Blood transfusions and krovozameniteley

. method of therapeutic action range is wide. Particular efficiency is in acute anemia, shock, intoxication and stimulation of immune reactions. The accepted international classification represents each blood group on the presence or absence in it of two sera agglutinins, which are called alpha (a) and beta (b) and the two agglutinogens of red blood cells, called A and B.
1. The first blood group is determined by the fact that in its red blood cells no agglutinogens and serum have both agglutinin - alpha and beta. Thus, a complete blood count 1 group: I (0ab).
2. Blood group II erythrocytes agglutinogen have only one - A, and one serum contains agglutinin - beta. Thus, a complete blood count of group II: II (Ab).
3. IIl blood characterized by the fact that red blood cells have only one agglutinogen - B, and it contains only one serum agglutinin - alpha. Thus, a complete blood count group III: III (Ba).
4. IV blood characterized in that it agglutinogen erythrocytes have both - A and B, and it does not contain any serum agglutinins. Thus, a complete blood count group IV: (ABO).
At present, usually denoted by the blood group number and the content of red blood cells agglutinogens: I (0); II (A); III (B); IV (AB).
Human blood agglyutinov agglutinogens and constantly throughout life and does not change. Agglutinins titer may fluctuate due to the state of the organism, diseases.
Agglyutipogepy red blood cells appear in the 3rd month of fetal life, and agglutinins Serum - during the first year of life. The titer of serum agglutinins children is low, which explains the fact that the children carry blood transfusions (as odnogruppnoy and universal) with less reaction. Selective adsorption found that imeetdveraznovidnosti agglutinogen A: A1 and A2, wherein A1 is found in 95% of cases, and A2 - 5% of cases.
Therefore, we can speak of six groups of blood, but in practice of blood transfusion are dividing people into four groups. Distribution of blood groups in the population of various countries have some differences, but on average it is believed that people I (0) of the group - 41%, II (A) - 38%, III (B) - 18% IV (AB) - 3% . blood group was determined by standard Colyclons sera or anti-A and anti-B.
Blood transfusion is done right after vobyazatelpom:
1. Definitions blood group of the patient.
2. Definitions blood donor.
3. Samples of individual compatibility.
4. Samples biocompatibility.
Rhesus factor. 85% l yudey red blood cells have a particular antigenic substance, called the Rh factor. These people are considered rezuspolozhitelnymi, and the remaining 15% who do not have blood Rh factor, rezusotritsatelnymi.
Transfusion of Rh-positive blood rezusotritsatelnym patients leads to the development of their Rh antibodies. Repeated transfusions have serious postgransfuzionnaya reaction occurs that can lead to death. To prevent this complication necessarily blood test on the content of Rh-factor.
Rezusotritsatelnym sick and only rezusotrntsatelpuyu blood can be transfused in all doubtful cases.
The action of blood transfused per patient. Currently pyyaelyat substitution, stimulating, hemostatic (hemostatic), neutralizes (dezintoksikatsiopnoe) ilshunobiologicheskoe and nutritional effect of transfused blood.
Absolutely shown transfusion sprinkled in cases where it can not be replaced by other methods of treatment, and can be waived dramatically worsen or lead to the death of the patient.
Protivopohazapiyamn for transfusion should be considered:
1. Serious liver and kidney function (acute hepatitis, acute inflammatory etiology pefrozonefrity, amyloidosis, and others.).
However, if these bodies disease associated with intoxication, in some cases a blood transfusion produced in small doses, infusion may lead to an improvement of their functions.
2. cardiac decompensation with symptoms of edema, ascites, and others.
3. Lung disease accompanied by severe congestion in the pulmonary circulation.
4. Allergic conditions and diseases (eg, acute eczema, asthma and others.).
5. The active tuberculous process in the stage of infiltration.
Blood transfusion and manufacture of its products taken from the donor, which mozhetbytlyuboy adult zdorovyychelovek, voluntarily agreed to become.
