, the pulse should have rhythm, that is, the presence of order and periodicity in beats. In the absence of rhythm, the pulse has a wave-like character, which indicates a violation of cardiac activity due to the presence of a certain disease. The filling of the pulse is the value determined by the force that must be applied to stop the movement of blood through the vessels. The filling of the pulse depends on the amount of blood in the human cardiovascular system, on its distribution, the strength and intensity of heart contractions, and the state of the vascular walls. If there is a cessation of the pulse even with a slight pressure on the walls of the vessel, this indicates a violation of the cardiovascular system: large blood loss, poor elasticity of blood vessels, heart valve defects. Blood pressure is the pressure of blood on the walls of blood vessels. Blood pressure is characterized by two values - systolic and diastolic pressure (maximum and minimum). Normally, systolic pressure should correspond to the interval from 110 to 130 mm Hg. Art., diastolic - from 60 to 90 mm Hg. Art. Systolic pressure is the pressure of blood on the walls of blood vessels at the moment the coronary valve opens, at which blood from the heart enters the systemic circulation. Diastolic pressure is the pressure at the moment the coronary valve closes. Blood pressure fluctuates with age. In older people, its indicators are slightly higher than the norm. The following factors influence blood pressure: the strength of contractions of the heart muscles; the size of the lumen of blood vessels (arteries and capillaries); physical stress (during exercise, the value of blood pressure increases); nervous tension. High blood pressure is called hypertension, low blood pressure is called hypotension. According to G.L. Apanasenko, the main criterion of health is the energy potential of the biosystem, since the vital activity of any living organism depends on the ability to consume energy from the surrounding world, accumulate and mobilize it to ensure its physiological functions. According to the theory of V.I. Vernadsky, the greater the power and capacity of the realized energy potential, as well as the efficiency of its expenditure, the higher the level of health of the individual. From this we can conclude that the main criteria for the level of health are the magnitude of the energy potential, i.e., the maximum value of aerobic capacity, and the threshold of anaerobic metabolism (ANOT), which reflects the efficiency of the aerobic process. PANO corresponds to such an intensity of muscle activity, at which oxygen is clearly not enough for complete energy supply, the processes of oxygen-free (anaerobic) energy generation are sharply enhanced due to the breakdown of energy-rich substances (creatine phosphate and muscle glycogen) and the accumulation of lactic acid. With the intensity of work at the level of PANO, the concentration of lactic acid in the blood increases from 2,0 to 4,0 mmol/l, which is a biochemical criterion for PANO. The value of aerobic capacity characterizes the power of the aerobic process, that is, the amount of oxygen that the body is able to assimilate per unit time (1 min). This value depends on the function of the oxygen transport system and the ability of the working skeletal muscles to absorb oxygen. Blood capacity (the amount of oxygen that can bind 100 ml of arterial blood by combining it with hemoglobin), depending on the level of fitness, ranges from 18 to 25 ml. The venous blood drained from working muscles contains no more than 6-12 ml of oxygen (per 100 ml of blood). If we take into account that during endurance training in runners and skiers, the minute blood volume can increase up to 30-35 l / min, then this amount of blood will ensure the delivery of oxygen to the working muscles and its consumption up to 5,0-6,0 l / min, which is the maximum aerobic capacity. Oxygen consumers - working skeletal muscles - play an important role in determining the level of health. There are two types of muscle fibers - fast and slow. Fast muscle fibers are capable of developing greater strength and speed of muscle contraction, but are not adapted to long-term endurance work. They are dominated by anaerobic mechanisms of energy supply. Slow fibers are adapted to long-term low-intensity work. Another component of the body's aerobic performance is the reserves of the main energy substrate (muscle glycogen), which determine the capacity of the aerobic process, i.e., the ability to maintain a level of oxygen consumption close to the maximum for a long time. Depending on the magnitude of the maximum aerobic capacity for untrained people, five functional groups of physical condition are distinguished. The absolute values of aerobic capacity depend on body weight, so in women these figures are 20-30% lower than in men. To determine the level of physical condition, the maximum value of aerobic capacity is compared with the proper values corresponding to the average values of the norm for a given age and sex. For men, the due value is 52 (0,25 × age), for women - 44 (0,20 × age). Next, the ratio of the maximum value of aerobic states to its proper parameters is found. Determining the actual value of aerobic states by a direct method is quite difficult, therefore, in mass physical culture, indirect methods for determining the maximum aerobic performance by calculation using various tests have become widespread. When determining the maximum value of aerobic states of a large number of individuals, the 1,5-mile Cooper test in vivo training can be used. To do this, it is necessary to measure the distance that a person can run in 12 minutes along the track of the stadium at maximum speed. Further, with the help of comparison, the level of endurance and preparedness is determined. 2.2. Disease Illness is a violation of the vital activity of the body as a result of the action of extreme stimuli of the external and internal environment. The process of disease development is called pathogenesis. Diseases can be acute and chronic. An acute illness has an acute onset, a short duration of the course, and, as a rule, ends in recovery (acute pneumonia, acute food poisoning, etc.). Most diseases are chronic. Chronic diseases proceed cyclically: the exacerbation phase after treatment is replaced by a remission phase, when the symptoms of the disease decrease or disappear and the patient feels much better. After exposure to adverse factors (for example, cooling, diet violations), the disease worsens again (exacerbation phase). This alternation of phases of exacerbation and remission can occur repeatedly. The long existence of a chronic disease, its repeated exacerbations lead to a gradual deterioration of the patient's condition. At the beginning of the disease, harm was done to the body insignificantly, all changes were reversible, and in the process of disease progression, severe, irreversible changes in internal organs develop and the state of health worsens. An example of such chronic diseases can be chronic bronchitis, chronic gastritis, chronic nephritis. In the process of developing a chronic disease, its various stages can be distinguished, for example, stages I, II and III of hypertension. The transition of the disease from one stage to another is an irreversible process, and if stage I characterizes the onset of the disease, minor changes, then stage III corresponds to the final stage of the disease, major changes in the body and the patient's serious condition. A symptom is an outward manifestation of a disease. Among the symptoms are high body temperature, shortness of breath, cough, etc. A symptom is a sign of an illness. Symptoms are determined during the interview, examination and examination of the patient, as well as during a special laboratory and instrumental examination. A diagnosis is made based on the totality of symptoms. A syndrome is a set of symptoms united by a common mechanism of occurrence and characterizing a certain pathological state of the body. For example, the "cardiac asthma" syndrome, which develops with a decrease in the function of the left ventricle of the heart, is manifested by the following symptoms: shortness of breath, turning into suffocation, cough with foamy, pink sputum, cyanosis, tachycardia, etc. Thus, a symptom is an external manifestation of the disease, and not its cause, therefore, in the treatment of diseases, it is necessary to consider and eliminate not the symptoms, but the causes of the disease. The cause of the disease is very important to know for proper treatment. The doctrine of the causes and specific conditions for the occurrence of diseases is called etiology. For example, the etiological factor of pneumonia is a bacterial or viral pathogen; scurvy - lack of vitamin C in food; vibrational diseases - the vibration experienced by the sick person, etc. Also in the etiology, factors predisposing to the onset of the disease are also considered. Predisposing factors include malnutrition, hypothermia, the presence of hereditary diseases, constant psychological stress, etc. The cause of the disease can also be occupational hazards (dust, vapors of acids, alkalis and other chemical compounds, vibration, electromagnetic field, noise, sudden changes in temperature, etc.) and bad habits (smoking, drinking alcohol, drug addiction, etc.). The probability of the appearance of the disease depends not only on predisposing factors and occupational hazards, but also on the reactivity of the organism. Reactivity is the property of an organism to respond to environmental factors by changing its vital activity, which ensures one or another degree of adaptation of the organism to the external environment. Individual reactivity is manifested in the characteristic features of each individual person, his constitution, gender, age, living conditions. Human reactivity depends on factors such as: - external conditions (the situation in the country and in the family, lifestyle, etc.); - the constitution of the body (a set of functional and morphological features of the body, formed on the basis of hereditary and acquired properties); - functional state of the nervous and endocrine systems. In medicine, there are three main types of constitution based on external signs and functional properties of the body: 1) asthenic; 2) normosthenic; 3) hypersthenic. The reactivity of the body changes. For example, sensitization may occur, i.e., the acquisition by the body of a special hypersensitivity to foreign substances, more often of a protein nature. Such substances are usually called allergens (microbes and their toxins, therapeutic and prophylactic sera, drugs, industrial poisons, plant pollen, food, etc.). An allergy is a disease caused by sensitization to a particular allergen. In the process of the onset and course of the disease, there is not only a change in the reactivity of the whole organism, but also local changes in individual internal organs. Inflammation is a change in the size of organs that occurs as a result of the action of certain damaging factors. Inflammation is one of the protective functions of the body. It can be caused by a number of reasons: infection, injury, burns, frostbite, radiation exposure, exposure to chemicals. Inflammation is characterized by damage to cellular structures, impaired blood circulation and vascular permeability in the pathological focus, and multiplication of cellular elements along the periphery of the inflammation focus. In the process of inflammation, infiltration of the diseased organ occurs - the penetration and accumulation of cellular elements, biological fluids (blood, lymph) and various chemicals into the tissues. In the presence of an infiltrate, the tissue increases in volume, becomes denser, changes color, and sometimes becomes painful. Inflammatory infiltrate, depending on the nature of the reactivity of the body, as well as on the method of treatment, can resolve and disappear or disintegrate with the formation of an abscess. In place of the previously existing inflammatory infiltrate or in the area of poor blood supply, the cells of the diseased organ may die and be replaced by coarse fibrous connective tissue, and sclerosis of this organ may develop. Treatment of the disease includes the following elements: 1) elimination of the cause of the disease (etiological therapy); 2) restoration of impaired functions of organs leading to disease (pathogenetic therapy); 3) reduction or elimination of individual symptoms of the disease (symptomatic therapy); 4) increasing the overall resistance of the patient's body (restorative therapy). In medicine, emergency therapy is also distinguished, which is performed under special circumstances, when changes have occurred in the patient's condition that directly threaten his life (acute gastric bleeding in a patient with peptic ulcer; an attack of bronchial asthma, etc.). 2.3. Types of diseases All human diseases can be divided into groups and systematized according to a number of features. So, according to the nature of the course of diseases, they are divided into acute and chronic. Diseases can also be congenital and acquired. The causes of congenital diseases are inherited from parents (through the blood), the causes of acquired diseases are determined by the external environment surrounding the person. Diseases can be divided into groups and by the name of the affected organs or systems. Let's take a closer look at these groups and some of the diseases in them. 1. Diseases of the respiratory system. The respiratory system includes the lungs, bronchi, larynx, nasopharynx, involved in external respiration. Also in the human body, internal respiration occurs, i.e., the transfer of oxygen from the blood to the cells of various tissues. Violation of external respiration can occur due to such disorders of the lungs and bronchi, such as: - inflammatory processes in the lungs, leading to a decrease in the mass of ventilated alveoli; - formation after the inflammatory process in the lungs of scar connective tissue (pneumosclerosis, pneumofibrosis), which reduces the mass of ventilated alveoli and reduces the elasticity of the lungs; - a decrease in air conduction of the bronchi and bronchioles, an increase in their resistance to air flow due to various reasons - spasm, edema, cicatricial narrowing of the bronchi; - emphysema of the lungs, which develops as a result of increased bronchial resistance to air flow, overstretching and disappearance of a significant part of the alveoli. Deformation of the chest, weakness of the respiratory muscles, and especially the diaphragm, adhesions between the pleural sheets create great difficulties for respiratory excursions of the chest. For the implementation of the act of breathing, more energy costs are required, which contributes to the development and progression of pulmonary insufficiency. For diseases of the respiratory system, the following symptoms are characteristic. 1. Shortness of breath, i.e. difficulty breathing, causing an increase in its frequency by more than 14-16 breaths per minute, depth and rhythm. Shortness of breath is characteristic of acute pneumonia, effusion pleurisy, bronchial asthma, intoxication with toxic substances, etc. 2. Cyanosis - bluish coloration of the skin. This symptom usually indicates insufficient blood oxygen saturation in various lung diseases (pulmonary emphysema, pneumosclerosis, etc.). Cyanosis of the lips, tip of the nose, ears, fingers and toes is more associated with insufficient heart function. 3. Dull percussion tone. It is detected by percussion of the chest and indicates compaction and a decrease in the airiness of the lung, which may be the result of pneumonia or a lung tumor, or the presence of fluid in the lung. 4. Tympanic pulmonary tone that occurs during percussion of the lungs, when their airiness is increased (pulmonary emphysema), and when air enters the pleural cavity (pneumothorax). 5. Weakening of vesicular respiration. It is determined by auscultation of the lungs and is a sign of emphysema. 6. Harsh breathing - coarser and sonorous vesicular - occurs with bronchitis, acute pneumonia. 7. Bronchial breathing - is determined with a pronounced compaction of the lung tissue (croupous pneumonia). 8. Dry rales in the lungs during auscultation - occur when thick, viscous sputum is present in the bronchi. 9. Crepitant rales - are heard when an effusion appears in the alveoli (croupous pneumonia). 10. Small bubbling wet rales - appear when an inflammatory secret accumulates in the small bronchi during pneumonia. 11. Medium bubbling wet rales - occur in the bronchi of medium caliber with bronchitis. 12. Large bubbling rales - are formed in the large bronchi, most often this is due to heart failure and stagnation of fluid in the lungs. The most common type of respiratory diseases are acute respiratory diseases (ARI). Acute respiratory infections. ARI occur with symptoms of damage to the mucous membranes of the respiratory tract (nasopharynx, larynx, trachea and bronchi), mucous membranes of the eyes (conjunctivitis) and pneumonia, which is a common complication of acute respiratory diseases. Both individual cases and epidemics of these diseases are possible. ARI is caused by various viruses (influenza, parainfluenza, adenoviruses, etc.). The disease spreads by airborne droplets. Symptoms include general malaise; constant headache, pain in the eyeballs, muscle pain; feeling hot, fever, chills, sweating; runny nose, sore throat and hoarseness, redness of the mucous membranes of the pharynx; dry cough; lacrimation. Treatment depends on the severity of the course of the disease. The patient is provided with rest, bed rest and fortified food are shown. If necessary, you can alleviate the manifestation of symptoms with the help of medications. In severe cases and with the appearance of complications of the disease, antibiotics or drugs similar in action are used. 2. Diseases of the cardiovascular system. Such diseases occur when the functions of the cardiovascular system are impaired, which is a consequence of damage to the heart and blood vessels. Diseases of the cardiovascular system can be caused by a number of reasons, such as: - inflammatory changes in the heart muscle, causing the replacement of muscle fibers with connective tissue (development of cardiosclerosis). This leads to a decrease in myocardial contractility and the development of heart failure, characteristic of rheumatism; - narrowing of the holes between the left atrium and the left ventricle, between the left ventricle and the aorta, leading to a delay in the movement of blood and its insufficient flow into the systemic circulation; - incomplete closure of the valves between the right atrium and the right ventricle, between the left atrium and the left ventricle, between the left ventricle and the aorta, leading to an abnormal return of blood from the right ventricle to the right atrium, from the left ventricle to the left atrium and from the aorta to the left ventricle. As a result, hemodynamics is disturbed and the work of the heart becomes more difficult; - spasm of small arteries and arterioles, leading to increased resistance to blood flow and an increase in blood pressure. This is characteristic of patients with hypertension and symptomatic hypertension; - deposition of cholesterol and lime in the walls of the arteries in combination with spasm of the arteries, leading to narrowing of the lumen of the vessels and dysfunction of the affected organs (brain, heart, kidneys); - a metabolic disorder that causes the deposition of cholesterol, calcium salts in the walls of the coronary arteries of the heart, narrowing of the coronary arteries of the heart. This causes malnutrition of the heart muscle and replacement of muscle fibers with connective tissue (development of cardiosclerosis), which is characteristic of atherosclerosis; - unfavorable external conditions (lack of oxygen and nutrients supply, inflammatory changes, increased loads, etc.), leading to various dysfunctions of the heart muscle and heart failure (shortness of breath, cardiac asthma, edema, ascites); - decrease in vascular tone, which can cause vascular insufficiency (fainting, shock). Among the symptoms of diseases of the cardiovascular system, the following can be distinguished. 1. Increase or decrease in blood pressure. Blood pressure in a healthy adult is 120/70 mm Hg. Art. with fluctuations of 10 mm Hg. Art. Blood pressure increases with age, in childhood it is below the described norm. The first digit in the blood pressure value corresponds to the systolic pressure, the second to the diastolic pressure. 2. The border of relative cardiac dullness, which is determined by percussion (i.e., by percussion). In this way, the size of the heart is determined. Normally, the border of relative cardiac dullness, corresponding to the apex of the heart (left ventricle), is located on the left in the fifth intercostal space 1,5-2 cm to the right of the left mid-clavicular line. 3. Heart sounds determined by auscultation (i.e., listening). In this case, the I heart sound shows the contraction of the ventricles and is best heard at the apex of the heart. The weakening of this tone may indicate the presence of a disease. II tone corresponds to the end of systole and the closure of the valves of the aorta and pulmonary artery. Above the mouth of the aorta, it is heard in the second intercostal space to the right of the sternum, above the projection of the valves of the pulmonary artery - in the second intercostal space to the left of the chest. II tone can be weakened, strengthened, split and forked. 4. Noises in the heart, manifested in the phase of systole (systolic) and diastole (diastolic). Among the diseases of the cardiovascular system, the main ones are the following. Rheumatism. This is a chronic disease of an infectious-allergic nature, as a result of which harm is done to all human organs and systems. The greatest damaging effect is felt on the vessels, the heart (all its membranes), joints, lungs and nervous system. During the course of the disease, there is a change in the active and inactive phases of rheumatism. According to the nature of the course, acute, subacute, protracted, continuously recurrent and latent course of the disease are distinguished. Rheumatism may be the result of a chronic inflammatory process in the palatine tonsils. The exacerbation of rheumatism is often caused by a previous angina or scarlet fever. Among the symptoms of rheumatism can be distinguished: general malaise, weakness, decreased appetite, sweating; pain in large joints (elbow, knee, shoulder, etc.), dull pain in the left half of the chest; shortness of breath palpitations, pallor of the skin, ruddy cheeks with a cyanotic tinge, cyanosis of the lips, nose, fingertips; swelling of the joints, fever in the area of the joints, soreness of the joints and their limited mobility. Rheumatism affects the human nervous system. In children and adolescents, rheumatic changes in the nervous system can be manifested by chorea, the main symptoms of which are involuntary muscle contractions, erratic motor restlessness, impaired coordination of movements, muscle weakness, tearfulness, irritability. Skin manifestations of rheumatism are possible in the form of pale pink, less often red or bluish-pink closed or semi-closed rings (erythema) or infiltrates on the skin ranging in size from a pea to a red-violet plum. Treatment is carried out in a hospital. The patient must comply with bed rest, while he must be provided with peace. The food of the patient should not contain excessive fat and salt. As a preventive measure, the patient is given oxygen to breathe. Heart defects. These are lesions of the valvular apparatus, which can be congenital or acquired. Mitral valve insufficiency is a defect resulting from rheumatism, atherosclerosis and sepsis. The disease manifests itself in the incomplete closure of the left atrioventricular orifice, which leads to blood entering the left atrium during systole. Symptoms: shortness of breath and palpitations even with little physical exertion, increased cardiac dullness to the left, systolic murmur at the apex of the heart. Narrowing of the left mitral orifice is a defect in which the passage of blood from the left atrium to the left ventricle is difficult. This leads to stagnation of blood not only in the small, but also in the large circle of blood circulation. Symptoms: shortness of breath and palpitations not only during exercise, but also at rest; cough develops, sometimes with hemoptysis; asthma attacks; swelling in the legs; an increase in the size of the liver; decrease in systolic and increase in diastolic pressure; systolic murmur in the prediastolic state. Combined mitral heart disease is a disease that develops as a result of rheumatism, manifested initially in valve insufficiency, and then in the narrowing of the holes. Symptoms: blush on the cheeks, which has a bluish tint; blue tip of the nose, ears, lips; heart rhythm disturbance, decrease in systolic and increase in diastolic pressure; swelling in the legs; fluid in the abdominal and pleural cavities. Aortic valve insufficiency is a defect that leads to incomplete closure of the aortic orifice during diastole. As a result of this, part of the blood enters back into the left ventricle, which is overloaded with excess blood volume, as a result of which it significantly increases and hypertrophies. The disease most often develops as a result of rheumatic or septic endocarditis, atherosclerosis, and may also be the result of syphilitic damage to the aorta. Symptoms: dizziness and headache; dull pain in the left side of the chest; skin blanching; expanding the boundaries of cardiac dullness; increase in heart rate; noticeable shaking of the head with a heartbeat. Narrowing (stenosis) of the aortic wall is a violation of the left ventricle as a result of difficulty in the movement of blood from the left ventricle to the aorta. Symptoms: palpitations, shortness of breath, pain in the region of the heart; skin blanching; a rare pulse of reduced intensity; increase in systolic pressure; systolic trembling in the sternum; weakening of the heart tones; systolic murmurs at the apex of the heart. Combined aortic defect - insufficiency of the aortic valves and stenosis of the aortic orifice. This defect is more common than isolated insufficiency and stenosis, since the rheumatic process, together with damage to the valves, causes fusion of their edges and narrowing of the aortic orifice. Aortic valve insufficiency usually precedes the development of aortic stenosis. Treatment. Patients suffering from heart defects need treatment of the underlying disease that led to heart disease (rheumatism, atherosclerosis, syphilis), and measures aimed at eliminating signs of heart failure. Patients must comply with bed rest. They need high-calorie, low-energy, vitamin-rich food, which should be taken in fractional doses. The amount of liquid drunk should not exceed the volume of urine excreted the day before by more than 100-200 ml. In the presence of edema, salt intake is limited to 4 g per day. Unloading apple or milk days are periodically carried out, which contribute to the removal of excess fluid from the body. As a medical treatment, sedatives and hypnotics are used: bromine, valerian tincture, phenobarbital, noxiron. Strofanthin has a very strong effect, which is prescribed 3-4 days after the abolition of digitalis. It is administered intravenously in 0,5-1 ml of a 0,05% solution. A good effect is given by the combination of strophanthin with intravenous administration of 5-10 ml of a 2,4% solution of aminophylline. To improve urine output, 1 ml of Novurite or another diuretic is administered intramuscularly. It is also useful for patients with heart defects to breathe oxygen through a nasal catheter or in an oxygen tent. It is necessary to constantly monitor the convergence of edema, daily measure the daily amount of urine, systematically weigh the patient. Hypertonic disease. This is a chronic disease that occurs with an increase in systolic and diastolic blood pressure, and hypertension is the main symptom of hypertension. The course of hypertension can be divided into three stages: - Stage I, in which, under the influence of external factors, blood pressure rises for a short time and normalizes on its own; - Stage II, in which blood pressure is unstable. During treatment, it decreases to normal numbers, but under the influence of various external factors, it easily rises again; - Stage III, when hypertension is the cause of the development of organic changes in small vessels and irreversible organic changes in the heart, brain and kidneys. According to the type of affected organs, there are three forms of hypertension: - cardiac hypertension; - cerebral hypertension; - renal hypertension. In practice, it is rather difficult to distinguish between these forms, since they are often combined. Symptoms depend on the stage and form of the disease. Hypertension stage I and II is characterized by the presence of headache, mainly in the occipital region, aggravated after mental and physical exertion; feelings of heaviness in the head; sensations of pulsations of blood vessels in the temples, neck; feeling of "tide" to the head; flickering "flies" before the eyes; dizziness; numbness of the fingers; shortness of breath; heartbeat; increase in blood pressure. The course of the disease depends on the form of the disease, the severity of the development of atherosclerosis. In patients with a cardiac form of hypertension, angina attacks occur, which can lead to acute myocardial infarction. Patients with a cerebral form of hypertension suffer from changes in the vessels of the brain; they may experience hypertensive crises, hemorrhages in the brain. The renal form of hypertension is characterized by impaired renal function and the development of secondary renal failure. Treatment is aimed at normalizing the function of the central nervous system. The patient is prescribed mental rest and sleep for at least 8-9 hours a day. Of the drugs, a solution of sodium bromide is used, 1 tbsp. l. 3 times a day, valerian tincture 30-40 drops 3 times a day, Luminal 0,05 g at night. Physical therapy is also helpful. Night work, smoking, alcohol consumption, fatty and salty foods, mental stress are prohibited. To lower blood pressure, papaverine, dibazol, theobromine are used, with a high increase in blood pressure - reserpine. For a more rapid decrease in blood pressure, a papaverine solution and a dibazol solution are injected subcutaneously, intramuscularly or intravenously a magnesium sulfate solution. Hypertensive crisis. This is a sharp increase in blood pressure and a manifestation of an exacerbation of the symptoms of hypertension. A hypertensive crisis appears as a result of physical and mental overstrain, weather changes and other reasons. Symptoms of a hypertensive crisis can be a sharp headache, mainly in the back of the head; irritability, difficulty in speech, head motility, dizziness, loss of balance, tinnitus, nausea and vomiting, blurred vision, pain in the heart, palpitations, shortness of breath, drowsiness, increased sweating, chills, a sharp increase in blood pressure. Treatment. In a hypertensive crisis, urgent therapeutic assistance is needed. For its provision to the patient, a solution of dibazol, a glucose solution is administered intravenously. If the symptoms cannot be removed, an intravenous or intramuscular solution of magnesium sulfate is administered. Instead of dibazol and magnesium sulfate, papaverine solution and intravenous eufillin solution with novocaine solution can be administered subcutaneously. Mustard plasters are placed on the back of the head, lower back and legs. If possible, hirudotherapy (treatment with leeches) is used. The patient is provided with complete physical and mental rest. Angina pectoris (angina pectoris). These are acute paroxysmal pains in the region of the heart. Allocate angina pectoris, characterized by the occurrence of pain during exercise, and rest angina, when the pain appears at night. The main distinguishing feature of pain in angina pectoris is their paroxysmal. Attacks of angina pectoris are short-lived. The occurrence of angina pectoris is mainly associated with atherosclerosis of the arteries of the heart and hypertension. An attack of angina pectoris can occur under various circumstances: after neuropsychic stress, excitement, physical stress, heavy meals, drinking alcohol, smoking, bloating, going outside in cold weather, changing weather. Symptoms of angina pectoris: a feeling of tightness in the chest, pain of varying intensity behind the sternum, in the left half of the chest, pressing, squeezing, stabbing in nature, spreading to the left shoulder, left arm, shoulder blade, sometimes burning in the left half of the chest, headache, dizziness, shortness of breath, feeling short of breath, vomiting, fear of death, redness or pallor of the skin, cold extremities, copious urination after an attack. Treatment. As an emergency in the treatment of angina pectoris, validol (tablet under the tongue) or nitroglycerin tablets (under the tongue) are used. A good effect is given by subcutaneous injection of a solution of papaverine hydrochloride with a solution of platyfillin or intramuscularly 1 ml of a solution of aminophylline, as well as intramuscular injection of an analgin solution. In the absence of results of medical care, narcotic drugs are used: subcutaneously a solution of promedol or a solution of omnopon. Symptoms characteristic of angina pectoris are harbingers of acute myocardial infarction. To eliminate them, heating pads are placed at the patient's feet, he is calmed down. The frequency and intensification of angina attacks are considered as a condition preceding myocardial infarction (pre-infarction condition). Myocardial infarction. This is the necrosis of a section of the heart muscle, which develops as a result of a violation of its blood supply. The immediate cause of myocardial infarction is a sharp decrease or complete closure of the lumen of the coronary arteries with an atherosclerotic plaque or thrombus. Vasospasm further worsens the blood supply to the myocardium. Very often the cause of myocardial infarction is atherosclerosis of the arteries of the heart. Acute myocardial infarction can occur in three main clinical forms: - painful; - gastritis; - asthmatic. Each of these forms has different symptoms. So, in the painful form of acute myocardial infarction, pain occurs, more often behind the sternum or to the left of it, usually spreading to the left shoulder, arm, shoulder blade, sometimes to the epigastric region, to both shoulder blades. Pain attack lasts for tens of minutes, hours, and sometimes days; validol and nitroglycerin do not remove it. Often a pain attack is accompanied by a fear of death. Sometimes there is a feeling of palpitations, interruptions of the heart, nausea (sometimes accompanied by vomiting), shortness of breath. In the gastritis form, symptoms of the painful form of myocardial infarction are observed, but the patient complains of pain in the upper abdomen, bloating, nausea and vomiting. With an asthmatic form, pain in the region of the heart can be expressed unsharply. Complaints of shortness of breath, a feeling of lack of air, suffocation, cough with the release of frothy, pink sputum predominate. The asthmatic form often develops with repeated myocardial infarctions and significant changes in the heart muscle. Treatment. Emergency care in the acute period of a heart attack should be aimed at relieving a painful attack. If the preliminary administration of nitroglycerin or validol did not relieve the pain, it is necessary to inject subcutaneously a solution of promedol or a solution of omnopon, a solution of morphine with a solution of atropine and cordiamine. You can apply anesthesia with nitrous oxide mixed with oxygen. Complications of acute myocardial infarction can be acute vascular insufficiency (cardiogenic collapse) and acute left ventricular failure (cardiac asthma). Acute vascular insufficiency (collapse, shock). With bleeding, trauma, infectious diseases, acute myocardial infarction, acute vascular insufficiency may occur. Its symptoms include general malaise, weakness, nausea, cold clammy sweat, fainting, pallor of the skin, haggard face, sunken eyes, cyanosis of the lips, tip of the nose, ears. Collapse occurs at a maximum pressure below 80 mm Hg. Art., when the veins become collapsed, rapid breathing. Treatment. Emergency care for collapse includes providing rest to the patient, creating heat, he needs to be given a hot drink; subcutaneously inject 2 ml of cordiamine. If after a few minutes the patient's condition does not improve, 1 ml of a 1% solution of mezaton is injected into the vein. In the absence or insufficient effect, 1-2 ml of a 0,2% solution of norepinephrine are injected intravenously with 200 ml of a 5% glucose solution at a rate of 16-20 drops per minute. Simultaneously with the introduction of agents that increase vascular tone, it is necessary to eliminate the cause that caused the collapse. If the collapse is associated with pain, narcotic drugs should be used. If a collapse occurs in a patient with food poisoning, you need to wash the stomach and inject a saline laxative through a tube, then inject 10 ml of a 10% solution of calcium chloride into a vein. In case of collapse due to acute blood loss, it is necessary to take measures to stop bleeding and transfuse blood or blood-substituting solutions. Acute heart failure (cardiac asthma). This is a consequence of acutely developed weakness of the muscle of the left ventricle. The cause of the disease is hypertension, acute myocardial infarction (asthmatic form), combined mitral heart disease with a predominance of stenosis of the left atrioventricular orifice, cardiosclerosis, kidney disease, etc. Acute left ventricular failure often occurs with chronic heart failure after any exertion and manifests itself cardiac asthma. Often, cardiac asthma develops at night and can progress to pulmonary edema. Symptoms: a feeling of lack of air, suffocation, sometimes accompanied by a cough; fear of death; the skin is covered with drops of sweat, the skin is cyanotic, the chest is expanded, the intercostal spaces are retracted, swollen veins are visible on the neck; tachycardia, palpitations. With this disease, the formation of frothy, pink sputum and bubbling wheezing, heard at a distance, may be a consequence of the threat of developing pulmonary edema, in which there is a threat to the life of the patient. Treatment. In case of emergency, 1 ml of a 1% solution of morphine or 1 ml of a 2% solution of omnopon is injected subcutaneously together with 0,5 ml of a 0,1% solution of atropine sulfate. At low blood pressure, instead of morphine and omnopon, 1 ml of a 2% solution of promedol and 1 ml of cordiamine or 1 ml of a 10% solution of caffeine sodium benzoate are injected subcutaneously. It is also necessary to adjust the patient's breathing. 3. Diseases of the digestive system. Among the main causes of diseases of the digestive system, the following can be distinguished: - malnutrition, alcohol and nicotine intoxication, food poisoning, mental overload (cause changes in the gastric mucosa, impaired muscle tone, abnormal gastric peristalsis, followed by the development of gastritis, initially with increased and then decreased secretory activity, and peptic ulcer); - a decrease in the acidity of gastric juice, as a result of which a decrease in its sterilizing activity is observed. This leads to an increase in the likelihood of infection from the stomach into the duodenum and into the biliary tract, followed by the development of cholecystitis; - violation of the outflow of bile from the gallbladder and bile ducts, the inflammatory process in them, the violation of fat metabolism. This leads to the formation of stones in the gallbladder and bile ducts and contributes to the development of gallstone disease and calculous cholecystitis. In this case, inflammation of the pancreas is often observed - chronic pancreatitis; - infectious and inflammatory lesions of the intestine: acute and chronic enteritis, colitis and enterocolitis, leading to impaired digestion and absorption of nutrients. Separately, it is necessary to mention infectious diseases that are accompanied by enteritis and colitis (dysentery, cholera, etc.); - violation of the functions of the pancreas or liver, resulting in digestive disorders. Let us consider in more detail the most common diseases of the digestive system. Acute gastritis. This is an inflammatory disease, accompanied by damage to the mucous membrane or even deeper layers of the stomach wall. In this case, there is a disorder of the function of the stomach and the phenomenon of intoxication. The cause of acute gastritis can be malnutrition (overeating, poor quality, rough, hot or too cold, fatty or spicy food), alcohol abuse, smoking. Bad habits increase the likelihood of acute gastritis. Symptoms of acute gastritis: loss of appetite and unpleasant taste in the mouth; eructation of eaten food, "rotten egg"; nausea, sometimes vomiting of food eaten; salivation, a feeling of fullness and heaviness in the epigastric region, pain (sometimes cramping) in the epigastric region, thirst, general malaise, weakness; in severe cases, chills, pale skin; grayish-yellow coating on the tongue; bad breath; elevated body temperature. Treatment. Treatment of acute gastritis begins with gastric lavage. The patient is given 30 g of magnesium sulfate dissolved in 100 ml of water. With profuse vomiting and associated dehydration, subcutaneous or intravenous drip injection of 1-1,5 liters of isotonic sodium chloride solution or 5% glucose solution is recommended. To reduce pain, a warm heating pad is applied to the abdomen. The patient is prescribed a special diet that excludes fatty, fried, rough, cold and spicy foods; on the first day, it is recommended to refuse to eat at all if possible. Chronic gastritis. This is a widespread disease that occurs with phases of exacerbation and remission and is accompanied by a violation of the secretory, motor and other functions of the stomach. Depending on the functional state of the stomach, chronic gastritis is distinguished: a) proceeding without violation of the secretory function (normacid); b) flowing with a slight decrease in secretory activity (hypacid); c) with significant inhibition of secretion (anacid); d) with increased secretory activity (hyperacid). Chronic gastritis is the result of irregular nutrition, dry eating, poor chewing of food, eating rough and spicy foods, overeating, alcohol abuse, insufficient protein and vitamins in food. In addition, chronic gastritis can be a consequence of acute gastritis. The occurrence of chronic gastritis is promoted by defects in the masticatory apparatus, foci of infection in the oral cavity and nasopharynx (stomatitis, gingivitis, tonsillitis), diseases of the cardiovascular system with symptoms of heart failure, liver and biliary tract diseases (chronic cholecystitis), kidney disease with symptoms of renal failure. Symptoms of chronic gastritis: loss of appetite, dull pain in the epigastric region, aggravated after eating; belching of food eaten, sometimes a "rotten egg" (especially with gastritis with low acidity of gastric juice); heartburn; tendency to diarrhea with anacid gastritis; weakness, general malaise, weight loss, pale skin, plaque on the tongue, soft but slightly swollen abdomen, tension and soreness in the epigastric region. Treatment: adherence to a special diet that excludes spicy, rough, fatty, cold and hot foods and alcoholic beverages. Eating should be regular: 3-4 times a day in small portions. In addition, patients need to consume a complex of vitamins. A peptic ulcer. It is a chronic disease characterized by phases of exacerbation and remission. Peptic ulcer is caused by frequent nervous strains, dysfunction of the pituitary and adrenal glands. The development of an ulcer depends on the previous increase in acidity and peptic activity of gastric juice. Factors predisposing to the development of peptic ulcer include smoking, alcohol abuse, unhealthy diet, eating rough and spicy foods. Exacerbation of peptic ulcer occurs in the cold and damp season. Symptoms of peptic ulcer: dull, gnawing, burning pain in the epigastric region that occurs 1-1,5 hours after eating; heartburn after eating, nausea, and sometimes vomiting of food eaten, leading to a decrease in pain, belching of food eaten and "rotten egg", especially pronounced in patients with low acidity of gastric juice; general malaise, weakness, increased irritability, pallor of the skin and weight loss, gray-brown coating on the tongue, tense abdominal wall. Treatment. In the treatment of peptic ulcer, the patient must comply with bed rest. It is necessary to create physical and mental peace for him. The patient is prescribed a diet that excludes spicy, salty and extractive foods. You need to eat at strictly fixed hours in fractional portions (5-6 times a day). It is important that the patient receives a large amount of vitamins. Almagel is used to treat peptic ulcer, and painkillers are used for severe pain. Hypoglycemic coma. Most often, this condition of the body is due to a violation of the diet, increased physical activity or an overdose of insulin. Hypoglycemic coma can come on suddenly, without previous signs, 2-2,5 hours after eating. Symptoms of hypoglycemic coma are profuse sweating, cold extremities, hunger, discomfort in the abdomen, nausea, headache; then convulsions appear, and the patient loses consciousness. Treatment. With the symptoms described above, it is necessary to provide the patient with emergency care. To do this, they give him a glass of sweet tea with a piece of white bread or eat 2-3 pieces of sugar at the first symptoms of an attack. Then you need to intravenously inject 20-40 ml of a 40% glucose solution and subcutaneously 0,5 ml of a 0,01% solution of adrenaline. 