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Bulgakov's story “Morphine” (usually included in the cycle “Notes of the young doctor”) is the diary of the Zemsky doctor Polyakov, in which the first person describes the gradual degradation of the person under the influence of the drug. At first, the shots were intended simply to relieve attacks of stomach pain, but rather quickly it turned out that morphine helps from loneliness and unhappy love, causes clarification of thoughts, an explosion of efficiency - and in general, a novice addict is ready to attribute to him all the advantages in the world: medical education it turns out to do very convincingly. The subordinates beg the doctors to stop, they assure him that he becomes addicted, he answers that all this is complete nonsense. They are trying to block morphine from Polyakov - the doctor extracts the coveted drug with a fight, continuing to assert that there is no drug addiction. Doses are growing, in the county warehouse they do not understand how a small hospital can consume so much morphine, it is necessary to buy it at different pharmacies, pharmacists are carping at the lack of correct seals. 1917, war, time of troubles, nowhere to get morphine, it causes a constant panic. Polyakov takes himself in hand and goes to the city for treatment, but refuses this idea as soon as he manages to steal morphine from the hospital cabinet. Independent attempts to reduce the dose, of course, do not lead to anything. Vomiting, boils, insomnia, the last decisive attempt to get off - 14 hours without a shot - and suicide, because it is impossible to endure life without morphine.
In the meantime, European chemists were experimenting intensively with a morphine molecule, hoping to find a modification that would effectively relieve pain, but would not cause dependence. One of the options on which the medical community in the beginning of the XX century had high hopes was diacetylmorphine. A very small restructuring of the morphine molecule, the appearance of two acetyl groups (-COCH3), led to a significant change in the properties of the drug. Now he was much easier to overcome the blood-brain barrier, the boundary between the circulatory system and the brain, which means that a significantly smaller dose was enough for effective action. On this occasion, everyone was delighted, considered a new substance safe and sold it in pharmacies as a treatment for morphine. In addition, like morphine itself, the new modification well suppressed the cough center in the medulla oblongata, therefore the pharmaceutical company Bayer from 1898 to 1910 produced diacetylmorphine as a cough medicine under the short and attractive trade name “heroin”. The newspaper advertisement of 1901 has been preserved - heroin is sold in cute little bottles and costs $ 4.75 per ounce;
The announcement proudly reports that heroin is the cheapest cough medicine.
In reality, this cough medicine turned out to be the most expensive. According to the UN, heroin and related substances currently consume approximately 0.7% of the adult population of the planet2. It's a lot. If drug addicts were evenly distributed around the world, there would be 70 thousand in Moscow’s ten millionth
- almost as much as employees of the hotel and restaurant business (judging by the employment structure of Rosstat). In 2010, about 384 tons of heroin were produced (and this is less than in previous years - the fact is that Afghanistan suffered a poor harvest of opium poppy), and at least 99 thousand people died from drug use - this is the most restrained estimate of all existing, it takes into account cases of overdose, but not death from associated diseases. The price of heroin in Europe, also according to the UN, is about 50 euro per gram, while the concentration of the drug in the withdrawn doses varies around 50% - the volume is increased using any white powder that has been turned up in the hands of traffickers - chalk, flour, money for washing and so on.
The daily dose of heroin depends primarily on the experience of regular use. When in studies on monkeys they are given the opportunity to increase the dose of the drug themselves, then in the first 12 experimental sessions the desired dose increases tenfold - from 0.0003 to 0.003 mg per kilogram of weight. In terms of a person weighing 100 kg, this would correspond to a dosage increase from 0.03 to 0.3 mg - but in reality only scientists in the laboratory who need to take care of their expensive experimental animals tinker with such tiny dosages, while the traffickers immediately offer a person times more. The United Nations International Narcotics Control Board at the UN proposes for statistical purposes that the daily dose of heroin be equal to 30 mg. In the Russian criminal chronicle 50 mg is called a conditional dose of heroin. And indeed, for the first use of a drug of this amount is enough for the eyes and ears. But when it comes to drug addicts who have been taking heroin daily for several years now, the numbers are increasing by an order of magnitude. According to the Moscow Center for Social and Forensic Psychiatry. Serbian, with the experience of using about three years, the dose of heroin ranges from 0.2 to 1 g per day. I write all this in order to estimate the severity of the drug addict's life: it all started very well and one gram of the drug lasted for at least 20 days - not such a big expense. But gradually, in order to achieve the former pleasure, and then just to get rid of the painful withdrawal, it became necessary to extract a gram of the drug daily. In the meantime, health has been fundamentally flawed, and it’s no longer possible to earn 100 euros a day using socially acceptable methods (it’s not even enough without drugs). A female drug addict can at least engage in prostitution (as long as she has a more or less attractive appearance), and what should a man do? That's right, to involve in the use of heroin all their friends, then to sell the drug to them and thus intercept the dose for themselves. There is no other way out: the drug turns into a vital need, much more important than sleep or food, and even more so some moral standards there.
