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“The physiological response to severe sepsis is the result of a complex interaction between sympathetically determined cardiac, vascular and pulmonary compensatory mechanisms in response to fundamental disturbances in the intermediate metabolism caused by the septic process.”


“Physiological and metabolic correlations in human sepsis”

Essentially, in this chapter we will focus on an objective assessment of the functional state of a sick organism. Above, in the second chapter, it was already mentioned that a functional state as a clinical category carries specific information. Determining the severity of a functional condition is different from determining the severity of an injury or damage. In the latter case, we mean stable indicators characterizing the degree of destruction of organs and tissues. Functional state, on the contrary, is very labile. It depends on many factors, in addition to morphological disorders, and reflects (if correlated with the pathological situation) the level of functional failure of the body at the time of the study. The implementation of intensive corrective measures in some cases (for example, in acute blood loss) sometimes makes it possible to radically change the functional state in a short time.
But then other circumstances often arise that can cause an equally rapid reverse transformation.

In a clinic, an assessment of the severity of a condition, even if it is based on integral quantitative indicators, usually reflects only the distance from one of two polar characteristics - “good” and “bad” - or, on the contrary, approaching the other. In the language of clinicians, an assessment of the severity of a condition is formed using several gradations - satisfactory, moderate, severe and extremely severe. This assessment guides the doctor regarding the degree of life threat at the time of the examination.

Meanwhile, any disease can be considered as a change in the functional states of the body, occurring simultaneously, after reaching a critical level of quantitative changes in functional indicators that determine the qualitative characteristics of the state. With mathematically objective reproduction of an individual “image” (or “profile”) of a functional state, it is possible to distinguish signs defining the directions of subsequent transformation. This principle can be the basis for the development of a functional computer monitoring system
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  1. Functional computer monitoring system for uncomplicated early post-shock period
    A functional computer monitoring system was developed with the aim of early recognition and prevention of complications arising in patients with mechanical damage, especially the systemic inflammatory response syndrome. In this regard, a comparison was made of clinical and laboratory parameters with the parameters of the FCM system in patients who suffered severe mechanical trauma with
  2. Functional computer monitoring system in the diagnosis of sepsis
    An analysis of the dynamics of the criteria of a functional computer monitoring system for the systemic inflammatory response syndrome and sepsis, performed by us. showed that for sepsis, as one form of SSVR. all the characteristic features of this syndrome are inherent. First of all, this is a significant increase in the C / B ratio, corresponding to an increase in the role of anaerobic metabolic mechanisms against the background,
  3. Methodology for the development of a functional computer monitoring system
    In the period from 1988 to 1992, 207 patients with severe mechanical trauma who were admitted to the clinic by ambulance were examined at the clinic of field surgery. As a result of a thorough verification of the data, the observations with obvious technical errors were deleted, as well as the data of three victims who died shortly after the injury (during the first day). Reason
  4. Functional computer monitoring for systemic inflammatory response syndrome
    The conducted studies have demonstrated the existence of rather close clinical and pathogenetic parallels in the dynamics of the post-traumatic period between the general condition of the wounded, the data of his laboratory analyzes and dynamic assessments in the system of functional computer monitoring in uncomplicated course, as well as in transitional states that “threaten” the development of CVD. Together with
  5. The principles of the functional computer monitoring system
    The analysis of the obtained four clusters not only showed a mathematically significant difference between them, but also revealed the clinical, biochemical and pathophysiological characteristics of each of the analyzed patterns that are fundamentally different from each other. In this study, we intentionally did not compare the studied clinical and pathophysiological aspects of the course of traumatic disease with
  6. Functional computer monitoring system in the diagnosis of conditions that "threaten" the development of a systemic inflammatory response syndrome
    Successful treatment of the systemic inflammatory response syndrome and sepsis as one of its forms should be based, first of all, on early diagnosis. As a rule, the treatment of advanced conditions that manifested themselves in the full clinical picture, unfortunately, is ineffective and leads mainly to adverse results. This position has long been well known to practitioners, but early
  7. Justification of the chosen approach to the development of functional computer monitoring
    Proposed by JHSiegel et al. | 33. 35], the system of functional computer monitoring is based on the assumption that the application of the mathematical methodology of cluster analysis allows us to identify typical clinical images (as the author himself calls them, patterns [31. 32 |). The pathogenetic basis for determining such clinical images in certain critical conditions (trauma, sepsis)
    “Direct confirmation of sepsis. usually late, and decides the outcome of a quick treatment, its early start. A full diagnosis should be made on the basis of indirect signs of sepsis - clinical and laboratory. ” A.P. Kolesov “Hospital infection” The main difference between the modern stage of the study of surgical infection is the formation of in-depth ideas about the mechanisms of interaction
    Registration of blood pressure. The most common way to control hemodynamics is the Riva-Rocci auscultation method using Korotkov sounds, however, it requires a number of conditions to be fulfilled to eliminate errors. So, to measure blood pressure in pregnant women should be in the position on the left side with the location of the cuff on the left hand. In addition, the cuff size matters: if the cuff
  10. Dynamic monitoring of the functional state of the central nervous system, respiratory system, hemodynamics, homeostasis (2nd principle)
    ICP monitoring is leading in patients with severe OCD and swelling symptoms. The most common invasive monitoring of ICP is used for severe traumatic brain injury, after operations to remove intracerebral hemorrhages, brain tumors. However, with ischemic strokes, hypoxic and ischemic injuries of the central nervous system, an invasive ICP measurement is practically not used. therefore
  11. Biochemistry of the general inflammatory reaction in severe concomitant injury
    Immediately after an injury and hypoperfusion of tissues, peptide substances appear in the blood, which in their structure and functions relate mainly to inflammatory mediators [55, 56, 93]. Due to the property of being (along with catecholamines) the main regulators of microcirculation, inflammatory mediators are classified as shock mediators. Emerging neurotransmitters in turn cause release and
  12. The phenomenon of mutual aggravation of injuries in severe combined injury
    In clinical medicine, quite often we are talking about a phenomenon. or syndrome, mutual burden. It certainly is always present in the case of the coexistence of several pathological processes. Pathogenetic factors of these processes do not just add up, but also overlap one another due to the commonality of individual pathogenetic mechanisms. The result is an aggravating effect,
  13. LESSON 13 First aid for injuries. Closed soft tissue damage. Traumatic brain injuries. Damage to the chest. Transport immobilization for injuries.
    Purpose: To teach students the differentiological diagnosis of various traumatic conditions, the rules of first aid to the victim. Test questions 1. Injury. Definition Classification of injuries. 2. Closed soft tissue damage. Injury. First aid. 3. Stretching. Complaints First aid. 4. The gap. Complaints First aid. 5. The syndrome of prolonged crushing. Pathogenesis. The clinical picture.
  14. How to avoid the adverse effects of ECT in severe diseases of the cardiovascular system?
    Excessive cholinergic stimulation is eliminated by atropine. All patients should be pre-sedated with glycopyrrolate to prevent bradycardia and suppress excessive secretion of the salivary and respiratory glands. Sympathetic hyperactivity is eliminated by nitroglycerin, nifedipine, and - and (3-adrenergic blockers. High doses (3-adrenergic blockers (es-molol, 200 mg) reduce the duration of
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