4. Diseases of the urinary system. This type of disease is characterized by a violation of the functions of the urinary system with various injuries. There are several types of such damage: - inflammation of the renal pelvis (pyelitis), most often caused by Escherichia coli, can later lead to inflammation of the bladder (cystitis). Pyelitis can be the cause of kidney failure. An ascending path of infection is possible: from the bladder to the kidneys; - Inflammatory changes in the bladder and kidneys are facilitated by difficulty in excreting urine, which occurs due to the appearance of stones in the bladder and kidneys. Stones and sand formed in the kidneys and bladder injure tissues, which also contributes to the development of inflammation; - foci of infection in the nasopharynx (chronic tonsillitis, inflammation of the paranasal sinuses) lead to sensitization of the body and infectious-allergic damage to the glomeruli of the kidneys - nephritis, one of the main symptoms of which is an increase in blood pressure; - chronic infectious (tuberculosis) and suppurative (bronchiectasis, osteomyelitis) diseases cause damage to the tubular apparatus of the kidneys - nephrosis; - violation of the blood supply to the kidneys due to congenital pathologies or acquired in the process of various diseases (for example, hypertension) changes in the vessels of the kidneys; - various diseases of the kidneys, especially often - chronic nephritis, lead to a violation of their function. At the same time, the process of removing harmful substances from the body is disrupted, poisoning of the body may occur, uremia may develop; - severe injuries and burns can lead to large changes in the kidneys and the development of acute renal failure. Consider the main diseases of the urinary system. Cystitis. This is an inflammation of the mucous membrane of the bladder that occurs when an infection from the kidneys enters the ureters. The following factors contribute to its appearance and development: prostatic hypertrophy, pregnancy, consumption of spicy food, hypothermia. The source of the disease is Escherichia coli. Distinguish cystitis acute and chronic, periodically aggravated. Symptoms of acute and chronic cystitis with complications coincide: frequent, painful urination (dysuria); burning sensation at the end of urination; dull pain in the lower abdomen. Treatment. In the treatment of acute cystitis, the patient must comply with bed rest. Spices and hot spices, sauces, canned food are excluded from his diet, the use of alcoholic beverages is prohibited. The patient is shown to drink plenty of water, it is recommended to take an infusion of bear's ear herbs, 1 tbsp. l. 3-4 times a day, taking antibacterial drugs. Pyelitis. This is an inflammatory disease of the renal pelvis associated with the penetration of Escherichia coli into it. E. coli can enter the pelvis from an inflamed bladder. Factors predisposing to pyelitis include: diabetes mellitus, pregnancy, bladder stones, difficulty in urine outflow due to prostate adenoma, acute (flu) and chronic (tuberculosis) inflammatory diseases. There are acute and chronic pyelitis with exacerbations and remissions. Exacerbations of chronic pyelitis can be the result of taking spicy food, alcoholic beverages, hypothermia, physical overstrain. Symptoms: chills; dull pain in the lower back; frequent, painful urination; nausea, sometimes vomiting; shortness of breath, palpitations; general malaise, weakness, headache, dark urine. Often inflammation of the renal pelvis is accompanied by inflammation of the kidney tissue, and pyelonephritis occurs (see 1.5). This increases blood pressure and increases renal failure. Treatment. In the treatment of acute pyelitis, strict bed rest must be observed. The patient is prescribed a fruit and vegetable diet with the exception of spicy food; plentiful drink. Herbal infusions, antibacterial drugs are also used. Kidney stone disease. This is a chronic disease characterized by a violation of metabolic processes in the body, changes in the kidneys and urinary tract with the formation of urinary stones in them. Stones are formed in the pelvis of one or two kidneys, they can be single and multiple. The size of the stones ranges from the size of a grain of sand to a child's head. The chemical composition of the stones is different. Their occurrence may be due to the peculiarities of drinking water and food, lack of vitamins, the constitution of the patient, etc. Stones form faster with inflammation of the renal pelvis (pyelitis), impaired urine outflow, pregnancy, sedentary, sedentary lifestyle. During the passage of stones, renal colic occurs, which are caused by spicy foods, alcoholic beverages, bumpy driving, physical and mental overstrain. Symptoms: unbearable pain in the right or left half of the lower back, passing into the genitals, thigh on the corresponding side; frequent, sometimes painful urination, in severe cases - urinary retention; nausea, sometimes vomiting; dry tongue; swollen belly; tachycardia. Treatment. With renal colic, the patient needs urgent therapeutic assistance. To do this, the patient is given a hot bath or heating pads are placed on the lower back, 1-2 ml of promedol solution and 1-2 ml of atropine solution are injected subcutaneously. In the future, he is assigned a special diet with the exception of spicy and salty foods, alcoholic beverages, and chocolate. Acute diffuse glomerulonephritis. This is an acute inflammatory disease of the renal glomeruli, which is of an infectious-allergic nature. The most common cause of the disease is a streptococcal infection localized in the nasopharynx. In addition, the disease can be triggered by vaccination, allergy to plant pollen, drugs, and hypothermia. The first symptoms of nephritis occur 10-20 days after an acute infection or an exacerbation of a chronic infection, causing a general decrease in the body's reactivity. Symptoms: headache; dull nature of lower back pain; nausea; vomit; dyspnea; swelling on the face; increased blood pressure, tachycardia; urine cloudy, reddish, reminiscent of meat slops. Patients may develop acute left ventricular failure and acute encephalopathy or eclampsia, expressed as arterial hypertension. Treatment. Emergency care for eclampsia begins with bloodletting. A glucose solution and a magnesium sulfate solution are administered intravenously, a magnesium sulfate solution is administered intramuscularly. Treatment of patients with acute diffuse glomerulonephritis is based on bed rest and a diet that limits the intake of salt and fluid, protein. Of the drugs prescribed reserpine, hypothiazide, in the presence of foci of infection - antibiotics and large doses of vitamin C and B vitamins. Chronic glomerulonephritis. The course of chronic glomerulonephritis is divided into several forms: latent, edematous-proteinuric, hypertensive and edematous-hypertonic. With a latent form, the disease is asymptomatic for a long time. In the edematous-proteinuric form, headache, puffiness and swelling of the face, dull pain in the lumbar region, poor appetite, nausea, weakness and general malaise are observed. In the hypertensive form of chronic glomerulonephritis, a constant severe headache, nausea, blurred vision, high blood pressure, tachycardia, and a tense pulse appear. Over time, anemia and kidney failure worsen. With the edematous-hypertonic form, symptoms of the edematous-proteinuric and hypertensive forms of chronic diffuse glomerulonephritis simultaneously occur. Signs of the disease are edema, hypertension, disruption of the heart. This form of chronic glomerulonephritis is severe and leads to symptoms of renal failure, azotemia and uremia. Treatment: bed rest, restriction of salt intake, consumption of dairy products. Of the medicines, prednisolone, antibiotics or other antibacterial drugs are used. With high blood pressure, reserpine is prescribed. Nephrosis. This disease occurs when the renal tubules are damaged, which entails a violation of the water-salt, protein and fat metabolism in the body. Tuberculosis, chronic suppurative diseases, and intoxications contribute to the development of nephrosis. The symptoms of nephrosis include swelling on the face, limbs, lower back, weight loss, weakness, general malaise, pallor of the skin, increased blood pressure. Treatment is carried out in a hospital. It is determined by the disease that led to the development of nephrosis. The patient is prescribed bed rest, a special diet (cottage cheese, meat, fish), vitamins. Uremic (azotemic) coma. As a result of poisoning the body with protein metabolism products, due to their insufficient excretion by diseased kidneys, uremic coma occurs. It develops in the final stage of chronic renal insufficiency in patients with chronic diffuse glomerulonephritis, pyelonephritis, etc. Characteristic for such patients is a gradual worsening of the condition due to an increase in renal failure. Symptoms: general weakness, fatigue, drowsiness and apathy, dull headaches, constant feeling of heaviness in the head, blurred vision, depression of consciousness. Treatment is carried out subject to bed rest. The patient is prescribed a diet with the complete exclusion of proteins. Washing of the stomach and kidneys is carried out daily. Intramuscularly enter a solution of chlorpromazine and a solution of diprazine. With edema, hypothiazide is prescribed. In the absence of anemia, bloodletting is recommended. Strofantin solution is administered intravenously along with glucose. To combat severe renal insufficiency, extracorporeal hemodialysis is used using an "artificial kidney" apparatus. 2.4. Peculiarities of childhood traumatism Most children, especially at an early age, are very mobile, but children's games and fun can sometimes lead to serious injuries. In addition, children often do not realize that one or another of their actions can harm them, and sometimes, when a child does not understand all the responsibility for his actions, his actions can be directly aimed at causing harm. Child injury has certain features that are important to consider. Let's list some of them. 1. Children may hide their injuries for fear of being punished for wrongdoing. As a result, they do not receive the necessary care, which leads to a deterioration in their overall health. 2. Children cannot correctly describe the nature of pain, determine the location of a bruise or injury, which significantly complicates the provision of first aid and other types of medical care to them. 3. The skeleton of a child is more cartilaginous than the skeleton of an adult. This is the reason that the children's skeleton is injured even with small loads and damage. 4. Due to the increased metabolic rate, the bones of children grow together much faster than the bones of an adult. 5. Injuries suffered in childhood can lead to complications that manifest themselves at an older age in the form of various diseases. 2.5. Caring for sick children Children's bodies grow and change constantly. This explains its susceptibility to any movements of the external environment. This is especially noticeable when the child becomes ill. Due to the peculiarities of the structure of the subcutaneous tissue, the child is much more difficult to tolerate hypothermia. The child's body is more difficult to tolerate blood loss. In addition, the child has a weak immune system, since the acquired immunity has not yet fully formed. A sick child becomes very susceptible to the quality and quantity of food, to the cleanliness of the surrounding space, to the attitude of adults. Based on all the above factors, a number of mandatory requirements can be identified that must be met when caring for a sick child. First of all, it is necessary to strictly observe sanitary and hygienic standards: ventilate the room in which the sick child is located, disinfect dishes and furniture; monitor the child's compliance with hygiene rules; change his personal and bed linen. It is necessary to regularly measure the body temperature and pulse of a sick child: the temperature is measured after sleep, the pulse is taken at rest on the femoral or temporal artery. Warming of children is carried out with the help of warming compresses (without tightening the chest). You can also apply mustard wrap, general and foot baths (bath temperature should not exceed 40 ° C). Topic 3. The concept of infectious diseases 3.1. Infectious diseases and their pathogens Infectious diseases are caused by certain microorganisms - pathogens, are transmitted from an infected organism to a healthy one and can cause an epidemic or pandemic. Among the causative agents of infectious diseases are: - microbes (bacteria); - viruses; - rickettsia; - spirochetes; - fungi; - the simplest. Bacteria are single-celled microorganisms that have the form of rods (causative agents of typhoid fever, paratyphoid A and B), a ball (staphylococci, streptococci), winding filaments (spirilla) or curved rods (cholera vibrio). The rod-shaped form is represented by the most numerous and most diverse group of bacteria. Viruses are the smallest microorganisms measured in millimicrons. These include pathogens of influenza, foot and mouth disease, poliomyelitis, smallpox, encephalitis, measles and other diseases. Viruses can only be seen at very high magnification (30 times) using an electron microscope. The structure of viruses is very complex, they are characterized by a wide variety of properties. Viruses are strict intracellular parasites that can only develop inside the cells of their host. The main component of viruses - nucleic acid - is a compound that serves as the material basis of heredity and many other phenomena of life. Viruses cause a large number of human diseases. Rickettsia - the causative agents of typhus, Q fever, etc. - occupy an intermediate position between bacteria and viruses. Rickettsia are shaped like sticks or cocci. They are much smaller than many bacteria. Unlike bacteria, they do not grow on artificial nutrient media. Diseases caused by various types of pathogens in this group are called rickettsiosis. Spirochetes (causative agents of relapsing fever, syphilis) have the form of thin, corkscrew-shaped, actively bending bacteria. Fungi, or microscopic fungi, unlike bacteria, have a more complex structure. Most of them are multicellular organisms. Cells of microscopic fungi are elongated, similar to a thread. Sizes range from 0,5 to 10-50 microns or more. Most fungi are saprophytes, only a few of them cause diseases in humans and animals. Most often they cause various lesions of the skin, hair, nails, but there are species that also affect internal organs. Diseases caused by microscopic fungi are called mycoses. Depending on the structure and characteristics, fungi are divided into several groups. 1. Pathogenic fungi include: - a yeast-like fungus that causes a serious disease - blastomycosis; - radiant fungus that causes actinomycosis; - causative agents of deep mycoses (histoplasmosis, coccidoidosis). 2. From the group of so-called "imperfect fungi" pathogens of numerous dermatomycosis are widespread. 3. Of non-pathogenic fungi, molds and yeasts are the most common. The simplest are single-celled microorganisms that can harm human health, especially when the protective functions of his body are reduced. Protozoa are more complex than bacteria. The causative agents of human infectious diseases among the protozoa include dysentery amoeba, malarial plasmodium, etc. Unlike other pathogens, some members of this group, such as helminths (parasitic worms), arthropods (scabies mites, etc.), are larger. Thus, the cause of an infectious disease is the penetration of a pathogen into a susceptible organism in sufficient quantity and in a specific way for the pathogen. Most infectious diseases have an incubation period - the amount of time between infection and the onset of the first symptoms. 3.2. Concept of microbiology, immunology and epidemiology Microbiology is the science that studies the life and development of living microorganisms (microbes). Microorganisms are an independent large group of unicellular organisms related in origin to the plant and animal world. The development of microbiology began in ancient times, when doctors first suggested that "the infection is transmitted from person to person" through some kind of living beings. As a result of the subsequent development of the natural sciences, special methods of scientific research appeared, which allowed scientists to finally verify this statement. Among the outstanding microbiologists, one can single out L. Pasteur, R. Koch, I.I. Mechnikova, D.I. Ivanovsky. Microorganisms include many and varied types of beneficial and harmful microbes. Many types of microbes have become parasites - microorganisms that have adapted to life at the expense of another living organism. They are the causative agents of infectious diseases in humans, animals and plants. Such microorganisms are called pathogens. Pathogenicity is the ability of microorganisms, when infected, to cause a specific disease that is characteristic only of this pathogen. Among the microbes, there are also saprophytes - harmless microorganisms. Their role is reduced to the decomposition of dead organic residues in the soil, wastewater, etc. There are also conditionally pathogenic organisms that constantly live inside a living organism without harming it. Their pathogenic effect is manifested only when living conditions change and the body's defenses decrease, caused by various factors. In these cases, they can manifest their pathogenic properties and cause corresponding diseases. By structure and form, pathogenic microorganisms are divided into groups: bacteria, spirochetes, rickettsiae, viruses, fungi and protozoa (see 3.1). Each of these groups includes numerous species, varieties and types of pathogenic representatives and related non-pathogenic microbes. A bacterial cell consists of the following elements: shell, protoplasm, nuclear substance. In some bacteria, capsules form from the outer layer of the shell. Pathogenic bacteria are able to form a capsule only when they are in the human or animal body. The formation of a capsule is a defensive reaction of the bacterium. The bacterium inside the capsule is resistant to the action of antibodies. Many rod-shaped bacteria inside the body, in the middle or at one of the ends, have characteristic formations - endogenous spores of a round or oval shape. Spores appear under adverse external conditions for the existence of bacteria (lack of nutrients, the presence of harmful metabolic products, unfavorable temperature, drying). One bacterial cell forms one endospore, which, getting into a favorable environment, germinates, forming one cell. Spores are resistant to external influences. Many bacteria are active motile. All spirilla and vibrios are mobile. Motility is also characteristic of many types of rod-shaped bacteria. Cocci are non-motile, with the exception of single species. The motility of bacteria is carried out with the help of flagella - thin threads, sometimes spirally twisted. In some pathogenic microbes, under certain external influences, weakening or even loss of pathogenic properties can be achieved. However, at the same time, their ability, when administered to a person, to cause immunity to the disease, or immunity, is preserved. This provision formed the basis for the production of live attenuated vaccines, which are widely used in the prevention of morbidity through vaccination. To recognize and study the characteristics of various types of microbes, they are sown on artificial nutrient media, which are prepared in laboratories. Pathogenic microbes grow better if the composition of nutrient media more fully reproduces the conditions of their nutrition in a living organism. Unlike saprophytes, the external environment is unfavorable for pathogenic microbes. The most powerful factor influencing microorganisms is the ambient temperature. Many microorganisms are already killed at 60 °C, and at higher temperatures this happens even faster. Microbial spores are the most resistant to changes in ambient temperature. Among other environmental factors, drying, radiant energy (especially solar - ultraviolet part of the spectrum), many chemicals, etc., have a detrimental effect on microbes. Some types of pathogenic microorganisms in the process of life emit special toxic products - toxins. Microbial toxins significantly affect the course of an infectious disease, and in some diseases they play a major role (botulism, diphtheria, tetanus). After neutralization of exotoxins (formalin and high temperature), they are called toxoids. Toxoids are used for vaccinations to create immunity to certain infectious diseases, such as tetanus, diphtheria, botulism. Interferon is a protein found in normal tissue cells. When cells are lysed, for example, under the influence of a virus, it passes into the surrounding fluids. By blocking some enzyme systems of cells, free interferon has the ability to prevent the virus from infecting these cells. Further reproduction of the virus is possible only in those cells that are not blocked by interferon. Thus, interferon is a mechanism for protecting cells from foreign nucleic acids. Epidemiology studies the patterns of occurrence and spread of infectious diseases in human society and uses the data of its theoretical conclusions and generalizations to prevent and combat them. The occurrence of infectious diseases is always due to infection, penetration into the human body of certain pathogenic microbes, the specificity of the clinical manifestation of the disease and its outcome depend on the species of which the specificity of the clinical manifestation of the disease and its outcome depend. In order for infection to occur, there must be a source of infection. The source of infection is the object that serves as a place of natural residence and reproduction of pathogens, in which the process of natural accumulation of the infectious principle takes place and from which the pathogen can infect healthy people in one way or another (L.V. Gromashevsky). The first law of epidemiology states: the source of an infectious principle is an infected (sick and bacteriocarrier) organism of a person or animal. For the spread of the disease, there must be a certain mechanism for its transmission. In order to pass from one organism to another, the pathogen (parasite) must leave the body of its host and enter the external environment. Only under the condition of movement in the external environment, the pathogen enters another organism, if it is introduced into a favorable environment, infection and the onset of the disease occur. The presence of the source of infection, transmission factors and the susceptibility of the organism maintain continuity and regularity in the chain of successive cases of each infectious disease, the totality of which is called the epidemic process. The absence of any of the distribution factors leads to a break in the chain of the epidemic process and the cessation of the further spread of the corresponding diseases. The infectious process is a combination of physiological protective and pathological reactions that occur under certain environmental conditions in response to the action of pathogenic microbes. Epidemic focus (center of infection) - the location of the source of infection with the territory surrounding it to the extent that it is capable of transmitting an infectious beginning in a given situation with a given disease. Immunology is a science that studies the ability of the human body to resist the activity of pathogenic microorganisms and fight them. Accordingly, immunity is the immunity of the body to an infectious agent or to some substance foreign to the body. Immunity is due to the totality of all hereditarily obtained and individually acquired adaptations by the body that prevent the penetration and reproduction of microbes, viruses and other pathogenic agents and the action of harmful products released by them. In modern conditions, immunity includes a wider range of phenomena, including many important physical, chemical and physiological phenomena. By origin, a distinction is made between innate and acquired immunity. Innate immunity is due to the biological characteristics of the species and is inherited, due to which animals or humans become immune to certain infections. Acquired immunity is not innate. It is acquired by the body during its individual life, after a disease, or artificially, by vaccination (inoculations). Such immunity is called active. Active immunity occurs 2-3 weeks after illness or vaccination and lasts 1-2 years or more. Acquired immunity can also be due to the transfer of antibodies by the placental route from mother to fetus (to diphtheria, scarlet fever, etc.), i.e., in a passive way. The duration of such natural passive immunity is short (usually several months). Passive immunity is also formed with the introduction of the serum of recovered or vaccinated people and animals. In this case, a person also receives ready-made protective or immune substances, but he himself does not participate in their production. The duration of such immunity is not more than 3-4 weeks. In the system of the body's defense mechanisms in relation to microbes, non-specific factors are also of great importance: the general condition of the body, age, etc. People weakened by overwork, starvation, the adverse effects of external conditions and diseases, and also in old age are more susceptible to various infections. The skin and mucous membranes, especially in adults, act as a barrier that protects the body from the introduction of foreign microbes. The mechanical function of the barrier is supplemented by the release of various substances that have a detrimental effect on microbes. The skin, mucous membranes of the upper respiratory tract, conjunctiva, sputum, saliva, peritoneal fluid, blood plasma and serum, leukocytes, breast milk and other tissues and organs contain a special enzymatic substance that has a detrimental effect on many microbes or delays their reproduction. It's called lysozyme. The highest concentration of lysozyme is found in tears and cartilage. Many microbes that enter the stomach are killed by the high acidity of gastric juice. However, with a significant concentration of bacteria, skin and mucosal barriers may not be sufficient to protect against the introduction of pathogenic pathogens, and a more powerful mechanism of protection of a specific order - phagocytosis and antibodies - begins to show its effect. Phagocytosis is the process of engulfing and digesting microbes or other foreign particles by special cells called phagocytes. These cells are divided into micro- and macrophages. Microphages include granular blood leukocytes and lymphocytes. The most active of them are polymorphonuclear neutrophils. Among macrophages, two types of cells are distinguished - mobile and fixed. Mobile macrophages are blood monocytes, large lymphocytes of the lymph nodes and spleen, as well as cells located in loose connective tissue, called polyblasts, histiocytes, etc. Fixed macrophages are cells of the walls of blood vessels, liver, bone marrow. Together with motile macrophages, they are united under the general name of the reticuloendothelial system. Antigens - bodies that can cause the formation of specific antibodies in the body and enter into various compounds with them. These include various substances of a protein nature, mixtures of proteins with other substances (lipoids, carbohydrates), toxins, sera, microbes, animal and plant cells, and other substances harmless to it. With regard to infections, antigens of microbes are most important. Bacterial cells contain a whole complex of various antigens of both a full-fledged protein nature and haptens - carbohydrates and lipoids. Antibodies are microorganisms produced in response to irritation with specific antigens in infectious diseases, as well as during immunization with microbes and their toxins. Antibodies have strict specificity. When interacting with an antigen, changing their state and structure, they neutralize the latter, in connection with which they are called protective immune bodies. Antibodies do not appear in the body immediately. Their increase occurs gradually, reaching a maximum by the 16-20th day, then after a while the level of antibodies begins to decrease and after 2-3 months drops to the original level. With the repeated introduction of the antigen, the formation of antibodies occurs faster and they persist for a longer time. This phenomenon serves as the basis for the formation of active immunity, its duration and intensity. Vaccines are preparations consisting of killed or weakened pathogens (respectively, killed or live vaccines), as well as microbial waste products - toxins that are used in a neutralized state and are called toxoids. Vaccines are administered to the human body to produce artificial immunity. In addition to active immunization, serum, as well as gamma globulin of the sera of artificially immunized animals and people who have had infectious diseases, are used as specific prophylactic agents. Such preparations contain ready-made antibodies. The passive immunity induced in this case is short-lived (2-3 weeks), and therefore the passive immunization method is more often used when infection has occurred or is suspected. The significance of protective vaccinations is reduced to a more or less sharp decrease in the incidence among the vaccinated compared to the unvaccinated, and in the case of diseases of the vaccinated, to a milder course of the disease and, consequently, to a decrease in mortality. Thus, although immunity induced by vaccination is not absolute, the reduction in morbidity achieved as a result of individual methods of immunization is always a major and valuable achievement in the fight against infections. 3.3. Prevention of infectious diseases The main direction in health care is not to obtain new methods of treating infectious diseases, but to comply with measures to prevent them. In the complex of preventive measures, a number of measures can be distinguished aimed at three links of the epidemic process: 1) the source of the disease; 2) ways of its transmission; 3) the human body capable of perceiving the infection. To prevent the appearance of the source of the disease and to localize it, the following are carried out: - timely detection of sick people; - isolation and treatment of victims; - disinfection of the source of infection. The elimination of the second link of the epidemiological process is carried out by the destruction of the pathogen transmission routes. To do this, the following activities are carried out: - control over observance by citizens of the necessary rules and norms of personal hygiene; - advertising and promotion of hygienic skills and sanitary culture of the population; - implementation of anti-epidemic actions by health authorities. Anti-epidemic actions include sanitary and hygienic control over the sale of food products, especially in the lesions; control over the state of food and water supply facilities; verification of compliance with the rules for the preparation, storage and transportation of products, prepared food, water quality, etc. In order for the human body to become immune to infectious diseases, health authorities are taking measures to create and strengthen immunity in the population. Immunity is the body's ability to withstand and resist the actions of pathogens. Immunity can be either innate (natural) or acquired (artificial). A person receives innate immunity at birth through the mother's blood, acquired immunity appears as a result of the transfer of diseases or the adoption of special measures - vaccination (inoculations). Innate types of immunity include immunity against chicken cholera, rinderpest, and other diseases. As a result of past diseases, a person develops immunity against measles, smallpox, etc. In the case when pathogens are unknown and there are no appropriate vaccines, emergency prophylaxis is used - the use of antibiotics and other antimicrobial agents to resist the disease. Vaccination can be carried out by intradermal administration, subcutaneous administration, skin and aerosol methods. At the same time, it must be remembered that a person who leads a healthy lifestyle, eats right and monitors his physical condition, is much less susceptible to infectious diseases. Proper nutrition and a healthy lifestyle is one of the main measures for the prevention of infectious and other types of diseases. For some infectious diseases, such as AIDS and hepatitis B, prevention is the key to control. These diseases are difficult or not at all treatable at the current level of development of medicine. They are transmitted from person to person through the blood, so the possible routes of entry of the viruses of these diseases include blood transfusion, a contaminated needle, and the genital tract. Based on this, the prevention of these deadly diseases includes the following measures: - compliance with the rules of personal hygiene; - exclusion of promiscuity; - the use of special methods of protection during sexual intercourse; - use of disposable syringes; - sterilization of medical instruments. It is extremely important to diagnose these diseases in a timely manner, since in the early stages of the disease it is possible, if not a complete cure, then at least a significant prolongation of the patient's life. At the same time, a person who knows about the presence of this disease must take all precautions to prevent its spread. Currently, in most countries of the world there are anonymous diagnostic examination points for AIDS and hepatitis B, where each person can control their health. At the same time, remembering the threat posed by these deadly diseases, we must not forget that a person suffering from, for example, AIDS is not contagious if the rules of communication with him are observed. If multiple cases of infectious diseases occur in a certain area, quarantine is imposed. Quarantine is a complex of regime, administrative and sanitary anti-epidemic measures aimed at preventing the spread of infectious diseases and eliminating the focus of the lesion. During quarantine, it is possible to organize an armed cordon of the focus of infection, prohibition of movement outside the quarantine zone of persons and groups of the population without prior temporary isolation and medical supervision, removal of property from the focus without prior disinfection, as well as the passage of vehicles and people through the focus of the lesion. During quarantine, contact between people is limited. Employees of medical institutions and other employees associated with constant communication with people take special measures to avoid mutual infection. One of these measures is special clothing. For example, a complete anti-plague suit consists of overalls, a hood, boots, a cotton-gauze bandage on the nose and mouth, canned glasses, rubber gloves and a medical gown. If, as a result of research, pathogens of especially dangerous infections have not been identified in the outbreak and there is no threat of the spread of mass diseases, quarantine is replaced by an observation regime. Observation is a set of measures that provide for enhanced medical monitoring of the lesion and the implementation of therapeutic and preventive and restrictive measures in it. The period of quarantine and observation is determined by the duration of the maximum incubation period of the disease, calculated from the moment of isolation of the last patient and the end of disinfection in the outbreak. Timely isolation of patients in the quarantine zone is one of the most important measures against the spread of infections in the focus of infection. The elimination of emerging foci of infectious diseases is carried out by the Ministry of Emergency Situations of Russia, the Ministry of Health and Social Development of Russia, etc. The work of medical institutions in the infectious focus has a number of features. To exclude the possibility of the removal and spread of the infection outside the hospital, the work of the medical institution is carried out in a strict anti-epidemic regime, which provides for: - protection and isolation of the territory of a medical institution (infectious diseases hospital); - barracks for hospital personnel; - organizing the transfer of medicines, food and other necessary sanitary equipment through special transfer points; - increasing the protection of personnel from nosocomial infection by using special personal protective equipment for workers during work (for example, anti-plague suits). 3.4. Disinfection, disinsection and deratization Disinfection, or disinfection, is a set of special measures aimed at the destruction of pathogens of infectious diseases in the human environment. Private types of disinfection are disinsection, which is understood as the destruction of insects and ticks - carriers of infectious diseases, and deratization - the extermination of epidemiologically dangerous rodents. There are preventive, current and final disinfection. Preventive disinfection is carried out in order to prevent the possibility of infectious diseases or infection from objects and things that are in common use. Current disinfection is carried out at the bedside of the patient in order to prevent the spread of infection (decontamination of the patient's secretions and objects infected by them). Final disinfection is carried out in the focus of infection after isolation, hospitalization, recovery or death of the patient in order to completely free the infectious focus from pathogens. Depending on the indications, biological, mechanical, physical and chemical methods and means of disinfection are used for disinfection. The biological method is used in the treatment of wastewater in irrigation fields. Mechanical disinfection methods include wet cleaning of rooms and furnishings, knocking out clothes and bedding, freeing rooms from dust with vacuum cleaners, whitewashing and painting rooms, and washing hands. The simplest and most affordable methods of disinfection are physical means and methods. These include the sun's rays and exposure to ultraviolet emitters, ironing with a hot iron, burning garbage and objects of no value, boiling water or heating to a boil. Reliable disinfection and disinfestation of contaminated clothing, bedding and other accessories can be carried out in special disinfection chambers - steam-air or steam-formalin. The essence of chamber disinfection consists in heating the contents of the chambers with hot air (steam) to a certain temperature, and, if necessary, intensifying the effect of steam, in the additional introduction of formaldehyde (formalin) into the chamber. Among the chemicals that have a detrimental effect on the microbial cell, the following disinfectants are most widely used: - bleach - used for disinfection of water, vessels, premises, discharges of patients, toilets, etc. in the form of 0,7-0,5%, 2-3%, 5-10% aqueous solutions and in dry; - an aqueous solution of sulfachloranthin; - 1% solution of orgoxydin bigluconate (gibitan); - sodium (potassium) water; - dichloroisocyanuric acid (DCCA). Disinsection measures are conditionally divided into preventive and extermination. Preventive pest control measures include keeping dwellings and utility rooms clean, equipping window and door openings with nets, clearing shallow water bodies and ditches, etc. Destructive pest control measures are carried out by physical and chemical means. For these purposes, in addition to disinfection chambers and physical means, poisons called insecticides are widely used, among which are hexachloran (hexachlorocyclohexane), karbofos, methylacetophos, alfacron (phosphothioate), alcestine, insorptide-MP, etc. For the destruction of rodents - carriers of pathogens of infectious diseases in humans and animals, mechanical and chemical methods are used. The mechanical method consists in the use of various traps, traps, mousetraps, picks, etc. The essence of the chemical method is the poisoning of rodents with toxic substances - raticides. Effective raticides are zinc phosphide, ratindan, zoocoumarin, thallium sulfate, thiosemicarbazide, barium carbonate, fluoroacetamide, etc. Gas deratization is used mainly for the extermination of rodents on ships, in railway cars, aircraft and in the field. 