Besides blood may be preserved and then apply pupovinnoplatsentarnuyu, taken at therapeutic phlebotomy, autokrop, ie taken from the patient prior to surgery or internal bleeding.
It is found that a number of diseases can not transfuse whole blood, and its components (eritrotsntnuyu, leukocyte, trombotsitpuyu weight plasma, serum), and in some instances, a sufficient effect can be obtained using blood substitutes. They are divided according to their functional significance for the body and the main therapeutic action. Currently, the following groups of blood substitutes: anti-shock, detoxification, regulators of water-salt and acid-base balance, developed products for the transport of oxygen (hemoglobin solutions, emulsions ftoruglevodov), as well as means of complex action.
Fracture. Violation of the integrity of the bone, vyznat violence or pathological process (swelling, inflammation, and others.). In fractures, the following complications: 1. Damage to the large vessels of the sharp ends of bone fragments. Bleeding, leading to severe anemia or vnutritkapepoy hematoma. 2. The shock or paralysis caused by injury of nerve trunks fragment of bone. 3. Infection and fracture development cellulitis, osteomyelitis, or general purulent infection (often with open fractures). 4. Damage to vital organs (brain, lung, liver, etc.).
As coating fabrics fracture is divided into open and closed. By origin - at birth (fetal) and acquired, which in turn are traumatic and pathological. The peculiarities of the fracture line - on the cross, oblique, helical, comminuted, impacted, and others.
Fractures note without displacement and with displacement of bone fragments. Without bias are often subperiosteal fractures, when the whole periosteum retains bone fragments. Such fractures are more likely in children, as with significant elasticity of children's bones are often broken by the type of "green branches", ie preserving periosteum. Most fractures - offset fragments, which can be: angle, lateral, lengthwise, on the periphery offset in relation to the rotation of the fragments about the axis (rotational).
When fracture healing are three periods: a) changes caused by direct trauma and the development of aseptic inflammation; b) the period of bone formation; c) restructuring of the callus. This division is conditional, since in every period the processes that are typical not only for him, but also partly for the next period for him.
Clinical symptoms of fractures. Local: pain, body deformation, infringement of its functions, abnormal motility, shortening and bone crunching (crepitus). From the general symptoms of intoxication can occur, shock, growing due to severe pain in the area of ​​the fracture; absorption of injured tissue decay products may be associated with renal dysfunction. In these cases appears in the urine protein, fat droplets, blood corpuscles et al., As well as the temperature rises to 3738 ± C.
Pain arises when a bone fracture, various duration and intensity. When injury of nerve trunks bone fragments, the development of large hematomas it is very strong, especially during movement and decreases with rest. Even the cautious feeling causes severe pain, localized along the fracture lines. This facilitates diagnosis of the symptom in the absence of other indications of fracture and bone fractures. It is very important in bone fractures, soft tissue deeply hidden or not carrying a large displacement of bone fragments by holding them in the normal position of the adjacent intact bone (fractures and rib fractures, the fibula, and others.).
An important feature - dysfunctions. Only when impacted fractures he is weak, and bone fractures offset limbs - usually so sharp that attempts limb movements cause sharp pain. The emergence over the bones of abnormal, pathological mobility. She is weak, on the contrary, fracture of long bones clearly visible at the fracture plane and short bones.
Offset bone fragments under the hood diminished spastic muscles leads to a shortening of the limb.
At displacement of bone fragments in relation to each other there is a bone crunching (crepitus). He felt a hand at a rearrangement of the victim, when attempting to move, if applied. Especially cause crepitus by artificial bone fragments rubbing against each other can not be, as this leads to further tissue injury and can cause fat embolism.
There is no difficulty. Only some patients may present significant difficulties in otstutstvii of the symptoms. It is not enough to diagnose a fracture, it is necessary to accurately determine the direction, the nature of the displacement of the central and peripheral fragments, their relative position, type of fracture, and others. In order to solve these diagnostic tasks necessary to complete clinical examination of the patient and required an X-ray in two mutually perpendicular planes.
First aid for fractures is the beginning of their treatment, as warns complications such as shock, bleeding, infection, additional displacement of fragments, etc.
