This article is dedicated to the 100th anniversary of the establishment of the Ambulance and Medical Emergency Care Station n. a. A. S. Puchkov in Moscow. Alexander Sergeyevich Puchkov, Doctor of Medical Sciences, Honored Doctor of the RSFSR, steadily led her from 1923 to 1952. The data presented in the articles of Mr. Puchkov served as the basis for comparing indicators about the station’s activities during its formation and the modern ambulance and emergency medical services in Moscow. Some features, characteristics and conditions for the provision of emergency and emergency medical care in Moscow in the year 1926 are shown. So, for example, the number of brigades increased by 68.7 times (from 15 in 1926 to 1,031 in 2018). The average time of arrival of the brigade for an accident both in 1926 and in 2018 is 10–12 minutes long. The share of calls by ambulance teams to children under 15 years of age has also increased significantly. The analysis of performance over the years has made it possible to trace the development of the ambulance station from the time of its creation to the present day. The fundamental principles laid down by Alexander S. Puchkov remain in the ambulance work at the present time. Doctors and paramedics of ambulance and emergency medical care teams continue to promptly provide medical care to all those in need, guided by many provisions that were developed and implemented over 90 years ago.

The article discusses the issues of prehospital diagnosis of acute coronary syndrome without ST segment elevation. A large number of errors that worsen the outcomes of the disease and the difficulties associated with the overload in patients with suspected acute coronary syndrome in emergency departments are indicated. The experience and prospects of studying the prehospital use of markers of myocardial necrosis are evaluated.

Mitochondrial respiratory chain enzyme activities were determined by spectrophotometric enzyme assay in lymphocytes of 100 patients with acute myocardial infarction. A significant decrease in the activity of complexes II–III and IV and an increase in the activity of complex I of the respiratory chain were found. According to the correlation analysis, the feedback of troponin T and I concentrations in the serum and the activity of complex IV of the respiratory chain was detected. A decrease in the activity of the IV complex of the mitochondrial lymphocyte respiratory chain below 2.87 IU/g of protein indicates an increased level of clinical risk in patients with acute myocardial infarction.

Aim. To evaluate the complex of antiarrhythmic therapy and adherence to treatment on an outpatient basis in patients with atrial fibrillation in hypertension in combination with extracardiac diseases.

Methods. In an observational cohort study, 308 men aged 45–60 years old were observed with atrial fibrillation and hypertension in combination with diabetes mellitus (n = 40), diffuse toxic goiter (n = 42), hypothyroidism (n = 59), abdominal obesity (n = 64) and chronic obstructive pulmonary disease (n = 47). The comparison group consisted of 56 patients without extracardiac pathology. The work evaluated clinical, anthropometric data, the results of daily monitoring of ECG and echocardiography. Adherence to therapy was evaluated using a specialized Moriski-Green questionnaire.

Results. Patients with diabetes mellitus on the background of electric cardioversion significantly more often developed CHF (p = 0.003), cardioembolism (p < 0.001), hospitalization (p = 0.040) and progression of AF (p < 0.050), relative to the comparison group. The number of regospitalizations was noted less after electrical cardioversion compared with only medical one. The adherence to drug therapy in patients with atrial fibrillation in hypertension with extracardiac disease was 26.7 %.

Conclusion. The reasons for the lack of patient adherence to treatment require an integrated approach to its early resolution.

The intensive care unit for nephrological patients is the first such intensive care unit in the Russian Federation and is unique in its specificity. The main task of the ICU department No. 2 is to provide an intensive care complex aimed at restoring and maintaining the vital functions of organs and systems in patients with kidney diseases of various origins, as well as in patients after kidney allotransplantation. The department is equipped with the most advanced equipment for the treatment of multi-organ pathology, including therapeutic plasma exchange, therapeutic plasmapheresis and double cascade plasma filtration.

Objective: to identify ultrasound (US) signs of intestinal failure syndrome (IFS) in patients with combined trauma and to determine their compliance with the clinical classification of IFS. In the process of dynamic ultrasound monitoring in 18 patients on the 5–7th day, gastrointestinal motility recovered with a decrease in intra-abdominal pressure (IAP) to normal, which corresponded to stage I of IIS. In 12 patients, gastrostasis and expansion of the small intestine, an increase in the linear blood flow velocity in the portal vein up to 30 cm/sec, IAP up to 20 mm Hg were observed which corresponded to stage II of IFS. On the 15–20th day, 3 patients with stage III of IFS recovered gastrointestinal motility, 9 patients died due to multiple organ failure. Ultrasound revealed an increase in the liver and spleen with portal hypertension, edema of the walls of the small and large intestines was observed, intra-abdominal pressure increased, which corresponded to stage III of intestinal failure.