3.5. The importance of personal hygiene of a schoolchild for the prevention of infectious diseases A school is not only a "temple of knowledge", but also a place where a large number of people gather. In conditions of infection, the school can become one of the centers of the disease. This is due to the fact that children, not yet having strong and stable immunity, do not always adequately fulfill the requirements of personal hygiene. Teachers and parents need to remember: how children are taught to take care of themselves depends on their protection from the occurrence of infectious diseases. Each student must observe the following rules of personal hygiene. 1. Make a daily morning toilet. 2. Thoroughly wash your hands before eating and after each visit to the toilet. 3. Do not take foreign objects into your mouth: pen, pencil, etc.; Don't slobber your fingers when reading books. 4. Keep your workplace clean and tidy. 5. Eat only in specially designated places (if any), etc. There are also a number of measures to prevent infectious and other types of diseases, the implementation of which should be monitored by the teacher and the school administration. For these purposes it is necessary: - regularly ventilate classrooms; - daily carry out wet cleaning of classrooms and corridors of the school; - check the availability of changeable shoes for students, especially in the autumn and spring periods; - carry out antibacterial treatment of toilets; - observe the hygienic cleanliness of catering units; - to control food. 3.6. Danger of emergence and ways of penetration of dysentery at school Dysentery is a type of intestinal infection. The disease is manifested by damage to the mucous membrane of the large intestine with a dysentery bacillus, while painful sensations and intoxication phenomena are observed. The causative agents of dysentery are several types of bacteria that are biologically close to each other, belonging to the enteric-typhoid group: Grigoriev's sticks - Shigi, Shtuzer-Schmitz, Flexner, Sonne, etc. In the Russian Federation, the main causative agents of dysentery are Sonne and Flexner sticks. These bacteria are immobile due to their lack of organs of movement; they are highly stable in the external environment: they remain in the patient's secretions for up to 48 hours, and in winter - up to 100 hours. Dysentery bacilli die in sunlight for 30 minutes, when heated to 50-60 ° C - for 10 minutes, in solution phenol (1%) - within 30 minutes. The source of dysentery is a sick person whose secretions contain pathogens. The sick person is dangerous from the very first days of illness, since pathogenic microbes get on household items from his hands and as a result can get on food and water. That is why dysentery is sometimes called "dirty hands disease". The ways of spreading dysentery are similar to the ways of spreading other intestinal infections - contact-household transmission of the infection against the background of violation of the rules of personal hygiene. Microbes enter the human body through the mouth (mainly through water). A significant role in the spread of infection is played by flies that carry dysentery bacilli on their paws from cesspools, toilets, from garbage dumps to food. And although the causative agents of dysentery are less stable in the external environment than the causative agents of typhoid, which reduces the likelihood of an epidemic, however, with a negligent attitude to the sanitary and hygienic situation in the village, dysentery can bring a lot of trouble. Outbreaks of dysentery are seasonal in nature: they occur in the autumn and summer months. This is due to the characteristics of pathogens and ways of spreading the infection. Having penetrated into the stomach, like all food, dysentery sticks are exposed to the action of gastric juice and partially die. The remaining pathogens penetrate the large intestine and linger in the folds of the mucous membrane. Here they feed, excrete toxins, and multiply. As a result, the intestinal mucosa is damaged: swelling, redness, bleeding, mucus secretion, the appearance of ulcers. The waste products of pathogenic microbes - toxins - spread through the blood throughout the body, affecting organs and systems. The first symptoms of dysentery appear after 3-5 days. Depending on the severity of the disease, dysentery is mild, moderate and severe (toxic). In the moderate form, the symptoms appear suddenly. Body temperature rises to 38-38,5 ° C. The patient's condition deteriorates sharply: weakness, lethargy, general malaise develops, appetite decreases or completely disappears; possible nausea, vomiting. The stools become liquid. After 1-2 days, the stool acquires a typical dysentery appearance: mucopurulent discharge with streaks of blood. The chair becomes more frequent, accompanied by stabbing cramping pains, more often in the left side of the abdomen. On examination, the abdomen is somewhat swollen, painful on pressure, a tense sigmoid colon is palpated on the left. The amount of mucus increases rapidly, the stool loses its fecal character and its volume decreases significantly. These symptoms persist for about a week, after which the patient's general condition improves, body temperature decreases. The number of bowel movements per day is reduced and the stool becomes more formed, but for another 1-2 weeks it can be unstable, retaining a mucous-bloody appearance. The toxic form of dysentery is quite rare. It begins immediately with signs of a general poisoning of the body with microbial waste products: a very high temperature, rapidly increasing cardiovascular insufficiency and impaired consciousness. Due to frequent stools (20-30 times a day), repeated vomiting and refusal to eat, the patient's general condition deteriorates rapidly: he becomes dehydrated and loses weight. The patient's facial features are sharpened, the eyes are deeply sunken, the look becomes cloudy, the skin turns pale. Disturbances of consciousness up to a coma are possible. The patient's breathing is rare, deep, noisy. The amount of urine in which protein is found decreases. Renal failure develops. The toxic form of dysentery is difficult to distinguish from other severe forms of infectious diseases, so it is she who most often leads to death. A mild form of dysentery occurs with a slight temperature, which lasts for several days. Feces up to 4-5 times a day, usually have a mucopurulent character with rare streaks of blood. The patient feels a slight malaise. The danger of a mild form of dysentery is that with such symptoms, patients prefer to be treated on their own, without going to the doctor and being the source of the disease. As a result of improper treatment of various forms of dysentery, or in the absence of treatment of a mild form of the disease, a chronic form of dysentery may occur, characterized by periodic exacerbations of the disease. In this case, the following symptoms are observed: mucous stools, decreased appetite, increasing dystrophy, periodic abdominal pain, sleep disturbances, increased irritability of the patient. This form of dysentery lasts for years and is difficult to treat. As a result of an illness, a sick person acquires immunity only to this pathogen. Treatment. Treatment of patients with dysentery implies their mandatory isolation. The patient is advised to rest, observance of mandatory hygiene measures. Within seven days, and if necessary, longer, antimicrobials are used. During the treatment period, the patient is prescribed special nutrition, plenty of fluids, and in case of a toxic form, intravenous administration of drugs and nutrients is used. The patient's bedside needs ongoing disinfection. Prevention of dysentery. Prevention of dysentery at school is one of the necessary measures to localize the disease. When a child with dysentery is identified, his immediate isolation and examination of persons who were in direct contact with him are necessary. Disinfection of school premises is carried out: a classroom, a catering unit, a toilet, a lobby, a gym, etc. Catering staff are examined for bacillus carriers. Children who have been ill with dysentery attend classes only after the permission of the doctor. Measures to prevent the occurrence and spread of dysentery in the school include: - maintaining the cleanliness of classrooms; - compliance with the rules of storage and trade in food products; - maintenance of public toilets; - destruction of flies; - timely emptying of dustbins; - strict control over the personal hygiene of schoolchildren; - removal of children from cleaning bathrooms, washrooms in common areas, garbage and food waste; - the correct organization of the drinking regime at school; - familiarize students and their parents with the symptoms and danger of dysentery. 3.7. Clinical picture and prevention of viral hepatitis at school Hepatitis is an acute infectious disease that mainly affects the liver tissue, causing pathology of liver functions and, against this background, a metabolic disorder in the body. Hepatitis is also called Botkin's disease - after the scientist who studied this disease. Hepatitis can be primary, in which case it is an independent disease, or secondary, in which case it is a manifestation of another disease. The development of secondary hepatitis is associated with exposure to hepatotropic factors - viruses, alcohol, drugs or chemicals. Viral hepatitis is a disease of a viral nature, characterized by general poisoning of the body with the waste products of pathogenic viruses. At the same time, there is a violation of pigmentation of the skin (icteric color), an increase in the size of some internal organs (spleen, liver). Viral hepatitis is of independent importance and should not be confused with hepatitis caused by yellow fever, mononucleosis, herpes, etc. There are two types of causative agents of viral hepatitis - viruses of types A and B. Hepatitis A is called infectious hepatitis, hepatitis B - serum. The source of viral hepatitis is a sick person or a carrier of the virus. The maximum infectivity of the patient falls on the preicteric period of the disease and the first days of the icteric period. For different types of hepatitis, the mechanisms of transmission of infection also differ. The causative agents of hepatitis A from the blood of a virus carrier or a patient enter his secretions, and then through the contact-household route into the body of a healthy person. The causative agents of hepatitis B are found only in the patient's blood, where they remain for a long time after his recovery. Infection with hepatitis can also occur through various medical instruments, blood transfusions or in utero. The incubation period for infectious hepatitis is 7-45 days; serum hepatitis - 2-6 months. During this period, there are no external manifestations of the disease. The course of the disease can be divided into two periods: - preicteric (more than 1 week). The main symptoms of this period are general weakness, malaise, loss of appetite, a feeling of heaviness in the epigastric region, belching, short-term fever, pain in the joints, in the liver area. At the end of this period, a change in the color of the secretions occurs: the urine becomes brown, and the feces become white; - icteric (2-4 weeks). The main manifestations of this period are a change in the color of the soft palate and later - the skin (yellowing); the appearance of itching of the skin. Against this background, the size of the liver and spleen increases, sometimes there is bleeding of the skin and mucous membranes. Hepatitis B is more difficult than hepatitis A. Hepatitis B is characterized by constantly increasing weakness, aversion to food, repeated vomiting, sleep disturbance, sharp icteric coloration of the skin and visible mucous membranes, and pruritus. Hepatic coma - a complication of hepatitis B - is one of the main causes of death of the disease. In addition, the disease can go into a chronic form, in which periods of exacerbations appear. Treatment of viral hepatitis. The patient is prescribed bed rest - in this position, the blood supply to the liver improves. Due to the decrease in blood clotting due to hepatitis, the risk of various types of bleeding increases, so medical personnel need to be careful when administering injections. A patient with hepatitis is prescribed a special diet with a restriction in the amount of fat in food, the exclusion of protein from it and an increase in the content of amino acids. A large amount of liquid is also prescribed. With symptoms of intoxication, an intravenous drip infusion of a 5% glucose solution, gemodez up to 1-1,5 liters is indicated. At the same time prescribe hormone therapy (prednisolone, hydrocortisone). Also used ointments that relieve itching. If symptoms of hepatic coma appear, hormonal drugs and antibiotics are used. It is important to remember that the patient is a source of infection, so it is necessary to disinfect his linen, dishes, and discharge. Sanitary cleaning of the premises should be carried out at least three times a day. Prevention of hepatitis. Prevention of viral hepatitis in the school includes the following activities. 1. Information about the absence of students in the classroom is transmitted to the medical centers. 2. The educational institution is notified of all cases of illness of students and their families. 3. Students who miss school for more than three days are allowed to attend lessons only with the permission of a doctor. 4. Explanatory work is being carried out with students and their parents about the dangers, symptoms and preventive measures of viral hepatitis. 5. Strict control is exercised over school employees, especially catering workers. 6. Compliance with sanitary and hygienic requirements, rules for the transportation and storage of food, etc. is strictly checked. Additional measures are taken in the event of the appearance of cases of viral hepatitis in the school. 1. Active work is underway to identify patients who do not have symptoms of the disease. 2. All cases of the disease are reported to the sanitary and epidemic services. 3. Disinfection of all school premises (especially toilets) is carried out. 4. If necessary, a quarantine is declared. In preventing the incidence of hepatitis B, the main role is played by sanitary measures aimed at preventing injection infection, primarily during mass preventive vaccinations. The causative agent of hepatitis B is resistant to physical and chemical factors, it loses its activity only when sterilized with steam under pressure or when boiled. It is also necessary to constantly monitor the child's compliance with the necessary norms and rules of personal hygiene by teachers and parents. 3.8. Some other infectious diseases Let us consider in more detail some infectious diseases, as well as their symptoms, the main directions of treatment and prevention. Typhoid and paratyphoid A and B. These are acute infectious diseases of a bacterial nature related to intestinal infections. Their pathogens are bacteria from the Salmonella group. Salmonella are mobile short Gram-negative rods with rounded ends. All three pathogens are quite stable in the external environment - in water, soil, food, household items they persist for 2-3 months. The source of the disease is a patient or a bacteriocarrier. The greatest number of pathogens is excreted at the height of the disease along with feces and urine. The patient becomes contagious from the first days of the disease and remains so even in the last days of the incubation period, and in some cases even after recovery. Human contagiousness can last from several months to decades. Ways of transmission of typhoparatyphoid diseases are fecal-oral in nature. The infection is transmitted through water, food, contaminated hands, household items, etc. The intensity of the spread of the disease depends on the predominance of one or another route of spread. The most massive outbreaks of the disease occur when pathogenic microorganisms enter the water supply system. The food way of distribution of typhoid and paratyphoid diseases is also dangerous. Infection through hands and household items (household route) is most often recorded as separate, sporadic diseases. With typhoid fever, the latent incubation period of the disease is from 7 to 20 days, on average - 14 days, with paratyphoid fever - from 3 to 14 days, on average - 7-8 days. Symptoms and course. Usually, the course of typhoid and paratyphoid diseases is cyclical: the first 5-6 days there is a gradual increase in painful symptoms, the temperature rises to 39-40 ° C; on the 4-5th day, headache, insomnia, adynamia, blackout of consciousness, delirium appear; the tongue is lined, the skin has a rash, the pulse is rare, uneven; on the 7-8th day, the main symptoms and complications appear (intestinal bleeding, perforation of an intestinal ulcer with subsequent peritonitis, otitis, parotitis, psychosis, meningitis). In the future, there is a weakening of the clinical manifestations of the disease and a gradual decrease in temperature: the last period of the disease comes - convalescence (normalization of the state, lowering the temperature). The diagnosis of typhoid and paratyphoid diseases is made on the basis of a blood test from a vein and an examination for bacteriocarrier by culture of feces and urine. Treatment. Antibiotics levomycetin and synthomycin are used to treat patients with typhoid and paratyphoid diseases. It is important that the patient observe bed rest and a strict diet. Due to heavy bleeding, the patient needs constant drinking and regular meals, even if he has no appetite. The use of anti-epidemic measures is of great importance. Prevention. Preventive measures in the fight against typhoid and paratyphoid diseases are carried out by neutralizing the source of infection, neutralizing it or suppressing the factors and ways of spreading the disease and increasing immunity to it. These goals correspond to the hospitalization of patients with the neutralization of the focus of infection, treatment using all the most effective methods, discharge after a complete clinical recovery and a negative result of a double bacteriological examination. Neutralization of infection transmission mechanisms is achieved by a set of sanitary and hygienic measures that provide for the improvement of populated areas, providing the population with good-quality drinking water, food, observing sanitary rules in food storage and preparation areas, improving sanitary culture and personal hygiene at home and at work (especially among workers). food enterprises and staff of children's institutions). Another way to prevent the epidemic of typhoid fever and paratyphoid is the timely vaccination, which are used according to epidemic indications. Vaccinations are carried out when there is a high level of disease in the area or when there is a threat of an outbreak of the disease. The following types of vaccines are used for immunization: - killed vaccine - it is injected subcutaneously at 0,5 and 1 ml twice with an interval of 10-14 days; - chemical vaccine - administered once at a dose of 1 ml. Re-vaccination (revaccination) is carried out once a year with both vaccines at a dose of 1 ml. Foodborne diseases. These are diseases caused by pathogens belonging to the groups of salmonella, staphylococci (streptococci) and opportunistic microorganisms. Infection occurs as a result of ingestion of contaminated food. Salmonella caused by the ingestion of salmonella - very resistant microorganisms that persist in food for a long time. The main source of infection is animals (cattle, dogs, pigs) and birds (especially waterfowl). A person becomes ill with salmonellosis when eating meat, milk or eggs of sick animals and birds. The first signs of salmonellosis appear after 12-24 hours. Its symptoms are nausea, vomiting, headache, pain in the abdomen, diarrhea, convulsions, and a drop in cardiac activity. In this case, the body temperature is normal or slightly elevated, in severe cases it is high. The severity of the disease depends on the type of pathogen and the number of microbes that have been ingested with food. The duration of the disease is 3-5 days. Severe forms of this disease can lead to death. The diagnosis is established on the basis of epidemiological analysis and examination data, acute onset and rapid development of symptoms of the disease, as well as laboratory tests. Treatment. Mild forms of salmonellosis do not require treatment. In severe forms, medical assistance is needed, which consists in gastric lavage and the subsequent restoration of the activity of systems affected by the disease. Heat, foot warmers or a warm bath are recommended as aids in raising the heart's activity. With staphylococcal food poisoning, toxic substances are formed in food - enterotoxins, which are characterized by thermal stability and antigenic properties. Food poisoning infections caused by opportunistic pathogens (E. coli, Proteus, Morgan's bacillus, etc.) are easier and occur after eating ready-made meals that are already infected after cooking. Symptoms of the disease occur suddenly, their nature and treatment do not differ from the symptoms of salmonellosis. botulism - food poisoning caused by botulinum toxin. The causative agent of botulism is a mobile spore-bearing bacillus (bacillus) that lives in anaerobic conditions. Its spores are widely distributed in the external environment and are highly resistant. The botulism stick produces a poison - an exotoxin, which is in the first place in terms of toxicity. The source of infection are warm-blooded animals, in the intestines of which the botulism bacillus lives. Human infection occurs through various products in which the pathogen multiplies and the toxin accumulates. Especially dangerous in this regard are canned fish and vegetable products. Botulism is also common as a result of eating mushrooms that have been improperly preserved at home. The first symptoms of the disease occur about a day after the use of products infected with botulinum bacillus. In this case, there are signs of damage to the central nervous system, manifested by nausea, general weakness, dizziness, headache and double vision, dilated pupils, difficulty speaking and swallowing. Treatment: immediate gastric lavage and the introduction of a special serum. Serum therapy is recommended to be combined with the use of biomycin. Cholera - acute intestinal infection, characterized by the severity of the clinical course, high mortality and the ability to bring a large number of victims in a short time. The causative agent of cholera is Vibrio cholerae, which has a curved shape in the form of a comma and has great mobility. The most dangerous route for the spread of cholera is the waterway. This is due to the fact that Vibrio cholerae can persist in water for several months. Cholera is also characterized by a fecal-oral transmission mechanism. The latest cases of cholera outbreaks are associated with a new type of pathogen - El Tor vibrio, which differs in a number of features, such as: - the existence of long-term vibrio carrying after the disease; - the presence of a significant number of erased atypical forms and healthy vibrio-carrying; - more pronounced resistance (resistance) to the effects of adverse environmental factors. The incubation period for cholera ranges from several hours to five days. It may be asymptomatic. There are cases when, as a result of the most severe forms of cholera, people die in the first days and even hours of illness. The diagnosis is made using laboratory methods. The main symptoms of cholera are: sudden watery, profuse diarrhea with floating flakes, resembling rice water, turning over time into mushy, and then into loose stools, profuse vomiting, decreased urination due to loss of fluid, leading to a condition in which blood pressure drops, the pulse becomes weak, there is severe shortness of breath, cyanosis of the skin, tonic cramps in the muscles of the limbs. The patient's facial features are sharpened, the eyes and cheeks are sunken, the tongue and mucous membrane of the mouth are dry, the voice is hoarse, the body temperature is lowered, the skin is cold to the touch. Treatment: depends on the form and severity of the disease. In severe form, massive intravenous administration of special saline solutions to compensate for the loss of salts and fluids in patients is of decisive importance. As an additional measure, antibiotics (tetracycline) are prescribed. Routine disinfection and personal hygiene are of great importance in the treatment of cholera. Control measures and prevention. To eliminate the foci of the disease, a complex of anti-epidemic measures is being taken: through the so-called "household rounds", patients are identified, and persons who have been in contact with them are isolated; provisional hospitalization of all patients with intestinal infections, disinfection of foci, control over the good quality of water, food and their neutralization, etc. are carried out. If there is a real danger of the spread of cholera, quarantine is used as an extreme measure. When there is a threat of the disease, as well as in territories where cases of cholera are noted, the population is immunized with the killed cholera vaccine subcutaneously. Immunity to cholera is short-lived and not high enough tension, in connection with this, after six months, revaccination is carried out by a single injection of the vaccine at a dose of 1 ml. Zoonoses. Zoonoses are contagious diseases of animals, to the pathogens of which humans are also susceptible. Zoonoses include a large number of infectious and parasitic diseases, such as plague, tularemia, anthrax, rabies, brucellosis, etc. The group of zoonoses also includes diseases such as glanders and melioidosis. Their pathogens - thin, curved rods - are very close to each other in properties. Glanders is a disease caused by one-hoofed animals, most often horses. Infection occurs when caring for horses through hands and various objects. Human disease with glanders is rare. For glanders is characterized by an acute onset of the course of the disease with severe chills, headache and muscle pain. Later, joint pain and swelling appear. At the site of the introduction of the pathogen, a primary nodule develops, then a red-purple papule appears, which turns into an ulcer. Sap ulcers are distinguished by a greasy bottom and undermined edges. Ulcers also form on the nasal mucosa, which is accompanied by a greenish-purulent or (sometimes) bloody discharge. The patient's condition gradually worsens and becomes very serious. In acute glanders, no cases of recovery are observed. In the chronic course of glanders, three forms are distinguished: skin, pulmonary and nasal. All phenomena in chronic glanders develop slowly and are characterized by a change in deterioration and improvement. Treatment: strictly in hospital conditions. The patient is prescribed bed rest. Conduct ongoing disinfection. Strict precautions must be observed when caring for the sick. Melioidosis - a disease caused by a delicate bacillus with high mobility and high resistance in the external environment. The source of infection are rodents (wild rats and mice), which have a chronic course of the disease with the release of an infectious agent from the affected organs. People become infected with melioidosis by ingestion of pathogens or insect bites. The symptoms of the disease are varied. The most severe form is acute sepsis. The disease is characterized by a rapid and violent course: chills, vomiting, diarrhea and severe dehydration. The temperature quickly rises and stays around 40-41 °C. Severe headache, delirium and loss of consciousness are noted. The pulse sharply quickens and reaches 130-150 beats per minute. Death occurs on the 8-15th day from the onset of the disease. Along with symptoms, epidemiological data and blood tests are important to confirm the diagnosis. Treatment: the use of antibiotics and sulfa drugs. Sulfodiazine gives good results. Of the antibiotics, chloromycetin is most effective, both alone and in combination with other antibiotics - aureomycin or terramycin. Brucellosis - a zoonotic disease caused by brucella - small immobile coccoid bacteria. Brucella is divided into three types: the causative agent of brucellosis of small ruminants, the causative agent of brucellosis of cattle and the causative agent of brucellosis of pigs. They are characterized by long-term stability in the external environment (soil, water) and in food, especially dairy and meat. Human infection occurs most often from small ruminants in contact with the secretions of sick animals, as well as through food and water. The disease is of an occupational nature: it is more often observed among shepherds (shepherds), milkmaids, veterinary workers. For other groups of the population, contaminated products are of great importance in the transmission of infection: milk, feta cheese, cheese from sheep's milk, meat. Clinical course and diagnosis. The incubation period of brucellosis lasts from 7 to 21 days, while the disease is characterized by a variety of symptoms. The temperature rises gradually, reaches 39-40 ° C, and then for 2-3 months or more it has the character of an undulating fever with periods of decline to normal values. Chills, profuse sweat, headaches, pain in muscles and joints, lymphadenitis, enlargement of the liver and spleen, joint damage are also possible. The diagnosis is made on the basis of clinical symptoms, epidemiological data and laboratory tests. With brucellosis, a chronic course of the disease (up to 1-2 years) is often observed with frequent exacerbations. Treatment: vaccine therapy, radiotherapy, mud therapy. Antibiotics and hormones are also used. The prevention and control of brucellosis is associated with a complex of veterinary and medical and sanitary measures, such as compliance with the rules and norms of labor in farms, immunization according to epidemic indications with a live vaccine. Plague - an acute infectious disease belonging to the group of zoonoses. The source of infection are rodents (rats, ground squirrels, gerbils, etc.). The disease occurs in bubonic, septic (rare) and pulmonary forms. The most dangerous form of pneumonic plague. The causative agent of infection is a plague bacillus, stable in the external environment, well tolerated by low temperatures. There are two types of natural foci of plague: foci of "wild", or steppe, plague and foci of rat, urban or port, plague. With the pneumonic form of plague, the source of infection is a sick person. The ways of transmission of plague are associated with the presence of insects (fleas, etc.). With the pneumonic form of plague, the infection is transmitted by airborne droplets (by inhalation of droplets of sputum of a sick person containing the plague pathogen). Symptoms of the disease appear suddenly three days after infection, while there is a strong intoxication of the whole organism. Against the background of severe chills, the temperature quickly rises to 38-39 ° C, there is a severe headache, flushing of the face, the tongue is covered with a white coating. In more severe cases, delusions of a hallucinatory order develop, cyanosis and sharpness of facial features with the appearance of an expression of suffering, sometimes horror. Quite often, in any form of plague, various skin phenomena are observed: hemorrhagic rash, pustular rash, etc. In the bubonic form of the plague, which occurs, as a rule, with the bite of infected fleas, the cardinal symptom is bubo, which is an inflammation of the lymph nodes. The most frequent buboes of the lower extremities. In the acute period, the most characteristic indicator of the severity of the developing disease is the height of the rise and the course of the temperature curve. After a week, the manifestation of symptoms subsides and the person recovers, but complications are possible, among which the most dangerous is secondary pneumonic plague. At the same time, there is an increase in temperature, sharp stabbing pains in the chest, a cough with the release of bloody sputum containing a huge amount of plague sticks. The development of a secondary septic form of plague in a patient with a bubonic form can also be accompanied by numerous non-specific complications and increase its epidemic danger. The primary pulmonary form is the most epidemically dangerous and very severe clinical form of the disease. Its onset is sudden: body temperature rises rapidly, cough and copious sputum appear, which then becomes bloody. At the height of the disease, the characteristic symptoms are general depression, and then an excited-delusional state, high fever, signs of pneumonia, vomiting with blood, cyanosis, and shortness of breath. The pulse quickens and becomes thready. The general condition deteriorates sharply, the patient's strength fades away. The disease lasts 3-5 days and, without treatment, ends in death. The diagnosis of plague is made on the basis of the clinical picture of the disease. Treatment. All forms of plague are treated with antibiotics. Streptomycin, terramycin and other antibiotics are prescribed alone or in combination with sulfonamides. Treatment begins with the appointment of a shock (increased) dose: in the first two days, streptomycin is administered intramuscularly, in the following days - after 6 hours. Together with antibiotics, other therapeutic agents are used, especially cardiovascular, and in the bubonic form - ointment compresses, etc. It is very important to take precautions when caring for a plague patient. The patient is assigned a strict regimen. In addition to the shift on duty, no one (even medical workers) should be in the department. Quarantine is appointed, which ends six days after the recovery of the last patient. Prevention. Preventive measures are very important in the fight against plague. In natural foci, observations are made on the number of rodents and vectors, their examination, deratization in the most threatened areas, examination and vaccination of healthy population. A special role in the fight against plague is given to the timely detection of the first cases of the disease, the immediate isolation and hospitalization of patients. All persons who came into contact with the sick, infected things and the corpse of a person who died from the plague are also isolated for six days. Emergency prophylaxis with antibiotics is carried out for all those who come into contact with the patient. The locality in which the patient was identified is quarantined. The exit of the population is prohibited. Vaccination is carried out with a dry live vaccine subcutaneously or cutaneously. The development of immunity begins from the 5-7th day after a single injection of the vaccine. Tularemia - an infection from the group of zoonoses. The source of infection are rodents. The causative agent of tularemia is an immobile short stick, which is highly stable in the external environment. Ways of spread of the disease: water, food, air-dust, contact and transmissible. The clinical course of tularemia depends on the mechanism of transmission and the route of infection. It is customary to distinguish (GP Rudnev) several forms of tularemia: bubonic, ulcerative-bubonic, oculobubonic, anginal-bubonic, abdominal, or intestinal, pulmonary, generalized. There are mild, moderate and severe cases of the course of the disease. Laboratory tests are carried out to confirm the diagnosis. The onset of the disease is acute. Patients feel chills, headache, general weakness, muscle pain in the calves and lower back, dizziness, lack of appetite. Body temperature rises to 38-39 ° C and above. In more severe cases, vomiting and bleeding from the nose, confusion and delirium are observed. The bubonic form is characterized by inflammation of the lymph nodes (lymphadenitis). Axillary, cervical and submandibular buboes predominate. The generalized form of the disease is more severe, in which intoxication phenomena can be pronounced: delirium, loss of consciousness. The fever lasts for about three weeks. Treatment is carried out taking into account certain manifestations of the symptoms of the disease. In all clinical forms of the disease, cardiac agents and antibiotics are used. Prevention of tularemia is divided into general measures and specific measures. General anti-epidemic measures are aimed at neutralizing the mechanisms of infection transmission by exterminating rodents, protecting food products, and disinfecting water. For specific prophylaxis according to epidemiological indications, a live attenuated tularemia vaccine is used. Vaccinations are carried out by the skin method. Immunity lasts 5-7 years. The vaccinated rarely get sick. anthrax is a typical zoonotic infection. The causative agent of the disease - a thick, immobile bacillus (bacillus) - has a capsule and a spore. Anthrax spores remain in the soil for up to 50 years. The source of infection is domestic animals, cattle, sheep, horses. Sick animals excrete the pathogen with urine and feces. Ways of distribution of anthrax are varied: contact, food, transmissible (through the bites of blood-sucking insects - horseflies and flies). The incubation period of the disease is short (2-3 days). According to clinical forms, skin, gastrointestinal and pulmonary anthrax are distinguished. In cutaneous anthrax, a spot develops first, followed by a papule, vesicle, pustule, and ulcer. The disease is severe and in some cases ends in death. In the gastrointestinal form, the predominant symptoms are a sudden onset, a rapid rise in body temperature to 39-40 ° C, acute, cutting pains in the abdomen, hematemesis with bile, bloody diarrhea. Usually the disease lasts 3-4 days and most often ends in death. The pulmonary form has an even more severe course. It is characterized by high body temperature, disorders of the cardiovascular system, a strong cough with bloody sputum. After 2-3 days, patients die. Treatment. The most successful is the early use of specific anti-anthrax serum in combination with antibiotics. When caring for patients, it is necessary to take personal precautions - work with rubber gloves. Prevention of the disease includes the identification of sick animals with the appointment of quarantine, disinfection of fur clothing in case of suspected infection, immunization according to epidemic indicators. Smallpox. This is an infectious disease with an airborne transmission mechanism of an infectious beginning. The causative agent of smallpox is the Pashen-Morozov body virus, which has a relatively high resistance in the external environment. The source of infection is a sick person during the entire period of illness. The patient is contagious for 30-40 days, until the complete disappearance of smallpox crusts. Infection is possible through clothing and household items that the patient has come into contact with. The clinical course of smallpox begins with an incubation period lasting 12-15 days. Three forms of natural smallpox are possible: a mild form - varioloid and smallpox without a rash; natural smallpox of the usual type and confluent smallpox; a severe hemorrhagic form that occurs with phenomena of hemorrhage in the elements of the rash, as a result of which the latter become purple-blue ("black pox"). The mild form of smallpox is characterized by the absence of a rash. The general defeats are expressed poorly. Natural smallpox of the usual type begins suddenly with a sharp chill, a rise in body temperature to 39-40 ° C, headache and sharp pains in the sacrum and lower back. Sometimes this is accompanied by the appearance of a rash on the skin in the form of red or red-purple spots, nodules. The rash is localized in the area of the inner thighs and lower abdomen, as well as in the pectoral muscles and the upper inner part of the shoulder. The rash disappears in 2-3 days. In the same period, the temperature decreases, the patient's well-being improves. After that, a smallpox rash appears, which covers the entire body and the mucous membrane of the nasopharynx. At the first moment, the rash has the character of pale pink dense spots, on top of which a bubble forms. The contents of the bubble gradually become cloudy and suppurate. During the period of suppuration, the patient feels a rise in temperature and acute pain. The hemorrhagic form of smallpox (purpura) is severe and often ends in death. With this form, as a result of hemorrhage, the skin quickly acquires a purple hue, the mucous membranes bleed. Bleeding occurs from the intestines and urinary tract. The general toxicosis sharply increases, cordial activity falls. Death occurs 3-4 days after the onset of the disease. Treatment is based on the use of a specific gamma globulin. Treatment of all forms of smallpox begins with the immediate isolation of the patient in a box or a separate room. In patients with typical smallpox with skin lesions, it is necessary to monitor the condition of the skin and oral mucosa. During the formation of bubbles, severe itching appears, so you need to wipe the skin with a swab moistened with a solution of potassium permanganate. To reduce itching during the drying period of the crusts, you need to lubricate them with 1% menthol ointment. Prevention of smallpox consists in the general vaccination of children from the second year of life and subsequent revaccinations. As a result, cases of smallpox are virtually non-existent. In the event of smallpox diseases, the population is revaccinated. Persons who have been in contact with the patient are isolated for 14 days in a hospital or in a temporary hospital deployed for this