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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 directions of the imperative effect on the diseased organism, calculated on the ideas corresponding to the specific stage of development of medicine about the main, most general laws of the pathogenesis of an extreme condition and its aftereffect. However, the complexity of the problem under consideration lies in the fact that it is in an extreme situation that those hidden, deep-seated features of the vital activity of a particular organism that give it an individuality, often become crucial. Under ordinary conditions, these features, of course, are recognized by us, since they lay the foundation for constitutional differences, typical differences in the reactivity of the central nervous system, in hemodynamics, or in other systemic functions. However, the presence of these features is perceived by physiologists and doctors relatively calmly until the occurrence of an extreme situation requires a limit, significantly exceeding physiological norms, to realize the functional potential of the body.

Then the attitude to the individual (congenital or acquired) features of the deep, performed at the level of metabolism, vital activity changes dramatically. Suddenly, it turns out that these features largely determine whether the body can stay on the critical line of life, whether it can safely get out of an extreme situation, and which will suffer functional damage. A concrete idea of ​​the significance of certain features of this basic metabolism, of their role in the development of pathogenetic mechanisms and in the prediction of an extreme state, develops in the mind of the doctor in the form of an individual clinical image of the patient.

Recognition of the clinical image is of particular importance in the early post-extreme period, immediately after the anti-shock measures, when the unstable stabilization of the main parameters of life support creates the uncertain hope that the catastrophic shock of the body was overcome with the help of the imperative therapeutic effect [85, 94, 103). Now the imperative principle in treatment should gradually give way to another strategic principle - the dialogue of the doctor with a sick organism, which he (the doctor) perceives as a complex, self-regulating living system. It is at this stage that it is important to adequately determine the price of adaptation, the functional damage with which the body emerges from shock and enters a new functional state, after which there are unclear outlines of subsequent functional transformations, up to determining the final outcome. It is the formation of an adequate idea of ​​the individual price of the shock suffered by the body - and this is a special form of medical thinking - recognition of the patient’s clinical image.

Only on the basis of a clinical image can one navigate in a complex, intricate maze of causal relationships that form the basis for the development of multiple organ failure syndrome. That is how a violent, dramatic clinical manifestation, observed in the early post-shock period until the sixth to eighth day, and sometimes longer, is most often indicated now. The vulnerability of this designation lies in the fact that it was essentially originally designed for late diagnostic information, when it comes to stating the fact of the simultaneous functional failure of several organs and anatomical-functional systems. How events developed at a deep metabolic level, what followed, why, in the complex of manifestations of multiple organ failure, individual differences and a dynamic change in dominant disorders were observed - neither the concept of multiple organ failure nor the pathogenetic discussed in connection with this concept give an answer mechanisms. Usually, when discussing these mechanisms, the emphasis is first on general patterns, and then on fairly well-known pathological algorithms for the development of insufficiency of the cardiovascular system, external respiration system, liver, digestive and excretory systems, etc.

About latent, deep-seated violations at the preclinical level, most directly dependent on typical constitutional and. finally, from strictly individual characteristics of the basic metabolism of a particular living organism, which undoubtedly predetermine the main directions of events in an extreme situation, these discussions are usually not mentioned. Meanwhile, clinical practice constantly confirms the existence of such a causal relationship.
And to provide a methodological basis for the implementation of the strategic principle - dialogue with an organism undergoing shock from extreme impacts, without realizing the reality of this connection is practically impossible.

So, the clinical image is a subjective form of the integral perception by a doctor of multifaceted information about the functional state of a patient undergoing extreme exposure. However, it should be noted that such a definition is not specific. Moreover, it focuses on informal professional logic, contains elements of artistic intuitive perception, which cannot be described using language. Therefore, despite the desire to meet actual practical needs, such reasoning gives the impression of a certain exclusivity, elitism of the caste of doctors who are able to use in their professional activities the judgments arising from the integral clinical image of the patient.

In recent years, the widespread introduction of microprocessor computer technology in the analytical process has radically changed the situation. The new methodology of analysis entailed the development of general scientific areas, from which the scientific worldview corresponding to a particular historical stage is formed. The development of science, which is always an autocatalytic process with feedback, has led to an increase in interest in the thermodynamics of nonlinear processes. It became possible to describe these processes and the complex dissipative systems formed on their basis using a specific scientific language. A new general scientific direction has been formed - synergetics. The nonspecific, universal nature of the laws that make up this scientific field is illustrated by examples from various fields of natural science, and there is a basis for using them to solve scientific and practical medical problems. At a specific stage, the question arises of creating a kind of logical “bridge” between the fundamental general scientific views and their concrete embodiment in practical medicine. It seems that a very suitable area for developing the emerging direction is the problem of the extreme state of the body and post-extreme disorders.