Results. The results of ultrasound in dynamics with an assessment of the morphological and functional state of the gastrointestinal tract confirm their compliance with the stages of the clinical classification of intestinal failure syndrome. With the help of ultrasound with dopplerography and measurement of IAP, it was possible to objectify the clinical classification of intestinal failure syndrome.

Objective. To assess the effect of a three-day positive water balance (PWB) during infusion therapy on the level of blood plasma electrolytes (sodium, chlorine), hematocrit, the concentration of total hemoglobin and the influence of the studied factors on patient survival in the intensive care unit.

Materials and methods. In 47 patients with polytrauma who had multiple organ dysfunction and signs of systemic inflammation, using non-parametric analysis, the ROC-curve method, logistic regression, and relative risk analysis, we studied the effect of PWB on sodium and chlorine metabolism, hematocrit, total hemoglobin concentration and evaluated their relationship with treatment outcome. The subjects were divided into two groups: I — surviving patients whose PWB level for three days was less than 3,000 ml (n = 28) and II — the died (n = 19) whose PWB level for three days was more than 3,000 ml.

Results. The average value of sodium for three days was significantly higher in patients of group II: 140.267 ± 3.713 mmol/l against the patients (138.067 ± 2.515 mmol/l; p = 0.020906) of group I. By the end of three days, the level of total hemoglobin was statistically significantly lower in group II (101.89 ± 18.27 g/l) than in group I (120.30 ± 21.70 g/l); p < 0.000025. The hematocrit index was also significantly lower in patients of group II (29.40 ± 4.85 %) than in group I (34.30 ± 6.03 %); p < 0.000034.

Conclusion. At a PWB level of three days over 3,000 ml, there is an increase in blood sodium with a tendency to hypernatremia, a hemodilution effect with a decrease in hemoglobin and hematocrit. A negative effect of PWB on water-electrolyte metabolism, an acid-base state, the disorders of which cause an increased risk of death, is observed several times more often in patients with excess PWB (more than 3,000 ml in three days) than among patients with lower PWB (less than 3,000 ml for the same period).

Introduction. The authors discuss their first experience of applying the inert gas xenon (Xe) for relieving a persistent pain syndrome (PPS) and acute stress disorders (ASD) in children with severe injuries.

Material and methods. Seven children with severe trauma were taken into the trial: the five with severe combined trauma after a terroristic attack (Kerch, 2018) and the two with multiple dog bites. All victims had PPS and ASD after the survived fear of death. Xenon had 15–30 % concentration in oxygen . Xe-therapy lasted for 15–20 minutes.

Results. During Xe-sessions, patients were sedated. BIS-index decreased from 95.5 ± 2.5 to 86.5 ± 5.0 U (p < 0.05); mean values by Ramsay scale decreased from 5.5 ± 0.5 to 2.7 ± 1.2 scores (p < 0.05). Pain intensity by Numeric Rating Scale for Pain decreased from 4.1 ± 1.8 to 1.1 ± 0.4 scores (p < 0.05). Five sessions were needed for controlling PPS and refusing of analgesics; 12 session for phantom pains; 3 sessions for sleeplessness; 5 sessions for erasing tragic events from the memory.

Conclusion. 15–30 % Xe inhalations were effective in controlling PPS and ASD in children with severe injuries.

The article presents a clinical case of successful treatment of a patient with prolonged asthmatic status. The pathogenesis of purulent-septic and other life-threatening complications developing as a result of the above critical condition is described. The positive effect of a differentiated approach in conducting respiratory support depending on the stage of the disease is justified: at the beginning, when airway obstruction is in the foreground, and in the future, when restrictive respiratory disorders develop. When conducting respiratory support, the most reasonable methods for ensuring airway patency were selected. The necessity of neurovegetative blockade and myoplegia for the prevention of pulmonary barotrauma during respiratory support by aggressive ventilation modes and with the goal of antihypoxic protection of the brain is emphasized. During the treatment of the patient, it was confirmed that the optimal regime for obstruction of the bronchi is forced volume-cyclic ventilation of the lungs to provide the necessary minute volume of breathing, and in severe pneumonia, in the case of relief of bronchial obstruction, respiratory support is carried out in pressure control mode for better air-oxygen mixture distribution in the airways. The need for early tracheostomy and daily therapeutic fibrobronchoscopy to ensure airway patency and treat pneumonia has been confirmed.

The authors propose to consider one of the debatable topics of general pathology — the conventionality of the concept of ‘syndrome’ from the pragmatic positions of a resuscitator. At the same time, an important point is emphasized: the meaning of the concepts of ‘syndrome’ in resuscitation and general therapeutic practice is fundamentally different, the contradictions in this matter are due to the fact that when analyzing a critical condition, various authors operate with different levels of integration of body parameters that determine the degree of pathological disorders. Nevertheless, the use of one of the integral parameters — the syndrome — provides a real opportunity to move from cumbersome parametric monitoring to more visual syndrome monitoring based on computer cognitive graphics.