Licensed books on medicine
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TOUCH FROM THE NEEDLE
Bulgakov's story "Morphine" (usually it is included in the cycle "Notes of a young doctor") is a diary of Zemsky Dr. Polyakov, in which the first person describes the gradual degradation of a person under the influence of a drug. Initially, the injections were intended simply to stop the attacks of pain in the stomach, but it quickly became clear that morphine helps both from loneliness and unhappy love, causes clarification of thoughts, an explosion of efficiency - and in general, a beginning addict is ready to attribute to him all the virtues in the world: with medical education it turns out to do very convincingly. The subordinates beg the doctor to stop, assure him that he falls into an addiction, he responds that all this is complete nonsense. They try 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 a county warehouse they do not understand how a small hospital can consume as much morphine, it has to be bought by different pharmacies, pharmacists find fault with the lack of proper seals. 1917, war, troubled time, morphine nowhere to get, it causes a constant panic. Polyakov takes himself in hand and goes to the city to be treated, but refuses this idea as soon as he manages to steal morphine from the hospital wardrobe. Independent attempts to lower the dose, of course, lead to nothing. 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.
Meanwhile, European chemists intensively experimented with the molecule of morphine, hoping to find a modification that would effectively remove the pain, but did not cause dependence. One of the options on which the medical community at the beginning of the twentieth century had high hopes was diacetylmorphine. A very slight rearrangement of the morphine molecule, the appearance of two acetyl groups (-COCH3), led to a significant change in the properties of the drug. Now he much more easily crossed the blood-brain barrier, the boundary between the circulatory system and the brain, and therefore, for an effective action, a significantly smaller dose was sufficient. On this occasion, everyone was happy, found the new substance safe and sold it in pharmacies as a means of treatment for morphine. In addition, like morphine itself, the new modification well suppressed the cough center in the medulla oblongata, so the pharmaceutical company Bayer from 1898 to 1910 produced diacetylmorphine as a cough medicine - under a short and attractive trade name "heroin". The newspaper advertisement of 1901 is preserved - heroin is sold in small cute bottles and costs 4.75 dollars per ounce;
The announcement proudly reports that heroin is the cheapest cough medicine.
In reality, this cough medicine was the most expensive. According to the UN, heroin and related substances are currently consumed by approximately 0.7% of the adult population of the planet2. It's a lot. If drug addicts were distributed evenly around the world, then in 10 million Moscow they would have 70,000.
- almost the same as the staff of the hotel and restaurant business (judging by the structure of employment Rosstat). In 2010, about 384 tons of heroin were produced (and this is less than in previous years - the fact is that Afghanistan had a crop failure of the opium poppy), and at least 99 thousand people died of drug use - this is the most low-key estimate of all existing, it takes into account cases of overdose, but not death from concomitant diseases. The price of heroin in Europe, also according to the UN, is about 50 euros per gram, while the concentration of the drug in withdrawn doses fluctuates around 50% - the volume is increased with the help of any white powder that comes into the hands of traders - chalk, flour, washing and so on.
The daily dose of heroin depends primarily on the length of regular use. When in monkey studies they are given the opportunity to increase the dose of the drug themselves, 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 the growth of dosage from 0.03 to 0.3 mg - but in reality with such tiny dosages only scientists in the laboratory who need to protect their expensive experimental animals, drug dealers immediately offer a person in 100 times more. The International Narcotics Control Board of the United Nations proposes, for statistical purposes, a daily dose of heroin equal to 30 mg. In the Russian criminal chronicle, the conventional dose of heroin is 50 mg. Indeed, for the first use of the drug, this amount is enough for the eyes and ears. But when it comes to drug addicts who take heroin every day for several years, the numbers increase 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 varies from 0.2 to 1 g per day. I paint all this so that I can estimate the heaviness of the life of the drug addict: everything started very well and one gram of the drug was enough for at least 20 days - not such a big expense. But gradually, to achieve the former pleasure, and then simply and simply to get rid of the painful abstinence, it became necessary to extract a gram of the drug daily. In the meantime, health is thoroughly spoiled, and it is no longer possible to earn 100 euros a day by socially acceptable methods (this is not even very effective without drugs). A woman drug addict can at least engage in prostitution (as long as a more or less attractive appearance is preserved), and what should a man do? It's right to involve all your friends in heroin use, 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 a dream or a meal, and even more so some moral and moral norms.
