The article is devoted to the first documents of the decision of the Board of the medical and sanitary department of the Moscow Council of Workers’ Deputies on the organization of an ambulance station in Moscow. The data of archival materials on the formation of the first team of employees of the Moscow Ambulance Station, the memories of the first doctors about the organization and the first years of the team’s work, the difficulties faced by workers in providing emergency care, household issues are presented. The dynamic growth of the Ambulance Station staff is shown. The peculiarity of the visiting staff’s duties in the first years of work, the role of doctors in providing emergency care, and the formation of the driver’s staff is reflected. Eyewitnesses describe the working atmosphere, discipline, principles and fundamentals in providing emergency medical care to patients and injured, which were formed in the team with the arrival of Alexander Sergeevich Puchkov. The traditions that originated in the early years of the Moscow Ambulance Station are maintained today.

This literature review is devoted to the emergence and development of ambulances. The stage of the emergence and phased modernization of sanitary transport is considered separately. Foreign historical experience is widely represented. The main material of the article concerns the problems of ergonomics and safety of emergency medical vehicles (EMS), while modern recommendations are carefully considered. Close attention is paid to the issues of standardization in the field of designing transport for the transportation of patients. The authors conclude that currently there are a number of requests for changes in ambulances, namely: intensification of the process of providing emergency medical care and the need for it when moving sanitary transport; fixation of the patient and employee during work to ensure safety; requirements for ergonomics of space; free access from the workplace to the zones comfortable conditions of the transportation process for the patient and labor for the medical worker, and others. It is concluded that it is necessary to create a scheme for the innovative interior of a Russian ambulance as an autonomous medical and diagnostic complex, with its inclusion in regulatory documents of the federal level.

Septic complications in obstetric practice are the most important cause of maternal mortality and pregnancy complications; they account for about 15 % of the structure of maternal mortality in the world. It is likely that the incidence of sepsis during pregnancy is estimated inaccurately, which is due to both the provision of an insufficient number of reports and the not always correct interpretation of the clinical picture of the disease. A rare complication of a septic condition in the postpartum period in the form of embolism of small branches of the pulmonary artery indicates a variety of causative infections and risk factors, features of vital functions during pregnancy, features of diagnosis and therapy, as well as insufficient knowledge of the obstetric population regarding various factors of septic complications. The presented rare clinical case of successful treatment of septic embolism in a postoperative woman was analyzed, the main factors leading to this complication were identified, and markers of the complication and the main pathogenetic stages of intensive care were identified. Timely initiation of pathogenetically justified intensive therapy leads to successful treatment of patients with sepsis and septic thromboembolism.

The relevance of the problem of achieving high-quality hemostasis in patients with spontaneous nosebleeds (NC) in emergency medical care (SMP) is beyond doubt.

The purpose of the study. To compare the effectiveness of providing emergency medical care to patients over 18 years of age with anterior NC in the conditions of the NSR using a silicone single-chamber intra-nasal tampon with internal point glues and the classic method of tamponade using gauze turunda.

Research objectives. To analyze the prevalence and causes of NC development in the structure of SMP calls in patients over 18 years of age in Moscow; to compare the effectiveness of the developed silicone single-chamber intra-nasal tampon with internal point glues and gauze turunda.

Materials and methods. An analysis of the structure of calls to patients with NC and an assessment of the effectiveness of stopping NC using an intra-nasal tampon with internal point glues and a gauze turunda were carried out.

Results. In the study groups, NC ranged from 66 % to 68 % in patients with hypertension. It was found that in the first group of observations using a single-chamber intra-nasal tampon with internal point glues, the best characteristics of the effectiveness of stopping NC were revealed: hemostasis was achieved in 94 % of cases, which is 28 % higher than the result of nasal tamponade with gauze turunda (66 % of cases); less time spent on anterior nasal tamponade was 3 times before 1.2 ± 0.3 min. and 3.4 ± 0.4 min. accordingly, the time spent on making a call decreased by 9.4 minutes – from 33.1 ± 1.7 minutes to 23.7 ± 1.2 minutes; pain in patients was less pronounced – 0.31 ± 0.01 and 1.45 ± 0.01 points, respectively; the number of repeated calls with recurrent NC (6 % and 22 % of cases, respectively) and repeated anterior nasal tamponade (2 % and 12 % of cases, respectively).

Conclusion. The results are of great scientific and practical importance for SMP specialists and allow us to recommend a promising expansion of the range of medical devices used with an innovative approach to creating high-quality hemostasis in NC at the prehospital stage.

