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“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 of the modern stage of studying surgical infection is the formation of in-depth ideas about the mechanisms of interaction of a macroorganism (with its individual characteristics and systemic disorders), on the one hand, and microflora (with its dynamic variability and complexity of its microbiological factors), on the other. Severe concomitant injury is a very demonstrative clinical model. on which the complexity, multifactorial nature of such an interaction can be traced. As a result of deep systemic disorders after an extreme condition, the body loses its ability to suppress the infectious process in the damage zone and beyond. This determines the high preparedness of the body for severe forms of wound infection, acquiring a pronounced tendency to generalization and the development of sepsis. However, clinical observation can fix only an already developing infectious process. Therefore, the challenge is. so that, assessing the functional damage caused by the transferred extreme state, highlight some specific changes that allow you to recognize in advance the already developing generalization of the infectious process.

It should be noted that the specifics of the changes that determine the readiness of the damaged organism to enter the infectious process, initially acquiring a tendency to generalization. not fully reflected in the dynamics of immunity indicators. It is known that in the early stages of the development of a traumatic disease, it is always accompanied by a temporary secondary immunodeficiency, the severity of which does not always allow reliable prediction of the development of wound infection and its severity. The well-known signs of the general reaction of the body to the focus of inflammation, which correlate with the peculiarities of the course of the existing local infectious and inflammatory process, also do not solve the problem. The most complete sense of post-traumatic changes characterizing the body’s readiness to develop generalized forms of wound infection is indicated by the concept of a systemic inflammatory response syndrome.

The introduction into clinical practice in 1991 of the concept of a systemic inflammatory response syndrome was recommended at a joint conference of resuscitators and pulmonologists in the United States. Canada and several other countries [13-15). It should be emphasized some conventions of terminology. This is not about postulating the well-known classic signs of a local inflammatory process, but about highlighting a specific type of reaction of the body to a damaging effect, which, based on the inflammatory response, takes on a generalized, pathological character. By the decisions of the conference, the following criteria for diagnosing a systemic inflammatory response syndrome were recommended:

- Temperature above 38 ° C or below 36 ° C;

- Heart rate over 90 beats / min;

- The respiratory rate of more than 20 per minute or Raso2 less than 32 mm Hg;

- The number of leukocytes above 72 • 109 k / l, below 4 • 109 k / l or the number of immature forms exceeds 10%.

In accordance with the adopted documents, it is proposed to diagnose a systemic inflammatory reaction syndrome in the presence of at least two of the four listed symptoms. Sepsis is considered to be diagnosed (as was recorded in the conference decisions) in the presence of documented infection and positive signs (at least two) of the syndrome of systemic inflammatory reaction.

However, this approach leaves room for some methodological inaccuracies, primarily related to the diagnosis of the systemic inflammatory response syndrome in such an extremely difficult category of patients, as victims with severe mechanical trauma.

It seems to us that in this category of patients it is permissible to speak of a systemic inflammatory response syndrome as a pathological process only with the obligatory presence of all these diagnostic criteria. This will highlight the most severe contingent of victims with generalized inflammatory processes that.
Undoubtedly, it will contribute to a further deepening of our ideas about this pathology.

In this case, post-traumatic (or wound) sepsis can be defined as a generalized form of surgical infection that develops against the background of a systemic inflammatory reaction syndrome with proven pathogen circulation (bacteria, viruses and other microorganisms) in the bloodstream.

It should be noted that this definition does not in any way contradict the more general definition of sepsis as a pathological process characterized by the loss of the ability to suppress the pathogen vegetation outside the infectious focus. It only establishes a concrete connection between such a loss and a systemic inflammatory response.

In other words, a systemic inflammatory response syndrome can develop in response to severe mechanical damage, complicated or uncomplicated by the infection process in the wound. At the same time, the development of a systemic inflammatory response syndrome (SSVR) with proven circulation in the blood of a pathogenic pathogen should be regarded as sepsis.

Such an interpretation of sepsis only at first glance seems new. In fact, it only allows one to more clearly formulate a concrete understanding of the pathogenetic essence of this formidable complication of severe mechanical injury and to detail the principles of its diagnosis. It should be emphasized that the presented definition of sepsis does not enter into a semantic contradiction with the former definitions of V.Ya. Shlapobersky (1952), which have become classical. I.V.Davydovsky, (1944). B. M. Kostyuchenko (1982), V. G. Bochorishvili (1988) [1, 5. 12] and others. In our opinion, it is their constructive addition and excludes the ambiguity of interpretation of this process, eliminating such a concept as “Sepsis without a pathogen”, only causing terminological confusion.

The previous chapter is devoted to the methodology of developing a system of functional computer monitoring in the recognition of nodal clinical and pathogenetic parallels of the systemic inflammatory response syndrome in the early post-shock period. Based on this, a general approach to the use of a functional computer monitoring system (SPS) in the clinic has been formulated and justified. The main goal of this chapter is to identify typical forms of the course of the post-shock period based on the study of the clinical signs of a systemic inflammatory reaction in comparison with the criteria for functional computer monitoring.