purpose. Flu. This is an airborne infection, the most intense infectious disease. From time to time, the flu occurs in the form of large epidemics, during which from 30 to 70% of the population in large cities are ill. The causative agent of influenza is a virus characterized by variability. There are four types of influenza virus: A, B, C and O. In recent years, varieties of the A virus have been identified, which are called A1 and A2. Those who have had the flu develop immunity only to the virus that caused the disease. The immunity formed as a result of the disease is short-lived. The influenza virus dies at room temperature. The source of infection is a sick person. The incubation period for influenza ranges from several hours to 2-3 days. Infection occurs with close contact of patients. Symptoms of the disease: chills, fever, loss of appetite, headache, malaise, muscle pain. The disease lasts for 2-3 days, except for the severe toxic course of influenza. Recognition of influenza is difficult due to the fact that many infectious diseases have similar symptoms. For the diagnosis of influenza, laboratory tests are used. Treatment. In the treatment of influenza, a number of agents are used to prevent complications, including antibiotics - penicillin, levomycetin, and from sulfanilamide preparations - norsulfazol. In recent years, a good therapeutic effect has been obtained with the introduction of a specific gamma globulin. Influenza prophylaxis consists of immunization with a live influenza vaccine, as well as serum. Specially manufactured gamma globulin is used for preventive purposes in children's institutions. In conclusion, we note that many of the diseases listed above are very rare in medical practice. This happened due to the development of modern medicine, the invention of new drugs, as well as the use of blanket vaccination of children and adults. Topic 4. First aid and emergency care 4.1. Emergency conditions and their types Emergency conditions (accidents) are incidents that result in harm to a person's health or a threat to his life. An emergency is characterized by suddenness: it can happen to anyone, at any time and in any place. People injured in an accident need immediate medical attention. If there is a doctor, paramedic or nurse nearby, they turn to them for first aid. Otherwise, help should be provided by people who are close to the victim. The severity of the consequences of an emergency, and sometimes the life of the victim, depends on the timeliness and correctness of actions to provide emergency medical care, so each person must have the skills to provide first aid in emergency conditions. There are the following types of emergency conditions: - injuries; - wounds; - thermal injury; - poisoning; - bites of poisonous animals; - attacks of diseases; - consequences of natural disasters; - radiation damage, etc. The set of measures required for victims in each type of emergency has a number of features that must be taken into account when providing assistance to them. 4.2. First aid for sun, heat stroke and fumes Sunstroke is a lesion that occurs as a result of long-term exposure to sunlight on an unprotected head. Sunstroke can also be obtained when you stay outside for a long time on a clear day without a hat. Heatstroke is an excessive overheating of the whole organism as a whole. Heat stroke can also happen in cloudy, hot, windless weather - during long and hard physical work, long and difficult transitions, etc. Heat stroke is more likely when a person is not physically prepared enough and is very tired and thirsty. Symptoms of sun and heat stroke are: - heart palpitations; - redness, and then blanching of the skin; - violation of coordination; - headache; - noise in ears; - dizziness; - severe weakness and lethargy; - decrease in the intensity of the pulse and respiration; - nausea, vomiting; - nose bleed; - sometimes convulsions and fainting. The provision of first aid for sun and heat stroke should begin with the transportation of the victim to a place protected from heat exposure. In this case, it is necessary to lay the victim in such a way that his head is higher than the body. After that, the victim needs to provide free access to oxygen, loosen his clothes. To cool the skin, you can wipe the victim with water, cool the head with a cold compress. The victim should be given a cold drink. In severe cases, artificial respiration is necessary. Fainting is a short-term loss of consciousness due to insufficient blood flow to the brain. Fainting can occur from severe fright, excitement, great fatigue, as well as from significant blood loss and a number of other reasons. When a person faints, he loses consciousness, his face turns pale and covered with cold sweat, the pulse is barely palpable, breathing slows down and is often difficult to detect. First aid for fainting comes down to improving the blood supply to the brain. For this, the victim is laid so that his head is lower than the body, and his legs and arms are somewhat raised. The victim's clothing must be loosened, his face is sprinkled with water. It is necessary to ensure the flow of fresh air (open the window, fan the victim). To excite the breath, you can give a sniff of ammonia, and to enhance the activity of the heart, when the patient regains consciousness, give hot strong tea or coffee. Ugar - poisoning a person with carbon monoxide (CO). Carbon monoxide is formed when fuel burns without an adequate supply of oxygen. Carbon monoxide poisoning is unnoticeable because the gas is odorless. Symptoms of carbon monoxide poisoning include: - general weakness; - headache; - dizziness; - drowsiness; - Nausea, then vomiting. In severe poisoning, there are violations of cardiac activity and respiration. If the injured person is not helped, death may occur. First aid for fumes comes down to the following. First of all, the victim must be removed from the zone of carbon monoxide or ventilate the room. Then you need to apply a cold compress to the head of the victim and let him smell the cotton wool moistened with ammonia. To improve cardiac activity, the victim is given a hot drink (strong tea or coffee). Heating pads are applied to the legs and arms or mustard plasters are placed. When fainting, give artificial respiration. After that, you should immediately seek medical help. 4.3. First aid for burns, frostbite and freezing A burn is a thermal injury to the integument of the body caused by contact with hot objects or reagents. A burn is dangerous because, under the influence of high temperature, the living protein of the body coagulates, i.e., living human tissue dies. The skin is designed to protect tissues from overheating, however, with prolonged action of the damaging factor, not only the skin suffers from the burn, but also tissues, internal organs, bones. Burns can be classified according to a number of criteria: - by source: burns by fire, hot objects, hot liquids, alkalis, acids; - according to the degree of damage: burns of the first, second and third degree; - by the size of the affected surface (as a percentage of the body surface). With a first-degree burn, the burnt area turns slightly red, swells, and a slight burning sensation is felt. Such a burn heals within 2-3 days. A second-degree burn causes redness and swelling of the skin, blisters filled with a yellowish liquid appear on the burned area. The burn heals in 1 or 2 weeks. A third-degree burn is accompanied by necrosis of the skin, underlying muscles, and sometimes bone. The danger of a burn depends not only on its degree, but also on the size of the damaged surface. Even a first-degree burn, if it covers half the surface of the entire body, is considered a serious disease. In this case, the victim experiences a headache, vomiting, diarrhea appear. The body temperature rises. These symptoms are caused by a general poisoning of the body due to the decay and decomposition of dead skin and tissues. With large burn surfaces, when the body is not able to remove all decay products, kidney failure may occur. Second and third degree burns, if they affect a significant part of the body, can be fatal. First aid for burns of the first and second degree is limited to applying a lotion from alcohol, vodka or a 1-2% solution of potassium permanganate (half a teaspoon to a glass of water) to the burned area. In no case should you pierce the blisters formed as a result of a burn. If a third-degree burn occurs, a dry sterile dressing should be applied to the burnt area. In this case, it is necessary to remove the remnants of clothing from the burnt place. These actions must be performed very carefully: first, the clothes are cut off around the affected area, then the affected area is soaked with a solution of alcohol or potassium permanganate and only then removed. In case of an acid burn, the affected surface must be immediately washed with running water or a 1-2% soda solution (half a teaspoon per glass of water). After that, the burn is sprinkled with crushed chalk, magnesia or tooth powder. When exposed to particularly strong acids (for example, sulfuric), washing with water or aqueous solutions can cause secondary burns. In this case, the wound should be treated with vegetable oil. In case of burns with caustic alkali, the affected area is washed with running water or a weak solution of acid (acetic, citric). Frostbite is a thermal damage to the skin caused by their strong cooling. Unprotected areas of the body are most susceptible to this type of thermal damage: ears, nose, cheeks, fingers and toes. The likelihood of frostbite increases when wearing tight shoes, dirty or wet clothes, with general exhaustion of the body, anemia. There are four degrees of frostbite: - I degree, in which the affected area turns pale and loses sensitivity. When the action of cold ceases, the frostbite becomes bluish-red in color, becomes painful and swollen, and itching often appears; - II degree, in which blisters appear on the frostbitten area after warming, the skin around the blisters has a bluish-red color; - III degree, in which necrosis of the skin occurs. Over time, the skin dries out, a wound forms under it; - IV degree, in which necrosis can spread to the tissues lying under the skin. First aid for frostbite is to restore blood circulation in the affected area. The affected area is wiped with alcohol or vodka, lightly lubricated with petroleum jelly or unsalted fat and carefully rubbed with cotton or gauze so as not to damage the skin. You should not rub the frostbitten area with snow, as ice particles come across in the snow, which can damage the skin and facilitate the penetration of microbes. Burns and blisters resulting from frostbite are similar to burns from exposure to heat. Accordingly, the steps described above are repeated. In the cold season, in severe frosts and snowstorms, general freezing of the body is possible. Its first symptom is chilliness. Then a person develops fatigue, drowsiness, the skin turns pale, the nose and lips are cyanotic, breathing is barely noticeable, the activity of the heart gradually weakens, and an unconscious state is also possible. First aid in this case comes down to warming the person and restoring his blood circulation. To do this, you need to bring it into a warm room, make, if possible, a warm bath and easily rub the frostbitten limbs with your hands from the periphery to the center until the body becomes soft and flexible. Then the victim must be put to bed, covered warmly, given hot tea or coffee to drink and a doctor called. However, it should be taken into account that with a long stay in cold air or in cold water, all human vessels narrow. And then, due to a sharp heating of the body, blood can hit the vessels of the brain, which is fraught with a stroke. Therefore, heating a person must be done gradually. 4.4. First aid for food poisoning Poisoning of the body can be caused by eating various poor-quality products: stale meat, jelly, sausages, fish, lactic acid products, canned food. It is also possible poisoning due to the use of inedible greens, wild berries, mushrooms. The main symptoms of poisoning are: - general weakness; - headache; - dizziness; - abdominal pain; - Nausea, sometimes vomiting. In severe cases of poisoning, loss of consciousness, weakening of cardiac activity and respiration are possible, in the most severe cases - death. First aid for poisoning begins with the removal of poisoned food from the stomach of the victim. To do this, they induce vomiting: give 5-6 glasses of warm salted or soda water to drink, or insert two fingers deep into the throat and press on the root of the tongue. This cleansing of the stomach must be repeated several times. If the victim is unconscious, his head must be turned to the side so that the vomit does not enter the respiratory tract. In case of poisoning with strong acid or alkali, it is impossible to induce vomiting. In such cases, the victim should be given oatmeal or linseed broth, starch, raw eggs, sunflower or butter. The poisoned person should not be allowed to fall asleep. To eliminate drowsiness, you need to spray the victim with cold water or give him strong tea to drink. In case of convulsions, the body is warmed with heating pads. After providing first aid, the poisoned person must be taken to the doctor. 4.5. First aid for poisoning Toxic substances (S) include chemical compounds that can affect unprotected people and animals, leading to their death or incapacitating them. The action of agents can be based on ingestion through the respiratory system (inhalation exposure), penetration through the skin and mucous membranes (resorption), or through the gastrointestinal tract when contaminated food and water are consumed. Poisonous substances act in drop-liquid form, in the form of aerosols, vapor or gas. As a rule, agents are an integral part of chemical weapons. Chemical weapons are understood as military means, the damaging effect of which is based on the toxic effects of OM. Poisonous substances that are part of chemical weapons have a number of features. They are capable of causing massive damage to people and animals in a short time, destroying plants, infecting large volumes of surface air, which leads to the defeat of people on the ground and uncovered people. For a long time, they can retain their damaging effect. The delivery of such agents to their destinations is carried out in several ways: with the help of chemical bombs, aircraft pouring devices, aerosol generators, rockets, rocket and artillery shells and mines. First medical aid in case of OS damage should be carried out in the order of self- and mutual assistance or specialized services. When providing first aid, you must: 1) immediately put on a gas mask on the victim (or replace the damaged gas mask with a serviceable one) to stop the effect of the damaging factor on the respiratory system; 2) quickly introduce an antidote (specific drug) to the victim using a syringe tube; 3) sanitize all exposed areas of the skin of the victim with a special liquid from an individual anti-chemical package. The syringe tube consists of a polyethylene body, on which a cannula with an injection needle is screwed. The needle is sterile, it is protected from contamination by a cap tightly put on the cannula. The body of the syringe tube is filled with an antidote or other drug and hermetically sealed. To administer the drug using a syringe tube, you must perform the following steps. 1. Using the thumb and forefinger of the left hand, grasp the cannula, and with the right hand support the body, then turn the body clockwise until it stops. 2. Make sure there is medicine in the tube (to do this, press the tube without removing the cap). 3. Remove the cap from the syringe, while turning it a little; squeeze the air out of the tube by pressing it until a drop of liquid appears at the tip of the needle. 4. Sharply (with a stabbing motion) insert the needle under the skin or into the muscle, after which all the liquid contained in it is squeezed out of the tube. 5. Without opening your fingers on the tube, remove the needle. When administering an antidote, it is best to inject into the buttock (upper outer quadrant), anterolateral thigh, and outer shoulder. In an emergency, at the site of the lesion, the antidote is administered using a syringe tube and through clothing. After the injection, you need to attach an empty syringe tube to the victim’s clothing or put it in the right pocket, which will indicate that the antidote has been entered. Sanitary treatment of the skin of the victim is carried out with a liquid from an individual anti-chemical package (IPP) directly at the site of the lesion, as this allows you to quickly stop exposure to toxic substances through unprotected skin. The PPI includes a flat bottle with a degasser, gauze swabs and a case (polyethylene bag). When treating exposed skin with PPIs, follow these steps: 1. Open the package, take a swab from it and moisten it with the liquid from the package. 2. Wipe the exposed areas of the skin and the outer surface of the gas mask with a swab. 3. Re-moisten the swab and wipe the edges of the collar and the edges of the cuffs of the clothing that come into contact with the skin. Please note that PPI liquid is poisonous and if it enters the eyes, it may be harmful to health. If the agents are sprayed in an aerosol way, then the entire surface of the clothing will be contaminated. Therefore, after leaving the affected area, you should immediately take off your clothes, since the OM contained on it can cause damage due to evaporation into the breathing zone, penetration of vapors into the space under the suit. In case of damage to the nerve agents of the nerve agent, the victim must be immediately evacuated from the source of infection to a safe area. During the evacuation of the affected, it is necessary to monitor their condition. To prevent seizures, repeated administration of the antidote is allowed. If the affected person vomits, turn his head to the side and pull off the lower part of the gas mask, then put the gas mask back on. If necessary, the contaminated gas mask is replaced with a new one. At negative ambient temperatures, it is important to protect the valve box of the gas mask from freezing. To do this, it is covered with a cloth and systematically warmed up. In case of damage to asphyxiating agents (sarin, carbon monoxide, etc.), the victims are given artificial respiration. 4.6. First aid for a drowning person A person cannot live without oxygen for more than 5 minutes, therefore, falling under water and being there for a long time, a person can drown. The reasons for this situation can be different: cramps of the limbs when swimming in water bodies, exhaustion of strength during long swims, etc. Water, getting into the mouth and nose of the victim, fills the airways, and suffocation occurs. Therefore, assistance to a drowning person must be provided very quickly. First aid to a drowning person begins with removing him to a hard surface. We especially note that the rescuer must be a good swimmer, otherwise both the drowning person and the rescuer may drown. If the drowning man himself tries to stay on the surface of the water, he must be encouraged, a lifebuoy, a pole, an oar, the end of a rope should be thrown to him so that he can stay on the water until he is rescued. The rescuer must be without shoes and clothes, in extreme cases without outerwear. You need to swim up to the drowning man carefully, preferably from behind, so that he does not grab the rescuer by the neck or by the arms and pull him to the bottom. A drowning person is taken from behind under the armpits or by the back of the head near the ears and, holding the face above the water, they swim on their backs to the shore. You can grab a drowning person with one hand around the waist, only from behind. On the shore, you need to restore the victim’s breathing: quickly take off his clothes; free your mouth and nose from sand, dirt, silt; remove water from the lungs and stomach. Then the following steps are taken. 1. The first aid provider gets on one knee, puts the victim on the second knee with his stomach down. 2. The hand presses on the back between the shoulder blades of the victim until the foamy liquid stops flowing out of his mouth. 3. Next, mouth-to-mouth or mouth-to-nose artificial respiration is performed until (sometimes several hours) until the person begins to breathe on his own. 4. When the victim regains consciousness, he must be warmed by rubbing the body with a towel or overlaying it with heating pads. 5. To enhance cardiac activity, the victim is given strong hot tea or coffee to drink. 6. Then the victim is transported to a medical facility. If a drowning person has fallen through the ice, then it is impossible to run to help him on the ice when he is not strong enough, since the rescuer can also drown. You need to put a board or ladder on the ice and, carefully approaching, throw the end of the rope to the drowning person or stretch out a pole, oar, stick. Then, just as carefully, you need to help him get to the shore. 4.7. First aid for bites of poisonous insects, snakes and rabid animals In the summer, a person can be stung by a bee, wasp, bumblebee, snake, and in some areas - a scorpion, tarantula or other poisonous insects. The wound from such bites is small and resembles a needle prick, but when bitten, poison penetrates through it, which, depending on its strength and quantity, either acts first on the area of \uXNUMXb\uXNUMXbthe body around the bite, or immediately causes general poisoning. Single stings of bees, wasps and bumblebees are not particularly dangerous. If a sting remains in the wound, it must be carefully removed, and a lotion of ammonia with water or a cold compress from a solution of potassium permanganate or simply cold water should be put on the wound. Bites from venomous snakes are life-threatening. Usually snakes bite a person in the leg when he steps on them. Therefore, in places where snakes are found, you can not walk barefoot. When bitten by a snake, the following symptoms are observed: burning pain at the site of the bite, redness, swelling. After half an hour, the leg can almost double in volume. At the same time, signs of general poisoning appear: loss of strength, muscle weakness, dizziness, nausea, vomiting, weak pulse, and sometimes loss of consciousness. Bites of poisonous insects are very dangerous. Their venom causes not only severe pain and burning at the bite site, but sometimes general poisoning. The symptoms are reminiscent of poisoning by snake venom. In case of severe poisoning with the poison of a karakurt spider, death may occur in 1-2 days. First aid for the bite of poisonous snakes and insects is as follows. 1. Above the bitten place, it is necessary to apply a tourniquet or twist to prevent the poison from entering the rest of the body. 2. The bitten limb must be lowered and try to squeeze out the blood from the wound, in which the poison is located. You can not suck blood from the wound with your mouth, as there may be scratches or broken teeth in the mouth, through which the poison will penetrate into the blood of the one who provides assistance. You can draw blood along with poison from the wound using a medical jar, glass or glass with thick edges. To do this, in a jar (glass or glass), you need to hold a lit splinter or cotton wool on a stick for several seconds and then quickly cover the wound with it. Each victim of a snake bite and poisonous insects must be transported to a medical facility. From the bite of a rabid dog, cat, fox, wolf or other animal, a person becomes ill with rabies. The bite site usually bleeds slightly. If an arm or leg is bitten, it must be quickly lowered and try to squeeze the blood out of the wound. When bleeding, the blood should not be stopped for some time. After that, the bite site is washed with boiled water, a clean bandage is applied to the wound and the patient is immediately sent to a medical facility, where the victim is given special vaccinations that will save him from a deadly disease - rabies. It should also be remembered that rabies can be contracted not only from the bite of a rabid animal, but also in cases where its saliva gets on scratched skin or mucous membranes. 4.8. First aid for electric shock Electric shocks are dangerous to human life and health. High voltage current can cause instant loss of consciousness and lead to death. The voltage in the wires of residential premises is not so high, and if you carelessly grab a bare or poorly insulated electrical wire at home, pain and convulsive contraction of the muscles of the fingers are felt in the hand, and a small superficial burn of the upper skin can form. Such a defeat does not bring much harm to health and is not life-threatening if there is grounding in the house. If there is no grounding, then even a small current can lead to undesirable consequences. A current of a stronger voltage causes convulsive contraction of the muscles of the heart, blood vessels, and respiratory organs. In such cases, a violation of blood circulation occurs, a person may lose consciousness, while he turns pale sharply, his lips turn blue, breathing becomes barely noticeable, the pulse is palpable with difficulty. In severe cases, there may be no signs of life at all (breathing, heartbeat, pulse). There comes the so-called "imaginary death". In this case, a person can be brought back to life if he is immediately given first aid. First aid in case of electric shock should begin with the termination of the current on the victim. If a broken bare wire falls on a person, it must be immediately discarded. This can be done with any object that conducts electricity poorly (a wooden stick, a glass or plastic bottle, etc.). If an accident occurs indoors, you must immediately turn off the switch, unscrew the plugs or simply cut the wires. It should be remembered that the rescuer must take the necessary measures so that he himself does not suffer from the effects of electric current. To do this, when providing first aid, you need to wrap your hands with a non-conductive electrical cloth (rubber, silk, woolen), put on dry rubber shoes on your feet or stand on a stack of newspapers, books, a dry board. You can not take the victim by the naked parts of the body while the current continues to act on him. When removing the victim from the wire, you should protect yourself by wrapping your hands with an insulating cloth. If the victim is unconscious, he must first be brought to his senses. To do this, you need to unbutton his clothes, sprinkle water on him, open windows or doors and give him artificial respiration - until spontaneous breathing appears and consciousness returns. Sometimes artificial respiration has to be done continuously for 2-3 hours. Simultaneously with artificial respiration, the body of the victim must be rubbed and warmed with heating pads. When consciousness returns to the victim, he is put to bed, covered warmly and given a hot drink. A patient with an electric shock may have various complications, so he must be sent to the hospital. Another possible option for the impact of electric current on a person is a lightning strike, the action of which is similar to the action of an electric current of very high voltage. In some cases, the affected person instantly dies from respiratory paralysis and cardiac arrest. Red streaks appear on the skin. However, being struck by lightning often comes down to nothing more than a severe stun. In such cases, the victim loses consciousness, his skin turns pale and cold, the pulse is barely palpable, breathing is shallow, barely noticeable. Saving the life of a person struck by lightning depends on the speed of first aid. The victim should immediately start artificial respiration and continue it until he begins to breathe on his own. To prevent the effects of lightning, a number of measures must be observed during rain and thunderstorms: - it is impossible during a thunderstorm to hide from the rain under a tree, as the trees "attract" a lightning discharge to themselves; - during a thunderstorm, elevated areas should be avoided, since in these places the probability of a lightning strike is higher; - all residential and administrative premises must be equipped with lightning rods, the purpose of which is to prevent lightning from entering the building. 4.9. Complex of cardiopulmonary resuscitation. Its application and performance criteria Cardiopulmonary resuscitation - a set of measures aimed at restoring cardiac activity and respiration of the victim when they stop (clinical death). This can happen with electric shock, drowning, in some other cases, with compression or blockage of the airways. The probability of survival of the patient directly depends on the speed of resuscitation. It is most effective to use special devices for artificial ventilation of the lungs, with the help of which air is blown into the lungs. In the absence of such devices, artificial ventilation of the lungs is carried out in various ways, of which the most common is the mouth-to-mouth method. The method of artificial ventilation of the lungs "from mouth to mouth". To assist the victim, it is necessary to lay him on his back so that the airways are free for the passage of air. To do this, his head must be thrown back as much as possible. If the jaws of the victim are strongly compressed, it is necessary to push the lower jaw forward and, pressing on the chin, open the mouth, then clean the oral cavity from saliva or vomit with a napkin and proceed to artificial ventilation of the lungs: 1) put a napkin (handkerchief) in one layer on the open mouth of the victim; 2) pinch his nose; 3) take a deep breath; 4) tightly press your lips to the lips of the victim, creating tightness; 5) blow air into his mouth with force. Air is blown rhythmically 16-18 times per minute until natural breathing is restored. In case of injuries of the lower jaw, artificial ventilation of the lungs can be performed in a different way, when air is blown through the victim's nose. His mouth must be closed. Artificial ventilation of the lungs is stopped when reliable signs of death are established. Other methods of artificial lung ventilation. With extensive injuries of the maxillofacial region, artificial ventilation of the lungs using the mouth-to-mouth or mouth-to-nose methods cannot be performed, therefore, the methods of Sylvester and Kallistov are used. When performing artificial ventilation using the Sylvester method, the victim lies on his back, assisting him kneels at his head, takes both of his hands by the forearms and sharply raises them, then takes them back behind him and spreads to the sides - this is how a breath is made. Then, with a reverse movement, the victim's forearms are placed on the lower part of the chest and compress it - this is how exhalation occurs. With artificial ventilation of the lungs using the Kallistov method, the victim is laid on his stomach with arms extended forward, his head is turned to one side, putting clothes (blanket) under it. With stretcher straps or tied with two or three trouser belts, the victim is periodically (in the rhythm of breathing) raised to a height of up to 10 cm and lowered. When lifting the affected as a result of straightening his chest, inhalation occurs, when lowered due to its compression, exhalation occurs. Signs of cessation of cardiac activity and chest compressions. Signs of cardiac arrest are: - lack of pulse, heartbeats; - Lack of pupillary response to light (dilated pupils). When establishing these signs, you should immediately begin an indirect heart massage. For this: 1) the victim is laid on his back, on a hard, hard surface; 2) standing on the left side of him, put their palms one on top of the other on the region of the lower third of the sternum; 3) with energetic rhythmic pushes 50-60 times per minute, they press on the sternum, after each push, releasing their hands to allow the chest to expand. The anterior wall of the chest should be displaced to a depth of at least 3-4 cm. An indirect heart massage is performed in combination with artificial ventilation of the lungs: 4-5 pressures on the chest (on exhalation) alternate with one blowing of air into the lungs (inhalation). In this case, the victim should be assisted by two or three people. Artificial ventilation of the lungs in combination with indirect heart massage is the simplest way to resuscitate (revive) a person who is in a state of clinical death. Signs of the effectiveness of the measures taken are the appearance of a person’s spontaneous breathing, the restored complexion, the appearance of a pulse and heartbeat, as well as a return to the sick consciousness. After carrying out these activities, the patient must be provided with peace, he must be warmed, given a hot and sweet drink, and if necessary, apply tonics. When carrying out artificial ventilation of the lungs and indirect heart massage, the elderly should remember that the bones at this age are more fragile, so the movements should be gentle. For small children, indirect massage is performed by pressing in the sternum area not with the palms, but with a finger. 4.10. Provision of medical assistance in case of natural disasters A natural disaster is an emergency situation in which human casualties and material losses are possible. There are natural emergencies (hurricanes, earthquakes, floods, etc.) and anthropogenic (bomb explosions, accidents at enterprises) origin. Sudden natural disasters and accidents require urgent medical assistance to the affected population. Of great importance are the timely provision of first aid directly at the site of the lesion (self-help and mutual assistance) and the evacuation of victims from the outbreak to medical institutions. The main type of injury in natural disasters is trauma, accompanied by life-threatening bleeding. Therefore, it is first necessary to take measures to stop the bleeding, and then provide symptomatic medical care to the victims. The content of measures to provide medical care to the population depends on the type of natural disaster, accident. So, during earthquakes, this is the extraction of victims from the rubble, the provision of medical care to them, depending on the nature of the injury. During floods, the first priority is to remove the victims from the water, warm them, stimulate cardiac and respiratory activity. On the territory affected by a tornado or hurricane, it is important to quickly carry out medical sorting of the affected, to provide assistance first of all to those most in need. The victims of snow drifts and landslides are warmed after being removed from under the snow, then they are given the necessary assistance. In the centers of fires, first of all, it is necessary to extinguish burning clothes on the victims, to apply sterile dressings to the burnt surface. If people are affected by carbon monoxide, immediately remove them from areas of intense smoke. In the event of an accident at a nuclear power plant, it is necessary to organize radiation reconnaissance, which will make it possible to determine the levels of radioactive contamination of the territory. Food, food raw materials, water should be subjected to radiation control. Providing assistance to the victims. In the event of a lesion, the victims are provided with the following types of assistance: - first aid; - first medical aid; - Qualified and specialized medical care. First aid is provided to the injured directly at the site of injury by sanitary teams and sanitary posts, other units of the Russian Emergencies Ministry working in the outbreak, as well as in self- and mutual assistance. Its main task is to save the life of the affected person and prevent possible complications. Removal of the injured to the places of loading onto transport is carried out by the porters of the rescue units. The first medical aid to the injured is provided by medical units, medical units of military units and health care facilities that have been preserved in the outbreak. All these formations constitute the first stage of medical and evacuation support for the affected population. The tasks of first medical aid are to maintain the vital activity of the affected organism, prevent complications and prepare it for evacuation. Qualified and specialized medical care for the injured is provided in medical institutions. 4.11. Medical care for radiation contamination When providing first aid to victims of radiation contamination, it must be taken into account that in the contaminated area it is impossible to eat food, water from contaminated sources, or touch objects contaminated with radioactive substances. Therefore, first of all, it is necessary to determine the procedure for preparing food and purifying water in contaminated areas (or organizing delivery from uncontaminated sources), taking into account the level of contamination of the area and the current situation. First medical aid to victims of radiation contamination should be provided under conditions of maximum reduction of harmful effects. To do this, the victims are transported to an uninfected area or to special shelters. Initially, it is necessary to take certain actions to save the life of the victim. First of all, it is necessary to organize sanitization and partial decontamination of his clothes and shoes to prevent harmful effects on the skin and mucous membranes. To do this, they wash with water and wipe the exposed skin of the victim with wet swabs, wash their eyes, and rinse their mouth. When decontaminating clothes and shoes, it is necessary to use personal protective equipment to prevent the harmful effects of radioactive substances on the victim. It is also necessary to prevent contact of contaminated dust with other people. If necessary, gastric lavage of the victim is carried out, absorbent agents (activated charcoal, etc.) are used. Medical prophylaxis of radiation injuries is carried out with radioprotective agents available in an individual first-aid kit. The individual first-aid kit (AI-2) contains a set of medical supplies intended for personal prevention of injuries by radioactive, poisonous substances and bacterial agents. In case of radiation contamination, the following drugs contained in AI-2 are used: - I nest - a syringe tube with an analgesic; - III nest - antibacterial agent No. 2 (in an oblong pencil case), 15 tablets in total, which are taken after radiation exposure for gastrointestinal disorders: 7 tablets per dose on the first day and 4 tablets per dose daily for the next two days. The drug is taken to prevent infectious complications that may occur due to the weakening of the protective properties of the irradiated organism; - IV nest - radioprotective agent No. 1 (pink cases with a white lid), 12 tablets in total. Take 6 tablets at the same time 30-60 minutes before the start of irradiation according to the civil defense alert signal in order to prevent radiation damage; then 6 tablets after 4-5 hours while in the territory contaminated with radioactive substances; - VI nest - radioprotective agent No. 2 (white pencil case), 10 tablets in total. Take 1 tablet daily for 10 days when eating contaminated foods; - VII nest - antiemetic (blue pencil case), 5 tablets in total. Use 1 tablet for contusions and primary radiation reaction to prevent vomiting. For children under the age of 8 years, take one fourth of the indicated dose, for children from 8 to 15 years old - half the dose. The distribution of medications and instructions for their use are attached to an individual first-aid kit. Topic 5. First aid for injuries 5.1. First aid for bleeding Bleeding is the release of blood from blood vessels as a result of damage to them. Bleeding is the most dangerous complication of wounds, directly threatening the life of the victim. Types of bleeding. Distinguish between primary bleeding, which is a consequence of vascular damage, and secondary, which occurs after a while. According to the type of damaged vessel, bleeding is divided into: - arterial; - venous; - capillaries; - parenchymal. The most dangerous is arterial bleeding, as a result of which the victim loses a huge amount of blood. Characteristic signs of arterial bleeding are: a) scarlet color of blood; b) outflow of blood in a pulsating jet. Venous bleeding is characterized by a slow outflow of blood, while the blood has a dark purple color. Capillary bleeding occurs when small vessels of the skin, tissue and muscles are damaged. As a rule, capillary bleeding stops on its own, but in patients with bleeding disorders, it can lead to significant blood loss. Parenchymal bleeding occurs as a result of damage to internal organs: liver, spleen, kidneys, lungs. The danger of this type of bleeding is that it is difficult to diagnose and hard to stop. Bleeding is also divided into external and internal. With external bleeding, blood flows out through wounds in the skin, mucous membranes or cavities. With internal bleeding, blood is poured into the tissue, organ or cavity, this process is called hemorrhage. When a tissue bleeds, blood soaks it, forming a swelling called an infiltrate, or bruising. If the blood impregnates the tissues unevenly and, as a result of their expansion, a limited cavity filled with blood is formed, it is called a hematoma. Ways to stop bleeding. Depending on the type of bleeding and the means available in the provision of first aid, a temporary or final stop of bleeding is carried out. A temporary stop of the most life-threatening external arterial bleeding is carried out using the following actions: 1) applying a tourniquet or twist above the wound; 2) fixation of the limb in the position of maximum flexion; 3) by pressing the artery above the site of its injury with the fingers. Finger pressing of the arteries is the most affordable and fastest way to temporarily stop arterial bleeding. The arteries are compressed where they pass near or over the bone. The carotid artery is pressed below the wound. The temporal artery is pressed with the thumb against the temporal bone in front of the auricle when bleeding from head wounds. The mandibular artery is pressed with the thumb to the angle of the lower jaw when bleeding from wounds located on the face. The common carotid artery is pressed against the vertebrae on the anterior surface of the neck to the side of the larynx. Then a pressure bandage is applied, under which a dense roller of bandage, napkins or cotton wool is placed on the damaged artery. The subclavian artery is pressed against the first rib in the fossa above the clavicle with a bleeding wound in the shoulder joint, upper third of the shoulder, or in the armpit. When the wound is located in the region of the middle or lower third of the shoulder, the axillary artery is pressed against the head of the humerus, for which, leaning on the upper surface of the shoulder joint with the thumb, the artery is squeezed with the rest. The brachial artery is pressed against the humerus from the inside of the shoulder to the side of the biceps muscle. The radial artery is pressed against the underlying bone in the wrist at the thumb in case of damage to the arteries of the hand. The femoral artery is pressed in the groin against the pubic bone by pressing with a clenched fist (this is done when the femoral artery is damaged in the middle and lower thirds). In case of arterial bleeding from a wound located in the region of the lower leg or foot, the popliteal artery is pressed in the region of the popliteal fossa, for which the thumbs are placed on the front surface of the knee joint, and the rest are pressed against the artery to the bone. On the foot, you can press the arteries of the rear of the foot to the underlying bones, then apply a pressure bandage on the foot, and in case of severe arterial bleeding, a tourniquet on the shin area. After performing finger pressing of the vessel, it is necessary to quickly apply, where possible, a tourniquet or twist and a sterile dressing on the wound. The imposition of a tourniquet (twisting) is the main way to temporarily stop bleeding in case of damage to large arterial vessels of the extremities. The tourniquet is applied to the thigh, lower leg, shoulder and forearm above the site of bleeding, closer to the wound, on clothing or a soft bandage lining so as not to pinch the skin. Apply a tourniquet with enough force to stop the bleeding. With too much compression of the tissues, the nerve trunks of the limb are injured to a greater extent. If the tourniquet is not applied tightly enough, arterial bleeding increases, since only the veins are compressed, through which the outflow of blood from the limb is carried out. The correct application of the tourniquet is controlled by the absence of a pulse in the peripheral vessel. The time of applying the tourniquet, indicating the date, hour and minute, is noted in a note that is placed under the tourniquet so that it is clearly visible. The limb, tied with a tourniquet, is warmly covered, especially in winter, but not covered with heating pads. The victim is given an anesthetic. The tourniquet on the limb can not be kept for more than 1,5-2 hours in order to avoid its necrosis below the place of application of the tourniquet. In cases where 2 hours have passed since the tourniquet was applied, it is necessary to press the artery with a finger, slowly, under pulse control, loosen the tourniquet for 5-10 minutes and then apply it again a little higher than the previous place. This temporary removal of the tourniquet is repeated every hour. In the absence of a tourniquet, arterial bleeding can be stopped by applying a twist or by maximum flexion of the limb and its fixation in this position. To stop bleeding with a twist, use a rope, a twisted scarf, strips of fabric. An impromptu tourniquet can be a trouser belt, which is folded in the form of a double loop, put on a limb and tightened. A temporary stop of external venous and capillary bleeding is carried out by applying a pressure sterile dressing to the wound. To do this, the wound is closed with sterile napkins or a bandage in 3-4 layers, absorbent cotton wool is placed on top and tightly fixed with a bandage. In this case, the damaged part of the body is lifted up relative to the body. In some cases, a temporary stop of venous and capillary bleeding can also become a final stop. The final stop of arterial, and in some cases, venous bleeding is carried out during surgical treatment of wounds. In case of internal bleeding, an ice pack is placed on the intended bleeding area, the affected person is immediately taken to a medical facility. 