The constant increase in cases of arterial ischemic stroke requires the development of algorithms for the diagnosis and management of stroke patients. Currently, there are no effective methods for diagnosing arterial ischemic stroke (AII) in children at the stage of emergency medical care (SMP). In 2020, the Prehospital Stroke Diagnosis Scale (DDI) was developed, which may be the optimal algorithm for prehospital diagnosis of childhood stroke.

The purpose of the study. To determine the optimal algorithm for prehospital diagnosis of arterial ischemic stroke in children. Objectives of the study: To determine the frequency of occurrence of «masks» of stroke and separately migraine in the structure of cases of hospitalization with suspected ONMC. To evaluate cases of hospitalization with confirmed diagnoses of ischemic stroke and migraine on the DDI Scale. To determine the statistical indicators of the effectiveness of the DDI Scale as the optimal algorithm for prehospital diagnosis of stroke in children.

Materials and methods. 401 cases of hospitalization of children to the Center via the NSR channel with symptoms of ONMC for the period from June 2023 to June 2024 were analyzed. All patients were evaluated by the staff of the NSR and the doctors of the Center on the DDI scale. Statistical data on the effectiveness of the DDI Scale are determined.

The results of the study. «Masks» of stroke in the structure of cases of hospitalization with suspected ONMC are detected in 94.26 %. Migraine is the main «mask» of AII and is detected in 69 % of cases of stroke «masks» and in 65.05 % of cases among all children with suspected ONMC. High indicators of the effectiveness of the DDI Scale in the differential diagnosis of AII and migraine in children have been established: sensitivity 96 % and specificity 95 %.

Conclusion. Thus, the DDI scale can be used as an effective algorithm for diagnosing AII in children, used by NSR staff.

The material is devoted to an urgent problem, a discussion of the basic principles of cardiopulmonary resuscitation (CPR), which is a vital key to achieving an effective outcome in children with out– or (in-) hospital circulatory arrest. The current recommendations of the world’s leading scientific and practical community – the American Heart Association and the European Council for Intensive Care, dealing with CPR in adults, children and newborns, are presented with a logical, step–by-step and detailed discussion. The basic principles of basic and advanced cardiopulmonary resuscitation are described step by step. An important element of the CPR algorithm is to identify the possible most common causes of circulatory arrest. Modern recommendations define the use of capnometry as mandatory in patients who have undergone tracheal intubation. Currently, a fairly clear algorithm for conducting both basic and advanced CPR in children has been formed.

Medications are responsible for more than a quarter of cases of acute kidney failure (AKF) in both outpatient and hospital practice. This is often due to underestimating the safety of prescribed drugs, the over-the-counter availability of medications, insufficient justification for prescriptions, and uncontrolled use. In 70–90 % of cases, acute drug-induced kidney damage presents as acute tubulointerstitial nephritis (ATIN), with a mortality rate of around 10 %. This article presents a case of acute kidney injury in a teenage girl following the use of sodium metamizole during the postoperative period. The timely application of two hemodialysis sessions helped avoid disaster, and subsequent monitoring of the patient (enalapril 2.5 mg twice daily, levocarnitine 20 % 1 teaspoon twice daily, dietary restrictions) over nearly two years showed slow recovery of kidney function, which indicates the severe nature of the kidney damage.

Objective: Comparative analysis of laboratory blood parameters in patients with COVID‑19 without and with oncopathology, who are in the intensive care unit.

Materials and methods. A total of 118 people who had had COVID‑19 were examined. The main group consisted of 54 patients with various malignant neoplasms, the control group – 64 patients without oncological pathology. Laboratory parameters of a complete blood count (hemoglobin, leukocytes, lymphocytes, platelets) and a biochemical blood test (total protein, total bilirubin, urea, creatinine, ferritin) were examined.

Results. Before COVID‑19 treatment, the average hemoglobin level in patients of the main group was 117.8±5.3 g/l, in the control group – 134.5±1.9 g/l (p=0.008), the average total protein level was 62.0±1.6 g/l and 67.9±0.9 g/l, respectively (p=0.005). After COVID‑19 treatment, hemoglobin in cancer patients remained lower (112.1±5.2 g/l) than in the control group (130.1±1.8 g/l, p=0.004), as well as total protein (60.0±2.0 g/l versus 66.3±0.9 g/l, p=0.004). Also, in patients of the main group after treatment, statistically significantly (p=0.0001) lower levels of lymphocytes (1.3±0.1 cells/ml) were found than in the control group – 2.0±0.1 cells/ml.

Conclusion. Cancer patients had reduced levels of hemoglobin, total protein, and lymphocytes before and after treatment for COVID‑19. Increased urea, creatinine, and leukocytes were also noted, which requires enhanced monitoring of their condition.