In the course of conducting comprehensive comparative studies of the dynamics of the early Iostock period in patients with mechanical trauma, using clinical observation data, laboratory indicators and criteria of a functional computer monitoring system, four different types of its course were identified.

Here it is necessary to emphasize once again that the separation of the uncomplicated and complicated course of a traumatic disease was deliberately considered by us only in relation to the development of a systemic inflammatory response syndrome (SIR).

However, during the study, it became clear that the presence of SSVR marks a severe, refractory course of a traumatic disease and its complications with a high risk of sepsis and an adverse outcome. Therefore, the distinction between a complicated and uncomplicated course is focused not only on the identification of the systemic inflammatory response syndrome, but has a deeper prognostic meaning.

First of all, this is an uncomplicated course. It is characterized by the absence of any clinical signs of complications, there is a positive dynamics of all laboratory parameters and criteria of the functional computer monitoring system (PCM).

By comparing the clinical, laboratory data and the criteria of a functional computer monitoring system, it was possible to distinguish an intermediate type between the uncomplicated course and the development of the clinic of the systemic inflammatory response syndrome, called the “condition,“ threatening ”the development of the systemic inflammatory response syndrome”.

Victims with existing signs of SSVR, but without bacteremia, were assigned to the third group. Separately analyzed observations in patients with diagnosed sepsis.
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  1. The consequence of the transferred extreme state
    Recognizing the very fact of the development of an extreme state of an organism is not an end in itself. The main task is to, having established this fact, trace the features of its aftereffect in the complex and multifaceted functioning of the body. But for such a study, it is necessary first of all to identify what should be considered a consequence of the transferred extreme state. Necessary
  2. An objective assessment of the severity of a patient with a systemic inflammatory response syndrome and sepsis
    An objective assessment of the condition of the victim, which is necessary to draw up an adequate treatment program, as well as to evaluate the effectiveness of certain drugs or methods of therapy, is largely hampered by the complex nature of the surgical infection, the multiple aspects of the intensive care, and various surgical interventions. In this regard, it was developed
  4. 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
  5. Severe concomitant injury as an object of general scientific systemic research
    The concept of principles (from the Latin “principium” - the beginning, the basis) can be perceived both in a broad and in a narrower sense. In the previous section, it was used to indicate the basic standards of professional activity arising from the doctrine of emergency clinical as well as military medicine. In this sense, these principles reflect the main areas of imperative influence on
  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. I.A. Eryukhin, S.A. Shlyapnikov. Extreme state of the body. Elements of theory and practical problems in the clinical model of severe combined trauma, 1997

  8. 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
    “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.” JHSiegel “Physiological and metabolic correlations in human sepsis” Essentially in this chapter
  10. Sepsis, severe sepsis and septic shock
    Diagnostic criteria and classification of sepsis Methodical recommendations of the sepsis committee of the Russian Association of Surgical Specialists (RASHI), adopted at the Kaluga Conciliation Conference in June 2004 under the guidance of Academician V.S. Savelyeva. {foto301} Intensive care initiation: Intensive care begins immediately in patients with hypotension or
  11. Psychotic conditions associated with trauma or severe physical illness
    EMERGENCY ASSISTANCE Therapy is carried out taking into account the mental state and somatic pathology. · Correction of concomitant disorders (relief of convulsive seizures, phenomena of cerebral edema, hemodynamic disorders, etc.). · With psychomotor agitation, tranquilizers (diazepam up to 20–40 mg intramuscularly), antipsychotics: chlorpromazine (chlorpromazine *) or levomepromazine (tizercin *) 25–75 mg
  12. Determination of the severity of the condition and diagnosis of damage to a victim who is in an unconscious state
    First of all, it is established whether the victim is alive. (For signs of death, see the article “Cardiopulmonary resuscitation in adults.”) Diagnostics should be performed using the ABCD algorithm: first, airway patency is determined, then respiratory efficiency, then blood circulation, then the main life injuries are diagnosed. Algorithm "ABCD" (Airway - airway,
  13. Nursing care for victims of cold injury
    First aid to victims of frostbite in the pre-reactive period • Shine clothing in a warm room. • Treat the affected area with 70% alcohol (or another skin antiseptic). • Dry. • Apply an aseptic insulating dressing. • Give hot tea with honey and lemon, acetylsalicylic acid and ascorbic acid, no-shpa or papaverine (if any). • Call an ambulance
  14. Impotence in manufacturing bulls with mechanical damage, inflammatory processes and neoplasms in the genitals
    Bruises of the foreskin and penis are usually the result of blows with blunt objects, excessive constriction of the foreskin with fixation straps, unsuccessful jumping of a bull on a mechanical scarecrow, or falls of an animal. Accompanied by a severe pain reaction, especially during erection and urination, inflammatory edema of the affected genital areas, general depression and inhibition of genital
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