5.2. Bandage. Bandaging rules A bandage is one of the ways to protect wounds from external influences. To apply bandages, gauze bandages of various lengths and widths are used. When applying bandage dressings, you must follow some rules. Let's list them. 1. In order to prevent fatigue of the patient and provide him with the opportunity to change his posture, the dressing should be applied in a position convenient for the victim. 2. It is necessary to immobilize the part of the body on which the bandage is applied, since the movement can change the step of the bandage and thereby disrupt the correct application of the bandage. 3. When applying a bandage, the position of the bandaged part of the body should correspond to the further posture of the patient. 4. The bandager should be facing the patient in order to see his emotions. This will cause the patient minimal pain when applying a bandage. 5. Bandaging occurs from the bottom (from the periphery) up (towards the center). 6. Two hands are involved in the bandaging process: the right hand deploys the head of the bandage, and the left hand holds the bandage and straightens the bandage. 7. When bandaging, one of the main types of dressings is taken as a basis (see below), which can be modified as necessary. 8. Evenly pulling, the bandage is deployed in one direction, more often from left to right in relation to the bandage (clockwise). 9. Start bandaging with a circular, fixing course of the bandage. Each subsequent turn of the bandage should cover the previous one by one second or two thirds of its width. After the end of the bandage, it is important to check whether the bandage is applied correctly: whether it covers the diseased part of the body sufficiently, does not stray, etc. It is imperative to find out from the victim whether the bandage is pressing, whether it is applied too tightly, since in the latter case the limbs are bandages may soon appear blue and edematous. The end of the bandage must be strengthened on the healthy side of the patient's body, in a place where the knot will not bother him. The end of the bandage torn along the length is tied around the bandaged part. You can fasten the end of the bandage by sewing or fastening it with a pin to the bandage, or by tearing the bandage a little, strengthen it to one of the adjacent passages going in the other direction. There are the following main types of bandage bandages: - circular (circular) bandage - one of the simplest types of bandages. The end of the bandage is applied to the bandaged part of the body, holding it with the left hand, and the bandage is unwound with the right. The turns of the bandage should lie one on top of the other, covering it entirely. The bandage is used for application in the wrist area, on the lower third of the lower leg, forehead, neck and abdomen; - the spiral bandage is more difficult to use. They begin to apply it in the same way as the previous one (from 2-3 circular moves), after which the bandage moves in an oblique direction, while blocking the previous move by two-thirds. Bandaging occurs from the bottom up or from the top down. When applying bandages to limbs, the thickness of which varies, the course of the bandage may not fit snugly, when it is applied, kinks are allowed. Bends are made along one or two vertical lines outside the damaged area every two turns of the bandage. In the kink, the bandage is led obliquely. With the thumb of the left hand, hold its lower edge, roll out the head of the bandage a little and bend it towards you so that its upper edge becomes the lower one, and vice versa. A simple spiral bandage is then applied, flexing as needed; - cruciform (eight-shaped) bandage got its name due to the shape and course of the bandage: the bandage moves along the figure-eight. This type of dressing is used for bandaging the head and neck. When it is applied in circular motions, the bandage is strengthened around the head, then above and behind the left ear it is lowered in an oblique direction down to the neck. Next, the bandage is directed along the right side of the neck, bypassing it in front and lifting along the back of the neck to the head. Having circled the head in front, the bandage is held obliquely over the left ear. In the future, bandaging is continued, alternating the last two moves, and fixed around the head; - converging and diverging (turtle) dressing is very well suited for use in the area of the joints. At the knee joint, a diverging bandage begins with a circular bandage through the most superior part of the patella, then similar moves go below and above the previous one. When bandaging, the bandage crosses in the popliteal cavity, diverges on both sides of the first turn and, covering half of one turn with the other, more and more closes the joint area. This bandage is fixed around the thigh. The convergent dressing begins with circular passages located above and below the joint and crossing in the popliteal cavity. The next moves are the same as the previous ones, approaching each other and to the most convex part of the joint, until the entire damaged area is closed. 5.3. First aid for bruises, sprains, dislocations and fractures Bruises, sprains, dislocations and fractures are classified as injuries. There are many causes of injury, including falls, accidents, etc. A bruise is an injury to soft tissues, as a result of which capillaries can be damaged. A bruise causes pain, especially when moving, it swells. A bruise may occur on the bruised area - a sign of internal capillary bleeding. The first aid for a bruise is its local cooling by applying cold compresses, lotions, an ice pack. Under the influence of cold, blood vessels narrow and internal bleeding decreases. You can also apply a pressure bandage to the site of injury. With severe bruises, the damaged area is provided with rest to reduce pain. The most dangerous bruises include bruises of the head, chest and abdomen, as this can damage the brain and other vital organs. With such bruises, the victim must be taken to a medical facility. With a head injury, signs of a concussion may appear: nausea, vomiting, dizziness, and sometimes loss of consciousness. To alleviate the condition of the victim, cold is applied to his head, they provide peace. In case of bruises of the chest, the injured person is placed in a semi-sitting position, and when hemoptysis appears, the site of the bruise is cooled. In case of abdominal bruises, the patient is laid down with ice or a vessel of cold water applied to the abdomen. Sprain is a joint injury in which the ligaments cannot withstand tension and are stretched or torn. Symptoms of stretching are sharp pain, swelling of the joint, the appearance of bruising. A person who has received a sprain is provided with peace, immobilizes the affected joint. A pressure bandage is applied to the joint and cooled for several hours by applying ice or a vessel of cold water. After a few days, warm compresses or baths are used to speed up the disappearance of bruises. A dislocation is an injury in which a bone comes out of a joint. A dislocation is the result of stretching or rupture of the articular capsule. With a dislocation, the joint does not move, it swells and deforms. To alleviate the condition of the patient of the affected limb, it is necessary to create complete rest. This is done by applying a bandage or splint. Then the victim is transported to a medical facility. The dislocation is most easily reduced in the first hours after the injury. Do not try to straighten a dislocated bone on your own. Fractures occur with sudden movements, blows, falls from a height. The main signs of fractures are pain, swelling, bruising, abnormal mobility at the fracture site, and lack of mobility in the limb. With fractures of the limbs, they are shortened and curved at the fracture site. With fractures of the ribs, breathing difficulties appear, when feeling at the fracture site, a crunch of fragments of the rib is heard. With fractures of the pelvis and spine, disorders of urination and motor functions appear. Fractures of the skull bones are accompanied by ear bleeding. There are open and closed fractures. With closed fractures, the integrity of the skin is not violated, with open fractures, there is a wound at the fracture site. Open fractures are fraught with infection in the wound, which can significantly extend the duration of treatment. Open fractures are determined by the presence of fragments visible from the wound. Fractures are without displacement and with displacement of bone fragments. Fractures in which only two fragments are formed are called single, fractures with the formation of several fragments are called multiple. Fractures resulting from the impact of a bullet or projectile fragment are called gunshot. With gunshot fractures, fragmentation of the bone into large or small fragments, crushing of soft tissues in the area of the fracture, or detachment of a part of the limb are observed. With a severe fracture, the victim goes into shock. Especially often shock develops in open fractures with arterial bleeding. First aid for fractures includes the following measures: 1) stop bleeding (especially arterial); 2) prevention of traumatic shock; 3) applying a sterile or aseptic dressing; 4) ensuring the immobility of the limb with special or improvised means; 5) anesthesia; 6) transportation to medical institutions. The immobility of the limb is ensured by the imposition of special splints or improvised means. To do this, two nearby joints are fixed (above and below the fracture site). Tires can be metal ladder and mesh; plywood; special (Diterichs wooden tire). The use of ladder and mesh tires is as follows. First, one or more tires of the desired length are selected. Next, the tire is modeled on the underlying part of the body (not on the victim). A splint is placed over clothing. After application, the tire is fixed by bandaging it to the limb. Plywood splints are light, they can be of various sizes, but they cannot be modeled; when used, cotton is placed under them and bandaged to the limb. As improvised means for applying a tire, strips of plywood, sticks, thin boards, and household items can be used. First aid for fractures should be performed with care to avoid displacement of bones and damage to the skin. In case of fractures of the bones of the head, special care must be taken. After examining the victim, it is necessary to put him on a stretcher with his stomach down, put a soft bedding with a recess under his face, or use a cotton-gauze circle for this purpose. Damaged upper and lower jaws are fixed with a sling bandage, while the head is turned to the side to avoid retraction of the tongue, which can close the windpipe and cause suffocation. In case of clavicle fractures, two cotton-gauze rings are applied to the shoulder girdle area, which are tied on the back. The hand is hung on a scarf. In case of rib fractures, a tight bandage is applied to the chest in the state of exhalation or the chest is pulled together with a towel and sewn up. In case of a fracture of the bones of the forearm, the arm must be bent at the elbow joint at a right angle, turned with the palm to the chest and fixed in this position with a splint or with the help of improvised means. The tire is applied from the base of the fingers to the upper third of the shoulder. The hand is hung on a scarf. In case of injury of the shoulder joint and fracture of the humerus, a ladder splint or improvised means are used for immobilization. The hand is hung on a scarf. In the absence of a tire or improvised means, the injured arm is hung on a scarf and bandaged to the body. In case of fractures of the bones of the foot and damage to the ankle joint, a ladder splint or improvised means are used for immobilization. The tire is first bent so that it can be placed on the sole of the foot and the back of the lower leg up to its upper third. A recess is made for the heel, in which cotton wool is placed so that there is no pressure on the heel bone. The splint is then applied to the limb and secured. The foot should be fixed at a right angle to the lower leg. In case of a fracture of the bones of the lower leg, immobilization is carried out in the same way as in case of damage to the ankle joint. Provides immobility in two joints: ankle and knee. In the absence of the necessary means, the injured limb is bandaged to a healthy one. Fractures of the femur are a severe injury in which bleeding and traumatic shock often occur. Tires or improvised means in this case are superimposed on the lateral surface of the thigh: one on the inside, the other on the outside. Then the tires are bandaged to the limb and torso. In case of fractures of the pelvic bones, the victim is laid on his back, on a hard surface, a roller is placed under the knee joint so that the legs are half-bent and slightly apart. Topic 6. Medicines and their use 6.1. Forms of drugs. Recipe A prescription is a written instruction from a doctor to a pharmacist about the release or preparation of medicines for a patient with instructions for their use. A prescription is a legal document that only a doctor can write. The recipe is filled according to a certain scheme using special characters in Latin. The prescription must contain the name of the patient, the signature of the doctor, the date the prescription was filled. In addition, the prescription must contain the following information: - stamp of the medical institution; - an indication of whether this recipe is for children or adults; - date of preparation of the prescription (year, month and day); - surname and initials of the patient, his age (indicated before 18 and after 60 years); - surname and initials of the doctor; - the main part of the prescription - indications of the medicinal substances prescribed to the patient (in the genitive case), as well as the amount of the drug; - an indication to the patient about the procedure for taking the medicine (quantity, frequency of administration, connection with food intake, etc.); - doctor's signature; - personal seal of the doctor. If necessary, the name of the drugs can be abbreviated, but the meaning of the written should be preserved. Recipes consisting of one medicinal substance are called simple, those of two or more substances are called complex. In complex prescriptions, the following order of recording medicines is used: 1) the main medicine; 2) adjuvants (enhancing or weakening the effect of the main drug), substances that improve the taste or smell of the drug or reduce its irritating properties (corrective); 3) formative substances (preparations that give the drug a certain consistency). Doses of drugs. For the correct action of drugs, they must be used in an adequate dose. A dose is the amount of a drug that is injected into the body and has a certain effect on it. The strength of the drug is determined by the dose and the order of its administration. According to the mode of action, the dose can be minimal, therapeutic, toxic and lethal. The minimum effective (threshold) dose is the minimum possible amount of a drug that can have a therapeutic effect. The therapeutic dose is the amount of the drug that exceeds the minimum effective dose, which gives the optimal therapeutic effect and does not have a negative effect on the human body. Most often in medical practice, the average therapeutic dose is used, which in most cases gives the optimal therapeutic effect without pathological effects. The minimum toxic dose is the smallest amount of drugs that can cause a toxic effect on the body. The minimum lethal (lethal) dose is the amount of a drug substance that can lead to death. According to the amount of application, the dose can be single (single) and daily. For poisonous and potent substances indicate the maximum single and daily doses for adults and children in accordance with the age of the patient. In the event of an overdose of substances or when replacing one drug with another, poisoning may occur. Per unit of weight in the recipe, 1 g is taken - 1,0; per unit volume - 1 ml. When taking medications, it is important to consider that in 1 tbsp. l. contains 15 g of water, 1 tsp. - 5 g; in 1 g of water - 20 drops; in 1 g of alcohol - 47-65 drops. medicinal forms. Medicines are used in various dosage forms. The main dosage forms include: tablets, dragees, powders, suppositories, medicines, etc. Dosage forms can be solid, liquid, soft. 1. Solid dosage forms include powders, tablets, pills, dragees, granules and collections. Powders are bulk solid dosage forms for internal and external use. Powders are simple (consisting of one substance) and complex (consisting of several ingredients), divided into separate doses and undivided. According to the quality of grinding, powders are differentiated into large (needing dissolution), small (used inside) and the smallest (for powders). Undivided powders are suitable for external use (powders) and are prescribed in amounts from 5 to 100 g. Their use consists in applying to wounds and mucous membranes. These powders do not irritate body tissues and have a large adsorbing surface. When using such powders as powders, they add forming substances - starch, talc, white clay, etc. Inside, powders are taken divided or dosed, undivided or not dosed. Non-poisonous substances are prescribed undivided, which the patient can dose himself as directed by the doctor (laxative salts, magnesium oxide, etc.). Powders for internal use are most often divided and dispensed in paper capsules. Sugar is usually used as a formative agent. Volatile and hygroscopic powders, as a rule, come in capsules made of waxed or waxed paper, which is indicated in the recipe. Capsules are special shells of dosed powdered, granular, pasty or liquid medicinal substances intended for internal use. Capsules are resorted to if drugs have an unpleasant taste (levomycetin, etc.), an irritating effect on the mucous membranes of the esophagus (eufillin, etc.) or an unpleasant odor. Capsules can be gelatinous and starch. Tablets - a solid dosage form obtained by pressing certain medicines. The advantages of tablets are ease of administration, dosage accuracy, relatively long shelf life and low cost. Tablets for external use must first be dissolved. Tablets containing poisonous substances are colored so that they can be easily distinguished from other tablets (for example, tablets containing sublimate are colored red). There may be tablets for subcutaneous implantation and for the preparation of sterile solutions. They are prepared under aseptic conditions and do not contain fillers. Tablets can be multi-layered: one layer is absorbed quickly after administration, and the other slowly, resulting in the desired effect of the drug. To mask the taste of the tablets and protect their contents from various external influences, the tablets are coated with shells. Dragee is a solid dosage form for internal use, obtained as a result of multiple layers of medicinal and excipients on sugar granules. This dosage form is easy to swallow and the method of administration is similar to tablets. In the form of dragees, pharmaceutical plants produce chlorpromazine, diazolin, dikolin, etc. Medicinal collections are usually called mixtures of several types of crushed or whole herbal medicinal raw materials, sometimes with an admixture of salts and other additions. This form is used for external and internal use. Medicinal collections are produced in sachets, boxes, bottles of 50-200 g. Rinses and lotions are prepared from medicinal collections by brewing with boiling water and infusion, infusions for internal use (choleretic tea); make inhalations, burning medicinal collections and inhaling smoke during an asthma attack (anti-asthma collection), etc. 2. Liquid dosage forms include solutions, infusions, decoctions, tinctures, liquid extracts, mucus, emulsions and potions. A solution is a transparent dosage form consisting of medicinal substances completely dissolved in a solvent. As a solvent, distilled water, alcohol, oil, isotonic sodium chloride solution, glycerin and other liquids are used. Solutions are widely used for injections. There are solutions for internal and external use. Solutions intended for internal use are dosed with table, dessert, teaspoons and drops. Drops - one of the varieties of solutions. Drops of various solutions have different volumes and masses, depending on the physical properties of the drops (density, surface tension, viscosity), the outer and inner diameters of the pipette outlet, air temperature, etc. The concentration of the solution is of primary importance, since it must have a certain effect on tissues (astringent, cauterizing, anesthetic, antibacterial or other types of action). The dose of the drug is not taken into account, since solutions for external use are practically not absorbed into the blood. Drops are dosed on the basis that 1 ml of distilled water contains 20 drops, and 1 g of 90% alcohol contains 60 drops. When dispensing, the concentration of the solution is reflected in weight-volume units: the amount of the solute is in weight units (g), and the amount of solution is in volume units (ml). Among the drops for external use, there are eye (prepared under aseptic conditions), ear, nasal and dental drops. When preparing medicines, it is mandatory to comply with the rules of asepsis (taking care of the cleanliness of the room, air, disinfection of dishes, tools, etc.). When using solutions as injections, they must be sterilized. Sterilization is the removal of medicinal substances, utensils, auxiliary materials, instruments and apparatus from viable microbes and spores. Sterilization of solutions is carried out by several methods: - autoclaving - bringing to a temperature of 110 ° C and a pressure of 1,5 atmospheres for 60 minutes or up to 120 ° C and a pressure of 2 atmospheres for 15-20 minutes. This method is used for thermostable drugs. Heating with flowing steam is also used (at 100 °C for 30-60 minutes); - tyndalization - heating up to 60-65 °C for five days for 1 hour daily or up to 70-80 °C for three days for 1 hour a day. In the intervals between heating, the solutions are stored in a thermostat at a temperature of 37-25 °C. This method is used for thermolabile drugs; - bacterial filtration - carried out under aseptic conditions in special boxes (rooms); - the addition of an antiseptic (phenol, tricresol, etc.) - is used if the drug does not withstand tyndalization, and aseptic preparation is impossible. For long-term storage of injection solutions, stabilizers are added to them - substances that increase the safety of drugs (hydrochloric acid solution, sodium bicarbonate, etc.). The main forms of dispensing solutions for injections are ampoule and vial. The use of injections has a number of advantages. First of all, they include a quick and strong effect of the drug, since it does not enter the gastrointestinal tract and liver and is not subjected to the destructive action of enzymes. Injections can be used if the victim is unconscious. In addition, this method allows you to make the dosage of drugs as accurate as possible. Ampoules are used to relieve pain (morphine, omnopon, promedol), increase blood pressure (adrenaline, etc.), improve breathing (cytiton, lubelin), and relieve arousal (chlorpromazine, scopolamine, etc.). Sometimes ampoules or vials contain the substance in dry form, and solutions are prepared before use, as they are unstable (novarsenol, penicillin, etc.). Water (infusions, decoctions) and alcohol (tinctures, extracts) extracts are prepared from herbal medicinal raw materials. Aqueous extracts from plant materials intended for internal and external use are called infusions and decoctions. For their dosage use tablespoons. An infusion is an extract from plants. Infusions are prepared from dried, most often loose, parts of plants (leaves, flowers, herbs). To prepare the infusion, parts of the plants must be crushed, poured with water and heated in a water bath for 15 minutes, cooled for 45 minutes and filtered. A decoction is an aqueous extract from the dense parts of plants (bark, roots, rhizomes, etc.). The broth for preparation is heated for 30 minutes, then cooled for 10 minutes and filtered while hot. Infusions and decoctions are prescribed for no more than three days. Tinctures are called alcohol-water or alcohol-ether extracts from plants, liquid extracts - a concentrated extract from plant materials. Tinctures and extracts are dosed in drops. Extracts can be liquid, solid and thick, therefore, when prescribing them, the consistency must be indicated. These dosage forms can be stored for years. Potions are liquid dosage forms for internal and external use, which are a mixture of certain medicinal substances dissolved in water or in suspension in it. The medicine is dosed with spoons. When using mixtures, it is important to take into account the incompatibility conditions of some drugs (for example, salicylic sodium, together with an acid reaction syrup, will give a white precipitate). 3. Among the soft dosage forms, ointments, liniments, pastes, suppositories, plasters can be distinguished. Ointment is a dosage form used externally. The composition of the ointment includes the base and active ingredients, evenly distributed in it. The ointment base is animal fats, hydrogenated fats, petroleum jelly, lanolin, yellow wax, white wax, etc. Vaseline is the cheapest and non-perishable ointment base made from petroleum. The ointment base can be polymers (polyethylene oxides). Distinguish polymers liquid, ointment and solid. The polymers are water-soluble, stable during storage, do not irritate the skin, are an aggressive environment for most microorganisms, and are chemically and biologically indifferent. Liniment (liquid ointment) is a dosage form for external use, which has the consistency of a thick liquid or gelatinous mass, melting at body temperature. This dosage form is used for rubbing or rubbing into the skin. The basis for the liniment are vegetable (sunflower, olive, peach, linseed, etc.) oils, cod fat, glycerin, etc. Pastes are ointments, which include powdered substances (about 25%), which are made by mixing powdered ingredients with a molten base. If there is not enough powdered medicinal substance, then to create a thick consistency, indifferent powders are added to the paste: starch, talc, etc. Pastes have a thick consistency, stay longer on the affected surface, have adsorbing and drying properties, which favorably differ from ointments. Patches are called dosage form for external use, they are made at pharmaceutical factories. The patches stick to the skin at body temperature. This property of the patches is used to fix the dressings, bring the edges of the wounds together and prevent external influences on the affected and unprotected areas of the skin. Liquid patches (skin adhesives) are liquids that leave a film after the solvent has evaporated. This type of plaster includes a medicinal substance and a base (fatty acid salts, fats, wax, paraffin, resins, etc.). Plasters can be of various widths and lengths. Suppositories are solid under normal conditions and melt or dissolve at body temperature dosage forms. Suppositories are used for injection into cavities (rectum, vagina, urethra, fistulous passages, etc.) for local action on the mucous membrane. Suppositories are produced in various forms: rectal, vaginal and sticks. For the design of suppositories, substances are used that have a solid consistency at room temperature and melt at body temperature, do not have irritating properties, are poorly absorbed through the mucous membranes (for example, cocoa butter and products replacing it: vegetable, animal and hydrogenated fats, alloys of hydrogenated fats with wax , spermaceti, as well as various mixtures). Rectal suppositories are made in the form of a cone or a cylinder with a pointed end, inserted into the rectum and prepared with a mass of 1,1 to 4 g. Vaginal suppositories are found in spherical, ovoid or flat shapes; inserted into the vagina; their weight is from 1,5 to 6 g. The sticks are in the form of a cylinder with a pointed end, designed to be inserted into the canals (urethra, cervix, fistulas, wound passages). Suppositories can be used not only for local, but also for general action. The general effect of suppositories is due to their absorption into the blood upon contact with the mucous membranes. For general action, rectal suppositories are prescribed for diseases of the stomach, esophagus, liver, with the unconscious state of the patient, the introduction of unpleasant substances that cause vomiting, i.e., in cases where it is impossible to obtain an effect when the drug is administered orally. In the form of vaginal suppositories, substances of predominantly local action are used - disinfectants, anti-inflammatory, anesthetics, etc. They are prescribed either with an indication of a single dosage of all ingredients, or with an indication of the dose for the entire number of suppositories, that is, a single dose is multiplied by the number of prescribed suppositories. 6.2. The effect of drugs on the body The effect of medicinal substances on the body may be different depending on the route of their entry, duration of use, dose, age, state of the body, and other factors. Drugs have a local effect, the effect of which is manifested at the site of application without absorption into the blood and spread throughout the body (anesthetic, astringent, cauterizing, irritant, etc.). The action of any medicinal substance cannot be absolutely local: there are always some reflex reactions of the body, and therefore this concept is relative. Resorptive (general) is such an action in which absorption (resorption) of substances into the blood occurs. Resorptive action can be exciting or depressing, etc. The main effect of the medicinal product is the action, the manifestation of which was primarily expected when it was used. At the same time, the medicine can have side effects on the human body. It can be either neutral or negative. Actions considered as side effects in one disease may become central to the treatment of another disease. For example, the inhibitory effect of diphenhydramine on the central nervous system is a side effect in the treatment of allergic diseases. At the same time, taking into account this effect, diphenhydramine is used as a hypnotic for insomnia. Direct (primary) is the action, the therapeutic effect of which is associated with the direct influence of the medicinal substance on the diseased organ or tissue. For example, cardiac glycosides, due to their direct action on the heart muscle, improve the activity of the heart. Indirect (mediated) reactions are the body's response to the primary changes caused by the drug. So, cardiac glycosides, not being diuretics, by improving blood circulation and reducing edema in heart patients, lead to increased diuresis. The diuretic (diuretic) effect of cardiac glycosides in this case is indirect, or secondary. A reflex action is an effect that is realized as a result of a reflex that has arisen when a medicinal substance is exposed to sensitive nerve endings of the skin, mucous membranes, vascular walls, for example, dilation of the heart vessels during irritation of the cold receptors of the oral cavity caused by validol, menthol. If changes in the body caused by the action of a medicinal substance pass without a trace after a while, then its action is called reversible (for example, narcotic, hypnotic, anesthetic, etc.). Otherwise, the action is irreversible (for example, cauterizing action). If the effect of the drug is limited to the effect on any organ, tissue elements, function, it is called selective (for example, the effect of apomorphine on the vomiting center, morphine on pain centers, cocaine on sensitive receptors, etc.). Etiotropic is an action that is selectively aimed at eliminating the cause of the disease. For example, sulfonamides stop the development of pathogens of coccal infections (erysipelas, tonsillitis, pneumonia, etc.); arsenic acts on the causative agent of syphilis, akrikhin - on the causative agent of malaria, etc.; iodine preparations for goiter that has arisen in the focus, where the water contains little of this element, make up for its deficiency; antidotes are used for poisoning, etc. Symptomatic action, in contrast to the etiotropic one, does not eliminate the causes of the disease, but only removes or weakens the symptoms accompanying it, which does not significantly affect the course of the disease: for example, hypnotics are used for insomnia, laxatives for constipation, antipyretics - at high temperature. Particularly hypersensitivity of individuals to certain drugs (antibiotics, sulfonamides, acetylsalicylic acid, iodine) is called drug idiosyncrasy. Most often, it is expressed by the appearance of a rash and edema in response to the introduction of a substance. The phenomena of cumulation, addiction and addiction to drugs. Various phenomena can be associated with the use of medications. So, with repeated or prolonged use of the drug, the phenomenon of cumulation occurs, that is, an increase in its action. Cumulation can be the result of accumulation of a substance (material, chemical cumulation) or accumulation of dysfunctions (physiological, functional cumulation). With prolonged and frequent use of the drug, addiction can occur - a decrease in the body's response to repeated use of the drug in the same doses. Habituation is manifested in the fact that the desired therapeutic effect is not achieved with the introduction of the same dose of the drug, in this case, you should increase the dose of the drug or replace it with another drug of a similar effect. With the use of drugs that act on the central nervous system (psychotropic drugs), the phenomenon of addiction is associated, which is a drug dependence on a certain drug caused by its systematic use. Addiction is accompanied by a desire to increase the dose of the drug when taken again. This is due to the fact that with the introduction of such drugs, a state of euphoria can occur, characterized by a decrease in unpleasant sensations and leading to a temporary improvement in mood. Addiction to such substances is otherwise called drug addiction. Drug addiction can cause sleeping pills, narcotic, stimulants and painkillers. Accordingly, according to the name of the drug to which addiction has appeared, drug addictions are called alcoholism, ether addiction, morphinism, cocainism, etc. Drug addicts are seriously ill people who need qualified treatment from a specialist doctor. The combination of drugs (co-administration) can lead to a mutual enhancement of the effect (synergism) or a mutual weakening of it (antagonism). In cases of drug poisoning, the principles of antagonism must be used. There are several types of antagonism: - physical and chemical, based on the absorption of poisons on the surface of the adsorbent (for example, the use of activated carbon in case of poisoning); - chemical, based on the interaction of substances introduced into the body, as a result of which the drugs lose their effect (for example, neutralization of acids with alkalis); - physiological, based on the introduction of drugs that have the opposite effect on a given organ or tissue (for example, the introduction of stimulants in case of poisoning with depressants). The effect of drugs depends on the age and condition of the body. For example, a child's body is less resistant to substances that excite or depress the nervous system; sleeping pills are more effective when tired; in old age, sensitivity to substances that increase blood pressure, laxatives, and emetics increases. Routes of entry of drugs into the body. Medicinal substances can be divided into two groups according to the way they enter the human body: - enteral, administered through the gastrointestinal tract (mouth, rectum); - parenteral, entering the body bypassing the gastrointestinal tract, i.e. through the mucous membranes and serous membranes, skin, lungs, by injection. The most simple and convenient way for the patient to use the drug is enteral. The patient can use it without the help of a doctor or other medical professionals. However, this route is rarely used in emergency therapy: the drug taken orally does not act immediately, but after 15-40 minutes, since absorption in the intestine occurs gradually. In the intestinal lumen, the drug is affected by digestive juices, which inactivate it to a certain extent. Medicinal substances absorbed in the gastrointestinal tract undergo some neutralization in the liver and only then enter the general circulation. If the introduction of drugs through the mouth is not possible due to the patient's unconsciousness, violation of the act of swallowing, vomiting, etc., you can use the rectal (through the rectum) route of their administration in enemas and suppositories. From the rectum, drugs are absorbed faster (in 7-10 minutes), are not exposed to the action of digestive enzymes and enter the general circulation, mostly bypassing the liver, so their strength of action is somewhat higher than when taken by mouth. When applied, some drugs are placed under the tongue or behind the cheek, a good blood supply to the oral mucosa ensures their fairly rapid and complete absorption. These drugs include nitroglycerin, sex hormones and other drugs that are poorly absorbed or deactivated in the gastrointestinal tract. Among the parenteral routes of drug administration, the following can be distinguished: - dermal, which is usually used medicinal substances to obtain a local, reflex or resorptive action (ointments, pastes, liniments, etc.); - intradermal - the method used in the formulation of diagnostic reactions; - subcutaneous, in which the absorption of medicinal substances from the subcutaneous tissue occurs quickly and after a few minutes the action occurs; - intramuscular route of administration, which ensures the accuracy of dosage and the speed of entry of drugs into the blood, which is important in emergency care. For injections, only sterile solutions are used; - intravenous, in which medicinal substances enter directly into the bloodstream and their effect is manifested almost instantly. Medicinal substances should be injected into a vein slowly, monitoring the patient's condition all the time, since this method of administration simultaneously creates a high concentration of the drug in the blood, which can lead to an excessively strong effect; - intra-arterial; - intracardiac; - subarachnoid (through the arachnoid membranes of the brain and spinal cord); - the introduction of drugs through the serous and mucous membranes (in the cavity of the peritoneum, pleura, bladder); - inhalation, in which medicinal substances are used in the form of vapors or gases that enter the body by inhalation. With this method, medicinal substances enter the blood very quickly in an unmodified form and are quickly excreted from the body. Once in the body, drugs undergo changes and transformations, as a result of which the effect of the substance is most often weakened (i.e., it is inactivated), for example, oxidation of morphine, acetylation of sulfanilamide drugs, etc. Some medicinal substances in the process of transformation can form toxic compounds . Excretion of medicinal substances (in a modified or unchanged form) can be carried out in various ways - by the kidneys, gastrointestinal tract, lungs, glands, skin and mucous membranes. Most medicinal substances and products of their transformations are excreted by the kidneys, therefore, in diseases of this organ, drugs can be delayed and their action is enhanced and lengthened. A number of drugs that are poorly absorbed in the gastrointestinal tract (some sulfonamides and antibiotics) are retained for a long time in its lower sections and are used mainly to influence the intestinal microflora. Gaseous and volatile substances are released through the respiratory tract. Salts of iodine, bromine, heavy metals, and some other medicinal substances are excreted through the skin and especially through the sweat glands. During lactation (breastfeeding), many medicinal substances administered to a nursing mother are excreted in milk. 6.3. Pharmacological action of various groups of drugs Pharmacodynamics - a branch of pharmacology that studies the pharmacological effects and mechanisms of action of drugs. Let us consider in more detail the pharmacodynamics of various types of drugs. 