A wide range of physiological fluctuations of functional parameters at various levels of life support, from the molecular to the systemic organism, comparing the recorded parameters with the changes that they undergo in an extreme situation, comparing these and other indicators with clinical criteria for the development of the process, and finally, analyzing the results results from the standpoint of integral functional synergetics open up the prospects of creating a well-balanced system of individual functional mo nitoring, able to bring the clinician to the staged and final prognosis.

It is quite acceptable to expect that in this case the relationship of the factors of thanatogenesis and sanogenesis will appear. the nature of their interaction during the pathological process, as well as those key moments of the development of the latter that must be used in order to push the process in the right direction during dialogue supervision.

In this case, they find a concrete expression and fundamental scientific background of the judgment on why, for example, in some patients? depleting functional potential is spent on violent agony, while in others it is realized during prolonged hypobiosis. Or another question: why does a surgical infection, developing in the third stage (phase) of a traumatic disease, in some patients immediately tend to generalize (with all the characteristic immunological features), while in others it develops along a path that is also very difficult and often equally unfavorable in local process forecast [106]? So, let’s say, while studying the problem of acute peritonitis, we were convinced that the predominance of the tendency to delimitation or, conversely, to the spread of the process in the peritoneal cavity depends on the individual ratio in the spectrum of lysosomal enzymes of polymorphonuclear leukocytes, which affects the dynamics of the conversion of fibrinogen to fibrin [18] . It is possible that in the course of the development of the indicated direction, the recognition of the mechanisms and prerequisites for the development of diseases of endogenous nature — metabolic, endocrine, oncological and others — will gain prospects. The interaction in their pathogenesis of genetic factors and extreme situations transferred by the body will be manifested. But the main task, undoubtedly, is to provide a methodological basis for creating a system of “figurative” computer functional monitoring and preventive, proactive, measures in the treatment of post-extreme complications. Discussion of these issues is the main goal of the subsequent sections of the book.
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Severe concomitant injury as an object of general scientific systemic research

    “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
  3. 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,
  4. The concept of traumatic disease as applied to severe combined trauma
    The concept of traumatic disease as applied to severe combined
  5. 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
  6. General principles for the diagnosis and treatment of severe concomitant injury based on the concept of traumatic disease
    A comprehensive study of the various stages of the post-traumatic period with severe combined trauma showed that traumatic disease is essentially an adaptation pathology with its own developmental sequence and periodization. This allowed us to identify and formulate a number of principles of diagnostic and treatment tactics that apply not only to traumatic shock, corresponding to
  7. Psychotic conditions associated with trauma or severe physical illness
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  8. 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

  9. The meaning of life as an object of psychological research
    Why does a person live? What is the meaning of his life? These questions are always exciting. The desire to realize one’s purpose, to realize how to live, how to make plans for the future, what goals to follow, is inherent in man. Everyone who poses these questions for himself is faced with the difficult problem of understanding his life. Being a global problem, the meaning of life is relative to a specific person
  10. Business communication as an object of psychological and acmeological research
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  12. Multiple and combined injuries (injuries)
    Combined and multiple injuries are among the most severe injuries with high mortality both at the prehospital stage and in the hospital. Combinations are those injuries in which, along with damage to the organs of the abdominal or chest cavity, and the brain, there are injuries of the musculoskeletal system. Such injuries are called multiple when there are two or more
  14. Combined, multiple and combined injuries
    Polytrauma - simultaneous damage to two or more of the seven anatomical areas of the body (head, neck, chest, abdomen, limbs, pelvis, spine), at least one of which is severe. Polytrauma is divided into 3 large groups: ¦ combined injuries, which include damage to internal organs, musculoskeletal system, wounds, detachment of the skin and fiber, long-term syndrome
  15. Assessment of the severity of associated injuries
    Until recently, in practice, the traditional gradation of the severity of injuries was mainly used, based on the subjective experience of the doctor and expressed in nominal categories: mild, moderate, severe, and extremely severe injuries. These categories are correlated with the degree of threat to life and with the general functional damage, focused on the long-term prognosis. However, the use of such
  16. Intensive care for combined traumatic brain injury
    An analysis of mortality in severe combined head injury indicates a high percentage of adverse outcomes. There is a direct correlation between the severity of TBI, the degree of polysegmentarity of damage, the severity of the shock reaction of the body as a whole, and the age of the patient. To a large extent, the mechanisms of thanatogenesis are determined by decompensation of TBI, the uncontrolled progression of the consequences of which
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