When providing first aid to the victim with an open fracture of the main objective - the prevention of infection. For this purpose, aseptic posyazku applied.
When closed fractures is important to prevent displacement of bone fragments and injury of surrounding tissues by using overlay tires: special standard or improvised (cardboard, plywood, boards, etc.) That pribintovyvayut to the injured limb.
The material used shall be sufficiently strong that, in spite of the contraction of the muscles, joints and to immobilize to limit the mobility of bone fragments. Tire shaped (so far as the elasticity) fixed by limb. From this point of view is very convenient, wire and pneumatic tires Cramer, which consist of long, "bags", glued transparent plastic. If the bus for any reason you can not apply, during the patient's carrying is necessary, with gentle stretching of the affected limb, to keep the place hands fracture. Wrap and safer to transport the patient after the administration of his painkillers (pantopon, morphine and others.). Removing the shoes and clothing with the injured limb causes severe pain, so it is advisable to cut them along the seam.
Spend in a hospital or clinic. Fixation of bone fragments in the correct orientation may be effected by different ways: a) plaster cast, b) a traction or) operation.
Traction allows immobility otlomkop bone while maintaining joint mobility and muscle function. Certainly not compressed bandage, no blood circulation, which speeds up the callus formation, prevents atrophy, bedsores and other complications. Patient limb available for inspection, and the movement starts from the first days of treatment. The disadvantage of this method is that the patient is forced to "chained" to the bed.
Widespread use in the treatment of fractures received extrafocal devices for comparison and fracture fixation (Ilizarov Gudushauri, Volkov-Oganesyan et al.).
Surgical treatment is indicated: 1. ununited or wrong accrete fracture. 2. When fresh fractures following: a) the medial femoral neck; b) lateral thigh; c) separated when there is a large discrepancy between the bone fragments; g) interposition - contact between bone fragments muscle, fascia, healing and preventing the formation of callus; d) at a pressure on vital fragments or carrying out an important function of organs (brain, bladder, large nerves, vessels and others.).
Contraindications to surgery are severe general condition (shock, acute blood loss, etc.), The presence of general or local infection.
To accelerate fracture healing methods are used, improving local and general blood circulation and normalizing vitamin metabolism of the organism. The patient is prescribed a high-protein, vitamins and calcium salts of high calorie diet, provide rest and good care.
At the turn of the limb bones of concern for the preservation function of muscles and joints is carried out from the first day through the use of physical therapy, active and passive movements of the joints, and in the future - with the help of walking with crutches without loading the limb. Prop it can be resolved only after the full consolidation of the fracture, which, like the rehabilitation and in fractures of various bones occurs at different times.
Periostitis. Inflammation of the periosteum. Most often it occurs as a complication of trauma or inflammatory disease, especially if this was due to overcooling, and other infectious diseases.
Periostitis begins with severe pain, swelling in the area of ​​increasing destruction. Quite often while under the periosteum formed an abscess. The swelling spreads to the surrounding tissues, pain are diffuse in nature. Ulcer can spontaneously break through the skin, then comes the improvement of health. If the disease occurs without purulent infection, it can be treated on an outpatient basis: antibiotic therapy, cold, pain. If there is pus - surgical treatment.
Peritonitis. Inflammation of the peritoneum, accompanied by outputting not only local changes in peritoneal cover, but severe general reaction to purulent intoxication. The vast majority of developing secondary as a complication of suppurative disease or disorder integrity of an organ of the abdominal cavity (the appendix, stomach, gall bladder, intestines, etc.). In rare cases, the primary cause is not even on autopsy, and a peritonitis called cryptogenic.
Depending on the principle that forms the basis of, distinguish the following classification of peritonitis.
I. According to the etiology: 1) aseptic and 2) infections.
II. According to the pathogen mind: 1) staphylococcal, 2) strep, 3) caused by Escherichia coli; 4) caused by mixed flora, and others.