1. Drugs. These are drugs that, when introduced into the body, cause a state of anesthesia. Narcosis is a temporary functional paralysis of the central nervous system, in which all types of sensitivity are lost and reflex activity changes, there is no consciousness and relaxation of the skeletal muscles is observed (I.P. Pavlov). Anesthesia is general and local. According to the method of introduction into the body, narcotic drugs can be divided into inhaled (introduced through the respiratory tract) and non-inhaled, administered intravenously or rectally. Narcotic drugs are basically general cellular poisons, that is, they reduce the vital activity of any cell - animal and plant. In humans, these drugs primarily affect the synapses of the central nervous system (connections between neurons). The most widely used narcotic drugs include barbiturates, ketamine, fentanyl, myorelaxin, etc. In surgery, chlorpromazine and etaperazine are also used. Aminazine is used to treat shock and prevent postoperative complications. It has an antiemetic effect, slightly lowers body temperature. As a result of the use of chlorpromazine in injections, an orthostatic collapse is likely to occur (a drop in blood pressure when moving to a vertical position), therefore, after an injection of chlorpromazine, the patient should not be left unattended by a doctor. Etaperazine is a white hygroscopic powder. Less than chlorpromazine, it provokes the action of hypnotics, narcotic and other substances that depress the central nervous system. It has a great antiemetic effect. Etaperazine is used for uncontrollable vomiting and hiccups. It is included in the individual AI-2 first aid kit (see 4.14). 1. Tranquilizers. Tranquilizers are called substances that selectively suppress feelings of anxiety, fear, anxiety, mental stress, arousal, without disturbing higher nervous activity, performance and responsiveness to external stimuli. 2. The most widely used tranquilizers include chlordiazepoxide and diazepam. These drugs reduce the excitability of the subcortical formations of the brain responsible for the realization of emotions, and inhibit the interaction between the subcortical structures and the cerebral cortex; enhance the effect of sleeping pills, analgesics and local anesthetics; have an inhibitory effect on spinal reflexes and cause relaxation of skeletal muscles. They are used for neurosis, agitation, irritability, insomnia, fear in anticipation of surgery or any painful manipulations, in the postoperative period. Chlordiazepoxide is often addicted. 3. Narcotic analgesics. These are medicinal substances that have the ability to suppress the feeling of pain, affecting the central nervous system. These drugs are otherwise called drugs, they can cause addiction (addiction). Unlike funds, changed for anesthesia, these drugs, when administered in therapeutic doses, do not depress all elements of the central nervous system, but selectively act on some of them, for example, the pain, respiratory and cough centers, and do not cause a state of anesthesia. Alkaloids are called organic nitrogen-containing substances of an alkaline reaction, extracted from plants. Most of them are strong poisons and in small doses have a pronounced effect on the body. The action of alkaloids is selective: morphine affects the pain center; papaverine - on smooth muscles; cocaine (locally) - on sensitive nerve endings, etc. Alkaloids are poorly soluble in water, to improve their solubility they are transferred to salts. Opium is the name given to the air-dried milky juice of various forms of the soporific poppy. It consists of about 25 alkaloids belonging to two chemical groups: phenanthrene derivatives and isoquinoline derivatives. Phenantrene derivatives depress the central nervous system (pain, respiratory and cough centers) and increase the tone of smooth muscles. Derivatives of isoquinoline relax smooth muscles, have an antispasmodic effect, while having little effect on the central nervous system. The main alkaloid of opium is morphine. Omnopon - brownish-yellow powder, soluble in water; consists of a mixture of all opium alkaloids in the form of soluble salts. Omnopon contains about 50% morphine. Omnopon has an analgesic and spasmodic effect, as it contains papaverine. It is used for severe pain and colic of the intestines, gallbladder, which are associated with spasms of smooth muscles. The maximum single dose of omnopon is 0,03 g, the daily dose is 0,1 g. Morphine hydrochloric acid is a white crystalline powder with a bitter taste. When used in small doses, it selectively suppresses pain sensitivity without turning off consciousness and without changing other types of sensitivity. With increasing doses, it depresses the medulla oblongata and, last but not least, the spinal cord. Morphine is used to prevent and control shock in trauma; as an analgesic for myocardial infarction, malignant neoplasms, in the postoperative period, etc. With the introduction of morphine, respiratory depression occurs, since the drug reduces the excitability of the respiratory center. Therefore, the use of morphine is combined with artificial lung ventilation. Morphine increases the tone of many smooth muscle organs (bronchi, sphincters of the gastrointestinal tract, bile and urinary tract). Using morphine to relieve pain of a spastic nature, it must be combined with antispasmodics (atropine, etc.). Morphine depresses the cough center (antitussive action); has no significant effect on the cardiovascular system. By stimulating the center of the oculomotor nerve, morphine constricts the pupil. Morphine often acts depressingly on the vomiting center, but in 20-40% of people it causes nausea and in 10-15% - vomiting, stimulating the center of vomiting. The maximum single dose of morphine is 0,02 g, the daily dose is 0,05 g. With a single use of 60 mg of morphine, acute poisoning of the body occurs, its symptoms are a sharp weakening of breathing, loss of consciousness, lowering blood pressure and body temperature. Death occurs from paralysis of the respiratory center. Since cardiac activity continues for some time after respiratory arrest, prolonged artificial respiration is used in case of morphine poisoning, which leads to success even in a very serious condition. In case of morphine poisoning, substances that excite the respiratory center (cytiton, lobelia, atropine) are used, as well as nalorphine, a morphine antagonist. In the treatment of this type of poisoning, the stomach is washed with a 0,02% solution of potassium permanganate, and the intestines are emptied. At the same time, the bladder is emptied with a catheter, since morphine causes spasm of the ureters, and the patient is warmed. The use of morphine causes a state of euphoria in the patient, which may be the cause of the development of drug dependence, addiction to morphine - morphinism. This form of drug addiction can lead to complete degradation of the personality (lack of will, depression of the psyche, decreased intelligence, concepts of duty and morality). Promedol is a synthetic drug that replaces morphine; white powder of bitter taste. Unlike morphine, promedol relaxes smooth muscles, has a weaker effect on the respiratory center, is less toxic, and is less likely to cause addiction. As an analgesic, promedol is part of AI-2. Promedol is used for traumatic and postoperative pain, cholecystitis, myocardial infarction, renal colic, etc. Codeine is a white powder with a bitter taste, slightly soluble in water. According to pharmacodynamics, it is close to morphine, but its action is more selectively directed to the cough center; the analgesic effect is 7-8 times weaker than that of morphine, so it is mainly used for coughing. Unlike morphine, codeine depresses respiration and inhibits bowel activity to a lesser degree. With prolonged use of codeine, a side effect occurs - constipation. Ethylmorphine hydrochloride is a synthetic drug similar in properties to codeine; white crystalline powder, odorless, bitter taste. Produced in powders and tablets, administered orally when coughing. A solution (1-2%) and ointments of ethylmorphine are used in eye practice for inflammation of the cornea and iris, as they improve blood flow and lymph movement, which contributes to the resorption of inflammatory infiltrates. 4. Non-narcotic analgesics. These are synthetic medicinal substances that have analgesic, anti-inflammatory, antipyretic and antirheumatic effects. They can be divided into groups: - derivatives of salicylic acid (acetylsalicylic acid, sodium salicylate, etc.); - pyrazolone derivatives (analgin, amidopyrine, butadione, etc.); - aniline derivatives (phenacetin, etc.). Unlike narcotic analgesics, they have a less pronounced analgesic effect, are ineffective for traumatic pain and pain in the chest and abdominal cavities, do not cause euphoria and addiction. Non-narcotic analgesics are mainly used for pains of a neuralgic nature - muscular, articular, dental, headache, etc. The analgesic effect of non-narcotic analgesics is due to their anti-inflammatory effect (reduction of edema, cessation of irritation of pain receptors) and inhibition of pain centers. The antipyretic effect of these drugs, associated with the effect on the centers of thermoregulation, is expressed only when these centers are excited, that is, in febrile patients. Salicylic acid and pyrazolone derivatives have anti-inflammatory and antirheumatic effects. This effect depends on the stimulation of the functional state of the "pituitary-adrenal cortex" system, and pyrazolones inhibit the activity of hyaluronidase, an enzyme that increases the permeability of the vascular wall and plays an important role in the development of inflammation. Amidopyrine (pyramidone) is a white powder with a slightly bitter taste. It is used as an analgesic, antipyretic and anti-inflammatory agent, with headache (migraine), neuralgia of the sciatic nerve, trigeminal nerve, dental and other types of pain, with acute articular rheumatism. Analgin is a white powder, soluble in water. In terms of pharmacodynamics, it is close to amidopyrine, but it acts faster, as it dissolves well. It is used for pain (neuralgic, muscular), as well as for febrile conditions and rheumatism orally, intravenously or intramuscularly. Butadion is a white crystalline powder of bitter taste, almost insoluble in water. Used as an analgesic, antipyretic, anti-inflammatory agent. Butadion is one of the most effective drugs for the treatment of rheumatoid and other arthritis. Take during or after a meal. Phenacetin is a white, poorly soluble powder. It is prescribed as an antipyretic and analgesic. Acetylsalicylic acid (aspirin) - white needle-like crystals of slightly acidic taste. It is used for muscular, neuralgic, joint pains, to reduce temperature in febrile conditions and rheumatism. Sodium salicylate is a white crystalline powder with a sweetish-salty taste, highly soluble in water. Assign as an antirheumatic, anti-inflammatory, antipyretic and analgesic. In the treatment of pyrazolone derivatives, especially butadione, side effects may occur, manifested in the suppression of hematopoiesis (leukopenia - a decrease in the number of leukocytes; anemia - a decrease in the number of red blood cells in the blood); dyspeptic symptoms (nausea, vomiting). When using salicylic acid derivatives, nausea, vomiting, exacerbation of peptic ulcer (up to gastric bleeding and even perforation of the ulcer) may develop as a result of the irritating effect of the drug on the gastric mucosa. In order to prevent dyspeptic disorders, these drugs should be taken after meals and washed down with milk. 5. Substances that excite the central nervous system. These drugs act selectively on certain parts of the central nervous system. According to the direction of action, they are divided into the following groups. I. Psychostimulating substances - have a predominant effect on the higher parts of the brain (caffeine). When the dose is increased, they stimulate the activity of the medulla oblongata, where the vital centers (respiratory and vasomotor) are located, and in toxic doses they excite the spinal cord, causing convulsions. II. Analeptics (revitalizing) substances - have a predominant effect on the centers of the medulla oblongata (corazol, cordiamin, camphor, bemegrid, cytiton, lobelin, carbon dioxide). Analeptics excite the respiratory and vasomotor centers, causing the activation of respiration, an increase in blood pressure, and an improvement in heart function; in higher doses - excitation of the motor areas of the cerebral cortex, which leads to the development of seizures. III. Substances acting on the spinal cord (strychnine). With increasing doses, they have a stimulating effect on the medulla oblongata and some parts of the cerebral cortex; in toxic doses cause convulsions. Caffeine is an alkaloid found in coffee beans, cocoa, cola nuts, and tea leaves. Caffeine enhances the processes of excitation in the cerebral cortex, cardiac activity, increases the metabolism in the body; with increasing doses and parenteral administration, it excites the respiratory and vasomotor centers. Caffeine acts on the vessels in two ways: by stimulating the vasomotor center, it constricts the vessels (central pressor effect), while the direct effect of caffeine on the smooth muscles of the vessels leads to their expansion (peripheral, myotropic effect). The vessels of the striated muscles and the heart expand, the vessels of the abdominal cavity narrow. The central vasoconstrictor effect of the drug predominates. A side effect of caffeine is increased diuresis. Caffeine is used as a psychostimulant to activate mental and physical performance and reduce drowsiness, as an excitatory agent in case of poisoning with narcotic and hypnotic drugs, with weakening of breathing, impaired function of the cardiovascular system, etc. Strychnine is an alkaloid from chilibukha seeds. It is used in the form of nitric acid salt. Strychnine has a stimulating effect on some parts of the cerebral cortex, sharpening vision, hearing, taste, and tactile sensation. Excites the respiratory and vasomotor centers, affecting the medulla oblongata. Improves the functioning of the heart muscle, increases metabolism. It is used as a tonic for rapid fatigue, a general decrease in metabolism, a decrease in blood pressure, weakening of cardiac activity, paresis (incomplete muscle paralysis), atony (decreased tone) of the stomach, etc. Camphor is a semi-synthetic drug obtained by processing fir oil. When camphor is injected subcutaneously, the nervous system is excited, which begins with the centers of the medulla oblongata, resulting in increased breathing and increased blood pressure. Camphor enhances the work of the heart. When applied topically, it has an irritating and partly antiseptic effect. In ointments, oil and alcohol solutions, camphor is used in the form of rubbing as a distraction in inflammatory diseases of the muscles and internal organs to increase blood circulation. For injections, a solution of crystalline camphor in peach oil is used. Camphor is used for acute and chronic heart failure, collapse, severe infectious diseases, etc. When introducing oil solutions under the skin, one should be careful not to get them into the lumen of blood vessels, as this leads to oil embolism. Corazole is a white powder, highly soluble in water; absorbed faster than camphor and has a greater effect. Corazole excites mainly the centers of the medulla oblongata - respiratory and vasomotor. Corazol is prescribed for depression of the cardiovascular system and respiration, acute poisoning with narcotic and hypnotic drugs (it has an awakening effect). Assign inside in powders and tablets, as well as subcutaneously, intramuscularly and intravenously. Cordiamin is a colorless liquid of peculiar smell, bitter taste, mixes well with water. Exciting effect on the central nervous system (especially the respiratory and vasomotor centers), has an awakening effect in case of poisoning with narcotic and hypnotic drugs. Cordiamin is used for acute and chronic circulatory disorders, respiratory depression, poisoning with narcotic and sleeping pills. Assign inside and in the form of injections under the skin, intramuscularly and intravenously. Bemegrid is a white powder, poorly soluble in water. In terms of pharmacodynamics, it is similar to corazol; is an antagonist of hypnotics (barbiturates, noxiron, etc.), has a stimulating effect on the central nervous system and is effective in respiratory and circulatory depression. It is prescribed in cases of poisoning with sleeping pills of the barbiturate group (phenobarbital, etaminal, etc.), non-awakening during anesthesia (etheric, halothane). Lobelin is an alkaloid from the lobelia plant. The drug stimulates breathing. Assign in case of reflex respiratory arrest or a sharp weakening of respiratory activity (reflex respiratory arrest in the first phase of anesthesia, etc.). The main form used is the hydrochloric acid solution of lobelin. Available in powder form. Cytiton is a colorless transparent liquid, a 0,15% solution of the alkaloid cytisine from broom and thermopsis plants. Pharmacodynamically similar to lobelin. It is used for respiratory arrest, with asphyxia of newborns. Unlike lobelin, it constricts blood vessels and can be used in collaptoid conditions. Produced in ampoules of 1 ml for injection under the skin and into a vein. Carbogen is a substance that is a mixture of carbon dioxide (5-7%) and oxygen (95-93%). It is used by inhalation for poisoning, asphyxia of newborns, drowned people, etc., since carbon dioxide is a specific causative agent of the respiratory center. With an overdose of drugs that excite the central nervous system, side effects occur - convulsions, for the removal of which drugs that depress the central nervous system are used: narcotic and sleeping pills (ether, barbiturates, etc.). 6. Local anesthetics. Local anesthetics are substances that selectively block the transmission of impulses in sensitive endings and conductors, reducing pain sensitivity at the site of their introduction. Local loss of sensation (anesthesia) can be achieved by cooling, compression of the nerves, tissue ischemia, as well as special chemicals - local anesthetics. There are several types of anesthesia depending on the methods and purposes of use: - terminal (surface) anesthesia - a method of anesthesia in which a solution or ointment containing an anesthetic is applied to the surface of the tissue; - conduction (regional) anesthesia - an anesthetic solution is injected into the nerve or surrounding tissues; - infiltration anesthesia - tissues are impregnated in layers with a local anesthetic solution; - spinal anesthesia - an anesthetic is injected into the spinal canal; - intraosseous anesthesia - an anesthetic solution is injected into the cancellous bone. Consider some of the drugs used for anesthesia. Novocain is a synthetic preparation in the form of a colorless powder, soluble in water. It is used for anesthesia in surgical practice: in a 0,25-0,5% solution up to 500 ml for infiltration anesthesia, in 1-2% for conduction anesthesia, in 2-5% for 2-3 ml - for spinal anesthesia. It is not suitable for terminal anesthesia, as it does not penetrate well through intact mucous membranes. Novocain works for a short time. To reduce absorption, 1 drop of a 0,1% solution of adrenaline hydrochloride per 1 ml of novocaine solution is added to its solutions. Novocaine is used to dissolve some drugs that are given in the form of an injection. Some people may be hypersensitive to novocaine (idiosyncrasy), so it must be used with caution. With an overdose of novocaine, as well as other local anesthetics, there are phenomena of excitation of the central nervous system, turning into paralysis. Cocaine is an alkaloid obtained from the leaves of the South American coca bush, as well as synthetically. Used as the hydrochloride salt of cocaine. Available in the form of colorless crystals of a bitter taste. Cocaine solutions are used only locally for superficial anesthesia of the cornea of the eye, mucous membrane of the mouth, larynx, urinary tract, etc. After absorption, cocaine has a pronounced effect on the central nervous system: it can cause euphoria, hallucinations, resulting in addiction to the drug - cocainism. Dikain is a white powder, a synthetic substitute for cocaine. Dikain surpasses cocaine in activity and toxicity. It is used for superficial anesthesia of the cornea of the eye, mucous membrane of the oral cavity, respiratory tract, etc. Sovkakin is a white powder. One of the strongest local anesthetics. It has a long duration of action, is slowly excreted from the body. It is used for spinal anesthesia: 0,8-0,9 ml of a 0,5-1% solution is injected into the spinal canal. Chloroethyl - a drug used for short-term superficial anesthesia; colorless, transparent, volatile liquid with a peculiar odor. The boiling point of chloroethyl is 12-13 ° C, therefore, when it comes into contact with the skin, it quickly evaporates, causing severe cooling and a decrease in sensitivity, which is used for short-term operations (opening an abscess, panaritium, etc.). Very strong cooling can cause tissue damage. When inhaled, chloroethyl has a depressant effect on the central nervous system, being a strong narcotic with a short-term effect. Chloroethyl is toxic, so it is used only for short-term anesthesia. 7. Astringents. These are drugs that create a protective film on the surface of the mucous membranes. The astringent effect is exerted by substances contained in some plants (oak, sage, St. John's wort, etc.), and salts of heavy metals (aluminum, lead, silver, etc.). They coagulate (coagulate) proteins on the surface of the mucous membrane, forming an elastic contracting film, while the vessels narrow and the inflammation decreases. Tannin - tannic acid; yellow powder with a slight odor and astringent taste. It is used as an astringent, thickening and anti-inflammatory agent. Assign water and glycerin solutions of tannin. For rinsing and washing, a 1-2% solution of tannin is used, for lubrication with burns, cracks, bedsores - a 5% solution, for enemas with inflammation of the intestines - a 0,5% solution. Strong solutions of tannin (5-10%) give a cauterizing effect, causing irreversible protein coagulation. In this case, an albuminous film is formed, under which the healing of the affected surface occurs under aseptic conditions. Tannin in a 0,5% solution is also used for gastric lavage in case of poisoning with alkaloids, salts of heavy metals, as it converts these substances into insoluble compounds (precipitation). 8. Adsorbents. As adsorbents, the smallest powders with a large absorbing surface are used: activated carbon, white clay, magnesium oxide, talc, etc. Due to the ability to absorb liquids and gases, adsorbents are used as detoxifying agents in case of poisoning. Many of them are used for drying in the form of powders on the skin and mucous membranes (white clay, talc). Activated carbon is a black powder, odorless and tasteless, insoluble in water. It has a large surface that can adsorb poisons, gases, alkaloids, salts of heavy metals and other substances. Applied inside 20-30 g in the form of a suspension in water for various poisonings, including food. The same suspension is also used for gastric lavage in case of intoxication. Activated charcoal tablets of 0,25 and 0,5 g are prescribed orally for flatulence (accumulation of gases in the intestines) and dyspepsia (indigestion). Clay white - white powder, insoluble in water. Possesses the enveloping and adsorbing action. Applied externally (in powders, ointments, etc.) for skin diseases and inside (20-30 g) for gastrointestinal diseases and poisoning. Talc is a white powder, almost insoluble in water. Used for powders for skin diseases. 9. Emetics. These funds contribute to the eruption of the contents of the stomach out. When used in smaller doses, an expectorant effect is observed. The most commonly used emetic is apomorphine. Apomorphine hydrochloric acid is a synthetic drug produced in the form of a yellow-gray powder that turns green in air. Its solutions also turn green in the air, while losing activity, in connection with this they are prepared as needed. Apomorphine selectively stimulates the vomiting center. It is used by subcutaneous injection as an emetic in case of poisoning, alcohol intoxication, etc. 10. Expectorants. These are agents that help thin and remove secretions from the respiratory tract. These include thermopsis, ammonia-anise drops, sodium bicarbonate. Thermopsis grass - an expectorant drug, in large doses - emetic. It is used as an expectorant in the form of infusions and powder at a dose of 0,01-0,05 g. Ammonia-anise drops are a clear, colorless liquid with a strong anise and ammonia odor. Used as an expectorant, 10-15 drops per dose in a mixture. Sodium bicarbonate (bicarbonate soda) - white crystalline powder of salty-alkaline taste; dissolves in water to form alkaline solutions. Assign inside with increased acidity of gastric juice and as an expectorant, as it helps to thin the sputum. Available in powder and tablets of 0,3 and 0,5 g. 11. Laxatives. Laxatives are called drugs that, when they enter the intestine, increase its motility (peristalsis) and accelerate defecation. They are of mineral (salt) and vegetable (rhubarb, castor oil) origin. In case of poisoning, saline laxatives are usually used - magnesium sulfate and sodium sulfate. They are not absorbed, delay the absorption of poisons and contribute to their removal from the body. Magnesium sulfate - transparent crystals of bitter-salty taste. Applied inside for 15-30 g. This amount of the drug is pre-dissolved in half a glass of warm water and washed down with a glass of water. Salts are slowly absorbed in the intestine, and a high osmotic pressure is created there. This causes water retention in the intestines and dilution of its contents. Salt solution, irritating the intestinal mucosa, enhances its peristalsis, which facilitates defecation, i.e., there is a laxative effect. 12. Irritants. Irritating means are those that can excite sensitive nerve endings, which is accompanied by a number of local and reflex effects (improvement of blood circulation, tissue trophism, changes in breathing, etc.). The most widely used ammonia. Ammonia solution (ammonia) is a clear, colorless liquid with a pungent characteristic odor. It has an antimicrobial and cleansing effect on the skin. When small concentrations of ammonia are inhaled, irritation of the mucous membrane of the upper respiratory tract and reflex excitation of the respiratory center occur. Ammonia solution is used to excite breathing and bring patients out of fainting, bringing a small piece of cotton wool soaked in ammonia to the nose. Large concentrations of ammonia can cause respiratory arrest and slow heart rate. 13. Substances acting in the region of centrifugal nerve endings. These substances affect the transmission of nerve impulses in the area of synapses (contacts) between neurons or between nerve endings and cells of the executive organs. I. Anticholinergics block the endings of the parasympathetic nerves, and therefore the tone of the sympathetic department of the nervous system increases relatively. One of the representatives of this group of substances is atropine. Atropine is an alkaloid found in some plants: belladonna, henbane, dope. In medicine, atropine sulfate is used - a white powder. For injections under the skin, atropine sulfate is available in ampoules (1 ml of a 0,1% solution). Atropine relaxes smooth muscles (antispasmodic effect), reduces the secretion of salivary, gastric, bronchial and sweat glands, stimulates cardiac activity, dilates pupils, increases intraocular pressure, stimulates the respiratory center. It is used for spastic pain in the stomach, intestines, gallbladder, stomach ulcers, bronchospasm (bronchial asthma), vomiting. Before anesthesia, atropine can be used to reduce secretion, prevent reflex cardiac arrest, and excite the respiratory center. In ophthalmic practice, atropine is used externally (1% solution) to relax smooth muscles during inflammatory processes in the iris, cornea and to dilate the pupil in order to study the fundus. Atropine is an antidote for organophosphate poisoning. Toxic doses of atropine cause acute poisoning, accompanied by strong motor agitation, delirium, hallucinations, dry skin and mucous membranes, hyperthermia, dilated pupils, palpitations and increased respiration. To combat atropine poisoning, activated charcoal, tannin are given, gastric lavage is done, prozerin is dripped into a vein. To eliminate excitation, barbiturates and chlorpromazine are used. II. Adrenomimetics - substances that excite the endings of sympathetic nerves, according to the principle of action, resemble adrenaline. Adrenaline is a drug derived from the adrenal glands of cattle or synthetically. In medical practice, epinephrine hydrochloride and adrenaline hydrotartrate are used. Adrenaline excites the endings of sympathetic nerves, therefore, it affects various organs and systems. In medical practice, its vasoconstrictive effect and the ability to relax bronchial muscles are used. Adrenaline increases the strength and frequency of heart contractions: in case of cardiac arrest, it is injected into the cavity of the left ventricle in combination with heart massage. However, due to the increase in blood pressure, adrenaline can reflexively have an inhibitory effect on the heart. Adrenaline raises blood sugar and can be used in hypoglycemic coma. It is used in case of collapse to increase blood pressure, bronchial asthma, serum sickness, and also in a mixture with local anesthetics to prolong their action. Adrenaline-moistened tampons are used topically for capillary bleeding. The duration of action of adrenaline is short, as it quickly decomposes in the body. Norepinephrine hydrotartrate is a white, odorless powder. It has a stronger vasoconstrictor effect than adrenaline, has a weaker effect on the heart and bronchial muscles. It is used to increase blood pressure with a sharp decrease due to surgical interventions, injuries, poisoning, etc. Ephedrine is an alkaloid found in some plants. In medical practice, ephedrine hydrochloride is used - a white powder of a bitter taste, soluble in water. In terms of pharmacodynamics, ephedrine is close to adrenaline: it is inferior to adrenaline in strength, but surpasses it in duration of action. Ephedrine is stable and effective when taken orally. It has a stimulating effect on the central nervous system, increases the excitability of the respiratory center. Ephedrine is used as a vasoconstrictor to increase blood pressure in shock, collapse, as a substance that relaxes the smooth muscles of the bronchi in bronchial asthma. Locally, ephedrine is used to constrict the vessels of the mucous membranes and reduce their swelling, for example, with a runny nose. 14. Antihistamines. Antihistamines are drugs that are histamine antagonists, used in pathological conditions as a result of an increase in the amount of histamine in the body. They block the receptors with which histamine interacts. Histamine is a biologically active substance that is of great importance in the development of allergic reactions. The release of histamine from a coherent state occurs during injuries, the use of certain drugs, the action of radiation energy, etc. At the same time, expansion of small vessels (arterioles, capillaries), an increase in their permeability, a decrease in blood pressure, an increase in the tone of the smooth muscles of the bronchi, stomach, uterus, intestines and increased secretion of the digestive glands. Antihistamines remove or weaken the effect of histamine. Among antihistamines, diphenhydramine and suprastin are most widely used. They have a calming effect on the central nervous system. They are used to treat various allergic reactions, the most formidable manifestation of which is anaphylactic shock, and also as an antiemetic - to prevent sea and air sickness. Dimedrol is available in powder, tablets of 0,005; 0,01; 0,02; 0,03 and 0,05 g and in ampoules of 1 ml of a 1% solution for intramuscular injection; suprastin - in tablets of 0,025 g and ampoules of 1 ml of a 2% solution. 15. Cardiac glycosides. These are organic substances of plant origin that selectively act on the heart muscle, increasing its contractions. In toxic doses, cardiac glycosides increase the excitability of the heart nodes and can cause arrhythmia and cardiac arrest. Cardiac glycosides normalize cardiac activity and blood circulation in venous congestion due to insufficiency of the heart. At the same time, improving the work of the heart and blood circulation, they help eliminate edema. Cardiac glycosides are used in acute and chronic heart failure. Under the influence of these drugs, the heart begins to produce more work with a relatively lower oxygen consumption. They differ from other medicinal substances that stimulate the work of the heart in that they significantly increase the consumption of oxygen by the heart muscle and the consumption of energy resources. Apply cardiac glycosides for a long time. Digitalis is a plant rich in glycosides. Digitalis preparations do not act immediately, but they are most resistant in the body compared to other cardiac glycosides. They are excreted slowly, give cumulation, therefore, immediately after the abolition of digitalis, adonizide, strophanthin, corglicon and convallatoxin should not be administered. An aqueous infusion of digitalis leaves (0,5 g per 180 ml of water), digitalis leaf powder or tablets containing 0,05 g of digitalis leaf powder are used. Adonizide is a neogalenic preparation from spring adonis. Adonis glycosides are less active than foxglove glycosides, act faster and for less time. Adonis preparations are used for insufficiency of cardiac activity, blood circulation and vegetative-vascular neuroses. Strophanthin is a cardiac glycoside isolated from the seeds of a tropical plant called strophanthus. In medical practice, a solution of strophanthin is used. It is injected into a vein very slowly in a glucose solution. Produced in ampoules of 1 ml of a 0,05% solution. Convallatoxin is a glycoside derived from lily of the valley. By action close to strophanthin. Apply intravenously in 10-20 ml of 20% glucose solution. Korglikon - a preparation containing the amount of glycosides from the leaves of the lily of the valley. By the nature of the action is close to strophanthin, but has a longer effect. Enter intravenously in 20 ml of 20% glucose solution. Strophanthus and lily of the valley contain low-resistant glycosides, so they act for a short time, and are relatively ineffective when administered orally. With intravenous injections, they give a quick and strong effect. They are used for emergency care in chronic heart decompensation and acute heart failure. The toxic effect of glycosides is expressed in the appearance of nausea, vomiting, severe bradycardia, extrasystole, heart blockade. To compensate for such symptoms, potassium chloride, atropine, unitiol should be used. 16. Vasodilators. These are substances that can lower the tone of vascular smooth muscle. They can be divided into two groups. I. Vasodilators that dilate blood vessels in certain areas without significantly changing blood pressure (amyl nitrite, nitroglycerin). These substances are used to relieve spasms of the coronary vessels of the heart (angina pectoris) and peripheral vessels. They are able to relax the smooth muscles of the smallest blood vessels, especially those of the heart and brain. Amyl nitrite is a clear, yellowish, volatile liquid. Available in ampoules of 0,5 ml. Inhalation of amyl nitrite vapor causes a quick and short-term effect, which makes it possible to use it to relieve an attack of angina pectoris. Amyl nitrite promotes the formation of methemoglobin in the blood, which is used to treat poisoning with hydrocyanic acid and its salts. Nitroglycerin is an oily liquid. Nitroglycerin is taken in capsules under the tongue. It is easily absorbed, its action occurs after 2-3 minutes and lasts about 30-40 minutes. Nitroglycerin dilates the coronary vessels, while relieving pain in the heart. When using nitroglycerin, side effects are possible: dizziness, headache, tinnitus. Validol is also used to relieve angina attacks. II. Vasodilators that cause widespread vasodilation and a decrease in blood pressure. Such substances are called hypotensive. Eufillin is a white crystalline powder. It has an antispasmodic, vasodilating, diuretic effect. It is used for hypertension, strokes, angina pectoris, bronchial asthma. Papaverine is an alkaloid found in opium. In medicine, hydrochloric salt is used - a white bitter powder. Papaverine is prescribed as an antispasmodic, relaxing the smooth muscles of blood vessels or bronchi and abdominal organs. To relieve hypertensive crises, they are injected. Dibazol is a synthetic drug produced in the form of a yellow powder of a bitter taste; poorly soluble in water. As a vasodilator and antispastic agent, dibazol in doses of 0,05 g is used in the same way as papaverine. In smaller doses, it is used to eliminate paralysis, paresis, etc. Magnesium sulfate, when administered intramuscularly and intravenously, has a depressant effect on the central nervous system up to anesthesia. When taken orally, it is poorly absorbed and has a laxative effect. Has a choleretic effect. Excreted by the kidneys; in the process of excretion increases diuresis. It is used in injections for hypertensive crises, cerebral edema, convulsions; inside - as a laxative and choleretic. 17. Uterine remedies. These are medicinal substances that mainly cause an increase and increase in the rhythmic contractions of the uterus (pituitrin) or an increase in its tone (ergot preparations). These funds can be used to stop uterine bleeding and speed up delivery. Pituitrin (an extract of the posterior pituitary gland) is a hormonal preparation obtained from the pituitary gland of cattle. It is a clear colorless liquid. It is used for uterine bleeding and to speed up delivery. Available in ampoules of 1 ml, which contains 5 units of action. Ergot (uterine horns) is a dormant stage of a fungus parasitizing on cereals. Contains some alkaloids, which are part of the drug ergotal. It is used for uterine bleeding (after childbirth, during menopause, etc.), as it causes a strong and prolonged muscle contraction and mechanical squeezing of blood vessels. With an overdose of ergot preparations, psychosis, impaired sensitivity, agitation, and convulsions occur. Death occurs from respiratory or cardiac paralysis. 18. Substances that affect the process of blood coagulation. These are drugs that change the intensity of blood clotting. Among them are anticoagulants (slowing down the process of blood clotting) and coagulants (accelerating it). I. Anticoagulants (heparin, hirudin, sodium citrate, etc.) are used to prevent and treat thrombosis and embolism, to preserve blood, etc. If they are overdosed, bleeding is possible. Heparin is a direct-acting anticoagulant that directly affects blood coagulation factors (inhibits the activity of thromboplastin, thrombin, etc.). It is used intravenously for thrombosis, thromboembolism of large vessels, in the acute period of myocardial infarction. Heparin affects all phases of blood coagulation. The effect of the drug comes very quickly, but does not last long. Injections are made every 4-6 hours or administered drip in a 5% glucose solution. Hirudin is a drug secreted by the salivary glands of medicinal leeches. The isolation of the drug is difficult and expensive, therefore, leeches are used, which are prescribed to the skin in the area of superficial thrombophlebitis, and in hypertensive crises with severe headaches - in the neck. Sodium citrate is a drug that binds the calcium ions present in the blood, which are necessary for blood coagulation. It is widely used as a stabilizer in the preservation of donated blood. II. Coagulants (calcium salts, vikasol, etc.) are used for acute and chronic bleeding. Calcium salts are an essential physiological component of the blood coagulation process, which also seals the capillary wall, reducing its permeability. It is used for various types of bleeding (pulmonary, gastric, nasal, uterine, etc.), as well as desensitizing (with allergic reactions, radiation sickness) and anti-inflammatory substances. Calcium chloride is a hygroscopic powder, prescribed only in solutions. It has a strong irritating effect on tissues. If calcium chloride gets under the skin, necrosis of the subcutaneous tissue may occur, so it is administered intravenously (5-10 ml of a 10% solution). It should be administered slowly, since a rapid increase in the content of calcium ions in the blood can cause a violation of the rhythm and conduction of the heart. When taking calcium chloride orally (tablespoons in the form of a 10% solution), it is recommended to drink it with milk in order to reduce the irritating effect of the drug on the mucous membrane of the gastrointestinal tract. Calcium gluconate is a drug that is less irritating to tissues. It can be administered orally, intravenously, intramuscularly. Before injection, an ampoule with a solution of calcium gluconate is heated to body temperature. Vitamin K is a fat-soluble vitamin required for the synthesis of prothrombin in the liver. A water-soluble preparation of vitamin K, vikasol, is widely used. Blood clotting after taking the drug increases after 12-18 hours, since this time is required for the formation of prothrombin in the liver. It is used to prevent bleeding before surgery or before childbirth. 