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FREQUENCY AND STRUCTURE OF SANITARY LOSSES OF ENT PROFILE UNDER CONDITIONS OF BATTLE ACTION
In the modern system of medical and evacuation measures, the timeliness of medical care, the continuity and sequence of medical measures, that is, compliance with uniform treatment methods for the wounded and sick and the consistent increase in therapeutic measures at the stages of medical evacuation, are of particular importance. a common understanding of the pathological processes occurring in the ENT organs with lesions and diseases, common methods of their prevention and treatment. A prerequisite for continuity is a clear record of medical records.
In the process of conducting medical and evacuation measures, the troops provide for the following types of medical care: first aid, first aid (feldsher) aid, first aid, qualified and specialized medical care.
Under the guise of medical care, they mean a certain list (complex) of medical and preventive measures carried out in case of defeats and diseases by troops (self-help and mutual assistance) and medical service on the battlefield, in the centers of mass sanitary losses and at the stages of medical evacuation. The type of medical care is determined by the place of provision, the training of the people who provide it, and the availability of appropriate equipment. The volume of medical care is the totality of medical and preventive measures within the boundaries of a specific type of medical care performed at the stages of medical evacuation in relation to certain categories of wounded and sick for medical reasons and in accordance with the combat medical situation.
It is generally accepted to subdivide lesions requiring predominantly surgical treatment (wounds and bruises) into injuries with bone damage and without bone damage. However, in most published classifications of combat injuries of ENT organs, this symptom fades into the background. At the same time, studies conducted at the ENT department of the VMeda Medical University named after S.M. Kirov confirm that this criterion is leading for ENT injuries.
With gunshot injuries, isolated injuries of ENT organs were rare. In most cases, they were combined with injuries in other areas of the head and body. A similar pattern is observed with ENT injuries in both wartime and peacetime. This feature determines the need for close interaction between specialists of various fields (neurosurgeons, ophthalmologists, maxillofacial surgeons, otolaryngologists, general surgeons) in providing assistance to victims with head injuries. Obviously, determining the number of concomitant ENT injuries, along with identifying the frequency of such leading combat injuries, is essential, as it roughly reflects the amount of advisory work of otolaryngologist specialists.
Based on the most representative materials, according to the experience of the Great Patriotic War, the following was established: injuries of ENT organs and neck (as leading ones) occurred in 1.6% of all wounded, including 0.8% were isolated and 0.8% were wounds ENT organs in combination with injuries of other areas of the body. In addition, 1.7% of wounded with other locations of leading gunshot injuries had concomitant ENT injuries.
Thus, during the Second World War, 3.3% of all wounded with firearms needed otorhinolaryngology. By the type of hulling projectile: bullet - 32.2%, fragmentation - 66.1%, others - 1.7%. In tab. 6.6.1 presents data on the distribution of wounds of ENT organs by localization.
Distribution of gunshot wounds of ENT organs and neck
There is reason to believe that only some worsening of ENT wounds can take place.
In tab. 6.6.2 presents a classification of combat injuries of ENT organs by severity and nature.
Classification of mechanical damage to ENT organs by severity, nature and localization
As you know, from the action of conventional weapons, not only injuries of the ENT organs are observed, but also other types of combat mechanical injury - air blast damage (shell shock and closed injury - bruises). It has been established that with the development of military equipment there is a clear tendency to increase the proportion of shell-shock and bruises in the general structure of sanitary losses. This type of combat defeat is of particular importance in the case of the use of nuclear munitions. Therefore, defeats by the action of the shock wave deserve the most careful study.
At present, contusion is understood as the general trauma of an organism that has arisen as a result of instant mechanical action on the entire surface of the body or a large part of it.
Such general damage is most likely due to the effects of the environment, i.e., air, sometimes water, less often the action of large masses of loose bodies (earth, sand, grain, etc.). Under combat conditions, shell shock is usually associated with the defeat of an air blast wave.
Hearing and speech disorders are almost as frequent companions of commutation-concussion syndrome as loss of consciousness. In some cases, signs of damage to the nervous system prevail throughout the course of the disease, and signs of damage to the ENT organs are fading into the background, in others, the general symptoms are expressed only in the early period, and auditory-speech disorders prevail in the whole picture. This circumstance should explain the fact that it is much more expedient to treat this contingent of affected people in one medical institution (NPPG, HSNG), where there are departments for those affected with a closed brain injury and for ENT shocked.
The composition of the medical forces and means for the specialized care of ENTs affected.
The majority of patients with lesions of ENT organs (as well as those affected by other profiles) are received for treatment in hospitals, where they are provided with specialized care and treatment in full.
GB has one unit of specialized medical care (OSMP). Each OSMP includes, along with other medical groups, a neurosurgical group consisting of: the head of the group - a neurosurgeon, senior specialists - an otolaryngologist, ophthalmologist, maxillofacial surgeon, neurologist; two senior operating nurses, three surgical nurses, one orderly and one dental technician. If necessary (for example, with a mass flow of the wounded), a neurosurgical group is attached for reinforcement in HSNH and works in it as necessary.
The military medical service has full-time hospitals with the presence of ENT departments (VPNhG). There are hospitals in the staff of which ENT specialists are provided (VPMG, VPNG, VPOZHG, VPGLR) for the provision of specialized care (Table 6.6.3).
The required time-sensitive medical equipment intended to provide specialized ENT care in various medical institutions is presented in Table. 6.6.4.
From the above in table. 6.6.4 of the property of greatest importance is the set of UL (otorhinolaryngological). This kit is intended for equipping specialists of otolaryngologists of the neurosurgical group OSMP, VPOzhG and ENT department of the VPNhG department. The kit is packaged in two wooden crates with a total weight of 94 kg. The set includes 191 items of 101 items.
The UL kit provides specialized ENT care, including: diagnosis of injuries and diseases of ENT organs; the implementation of surgical aids on ENT organs in full; treatment and care of otolaryngological patients; conducting medical examination.
The UL kit contains: surgical instruments, medical devices and devices, including a BEF-1 bronchoscope, a laryngoscope, an electric headlight lamp, a gauge membrane and stethophonendoscopes, a frontal reflector, pocket inhalers, tuning forks, conchotomes and laryngeal bites, hollow probes and washing of the frontal sinuses, tracheotomy tubes of all numbers, a set for microoperations on the ear, ear instruments and other items.
The kit includes suture materials, medicines and other consumables - silk and catgut, dicain for anesthesia, surgical and sewing injection needles, eye pipettes, urethral catheters, drainage tubes, etc.
Thus, the UL kit allows the specialist to perform both an ENT examination and complete surgical treatment for ENT injuries and diseases.
Of course, in addition to having a specialist trained and equipped with the necessary equipment, an ENT specialist needs the correct organization of the work of the ENT department.
The medical staff and bed capacity of medical institutions intended for the treatment of ENT affected
The main medical equipment for the provision of ENT care in medical institutions
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