III. As the prevalence of the process: 1) total (diffuse), when struck by the peritoneum, 2) diffuse, struck a part of the peritoneum, but the process has no clear limits, 3) local, affected area is isolated from the ventral abdominal adhesions.
IV. For reasons of occurrence: 1) inflammatory and destructive processes of the abdominal cavity; 2) ruptured; 3) traumatic;
4) post-operative; 5) hematogenous; 6) kriptogeppy et al.
There are also peritonitis Resources (appendiceal, after perforation of the stomach ulcers, etc..), The clinical course (acute, chronic), by the nature of fluid (serous, seroplastic, purulent, hemorrhagic, putrid, etc..).
Peritonitis - secondary, so its clinical picture is superimposed on the primary symptoms of the disease. The complaints of the patient are reduced to abdominal pain, nausea, vomiting, weakness, zhazede, dyspnea and others. Inspection allows notice pointed facial features gray and sallow, sunken eyes, a hard type of breathing, stiffness of the abdominal wall, abdominal distension, maintaining consciousness at a certain lethargy reactions to various stimuli, hollow voice. There are also dry mucous membranes, dry, coated tongue, repeated vomiting, regurgitation. When abdominal palpation there is tension and soreness of the abdominal wall, which is almost always expressed a bit more in peritonitis source.
Patients with purulent peritonitis in need of immediate hospitalization and emergency surgery. Carry out comprehensive treatment, including operative and conservative methods. Operation Tasks - the elimination of the primary focus of infection, pus and removal of software, not only once, but the re-introduction of antibiotics in the abdominal cavity (through drainage). If it is impossible to eliminate the source of infection produce drain to create a strong outflow of pus from the abdomen.
Conservative strategy includes: 1) the fight against the microflora and intoxication; 2) improving the immune-biological body's defenses; 3) improvement of the functions of organs and systems of the patient.
Patients with suspected peritonitis should not use drugs, cold or hot water bottle on your stomach, as it may obscure the clinical picture and the reduction of pain - lead to a tragic delay. Unacceptable activities and also taking medications that increase peristalsis.
The diagnosis of peritonitis is an absolute indication for surgery. Refusal of surgical intervention is only permitted in exceptional cases, when extremely serious condition of the patient (confusion, lack of pulse, blood pressure below 60 mm Hg. Art., Etc.), Ie, substantially agonalpom predagonalnom or condition.
Before the advent of antibiotics patients with gonococcal and pneumococcal peritonitis treated only conservatively, relying on the process osumkovyvanie. Currently, the vast majority of surgeons considered indicative of the operational method in all cases of peritonitis. This view is based on the fact that firstly, before the operation is difficult to be absolutely sure of the presence of infection, secondly, the removal of abdominal pus and direct administration into it antibiotics (streptomycin, oxytetracycline dihydrate and others.) Significantly reduces the threat of death.
The basis of prevention - Emergency first aid, early hospitalization and timely treatment of patients with acute surgical diseases and injuries of the abdominal cavity.
Flatfoot. The deformation of the foot, with a flattening of its vaults. Distinguish longitudinal and transverse flattening may be a combination thereof. When transverse flat flattened transverse arch of the foot, it relies on the anterior head of all five metatarsal bones, rather than the V 1 and, as it happens normally. When longitudinal flat flattened longitudinal arch and foot contact with the floor almost the entire area of ​​the sole. Flat feet can be congenital (rare) and purchased. The most common causes are: trauma, clubfoot, weakness musculo-ligamentous apparatus, paralysis, wearing tight shoes.
The earliest signs of flatfoot: aching pain while walking, fast leg fatigue. In the evening, you may receive foot edema disappearing overnight. Shoes in patients with flat feet are usually worn on the inner surface of the soles and heels. A major role in the prevention of flatfoot is playing the correct selection of shoes, respect children correct posture, as well as daily gym, exercise, walking barefoot.
If there are signs of flatfoot is necessary to address to the orthopedist. In some cases, it is enough special gymnastics, sometimes special insoles used in advanced cases - orthopedic shoes, and even surgery.