19. Means that affect tissue metabolism. For the normal course of life processes, it is necessary to maintain the constancy of the chemical composition and physico-chemical properties of the internal environment of the body. Means that affect tissue metabolism include substances that are part of the normal composition of the internal environment of the body (glucose, sodium chloride, vitamins, hormones, trace elements, enzymes, etc.). Glucose - grape sugar. It is well absorbed by all cells, is the main source of energy for the brain, heart, liver, skeletal muscles. Promotes the neutralization of liver toxins (detoxifying effect), improves the function of the cardiovascular system. Isotonic (5%) glucose solution is used for parenteral nutrition and as a basis for blood substitute fluids. Glucose is widely used in diseases of the cardiovascular system, liver, infections, poisoning, shock, etc. Hypertonic (10, 20 and 40%) glucose solutions are administered drip (intravenously) for bleeding, acute pulmonary and cerebral edema, poisoning with radioactive substances, etc. . Sodium is an extracellular cation. The concentration of sodium chloride in the blood is maintained at a constant level, which ensures the constancy of the osmotic pressure of the blood. Sodium chloride is widely used to compensate for the loss of sodium salts by the body (diarrhea, vomiting, blood loss, burns, intense sweating). For this purpose, an isotonic (0,9%) solution of sodium chloride, called physiological, is used, which, in terms of osmotic pressure, corresponds to the conditions found in biological fluids. It is administered intravenously, subcutaneously and in the form of a drip enema. An isotonic solution is used as a basis for blood substitutes, a solvent for many injection solutions (antibiotics, novocaine, etc.). Hypertonic (10-20%) solutions of sodium chloride are administered intravenously for pulmonary, gastric and intestinal bleeding. They moisten dressings in the treatment of purulent wounds, since hypertonic solutions act antiseptically and contribute to the separation of pus from the wound, cleansing it. Sodium chloride is used for rinsing (1-2% solution) as an anti-inflammatory agent for diseases of the upper respiratory tract. 20. Vitamins. These are organic compounds contained in food and necessary for normal metabolism, vital activity, growth and development of the body. Entering the body with food, they are involved in the formation of numerous enzyme systems. Their lack in the body (hypovitaminosis) leads to disruption of the normal course of biochemical processes in tissues. Even more multiple and severe disorders occur in the absence of vitamins in the body, i.e., with beriberi. Avitaminosis and hypovitaminosis can be caused by an increased need for them as a result of a number of reasons, such as pregnancy, lactation, hard physical work, infectious diseases, and poisoning. In addition, beriberi may be the result of impaired absorption of vitamins (diseases of the gastrointestinal tract and liver), as well as the use of certain drugs (antibiotics, sulfonamides), which inhibit the intestinal microflora involved in the synthesis of vitamins (complex B and vitamin K). Vitamins are divided into groups according to their physical and chemical properties. I. Water-soluble: vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin PP (nicotinic acid), vitamin B6 (pyridoxine), folic acid, vitamin B12 (cyanocobalamin), vitamin C (ascorbic acid). II. Fat-soluble: vitamin A (retinol), vitamin D2 (ergocalciferol), vitamin E (tocopherols), vitamin K (phylloquinones), etc. Many vitamins are involved in the processes of splitting food substances and releasing the energy contained in them (vitamins B1 B2, PP, C, etc.). They are also of great importance for the synthesis of amino acids and nucleic acids (vitamins B6, B12), fatty acids (pantothenic acid), nucleic and pyrimidine bases (folic acid), the formation of many important compounds; acetylcholine (vitamin D), hormones of the adrenal cortex (vitamin C), etc. Vitamins are necessary for the normal development of bone tissue (vitamin D), epithelial tissue (vitamin A), the embryo (vitamin E). Vitamin preparations are prescribed for the prevention and treatment of hypo- and beriberi, in pathological conditions, the symptoms of which are outwardly similar to the symptoms of hypovitaminosis: in diseases of the nervous system - vitamins B1, B6, B12, PP; in diseases accompanied by increased bleeding - vitamins C and P; in violation of the epithelialization of the skin - vitamin A; in violation of the union of bone fractures - vitamin D. Vitamins C and PP have a positive effect on the neutralizing function of the liver and are used in case of poisoning. With prolonged use of large doses of vitamins, especially fat-soluble ones, overdose phenomena may occur - hypervitaminosis. 21. Antimicrobial agents. Antimicrobials are substances used to fight pathogens in humans. These drugs are divided into three groups. I. Disinfectants - substances that destroy microbes in the external environment. When used in sufficient concentrations, they cause changes in the protoplasm of the microbial cell and kill it. These substances, which have powerful antimicrobial activity, are devoid of pronounced selectivity of action and are capable of damaging the tissues of the human body. They are used to disinfect objects, premises, secretions and clothes of sick or healthy people, which can be a source of infection. II. Antiseptic substances - are used to influence pathogens on the surface of the human body (skin, mucous membranes, wounds). Possessing a strong antimicrobial effect, they should not damage and irritate tissues, as well as be absorbed in significant quantities into the blood. III. Chemotherapeutic agents are agents that are etiotropic in the treatment of infectious and parasitic diseases (suppress the vital activity of pathogens in the human body). These substances are not general cellular poisons; they act selectively on certain types of microbes or protozoa. Chemotherapeutic agents have a bacteriostatic effect, i.e., disrupting the normal course of biochemical processes, cause a delay in the growth and development of pathogens of infectious diseases. They do not violate the basic functions of the human body. Chemotherapeutic agents are used to treat tumors, they act selectively on certain types of cells. The division of antimicrobial agents into antiseptics and disinfectants is conditional. Many antiseptics in higher concentrations can be used for disinfection. Antiseptics and disinfectants are very diverse in nature, have great differences in action, and, consequently, in their use in medical practice. The action of most of them is weakened in the presence of proteins (pus, destroyed tissues, etc.). Chloride-giving compounds split off the active chlorine atom and atomic oxygen, which denature the proteins of microbial protoplasm. Their antimicrobial activity is more pronounced in an acidic environment. When dry, they are ineffective. These substances are oxidizing agents, they also have a deodorizing effect and can be used for deodorization, since, interacting with mustard gas, they deprive it of its toxic properties. Bleach is a white powder with a chlorine smell. It is a mixture of calcium hypochlorite, which provides the antimicrobial effect of the drug, with calcium oxide and calcium chloride. Hypochlorites quickly split off chlorine and have an irritating effect on tissues. Bleach is used to disinfect toilets, cesspools, etc. It is unsuitable for disinfecting painted things and clothes (discolors them) and metal objects (causes corrosion of metals). Chloramine B is a white powder with a characteristic odor. The elimination of chlorine is slow. Chloramine B has a long antimicrobial effect, does not cause noticeable tissue irritation. It is used for the treatment of infected wounds (1,5-2% solution), disinfection of hands, washing of wounds, douching (0,25-0,5% solution), disinfection of non-metallic instruments, skin dehydration (2-5% - solution). Alcoholic iodine solution (iodine tincture) is a dark red liquid with a characteristic odor. Iodine, like chlorine, causes denaturation of microbial protoplasm proteins. Apply iodine externally as an antimicrobial, antifungal and antiparasitic agent. In addition, iodine tincture causes local irritation with subsequent anesthesia, vasodilation and resorption of inflammatory foci, that is, it is an agent used for distraction therapy. The cauterizing effect of the drug provides a hemostatic effect in capillary bleeding. Iodine tincture is used to treat the surgical field, the surgeon's hands, the skin edges of wounds, sore joints, and also the skin in diseases caused by pathogenic fungi. Diocide - cationic soaps, which are good detergents and antimicrobial agents. Diocide solutions are used for washing the surgeon's hands before surgery, sterilizing surgical instruments. They are prepared before consumption. Potassium permanganate - dark purple crystals with a metallic sheen. Form solutions from crimson to dark red (depending on concentration); over time, the solutions darken, but do not lose their effectiveness. It is used in 0,01% and 0,1% solutions as a disinfectant, anti-inflammatory and deodorant for washing wounds, gargling, mouthwash, and also for washing the stomach in case of poisoning (strong oxidizing agent). In strong solutions (2-5%), potassium permanganate has a cauterizing effect. It is used for lubrication for burns, ulcers. At the same time, under the formed scab, the affected surface heals under aseptic conditions. Produced in the form of a crystalline powder in jars. Hydrogen peroxide solution is a clear, colorless liquid. In tissues, under the influence of the catalase enzyme, it quickly decomposes with the formation of molecular oxygen, which is a weak antimicrobial agent, but, foaming, mechanically cleans the wound from pus, blood clots, etc. It has a disinfectant and deodorizing effect. When applied topically, hydrogen peroxide promotes blood clotting. It is used in the form of solutions for rinsing the mouth, throat, and also for the treatment of wounds. Brilliant green is a golden-green powder, sparingly soluble in water. It has high antimicrobial activity against Staphylococcus aureus, the causative agent of diphtheria and some other bacteria. In the presence of organic substances, its antimicrobial activity is reduced. It is used externally for purulent skin lesions in the form of a 0,1-2% alcohol or aqueous solution. Available in powder form. Ethacridine lactate (rivanol) - yellow powder. Available in tablets, which are dissolved in a glass of water before use. solutions are unstable. If the solution changes from yellow to green, the solution becomes toxic and must not be used. It has an antimicrobial effect in infections caused by cocci. Apply solutions 1: 1000 and 1: 2000 for the treatment of infected wounds, ulcers, cavities, as well as in the form of lotions for abscesses and boils and in the form of rinses for inflammation of the mucous membranes of the mouth, gums, pharynx. Ethacridine lactate does not irritate tissues, is a relatively low-toxic drug. In rare cases, it is used orally for intestinal diseases. Furacilin is a yellow powder. Furacilin is an antibacterial substance that acts on staphylococci, streptococci and many other bacteria. Available in tablets of 0,1 g for oral administration and 0,02 g for external use. It is applied externally in the form of an aqueous 0,02% solution for the treatment of purulent wounds, bedsores, ulcers, burns, inflammatory eye diseases, etc. Sometimes furatsilin is prescribed orally for intestinal diseases (dysentery, etc.). Collargol (colloidal silver) - greenish or bluish-black small plates with a metallic sheen. With water gives colloidal solutions. Contains 70% silver. It has a pronounced antimicrobial activity, astringent and anti-inflammatory action. Collargol solutions are used for washing purulent wounds (0,2-1%), for purulent conjunctivitis (eye drops - 2-5%), for douching and for a runny nose (1-2%). Available in powder form. Mercury dichloride (sublimate) is a white soluble powder. Binds proteins of microbial cells, has a bactericidal effect. The antimicrobial activity of the drug is sharply weakened in the presence of proteins. Sublimate strongly irritates the skin and mucous membranes, its solutions can be absorbed, so it is used mainly for external disinfection of linen, patient care items, and washing. Sublimate tablets are colored with 1% eosin solution in pink or red-pink color. Ethyl alcohol also belongs to antiseptic agents. The group of chemotherapeutic agents includes sulfanilamide drugs, antibiotics, antimalarial, antituberculosis, antispirochetal and other drugs. They have a predominantly bacteriostatic effect. For effective chemotherapy of infectious diseases, it is necessary to follow certain principles: - choose the right chemotherapeutic agent; - start treatment in the early stages of the disease; - prescribe high enough doses of drugs so that a bacteriostatic concentration is created in the blood and tissues; - continue their use for some time after the elimination of the clinical symptoms of the disease; - combine chemotherapeutic agents with different mechanisms of action. A. Sulfanilamide drugs are synthetic chemotherapeutic agents derived from sulfanilamide that inhibit the growth of bacteria and some large viruses. All sulfonamides are bacteriostatic. They prevent the absorption by bacteria of para-aminobenzoic acid necessary for the development of the latter, with which sulfonamides are similar in structure. Sulfanilamides are white powders, poorly soluble in water. They are well absorbed in the gastrointestinal tract and are determined in many tissues and organs. In the body, they are partially destroyed and excreted by the kidneys. The therapeutic dose for most sulfa drugs (for adults) is 4-6 g; then the patient is transferred to maintenance doses - 3-4 g per day, since during this period the effective concentration of sulfonamides in the blood is maintained. Treatment should be started as early as possible and continued for 2-3 days after the symptoms of the disease disappear. Failure to follow these rules can cause the appearance of chronic diseases and the occurrence of relapse. Despite the general principle of action, individual sulfa drugs have a specific therapeutic use profile. Ftalazol and sulgin are poorly absorbed in the intestines and are used to treat intestinal infections (dysentery, enterocolitis). Streptocide, sulfadimezin, norsulfazol are well absorbed in the intestine and provide high concentrations in the blood and tissues. They are used to treat pneumonia, meningitis, sepsis, etc. Sulfadimezin and norsulfazol are available in powder and tablets of 0,25 and 0,5 g, streptocid - 0,3 and 0,5 g each. Streptocid can be used externally as a powder, and also ointments (10%) or liniment (5%) for the treatment of infected wounds, ulcers, burns, cracks. Sulfacyl sodium is rapidly absorbed from the intestine and rapidly excreted, creating high concentrations in the kidneys and urine. It is used in the treatment of urinary tract infections (pyelitis, cystitis), as well as for the treatment of eye infections (10%, 20% and 30% solutions and ointments). Available in powder of 0,5 g. Sulfapyridazine is a long-acting sulfonamide. It is quickly absorbed in the intestines and provides a high concentration in the blood for a long time, which makes it possible to prescribe it 1 time per day. It is used to treat pneumonia, purulent infections of the urinary tract, dysentery. With prolonged use of sulfonamides and increased sensitivity of the body to them, adverse reactions occur from the central and peripheral nervous system, kidneys, liver (hepatitis), blood (anemia and leukopenia) and other organs. To prevent blockage of the renal tubules, an alkaline drink (mineral water) should be prescribed. B. Antibiotics are substances of microbial, animal or plant origin that can suppress the vital activity of microorganisms. Microbial cells are more sensitive to antibiotics than animal and human cells. The relatively low toxicity of antibiotics allows them to be administered orally and by injection without fear of causing poisoning. Antibiotics are effective against a larger number of bacteria than sulfonamides, i.e., they have a wider spectrum of antimicrobial activity. Penicillins are produced by various molds. Their action is associated with inhibition of protein synthesis of the shell of the microbial cell. They can have bacteriostatic and bactericidal effects. Effective for pneumonia, tonsillitis, wound infections, syphilis, anthrax, sepsis, gonorrhea, etc. The most active drug from the group of penicillins is benzylpenicillin sodium or potassium salt - a white powder, odorless, bitter taste. Unstable, destroyed by light, heat, acids, alkalis, etc. The drug is administered only by injection intramuscularly or subcutaneously. To maintain the required concentration, the sodium or potassium salt of penicillin should be administered every 4 hours. Benzylpenicillin is combined with other drugs that act for a long time, since they are slowly absorbed and excreted from the body. Such drugs of prolonged (long-term) action include a solution of penicillin in novocaine, novocaine salt of penicillin, ecmonovocillin and bicillins. Injections of these drugs are used much less frequently than the introduction of potassium and sodium salts of benzylpenicillin. Ecmonovocillin is a suspension of benzylpenicillin novocaine salt in an aqueous solution of ecmolin. Both components are available in separate vials, the drug is prepared before use. Bicillin-1 (dibenzylethylenediamine salt of benzylpenicillin) is a long-acting drug. It is prescribed for infections caused by highly sensitive pathogens, as well as in the absence of the possibility of regular administration of the drug. It is administered intramuscularly only. Bicillin-3 is a mixture of bicillin-1 with equal parts of potassium or sodium and novocaine salts of benzylpenicillin. Its action is manifested faster than bicillin-1, and the concentration of the drug in the blood is higher. Bicillin is widely used for the prevention of rheumatism. Phenoxymethylpenicillin, a drug with high acid resistance, is well absorbed in the gastrointestinal tract, but it creates relatively low concentrations in the blood and cannot be recommended for severe infections. Penicillin preparations can cause side effects, most often allergic reactions (rash, urticaria, swelling of the face, etc.), which are observed in people with hypersensitivity to the drug. When these symptoms appear, it is urgent to administer adrenaline, diphenhydramine and other antihistamines to the patient. Some microorganisms, such as staphylococci, have become resistant to penicillin, and the diseases caused by them are not cured by this drug. Such penicillin-resistant forms of microbes are well affected by new drugs, the so-called semi-synthetic penicillins - methicillin and oxacillin. Erythromycin and oleandomycin phosphate are antibiotics with a spectrum of action close to that of penicillin. It is advisable to leave them in reserve and use only for those diseases whose pathogens have acquired resistance to other antibiotics. The drugs are administered intravenously. When taken orally, they are well absorbed, maintaining an effective concentration of the antibiotic in the blood for 4-6 hours. The drugs are of low toxicity, but can cause diarrhea, nausea, vomiting, and allergic reactions. As with other antibiotics, bacterial resistance can develop. Streptomycin is produced by a radiant fungus. In medicine, streptomycin sulfate or streptomycin calcium chloride complex is used - a white powder, odorless, slightly bitter taste. Streptomycin has a broader spectrum of action than penicillin. It is effective in tuberculosis of the lungs, meninges, larynx, intestines, in those forms of pneumonia that were not cured by penicillin, in dysentery, plague, cholera and other diseases. In the mechanism of action of streptomycin, the violation of the genetic code in the process of protein synthesis by cell ribosomes is important. Streptomycin is available in vials with rubber stoppers in a dry form. When using streptomycin, side effects are possible - dizziness, deafness, allergic reactions, vestibular disorders. Levomycetin is a synthetic drug identical to the natural antibiotic chloramphenicol; white powder of bitter taste, insoluble in water. The mechanism of its action is to suppress the protein metabolism of microbial cells. Levomycetin is very effective in dysentery, typhoid and typhus. It is used for sepsis, purulent infections, some forms of pneumonia, etc., if other antibiotics are ineffective in these cases. Side effects when taking chloramphenicol: nausea, vomiting, depression of bone marrow function (anemia, leukopenia). Tetracyclines are produced by actinomycetes. Antibiotics of this group - chlortetracycline hydrochloride, oxytetracycline hydrochloride and tetracycline - are effective in pneumonia, sepsis, dysentery (amebic and bacillary), typhus, etc. They are used to prevent infectious complications in surgical patients, especially during operations on the abdominal cavity, as well as in diseases caused by microbes resistant to penicillin and streptomycin. The mechanism of action of tetracyclines is associated with the suppression of the protein metabolism of microorganisms. These drugs are well absorbed from the gastrointestinal tract, may pass through the placenta and have an adverse effect on fetal development, so they should not be given to women during pregnancy. With the introduction of levomycetin, tetracycline and other broad-spectrum antibiotics, skin and gastrointestinal tract lesions may occur caused by antibiotic-resistant microbes or a yeast-like fungus that is part of the normal microflora of the human body. Antibiotics, suppressing the usual microflora, contribute to its growth, it becomes pathogenic and causes the disease candidiasis. Therefore, when using antibiotics, nystatin and levorin are prescribed. Gramicidin is a drug produced by soil bacillus. It has a bacteriostatic and bactericidal action against pyogenic microorganisms, pathogens of gangrene, tetanus, anthrax, etc. The drug is prescribed only externally, in the treatment of infected wounds, burns, ulcers, for washing cavities. It cannot be injected into a vein, as it damages red blood cells and causes degeneration of parenchymal organs. 6.4. Asepsis and antisepsis in first aid In nature, there are microorganisms that, penetrating into a human wound, can cause certain complications. These complications are called wound infections. There are several types of wound infections. 1. Purulent infection - occurs when staphylococci, streptococci, diplococci, gonococci, Escherichia and typhoid coli, Pseudomonas aeruginosa, etc. penetrate into the wound. A large number of such bacteria are found in pus and feces. The entry of these microorganisms into the wound of the patient can lead to the appearance of a purulent infection (suppuration), after which the formation of an abscess, phlegmon or other complication is possible. 2. Anaerobic infection - a type of wound infection that appears when anaerobic bacteria enter the wound. These bacteria include pathogens of tetanus, gangrene, etc. Infection with anaerobic infection occurs when it enters the wound of the earth. Anaerobic microbes are found mainly in manure soil, so soil contamination of wounds is especially dangerous. Among the ways of penetration of infectious agents into the wound, the following can be distinguished: - contact with an object on the surface of which there are microbes. Most often, infection with a wound infection occurs in this way; - ingestion of saliva or mucus into the wound upon contact with another person (drip infection); - exposure to microbes from the air (airborne infection). All of the above ways of getting bacteria into the wound are called exogenous, since microorganisms enter the wound from the environment. If the source of pathogenic bacteria is a focus of inflammation in the patient's body, the infection is called endogenous. The penetration of pathogenic bacteria does not always lead to the appearance of a wound infection. Infection occurs when a large number of bacteria enters the wound, when the patient has lost a lot of blood, when the patient's body is cooled, he is exhausted, and other types of decrease in the body's resistance. One way to prevent wound infection is asepsis. Asepsis is a system of preventive measures, the purpose of which is to destroy microorganisms before they enter the wound. According to the basic law of asepsis, everything that comes into contact with the wound must be sterile, that is, free from bacteria. Sterilization is carried out using elevated temperature, special chemical compounds, by using ultrasound or ion radiation. Asepsis is closely related to antisepsis. Antiseptic is a complex of therapeutic and preventive measures, the purpose of which is to reduce the number of bacteria in the wound or to completely destroy them. There are several types of antiseptics. 1. Mechanical antiseptics are the actions performed during the surgical treatment of a wound. It consists in excising the edges and bottom of the wound in order to remove more microbes and dead tissue from it, which is a breeding ground for bacteria. 2. Physical antiseptic is a series of measures aimed at creating unfavorable conditions for the life of microbes in the wound. Such measures include the imposition of a cotton-gauze bandage, the use of drying powders and tampons, the use of drains, and drying the wound in the air. Drainage is a rubber or plastic tube that is inserted into the wound to drain the discharge or wash the wound. 3. Chemical antiseptic is a set of measures aimed at the destruction of pathogens in the wound with the help of chemicals. We list the chemicals with the help of which chemical antiseptics are carried out. Silver nitrate (lapis) is used in the form of ointments, solutions for washing wounds. Aniline dyes (brilliant green, malachite blue) are used in the treatment of wounds, burns, etc. Degmin and diocide are used to treat medical instruments and hands. Iodine is used in the form of an alcohol solution to lubricate the skin in case of wounds, as an aseptic agent, etc. Carbolic acid is a poison that is used to sterilize instruments. Potassium permanganate (potassium permanganate) is used as a solution for washing, rinsing, bathing, as well as in the treatment of burns. Hydrogen peroxide is used as a freshly prepared solution for washing, stopping minor bleeding, soaking bandages adhering to the wound, in the treatment of wounds with anaerobic infection. Ethacridine lactate (rivanol) is used in the treatment of wounds, in the form of solutions for washing, etc. Furacilin is used in the form of solutions or ointments in the treatment of wounds, burns, acute purulent diseases. Vishnevsky's ointment is an antiseptic ointment consisting of 3 g of xeroform, 5 g of tar and 100 g of castor oil. Used to treat wounds. A triple solution, which includes 3 ml of carbolic acid, 20 ml of formalin and 15 g of soda per 1 liter of water, is used to sterilize instruments. In the treatment of wounds and burns, various antibiotics are also used: - Levomycetin is used in the form of tablets for oral administration before meals; - neomycin (chlortetracycline) is used for the preparation of solutions, powders; - nystatin is prescribed for oral administration in the treatment of infections caused by fungi; - penicillin is used in the form of solutions in novocaine, powder, ointments, aerosols, etc. The occurrence of a wound infection is possible not only in the case when an injury has occurred, but also during surgical operations and other medical procedures, if the rules of asepsis are violated. To prevent the occurrence of wound infections, it is necessary to use disposable or thoroughly sterilized medical instruments and materials. The doctor's hands should also be sterile clean during the procedures. Topic 7. Healthy lifestyle as a biological and social problem 7.1. Formation of a healthy lifestyle of students A healthy lifestyle is perhaps the main factor in the prevention of various diseases. One of the main tasks of educational work with students follows from this - the formation of a healthy lifestyle in them. However, we should not forget that this problem is the main one not only for teachers, but also for parents, and it is the latter who bear the main burden of responsibility. The concept of a healthy lifestyle includes a whole range of conditions and requirements, the implementation of which has a beneficial effect on human health. These include: - correct posture; - compliance with the daily routine; - proper and timely nutrition; - compliance with personal hygiene standards; - rejection of bad habits; - regular amateur sports, etc. Formation of a healthy lifestyle should include several aspects: 1) holding explanatory events with schoolchildren and their parents about the importance of a healthy lifestyle for a growing child's body; 2) building a correct schedule for the school life of a student; 3) the introduction of certain school rules and norms (wearing removable shoes, a neat appearance of a student, a ban on smoking and drinking alcohol on school grounds, etc.); 4) the introduction of penalties for violators of the rules of the school schedule, etc. In addition, one of the factors in the formation of a healthy lifestyle among schoolchildren, especially among primary school students, is a personal example, which the teacher should never forget. Parents of students often act as role models, it is necessary to conduct explanatory conversations on this topic at parent meetings. Personal hygiene rules. It is no secret that a person who leads a healthy lifestyle is less likely to get sick. To maintain and promote health, it is important to follow all the basic rules of personal hygiene. 1. Wash your hands as often and thoroughly as possible with soap and a brush. It should be remembered that dirty hands are the main source of intestinal infections and intestinal parasites in the human body. These diseases are called - "diseases of dirty hands." The nails are the most common source of infection. Food gets under the nails while eating, dirt, scales of one's own and other people's skin accumulate. The area under the nails is not always completely cleaned, so the nails should be cut short and washed with a brush. It is especially necessary to wash your hands before eating food, after visiting the toilet room, after communicating with an animal, traveling in public transport, visiting public places, and also after walking on the street. It is important to remember that, in addition to pathogens, particles of metals, harmful chemical compounds, etc. can remain on the skin. 1. It is necessary to thoroughly wash and wipe vegetables and fruits, as well as utensils used for eating, as they can also become a source of infection with various kinds of intestinal infections. Food is best washed with boiled water. 2. Among other personal hygiene rules, careful dental care occupies an important place. It is necessary to brush your teeth twice a day (morning and evening) using a toothpaste suitable for a person. Evening brushing of teeth is very important, as it removes the remnants of food that have accumulated in the mouth during the day. Their accumulation can lead to infection. It is important to choose the right toothpaste: for children's teeth, the use of whitening pastes, pastes with a high content of minerals is harmful. When choosing a toothpaste, you should be guided by the advice of a dentist. You need to visit the dentist twice a year. Our teeth are covered with enamel: if it is damaged, the tooth begins to deteriorate. Therefore, it is dangerous to gnaw nuts and bones, pick your teeth with needles or pins. Sudden changes in food temperature can also cause cracks in tooth enamel. 3. Before going to bed, wash your face, ears, neck and arms up to the elbows with soap and dry thoroughly with a towel. Each person should have their own towel. It is useful to accustom yourself to wash before going to bed and your feet with water at room temperature. This prevents them from sweating and hardens the body. 4. To remove sebum, dirt, dead cells of the epidermis (surface layer of the skin), sweat, it is necessary to regularly apply water procedures. It is also important to regularly change underwear and bedding. 5. You need to carefully care for your hair. For a neat appearance, you need to comb them regularly. Each person should use their own comb and other hair accessories. 6. As your hair gets dirty, wash your hair regularly with a shampoo suitable for your hair type. Failure to follow this rule can lead to the appearance of skin parasites, as well as fungal diseases that are difficult to cure and can lead to baldness. 7. It is necessary to monitor the neatness and cleanliness of clothes and shoes. Clothing should be comfortable, not restricting movement, and shoes should be suitable in size and with a small heel (for the prevention of flat feet). In rooms during the cold season, outerwear and shoes should be removed to prevent dust and dirt particles from getting into household items from the street, as well as to ensure that the body has a rest from outerwear and warm shoes. At home, you need to have special home clothes. Special clothing should also be used at school in the lessons of labor training and physical education. 8. Living rooms and classrooms should be ventilated as often as possible. This is done to increase the oxygen concentration in the room, as well as to reduce the amount of organic substances in the air (pathogenic bacteria and viruses). In addition, ultraviolet radiation (sunlight) can kill many microorganisms, which disinfects the air. 9. It is necessary to regularly carry out wet cleaning of premises (especially public ones). Following these simple hygiene rules will help keep you healthy. 7.2. Healthy lifestyle motivation The lifestyle of a child is the basis of his health throughout his subsequent life. An incorrectly laid foundation can lead to damage to the entire structure, even if all its other elements are laid correctly. For the health of the future generation of our nation, it is necessary to instill and motivate a healthy lifestyle. Motivation for a healthy lifestyle is a set of measures aimed at developing in children the desire to comply with all the rules and norms of a healthy lifestyle. Activities for the formation of motivation should begin from the very birth of the child. To do this, parents gradually accustom him to proper and regular nutrition, personal hygiene, etc. It is also necessary to instill in the child the skills of self-service and independent performance of basic personal hygiene. Growing up, the child gets used to the daily routine, the rules set for him by his parents and cannot imagine another way of life. A healthy lifestyle should become a necessity for a child: if a child, for example, could not do exercises or brush his teeth in the morning, then he already experiences discomfort. A huge influence on the formation of a healthy lifestyle of a child is imposed by the personal example of adults surrounding him, since the imitation of adults is inherent in the nature of children. This applies to the actions of parents, family members, kindergarten teachers, teachers. It is also important to constantly monitor the child: all his actions must be evaluated, he must receive encouragement or blame. Growing up and passing the transitional age, adolescents cease to look closely and listen to the adults around them. Often at this age, peers of the child enjoy great authority, so his lifestyle will largely depend on the lifestyle of his friends and company. At this age, the motivation for a healthy lifestyle should come not from adults, but from the child's peers. Therefore, it is necessary to hold special meetings and class hours, at which the children themselves must prepare reports on the importance of a healthy lifestyle: on the dangers of smoking, drinking alcohol, drugs, on the benefits of proper nutrition, playing sports. Adolescents are also greatly influenced by the media: radio, television, magazines, the Internet. To motivate a healthy lifestyle, you need to draw the attention of students to programs, articles and publications that promote a healthy lifestyle. It should be noted that nowadays a healthy lifestyle is becoming fashionable. More and more popular people are promoting a healthy lifestyle, in addition, healthy, athletic, strong personalities are more popular than those tormented by bad habits. Based on this, in conversations with schoolchildren, they should be made to understand that good health is one of the first steps to popularity and success. 7.3. Bad habits and their prevention To bad habits it is customary to attribute various types of human activities that are harmful to his health. Consider some bad habits and the harm they cause to the body. Smoking is one of the most harmful habits. Doctors have proven that tobacco smoke contains more than 30 toxic substances: nicotine, carbon dioxide, carbon monoxide, hydrocyanic acid, ammonia, various resins and acids, and other substances. Two packs of cigarettes contain a lethal dose of nicotine, and only the fact that nicotine enters the body in small portions saves the smoker. Doctors have found that, compared with non-smokers, long-term smokers are 13 times more likely to develop angina pectoris, 12 times more likely to have myocardial infarction, and 10 times more likely to have stomach ulcers. Of all lung cancer patients, 98% are smokers. In addition, medical studies have shown that smokers are more likely to develop cancer in other organs: the esophagus, stomach, larynx, and kidneys. In smokers, cancer of the lower lip often occurs due to the carcinogenic effect of the extract that accumulates in the mouthpiece of the pipe. Every seventh long-term smoker suffers from a serious disease of the blood vessels. Tobacco products are made from dried tobacco leaves, which contain proteins, carbohydrates, mineral salts, fiber, enzymes, fatty acids and other substances. Among them, it is important to note two groups of substances dangerous to humans - nicotine and isoprenoids. Substances contained in tobacco affect different human systems. The worst effect is nicotine. It enters the body along with tobacco smoke, which, in addition to nicotine, contains irritating substances, including carcinogenic (benzapyrene and dibenzapyrene), which contribute to the occurrence of malignant tumors. Nicotine is a nerve poison. In experiments on animals and observations on humans, it has been established that nicotine in small doses excites nerve cells, increases respiration and heart rate, causes heart rhythm disturbances, nausea and vomiting. Large doses of nicotine slow down or paralyze the activity of the cells of the central nervous system, including the autonomic one. A disorder of the nervous system is manifested by a decrease in working capacity, trembling of the hands, and a weakening of memory. Nicotine also affects the endocrine glands: adrenal glands (adrenaline is released into the blood, causing vasospasm, increased blood pressure and increased heart rate), sex glands (nicotine is the cause of sexual weakness in men). Smoking is especially harmful for children and adolescents, whose fragile nervous and circulatory systems react painfully to tobacco. Carbon monoxide found in tobacco smoke causes oxygen starvation, since carbon monoxide combines with hemoglobin more easily than oxygen, and is delivered with blood to all human tissues and organs. Very often, smoking leads to the development of chronic bronchitis, accompanied by a persistent cough and bad breath. As a result of chronic inflammation, the bronchi expand, which can lead to emphysema or circulatory failure. As a result, the smoker acquires certain distinctive features: a hoarse voice, a puffy face, shortness of breath. Smoking increases the chance of developing tuberculosis. This is because tobacco smoke destroys the lungs' defense system, making them more susceptible to disease. Often smokers experience pain in the heart. This is due to a spasm of the coronary vessels that feed the heart muscle, with the development of angina pectoris (coronary heart failure). Myocardial infarction in smokers is three times more common than in non-smokers. Smoking can lead to vasospasm of the lower extremities, contributing to the development of obliterating endarteritis, which affects mainly men. This disease leads to malnutrition, gangrene and eventually to amputation of the lower limb. From the substances contained in tobacco smoke, the digestive tract also suffers, primarily the teeth and oral mucosa. Nicotine increases the secretion of gastric juice, which causes aching pain in the stomach, nausea and vomiting. Smoking can cause nicotinic amblyopia, which causes partial or total blindness. A smoker must also remember that he puts not only his own health at risk, but also the health of others: people who are in a smoky room and inhale cigarette smoke (the so-called "passive smoking") consume a certain amount of nicotine and other harmful substances. Alcohol abuse is another bad habit that adversely affects the human body. Alcohol, or alcohol, acts on the body like narcotic drugs, but the stage of excitation caused by it is longer. In medical practice, ethyl alcohol is used - a transparent, colorless, volatile, flammable liquid of a burning taste with a characteristic odor. When taken orally in small concentrations, ethyl alcohol enhances the secretion of the gastric glands without affecting the digestive activity of gastric juice, and increases appetite. At higher concentrations, it has a strong irritant effect on the mucous membranes, inhibits the production of pepsin, reduces the digestive power of gastric juice and contributes to the development of chronic gastritis in people who constantly drink alcohol. When administered orally, alcohol is absorbed in the stomach and small intestine, enters the bloodstream and is relatively evenly distributed in the body, can penetrate the placental barrier and affect the fetus. Therefore, the use of alcohol is strictly prohibited during pregnancy. When alcohol is taken, heat production increases, skin vessels expand, a feeling of warmth is created, but heat transfer increases, body temperature decreases, so alcohol cannot be used to combat hypothermia. In addition, a person who has consumed alcohol does not feel external cold, which can lead to dangerous hypothermia. Like drugs, alcohol has a depressing effect on the central nervous system. When drinking alcohol, acute alcohol poisoning is possible, in which loss of consciousness, respiratory failure, increased heart rate, blanching of the skin, and a decrease in body temperature are observed. To eliminate these symptoms resort to gastric lavage. Alcoholic beverages contain a large number of harmful additives and components that have a general toxic effect on the body - and this is another danger associated with alcohol abuse. Alcohol has a negative effect on the liver - the natural filter of the human body. Long-term alcohol consumption can lead to a dangerous disease - cirrhosis of the liver. Chronic alcohol poisoning is observed in alcohol addiction - alcoholism. Alcoholism is a condition in which a person feels a daily need for alcohol, without which he cannot live. At the same time, mood instability, irritability, sleep disturbance, digestion, damage to internal organs (heart obesity, chronic gastritis, cirrhosis of the liver), and a steady decline in intelligence are noted. In the future, patients develop alcoholic psychoses, polyneuritis and other disorders of the nervous system. A person with alcoholism loses contact with the surrounding society, is considered socially dangerous. Treatment of persons suffering from alcoholism is carried out in special institutions with the use of drug therapy, psychotherapy, hypnosis. Prevention of alcohol abuse should begin in early childhood. Statistics know that in most cases, teenagers try alcoholic beverages for the first time, imitating adults, so a healthy lifestyle of parents should become an example for their children. Also, in order to prevent alcohol abuse and alcoholism, it is necessary to carry out explanatory work for schoolchildren, lectures on the dangers of alcohol consumption, etc. Drug addiction (addiction to narcotic drugs) is one of the most harmful habits. Most narcotic drugs are general cellular poisons, that is, substances that reduce the vital activity of any cell - animal and plant (the exception is nitrous oxide). Under the conditions of the body, in particular in humans, they primarily affect the synapses of the central nervous system, i.e., the places of connection between neurons. Intersynaptic transmission of impulses plays an important role in the implementation of all reflex activity of the body, therefore, a decrease in the functional activity of synapses is accompanied by inhibition of reflexes and the gradual development of a narcotic state. Under the influence of narcotic drugs in the central nervous system, a change in natural processes occurs, hallucinations occur, a sense of fear and control over oneself is lost. As a result, a person can commit acts that are dangerous for himself and for others. The use of narcotic drugs quickly leads to addiction: a person who is addicted to drugs has a "breakdown" - an urgent need to use the next dose of the drug. Such a person is capable of any actions to achieve his goal - to receive the next dose. As preventive measures to combat drug addiction, films depicting drug addicts and their suffering should be shown to children. This should cause in children an aversion to drugs, a fear of them. It is also important to monitor the child and at the first signs of drug use, contact specialists. Addiction treatment is very difficult. It is carried out in specialized clinics using various drugs, but does not always lead to the desired effect. 