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TOUCH FROM THE NEEDLE
- Puncture needles
For percutaneous access to the arterial channel, puncture needles of two types are used, corresponding to two types of vascular puncture technique - direct and Seldinger. The Seldinger needle (Figure 1.11) consists of several components: a metal shell that does not have an acute-angled cut, and one or two stilettos. The internal stiletto of the Seldinger needle does not have a lumen; he protects the needle from
- Needles for regional blockade
There are needles designed specifically to perform a regional blockade. Some of them are presented below. Needles with blunted cut edges Needles are designed to reduce nerve trauma with direct contact with the needle. The angle of cut is increased by 20-30 °, the end is rounded. Theoretically, such a needle with direct contact with the nerve will push it away rather than traumatize it. In addition, as far as
- CATHETERIZATION OF VIENES 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 constant location, determined by clear topographic and anatomical landmarks. Because of its close connection with muscles and fascia, Vienna has a constant lumen and does not subside even with pronounced hypovolemia. The diameter of the vein in an adult is
- Subarachnoidal analgesia
This type of anesthesia is used in the II period of labor and with operative vaginal delivery. Its advantages are simplicity of execution, rapid onset of action (after 2 min), less risk of toxic effect of anesthetic on cardiovascular and central nervous system due to lower doses, and, finally, cheapness of the method. Method of conducting. Before the spinal block begins
- Suboccipital puncture
Suboccipital puncture (puncture of a large brain cistern) is performed for diagnostic purposes (cerebrospinal fluid analysis), for the administration of medications and for the performance of myelography. It can be performed both in the recumbent and in the sitting position of the patient. Suboccipital puncture is performed as follows. Shaved hair in the neck of the occipital region, the skin is disinfected. When
- Percutaneous catheterization of central veins
1, Indications: * Acute blood loss with 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 first inserted into a vein with a cannula attached to it, and then, after extraction needles, a catheter is inserted through the lumen of the cannula, catheterization by a conductor, or Seldinger's technique
- General rules for performing regional anesthesia
1. If possible, inject anesthetic solution perineurally as close to the nerve as possible. This is usually achieved by paresthesia when the needle is inserted. 2. Avoid endoneural injections, and if necessary, slowly inject small amounts of anesthetic solution (3-5 ml). The rest of the anesthetic solution should be injected perineurally. 3. In order to level out the features
- Technique of the epidural blockade
Hand treatment of the anesthesiologist and the puncture site is carried out with strict adherence to asepsis rules, both for surgical operation. It is not recommended to treat the operative field with an iodine solution, since iodine microparticles, when entering the epidural space, can cause aseptic inflammation. The interstitial spaces widen when the back is bent. You can perform puncture in the position on the side,
- Methods of blockade of peripheral nerves
In the blockade of peripheral nerves, anatomical landmarks, infiltration anesthesia, verifying the position of the needle for paresthesia, peri-vascular blockade, cutaneous access, electrostimulation of the nerve are used. 1. CORRECT NEEDLE INSTALLATION Anatomical landmarks Some types of blockades perform strictly on anatomical landmarks. An example is the intercostal
- Lumbar puncture
Lumbar puncture is performed for various purposes: obtaining cerebrospinal fluid for its analysis, determining intracranial pressure and patency of subarachnoid spaces, performing myelography, with a therapeutic purpose (for extracting cerebrospinal fluid and thereby reducing intracranial pressure, for administering therapeutic drugs). Puncture is usually performed
- Laboratory lesson № 6 (2 hours)
Subject: Surgical treatment of vaginal and uterine prolapse in cows. Podsakralnaya novocaine blockade in cows, sheep, goats and pigs. Plan. 1. Suturing the vagina. 1.1. Anatomico-topographic 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 Vinogradova. 1.4. Clinical study
- Laboratory lesson № 22 (2 hours)
Subject: Operations in the field of the eye. Plan. 1. The teacher on the anatomical preparations of the eyes demonstrates the technique of performing operations - keratotomy, corneal piercing, iridectomy, peritomia, peridectomy. 2. Performing operations on animals: removal of the third century in a dog. 3. Operative intervention in the turn of the century; 4. Operative treatment at the turn of the century. 5. Extirpation
- Intraosseous injections
They are shown in the following cases: in the presence of injured large veins, intoxications, disorders of the function of the gastrointestinal tract; small animals - with a small diameter of the veins; with prolonged drip infusions; with shock, when the veins are in a collapsed condition; pigs - if intravenous infusion is difficult. Strong needles are used for intraosseous injections. In the olives of these needles
+++ acupuncture, acupuncture, zhen-tszyu-therapy, a method of treatment with needle-pricking. The essence of AI consists in the reflex action on the functions of organs with a therapeutic purpose, different in strength, nature and duration of injections. Each point of the injection is connected by channels (lines) with a certain organ. In animals of such channels 14 (Figure 1). For I. use special needles (Figure 2).
- CONDUCTOR INJURY OF ABDOMINAL WALLS
The innervation of the abdominal wall is mainly carried out by the last intercostal, the first (ilio-hypogastric) and the second (ilio-inguinal) lumbar nerves. For anesthesia of the 13th intercostal nerve, the needle is made at the posterior edge of the last rib at the level of the free end of the transverse rib of the 1st lumbar vertebra. The needle is pushed to the bone and,