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  1. Puncture needles
    For percutaneous access to the arterial bed, puncture needles of two types are used, corresponding to two types of vascular puncture technique - direct and Seldinger's. The Seldinger needle (fig. 1.11) consists of several components: a metal shell with no acute-angled cut, and one or two stylets. The inner stiletto of the Seldinger needle has no lumen; he protects the needle from
  2. Needles for regional blockade
    There are needles designed specifically for the regional blockade. Some of them are presented below. Needles with blunt edges of the cut Needles are designed to reduce nerve injury by direct contact with the needle. The cut angle is increased by 20-30 °, the end is rounded. Theoretically, such a needle in direct contact with the nerve is more likely to push it away than to injure it. In addition, as
  3. CATHETERIZATION OF VEINS AND ARTERIES
    Catheterization of the superior vena cava. Catheterization of the superior vena cava is performed through the subclavian or internal jugular vein. The subclavian vein is distinguished by its permanent location, defined by clear topographic-anatomical landmarks. Vienna due to its close connection with the muscles and fascia has a constant lumen and does not collapse even with severe hypovolemia. The diameter of a vein in an adult is
  4. Subarachnoid analgesia
    This type of anesthesia is used in the second stage of labor and during operative vaginal delivery. Its advantages are ease of implementation, rapid onset of action (after 2 minutes), less risk of toxic effects of the anesthetic on the cardiovascular and central nervous systems due to lower doses, and, finally, low cost method. Methodology. Before the spinal block begins,
  5. Suboccipital puncture
    A suboccipital puncture (puncture of a large cistern of the brain) is performed for diagnostic purposes (analysis of cerebrospinal fluid), for administering drugs, and for performing myelography. It can be performed both in the supine position and in the sitting position of the patient. Suboccipital puncture is performed as follows. Shave hair in the cervical occipital region, the skin is disinfected. At
  6. Percutaneous central venous catheterization
    1, Indications: * acute blood loss with a spasm of peripheral vessels, 2, Equipment: a needle and a catheter sufficient to reach the central vein, Currently, a technique has been developed, according to which a needle is put into a vein with a cannula put on it, and then, after extraction needles, a catheter is inserted through the lumen of the cannula, Catheterization through a conductor or Seldinger technique also
  7. General rules for regional anesthesia
    1. If possible, inject the anesthetic solution perinerally as close to the nerve as possible. This is usually achieved by paresthesia with the introduction of the needle. 2. Avoid endoneural injections, and if necessary, slowly inject small volumes of anesthetic solution (3-5 ml). The rest of the anesthetic solution should be injected perinerally. 3. In order to neutralize the features
  8. Technique of the epidural blockade
    The treatment of the hands of the anesthesiologist and the puncture site is carried out with strict observance of the rules of asepsis, as for a surgical operation. Treatment of the surgical field with a solution of iodine is not recommended, since iodine microparticles, if they enter the epidural space, can cause aseptic inflammation. Interspaces widen when the back is flexed. You can perform puncture in the position on the side,
  9. Peripheral nerve blocking techniques
    During the blockade of peripheral nerves, anatomical landmarks, infiltrative anesthesia, verification of needle position by paresthesia, perivascular periovascular blockade, transarterial access, electrical nerve electrostimulation are used. 1. CORRECT INSTALLATION OF THE NEEDLE Anatomical landmarks Some types of blockades are performed strictly according to anatomical landmarks. An example is intercostal
  10. Lumbar puncture
    A lumbar puncture is performed for various purposes: obtaining cerebrospinal fluid for its analysis, determining intracranial pressure and patency of subarachnoid spaces, performing myelography, for therapeutic purposes (to extract cerebrospinal fluid and thus reducing intracranial pressure; for administering therapeutic drugs). Puncture is usually performed
  11. Laboratory lesson number 6 (2 hours)
    Topic: Surgical treatment of vaginal and uterine prolapse in cows. Subsacral Novocain blockade in cows, sheep, goats and pigs. Plan. 1. Sheath filing. 1.1. Anatomical and topographical data. 1.2. Indications for surgery. 1.3. Clinical study of the animal. 1.4. The final diagnosis. 1.3. Fixation of the animal in the machine Vinogradov. 1.4. Clinical study
  12. Laboratory lesson number 22 (2 hours)
    Theme: Eye Operations. Plan. 1. The teacher on the anatomical preparations of the eyes demonstrates the technique of performing operations - keratotomy, cornea puncture, iridectomy, peritomy, peridectomy. 2. Performing animal operations: removing a third century dog. 3. Surgical intervention for eversion of the century; 4. Surgical treatment at the reversal of the century. 5. Extirpation
  13. Intraosseous administration
    They are shown in the following cases: in the presence of injured large veins, intoxication, disorders of the gastrointestinal tract; small animals - with a small diameter of the veins; with prolonged drip infusions; in shock, when the veins are in a collapsed state; swine - if intravenous infusion is difficult. Strong needles are used for intraosseous injections. In the olive of these needles
  14. AND
    +++ acupuncture, acupuncture, chen-chiu therapy, the method of treatment with injections with needles. The essence of I. consists of a reflex effect on the functions of organs with a therapeutic purpose of varying strength, nature and duration of injections. Each injection point is connected by channels (lines) with a specific organ. In animals, there are 14 such channels (Fig. 1). For I. use special needles (Fig. 2).
  15. Conductive anesthesia of the abdominal wall wall
    The innervation of the abdominal wall is mainly carried out by the last intercostal space, the first (iliac-hypogastric) and the second (ilio-inguinal) lumbar nerves. To anesthetize the 13th intercostal nerve, the needle is punctured along the posterior edge of the last rib at the level of the free end of the transverse-costal process of the 1st lumbar vertebra. The needle is pushed all the way into the bone and, having shifted the bones, it promotes
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