7.4. Ways to save students' vision Good vision is the ability to distinguish objects and things near and far, to distinguish one color from another. Good vision is a vital necessity. A person suffering from visual impairments (farsightedness, myopia, color blindness) experiences constant discomfort, since for a full life he needs the use of special means (glasses, lenses). Visual impairments can be congenital or acquired. A person receives congenital defects at birth, and their correction is almost impossible. Acquired deficiencies are the result of accidents, serious illnesses, non-compliance with the rules of vision protection. Thus, we can conclude that the vision received by a person from nature is practically impossible to improve, therefore, it is necessary to take all measures to preserve the vision given to a person from birth. With the beginning of schooling, a child's vision is put to a serious test. As a result of constant loads, it is strongly strained every day, and if certain rules are not followed, by the time of graduation from school, or even earlier, the child's vision can be significantly weakened. In order to preserve vision, the following basic rules must be observed. 1. Provide good lighting when reading, writing, drawing, designing, sewing, etc. The light should fall on the left side of the child so that the working right hand does not create a shadow. 2. The power of electric lighting lamps must be selected so that they give sufficient illumination and at the same time do not dazzle. 3. When reading, writing, drawing, etc., you need to sit straight with your head slightly tilted so that the distance from the eyes to the notebook or book is not less than 30 and not more than 40 cm. 4. Radiation from a TV screen and a computer monitor is harmful to eyesight, therefore, in order to maintain eyesight, one should watch TV from a distance of at least 3 m, use protective screens when working with a computer, and in their absence, periodically give eyes a rest. 5. An important condition for maintaining vision is to protect the eyes from mechanical damage. To do this, the child should avoid playing with slingshots, arrows, air and firearms; when working on machines and in dust, use safety goggles, etc. 6. To avoid the occurrence of infectious eye diseases that adversely affect vision, it is necessary to observe the rules of personal hygiene: do not touch your eyes with dirty hands, do not use someone else's towel, do not wear someone else's glasses, do not give your glasses to others, do not sleep on someone else's pillow or on a pillow with a dirty pillowcase, etc. If you notice a deterioration in vision, you should immediately consult a doctor. The sooner measures are taken to treat vision, the easier it will pass and the greater the likelihood of a positive outcome. 7.5. Posture of schoolchildren Posture refers to the position and shape of the bones of the skeleton. Posture is an important part of the overall appearance of a person, but correct posture is necessary not only from an aesthetic point of view, but also from a health point of view. Bad posture is not only ugly, it's bad for your health. With a good, slender posture, the body is straight, the spinal column is in a normal position with physiological bends forward in the region of the cervical and lumbar vertebrae; Shoulders are deployed and are at the same level, the head is held straight. At the same time, the internal organs of a person are in the correct position and work normally, and the movements of a person are free and unconstrained. If the posture is wrong, especially if the spine is curved, then the work of the heart and breathing are difficult. In children of primary and secondary school age, the bones of the skeleton are rich in organic matter and therefore very malleable. The constant incorrect position of the body at the table, when walking, during sleep leads to the fact that the chest becomes flat and narrow. There are various persistent curvatures of the spine (stoop, lateral bends). Correcting posture in such cases can be very difficult, and sometimes even impossible. In addition, the habit of standing, resting the whole weight of the body on one leg, badly affects posture. In order for the posture to be correct, the following recommendations must be followed. 1. When standing, always lean evenly on both feet. 2. The body must be kept straight. 3. Shoulders should be slightly laid back. 4. The chest should be slightly stick out, and the stomach should be pulled in. 5. The head must be kept elevated. 6. When walking, do not hunch over, sway from side to side and shuffle your feet on the ground. 7. You need to sit correctly at your desk or at the table. In order for the landing to be correct, the height of the table, chair and desk must necessarily correspond to the height of the child. If a student sits at a table that is too high or too low and holds his hands incorrectly, then his body assumes an unnatural posture, the body bends and the spine gradually curves. The height of the table for a student with a height of 130-140 cm should be 62 cm, a chair - 38 cm; for a student with a height of 140 to 150 cm - 68 cm and 41 cm, respectively. If the height of the student is below 130 cm, then the place for his studies must be specially equipped. When working at a table, you need to sit on a chair deeply so that you can lean on its back. You need to sit straight, slightly tilting your head and not lying on the table with your chest. Between the chest and the chair there should always be a distance equal to the size of the student's fist. The legs should be bent at the knees at a right angle and rest your feet on the floor. It is necessary to constantly ensure that the shoulders are always at the same level and that the correct distance from the eyes to the book or notebook is maintained. The correct posture should be maintained in all types of work: during industrial training, work at home, in physical education lessons. 8. The uneven load of the shoulder girdle has a bad effect on the posture of the schoolchild. Often the spine is twisted and one shoulder drops down from the fact that the student is carrying a briefcase with books or other weights in one hand. The briefcase must be held alternately in the right, then in the left hand. To evenly distribute the load on the shoulders, it is best to use a backpack. However, in any case, it is important to remember that children should not carry weights, as this can cause deformation of the fragile children's skeleton. Children under 8-10 years old should not carry loads heavier than 8 kg. 9. You should sleep on a fairly wide and long bed, with an even and not too soft mattress, put only one small pillow under your head. 10. Observations of doctors show that very often bad posture is due to weakness of the muscles of the body. Well strengthen and develop the muscles of the back and abdomen physical labor and exercise. However, physical education at school alone is not enough. You need to do gymnastics every morning, play outdoor games in your free time, swim in the summer, ski and skate in the winter, go in for sports sections. 7.6. Forms of recreational physical education According to the degree of influence on the body, all types of health-improving physical culture can be divided into two groups: exercises of a cyclic and acyclic nature. Cyclic exercises are motor acts in which the same complete cycles are constantly repeated for a long time. Among such exercises are walking, running, skiing, cycling, swimming, rowing. Acyclic exercises are motor acts, the structure of which does not have a cycle and changes in the process of execution. These are gymnastic and strength exercises, jumping, throwing, sports games, martial arts. Acyclic exercises have a predominant effect on the functions of the musculoskeletal system, which leads to an increase in muscle strength, quick reactions, flexibility and mobility in the joints, lability of the neuromuscular system. The types with the predominant use of cyclic exercises include hygienic and industrial gymnastics, classes in health and general physical training groups, rhythmic and athletic gymnastics, etc. Morning hygienic gymnastics is designed to bring the body into working condition after waking up, maintain a high level of efficiency during the working day, improve the coordination of the neuromuscular apparatus, the activity of the cardiovascular and respiratory systems. During morning exercises and water procedures, the activity of skin and muscle receptors, the vestibular apparatus is activated, the excitability of the central nervous system increases, as a result of which the functions of the musculoskeletal system and internal organs improve. Industrial gymnastics is one of the types of recreational physical education, which is used in various forms in the workplace. Gymnastics at the beginning of the working day activates the motor nerve centers and increases blood circulation in the working muscle groups. Such gymnastics is especially important for employees who sit in one place for a long time, and for people performing minor mechanical operations. During work, it is necessary to arrange physical culture breaks. The time of their implementation falls on periods of decline in the working capacity of employees, industrial gymnastics should be ahead of the phase of reducing working capacity. By performing exercises with musical accompaniment for unused muscle groups (according to the mechanism of active rest), the coordination of the activity of nerve centers, the accuracy of movements are improved, the processes of memory, thinking and concentration of attention are activated, which has a beneficial effect on the results of the production process. Rhythmic gymnastics differs from other types of gymnastics in the pace of movements and the intensity of the exercises, which are set by the rhythm of the musical accompaniment. In this type of gymnastics, various complexes are used that affect the body: - running and jumping exercises, affecting mainly the cardiovascular system; - tilts and squats, developing the motor apparatus; - methods of relaxation and self-hypnosis, which are important for the normalization of the activity of the central nervous system; - exercises in the stalls, developing muscle strength and mobility in the joints; - running series, training endurance; - dance exercises that develop plasticity, etc. Depending on the choice of means used, rhythmic gymnastics is divided into athletic, dance, psychoregulatory and mixed. The nature of energy supply, the degree of strengthening of respiratory and circulatory functions depend on the type of exercise. A series of ground exercises (in lying, sitting positions) has the greatest impact on the circulatory system, while all physical characteristics do not exceed the aerobic norm, i.e. work in the ground is predominantly aerobic in nature. In a series of exercises performed in a standing position, dance, global exercises (tilts, deep squats) significantly speed up the pulse, increase pressure and respiratory rate. The most effective effect on the body is provided by a series of running and jumping exercises, in which, at a certain pace, the pulse can reach 180-200 beats per minute, and oxygen consumption - 2-3 liters. Depending on the selection of a series of exercises and the pace of movements, rhythmic gymnastics classes can have both a sports and health-improving orientation. The maximum stimulation of blood circulation up to the level of 180-200 beats per minute can only be used in sports training by young healthy people. In this case, it is predominantly anaerobic in nature and is accompanied by inhibition of aerobic mechanisms of energy supply. There is no significant stimulation of fat metabolism with this nature of energy supply; therefore, there is no decrease in body weight and normalization of cholesterol metabolism, as well as the development of general endurance and working capacity. In health-improving classes, the choice of the pace of movements and series of exercises should be carried out in such a way that the training was mainly aerobic in nature. Then, along with improving the functions of the musculoskeletal system (increasing muscle strength, mobility in the joints, flexibility), it is also possible to increase the level of general endurance, but to a much lesser extent than when performing cyclic exercises. Athletic exercises can be recommended as a means of general physical development for young healthy men - in combination with exercises that increase aerobic capacity and general endurance. It should be noted that strength exercises are accompanied by large drops in blood pressure associated with holding the breath and straining. During straining, as a result of a decrease in blood flow to the heart and cardiac output, systolic pressure drops sharply and diastolic pressure rises. Immediately after the end of the exercises, due to the active blood filling of the ventricles of the heart, the systolic pressure rises to 180 mm Hg. Art. and more, and the diastolic falls sharply. These changes can be largely neutralized by changing the training methodology (working with weights no more than 50% of the maximum weight and lifting the projectile in the inhalation phase), which automatically eliminates breath holding and straining. It is also important to remember that people of more mature age can use only individual exercises of the athletic complex aimed at strengthening the main muscle groups (muscles of the shoulder girdle, back, abdominals, etc.) as a supplement after endurance training in cyclic exercises. Gymnastics according to the yoga system is quite popular in our country, but its effect on the body has not yet been studied enough. Yoga includes a number of physical exercises, the purpose of which is to improve the human body and the functions of internal organs. In gymnastics, static elements (postures) of breathing exercises and elements of psychoregulation (auto-training) are distinguished. The effect of postures on the body depends on two factors: strong stretching of the nerve trunks and muscle receptors, increased blood flow in a particular organ (or organs) as a result of a change in body position. When the receptors are excited, a powerful stream of impulses arises in the central nervous system, stimulating the activity of the corresponding nerve centers and internal organs. Performing special breathing exercises (controlled breathing) associated with holding the breath, in addition to the neuro-reflex effect on the body, helps to increase the vital capacity of the lungs and increases the body's resistance to hypoxia. The yoga system can be used in health-improving physical culture. For example, such exercises as abdominal and full breathing of yogis, autogenic training (which is essentially a variant of the "dead posture"), some flexibility exercises ("plow", etc.), elements of body hygiene and nutrition, etc., are successfully used. gymnastics according to the yoga system cannot act as a sufficiently effective independent health-improving means, since it does not lead to an increase in aerobic capacity and the level of physical performance. The forms of health-improving physical culture described above (with the use of acyclic exercises) do not contribute to a significant increase in the functionality of the circulatory system and the level of physical performance, and therefore are not of decisive importance as health-improving programs. The leading role in this regard belongs to cyclic exercises that ensure the development of aerobic capacity and overall endurance. Aerobics is a system of physical exercises, the energy supply of which is carried out through the use of oxygen. Aerobic exercises include only those cyclic exercises in which at least two-thirds of the muscle mass of the body is involved. To achieve a positive effect, the duration of aerobic exercises should be at least 20-30 minutes. It is for cyclic exercises aimed at developing general endurance that the most important morphofunctional changes in the circulatory and respiratory systems are characteristic, such as an increase in the contractile and "pumping" function of the heart, an improvement in the utilization of oxygen by the myocardium, etc. Differences in certain types of cyclic exercises associated with the peculiarities of the structure of the motor act and the technique of its implementation are not of fundamental importance for achieving a preventive and healing effect. Improving walking - accelerated walking at an appropriate speed (up to 6,5 km / h). Its intensity can reach the training mode zone. With daily recreational walking (1 hour each), the total energy consumption per week will be about 2000 kcal, which provides a minimum (threshold) training effect - to compensate for the lack of energy consumption and increase the body's functional capabilities. Accelerated walking as an independent health remedy can be recommended only if there are contraindications to running (for example, in the early stages of rehabilitation after a heart attack). In the absence of serious deviations in the state of health, it can only be used as the first (preparatory) stage of endurance training for beginners with low functionality. In the future, as fitness increases, recreational walking should be replaced by running training. 7.7. The influence of health-improving physical education on the body The health-improving and preventive effect of mass physical culture is associated with increased physical activity, strengthening of the functions of the musculoskeletal system, and activation of metabolism. Experiments have established the relationship between the activity of the motor apparatus, skeletal muscles and autonomic organs. Consequently, as a result of insufficient motor activity in the human body, the neuroreflex connections laid down by nature and fixed in the process of hard physical labor are disrupted, which leads to a disorder in the regulation of the activity of the cardiovascular and other systems, metabolic disorders and the development of degenerative diseases (atherosclerosis, etc.). .). For the normal functioning of the human body and the preservation of health, a certain dose of physical activity is necessary. In this regard, the question arises about the so-called "habitual motor activity", i.e., activities performed in the process of everyday professional work and in everyday life. The most adequate expression of the amount of muscular work produced is the amount of energy consumption. The minimum amount of daily energy consumption required for the normal functioning of the body is 12-16 MJ (depending on age, sex and body weight), which corresponds to 2880-3840 kcal. Of these, at least 5,0-9,0 MJ (1200-1900 kcal) should be spent on muscle activity; the remaining energy costs ensure the maintenance of the body's vital functions at rest, the normal activity of the respiratory and circulatory systems, metabolic processes (energy of the main metabolism), etc. Currently, in most countries of the world, the physical activity of a person at work has decreased by 200 times compared to the beginning of the last century. At the same time, the energy consumption of a modern person who does not engage in physical culture is three times less than the threshold value that provides a health-improving and preventive effect. In this regard, in order to compensate for the lack of energy consumption in the course of work, a modern person needs to perform physical exercises with an energy consumption of at least 350-500 kcal per day (or 2000-3000 kcal per week). A sharp restriction of motor activity in recent decades has led to a decrease in the functional capabilities of middle-aged people. Thus, most of the modern population of economically developed countries has a real danger of developing hypokinesia. Hypokinetic disease (hypokinesia) is a complex of functional and organic changes and painful symptoms that develop as a result of a mismatch between the activity of individual systems and the body as a whole with the external environment. The cause of hypokinesia is a violation of energy and plastic metabolism (primarily in the muscular system). The mechanism of the protective action of intense physical exercise lies in the genetic code of the human body. Skeletal muscles, which on average make up 40% of body weight (in men), are genetically programmed by nature for hard physical work. Human muscles are a powerful generator of energy. They send a strong stream of nerve impulses to maintain the optimal tone of the central nervous system, facilitate the movement of venous blood through the vessels to the heart ("muscle pump"), and create the necessary tension for the normal functioning of the motor apparatus. There are general and special effects of physical exercise, as well as their indirect effect on risk factors. 1. The overall effect of training is energy consumption, which is directly proportional to the duration and intensity of muscle activity, which makes it possible to compensate for the energy deficit. It is also important to increase the body's resistance to the action of adverse environmental factors: stressful situations, high and low temperatures, radiation, trauma, hypoxia. As a result of an increase in nonspecific immunity, resistance to colds also increases. However, the use of extreme training loads required in professional sports to achieve the "peak" of sports form often leads to the opposite effect - suppression of the immune system and increased susceptibility to infectious diseases. A similar negative effect can be obtained in mass physical culture with an excessive increase in load. 2. The special effect of health training is associated with an increase in the functionality of the cardiovascular system. It consists in economizing the work of the heart at rest and increasing the reserve capacity of the circulatory apparatus during muscle activity. One of the most important effects of physical training is a decrease in the heart rate at rest (bradycardia) as a manifestation of the economization of cardiac activity and a lower myocardial oxygen demand. Increasing the duration of the diastole (relaxation) phase provides more blood flow and a better supply of oxygen to the heart muscle. In addition to a pronounced increase in the reserve capacity of the body under the influence of health training, its preventive effect is also extremely important, associated with an indirect effect on risk factors for cardiovascular diseases. With the growth of fitness (as the level of physical performance increases), there is a clear decrease in all major risk factors - cholesterol in the blood, blood pressure and body weight. It is important to emphasize the influence of health-improving physical culture on the aging body. Physical culture is the main means of delaying age-related deterioration of physical qualities and a decrease in the adaptive abilities of the body as a whole and the cardiovascular system in particular, inevitable in the process of involution. Age-related changes are reflected both in the activity of the heart and in the state of peripheral vessels. With age, the ability of the heart to maximum stress decreases significantly, which manifests itself in an age-related decrease in the maximum heart rate. With age, changes also occur in the vascular system: the elasticity of large arteries decreases, the total peripheral vascular resistance increases, as a result of which, by the age of 60-70, systolic pressure increases by 100-140 mm Hg. Art. All these changes in the circulatory system, a decrease in the productivity of the heart entail a pronounced decrease in the maximum aerobic capacity of the body, a decrease in the level of physical performance and endurance. With age, the functionality of the respiratory system also deteriorates. The vital capacity of the lungs (VC), starting from the age of 35, decreases by an average of 7,5 ml per 1 sq. m of body surface. There was also a decrease in the ventilation function of the lungs - a decrease in the maximum ventilation of the lungs. And, although these changes do not limit the body's aerobic capacity, they lead to a decrease in the vital index, which can predict life expectancy. Metabolic processes also change significantly: glucose tolerance decreases, the content of total cholesterol increases, which is typical for the development of atherosclerosis. The state of the musculoskeletal system worsens: due to the loss of calcium salts, rarefaction of bone tissue occurs (osteoporosis). Insufficient physical activity and lack of calcium in the diet exacerbate these changes. Adequate physical training, health-improving physical culture can largely stop age-related changes in various functions. At any age, with the help of training, you can increase aerobic capacity and endurance levels - indicators of the biological age of the body and its viability. Thus, the health-improving effect of mass physical culture is determined by the following factors: - increasing the aerobic capacity of the body; - increase in the level of general endurance and physical performance; - a preventive effect on risk factors for cardiovascular diseases: a decrease in body weight and fat mass, cholesterol and triglycerides in the blood, a decrease in blood pressure and heart rate; - suspension of the development of age-related involutional changes in physiological functions, as well as degenerative changes in various organs and systems (including the delay and reverse development of atherosclerosis). In this regard, the musculoskeletal system is no exception. Performing physical exercises has a positive effect on all parts of the motor apparatus, preventing the development of degenerative changes associated with age and physical inactivity. The mineralization of bone tissue and the calcium content in the body increase, which prevents the development of osteoporosis. The flow of lymph to the articular cartilage and intervertebral discs increases, which is the best way to prevent arthrosis and osteochondrosis. All these data testify to the invaluable positive impact of health-improving physical culture on the human body. 7.8. The importance of daily routine The correct mode of the day is determined by the alternation of various activities: work and rest. With a properly composed daily routine, a person provides himself with a constantly high working capacity, a prosperous mental state, contributes to his physical and mental development, and also strengthens his health. Each person must choose for himself the regime of the day, taking into account, when compiling it, not only the type of activity necessary for him, but also his individual characteristics (type of temperament, physical condition, level of fatigue, etc.). The development of the daily routine should be based on some rules. 1. First of all, it should reflect all types of activities, their duration. 2. Different types of activities should alternate with each other. 3. It is necessary to allocate sufficient time for rest, part of the rest must be spent in the fresh air. 4. You need to eat regularly, at least three times a day. 5. Sufficient time should be allotted for proper sleep. As a result of observing the daily routine, the human body develops a certain rhythm of activity. This leads to the development of appropriate reflexes. For example, when eating at the same time, a daily need is developed to receive food at a given time, when the body and, in particular, the digestive system are ready for it. If you go to bed and get up at the same time every day, then a certain reflex is developed, as a result of which everyday awakening will occur at the same time and the person will feel cheerful until the evening. Failure to comply with the regime and its gross violations can lead to fatigue and overwork of the body. Fatigue is a condition in which the physiological processes of the body and, in particular, the activity of the cells of the cerebral cortex are disturbed. This is a protective reaction of the body, which is caused by excessive stress. The correct organization of the daily routine allows you to correctly alternate loads with rest, which makes it possible to delay the onset of fatigue. For these purposes, a number of measures are envisaged in the educational process. For example, training sessions should last no longer than 40-45 minutes. During the lesson, physical culture pauses are arranged for younger students, allowing them to distract themselves from the educational process. In addition, the lessons use the alternation of certain types of activities: oral and written work, etc. When tired, a person has a feeling of fatigue, the need for rest. If a person in this state does not get proper rest, the body's fatigue accumulates and develops into overwork. Overfatigue is a state of the body in which there is a violation of sleep, loss of appetite, performance, deterioration of attention and memory. With prolonged overwork, the body's resistance decreases, the level of immunity decreases, which can lead to the appearance of various diseases. Overwork is the result of improper organization of human activity, i.e., the result of an incorrectly drawn up daily routine: excessive work or study activities, irregular meals, short sleep, insufficient exposure to fresh air, etc. 7.9. Health-saving function of the educational process The educational process is a holistic process of development of the child's personality. It includes not only education as the transfer of some knowledge from one generation to another, but also the full development of the moral side of the individual, the development of certain rules and norms of behavior. It is also important to remember that the full and holistic development of the child is impossible if the child is sick or suffers from physical ailments. Therefore, among the functions of the educational process, it is necessary to include the health-saving function. The performance of this function should include a number of measures aimed at preserving and strengthening the health of all participants in the educational process. Among these measures are the following. 1. Organization of conditions for the normal passage of the educational process. This measure includes the availability of premises specialized for conducting training sessions, the creation of optimal conditions in them (temperature regime, illumination, etc.), the availability of comfortable classroom furniture (not spoiling the student's posture). 2. Compliance with the necessary sanitary and hygienic norms and rules in the educational institution (regular wet cleaning of all premises, preventive examination of all employees, etc.). 3. Organization of proper nutrition of students during their stay in an educational institution: the presence of special institutions (canteens, cafes), constant monitoring of the quality of initial and final products, strict observance of sanitary and hygienic standards. 4. Regular holding of special classes, the purpose of which is to instill in schoolchildren the rules and norms of personal hygiene, the basic rules of life safety, as well as to teach elementary methods of first aid. The upbringing of a healthy student should become an integral part of the general education of students. Consequently, the health-saving function of the educational process falls not only on the shoulders of the subject teacher, but also on the entire teaching staff of the school - from the janitor to the director. 7.10. The role of the teacher in shaping the health of students, preventing diseases It is known that the health of a child, especially at primary school age, depends on how the adults around him participate in the life of the child. In particular, the teacher, in whose company the student spends part of his time, is able to influence the health of his students. This influence can be both positive and negative. The influence of the teacher will be positive if the teacher fulfills the following requirements in the process of learning activities: - makes sure that sanitary and hygienic rules are regularly followed in the classroom (airing the classroom, periodic wet cleaning of the room, etc.), as well as ensuring that the child (especially younger ones) fulfills all the requirements of personal hygiene. Otherwise, the teacher should bring this to the attention of the student's parents; - timely detects children suffering from infectious diseases in the classroom. If sick children are found in the class, one should contact the medical center at the educational institution in order to confirm the diagnosis, and if the diagnosis is confirmed, then quarantine may be declared in the educational institution; - allows children to attend classes only if the attendance is approved by a doctor (violation of this rule can be dangerous both for a sick student and for others); - he himself observes all the rules and norms of personal hygiene in order to set an example of correct behavior by his own example (look neat, etc.); - in case of emergencies, is responsible for the life and health of children, i.e. takes all necessary measures to save children (carries out competent evacuation of children from school, takes measures to seal the premises, etc.). Every teacher should remember that the health of students is the main task of the school, since a sick and physically undeveloped child cannot receive a full-fledged education and, therefore, it will be difficult for him to become a full-fledged member of society. 7.11. Joint activities of the school and the family in the formation of a healthy lifestyle for students Preserving the health of the child is the main task of the adults around him: parents, teachers and other employees of the school in which the child is studying. In this regard, it is important to note that a child will be really healthy if the efforts of the school and family in shaping his health and a healthy lifestyle were coordinated, that is, they had the same goal, were implemented by the same methods. However, there are often cases when the policy of the school and the policy of the family do not coincide and the child falls "between two fires". An example of such a situation is how the school tries to fight bad habits among students. All employees of the school team ensure that students do not smoke while at school. At the same time, students claim that their parents allow them to smoke and teachers do not have the right to forbid them what their parents allow. In this case, firstly, all the efforts of the school staff to maintain the health of the smoking student become in vain; secondly, such a student is potentially dangerous for other students, since they become passive smokers, which is also harmful to health; thirdly, the authority of the teacher suffers both in the eyes of the smoking student and in the eyes of other students, which leads to a decrease in the educational impact on schoolchildren. Parents should remember that the health of the child is the foundation of the health of the future adult. And this foundation will be fragile if the child does not follow the rules of a healthy lifestyle. To coordinate the efforts of parents and the school staff aimed at preserving and strengthening the health of children, it is necessary to hold special parent meetings. At such meetings, parents should be explained the rules of behavior for students at school, and they can discuss the possibility of conducting additional activities in order to improve the health of children. Such activities include regular visits to the pool by the child (with the consent of the doctor), walks and excursions in the fresh air, the organization of sports sections and circles, additional medical examinations of children, etc. At the meetings, decisions are made that satisfy both parents and the school, the implementation of which should be mandatory. In addition, the parents of the child must ensure that the actions of the school administration or teachers do not violate the rights of the child, do not harm his health. For this purpose, a parent committee is being created, which monitors the process of teaching and raising children at school, observing all sanitary and hygienic standards, and creating optimal conditions for a fruitful educational process in the school. To increase the level of fitness of children at school, special sports sections and circles are organized. With the coordinated activities of the school team and parents, classes in these circles are structured in such a way that the maximum number of children can take part in them. Thus, the child not only trains and strengthens his health, but also acquires certain skills, develops reaction and coordination, and is also protected from the harmful effects of bad habits. If the child is not interested in sports games and activities, parents, together with the school administration, can choose another activity that contributes to his intellectual or aesthetic development, which would occupy the child's free time. Also, in coordination with the school administration and the parent committee, a decision should be made on the school uniform of students. However, in any case, the student's clothing must comply with certain rules. 1. A child should not wear tight, restrictive clothing, as this can lead to pathology in the development of muscle and bone structures. 2. The child's clothes should be clean, as his immunity is not completely formed, and the bacteria on the clothes can cause irritation and infectious diseases. 3. It is desirable that the child's clothes be made of natural materials, which allows the skin to "breathe" and prevents irritation from appearing on it. 4. The child's shoes should be comfortable, with a small heel. This is due to the fact that in the absence of a heel, or, conversely, if the heel is too high, the child gets tired faster when walking, and the likelihood of developing flat feet increases. If there are certain indications, the child must wear orthopedic shoes. List of used literature 1. Atropova M.V. Hygiene of children and adolescents. 6th ed., revised. and additional M.: Medicine, 1982. 2. Gogolev M.I., Gaiko B.A., Shkuratov V.A., Ushakova V.I. Fundamentals of medical knowledge of students: Textbook for secondary schools. M.: Education, 1991. 3. Textbook for the training of nurses / Ed. A.G. Safronov. Moscow: Medicine, 1979. Authors: Kapitonova T.A., Kozlova I.S.
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