Introduction. Nephroptosis, another name for the disease is «wandering kidney», means the prolapse of an organ that can move most often in the lower direction on its side along the retroperitoneal space of the abdomen and even reach the pelvis.

The purpose of the study: to substantiate the need for new diagnostic research methods using the given clinical examples.

Materials and methods. We observed 448 patients with nephroptosis, of whom 132 were operated on using various techniques. We studied the symptoms, paying special attention to somatopsychic abnormalities.

Results. A reference on the pathology of the kidneys – nephroptosis is given, special attention is paid to the incomplete study of clinical manifestations, their connection with functional changes in impaired hemo- and urodynamics, to somatopsychic deviations that are formed in the course of the disease. Vivid clinical examples are given, attention is drawn to the fact that in some cases it is possible to correct somatopsychic deviations only by surgery, which neutralizes hemo- and urodynamic disorders.

Conclusion. Despite numerous studies regarding the diagnosis and treatment of nephroptosis, new algorithms are needed.

The problem of the treatment of acute pyelonephritis and the prevention of its complications is one of the most urgent at the present stage of development of medicine. Among patients with acute pyelonephritis, due to anatomical features, women predominate, who are hospitalized 4–5 times more often than men. Ureteral catheterization or stenting is an effective way to drain the renal pelvis and pelvis system in patients with acute pyelonephritis without obstructive urine evacuation disorders. Indications for catheterization or ureteral stenting are duration of the disease for three days or more, hyperpyretic fever, expressed pain syndrome, chills, high leukocytosis, pyuria.

Objective. The aim of the study was to evaluate the efficiency of primary percutaneous coronary interventions (PCIs) in patients with ST segment elevation acute coronary syndrome (STE ACS) hospitalized in a Regional Vascular Center (RVC), taking into account the initial mortality risk, including that one assessed by TIMI, the significance of infarction-related artery (IRA) and the number of affected coronary arteries (CA) in different age groups.

Materials and methods. The study included 337 patients with STE ACS admitted at the Regional Vascular Center (RVC) in the initial 6 months after RVC opening at the N. V. Sklifosovsky Research Institute for Emergency Medicine in 2023. The patient age ranged from 26 to 99 years old: there were 176 patients under 65 years, 88 patients aged from 65 to 75 years, and 73 patients over 75. Primary PCI was performed in 321 patients, including 192, 47, and 82 patients in the first 6, 6–12, and 12–72 hours, respectively. All patients were assessed for baseline mortality risk (MR), including quantitative TIMI assessment, ECG, and angiographic signs of reperfusion; autopsy data were available for 44 deceased patients.

Results. When assessing the MR predictors, the most significant of them among the patients hospitalized in the first 6 hours were: BP < 90 mm Hg while on sympathomimetics, cardiopulmonary resuscitation (CPR) with a long-term use of a closed-chest cardiac massage device, and mechanical lung ventilation (MLV). In later study periods, the number of people aged 65–75 years and over 75 years increased. In older age groups, the initial TIMI-assessed MR was higher; three-vessel coronary lesions became more frequent as shown by coronary angiography data, and the angiographic success was less frequently achieved. When restoring the blood flow through left anterior descending artery (LAD), the ST segment reduction that had exceeded 70 % and 50–70 % made 20 % and 46 %, with 55 % and 33 % for the right coronary artery (RCA) and circumflex branch (CxB), respectively. Mortality rates in cases of hospital admission in the first 6, 6–12, and 12–72 hours were 10.9 %, 8.5 %, and 17.1 %, respectively; and taking into account different age groups, the figures were 4.6 %, 20 % and 22.4 % among patients under 65, from 65–75, and over 75 years old, respectively. Fatal outcomes due to fatal complications with prolonged CPR were predetermined by high prehospital mortality risk, associated with unresolved complications that arose during complex interventions for three-vessel disease were associated with a risk that increased during the procedures themselves.

Conclusion. The presented data have shown that the efficiency of primary PCI in patients hospitalized in the RVC depends on the initial MR, the complexity of the interventions associated with the significance of the IRA, and the number of affected coronary arteries. In patients admitted with fatal complications, and prolonged CPR, the IRA blood flow restoration does not prevent fatal outcomes. Angiographic success is reduced in interventions on the LAD in patients with a three-vessel disease, which is more often present in older age groups. Sudden progression of acute heart failure (AHF) during the procedures is complicated by the exacerbation of concomitant pathology, development of multiple organ failure. A comparative assessment of the efficiency of coronary interventions, taking into account mortality rates, requires studying a correlation with the initial risk or the comparison between different age groups.