Blood and blood transfusion
. The range of therapeutic effects of the method is wide. It is particularly effective in acute anemia, shock, intoxication and stimulation of the body's immune responses. The accepted international classification designates each blood group by the presence or absence of two serum agglutinins, which are called alpha (a) and beta (b), and two red blood cell agglutinogens, called A and B.
1. The first blood group is determined by the fact that its red blood cells lack agglutinogens, and both agglutinins, alpha and beta, are present in serum. Thus, the complete blood formula of group 1: I (0ab).
2. In blood of group II, red blood cells have only one agglutinogen - A, and serum contains one agglutinin - beta. Thus, the complete blood formula of group II: II (Ab).
3. IIl blood group is characterized by the fact that red blood cells have only one agglutinogen - B, and its serum contains only one agglutinin - alpha. Thus, the full blood formula of group III: III (Ba).
4. IV blood group is characterized in that its red blood cells have both agglutinogens - A and B, and its serum does not contain agglutinins at all. Thus, the full formula of blood of group IV: (AVo).
At present, it is customary to designate blood groups by the number and by the content of red blood cell agglutinogens: I (0); II (A); III (B); IV (AB).
The content of agglutins and agglutinogens in human blood is constant and does not change throughout life. The titer of agglutinins can fluctuate in connection with the state of the body, diseases.
RBC agglutipoheps appear at the 3rd month of fetal life, and serum agglutinins appear during the first year of life. Children’s serum agglutinin titer is low, which explains the fact that children undergo a blood transfusion (both single-group and universal) with a lesser reaction. By selective adsorption, agglutinogen A has two varieties: A1 and A2, with A1 occurring in 95% of cases, and A2 in 5% of cases.
Therefore, we can talk about six blood groups, but in practical work on blood transfusion, people are divided into four groups. The distribution of blood groups among the population of different countries has some differences, but on average it is believed that people of I (0) group - 41%, II (A) - 38%, III (B) - 18% and IV (AB) - 3% . The blood group is determined using standard serums or cyclones of anti-A and anti-B.
Blood transfusion is performed optionally after:
1. Definitions of the blood type of the patient.
2. Definitions of the blood group of the donor.
3. Samples for individual compatibility.
4. Biological compatibility tests.
Rhesus factor. In 85% of humans, red blood cells have a special antigenic substance called the Rh factor. These people are considered positive, and the remaining 15%, which do not have a Rh factor in their blood, are Rh negative.
Transfusion of Rh-positive blood to Rh-negative patients leads to the development of Rh antibodies. With repeated transfusions, they experience a severe post-transfusion reaction that can lead to death. To prevent this complication, a blood test for the content of the Rhesus factor is mandatory.
Rhesus-negative patients, as well as in all doubtful cases, can only be transfused with Rhesus-negative blood.
The effect of transfused blood on the patient. Currently, substitution, stimulating, hemostatic (hemostatic), neutralizing (detoxification), ilshunobiological and nutritional effects of transfused blood are given.
It is absolutely indicated that transfusion of sprinkles in cases where it cannot be replaced by other methods of treatment, and refusal from it will sharply worsen or lead to the death of the patient.
Contraindications for blood transfusion should be considered:
1. Severe violations of the liver and kidneys (acute hepatitis, acute pephrosonephritis of inflammatory etiology, amyloidosis, etc.).
However, if the disease of these organs is associated with intoxication, then in some cases, blood transfusions performed in small doses, drip, can lead to an improvement in their functions.
2. Decompensation of cardiac activity with the phenomena of edema, ascites, etc.
3. Disease of the lungs, accompanied by severe stagnation in the pulmonary circulation.
4. Allergic conditions and diseases (for example, acute eczema, bronchial asthma, etc.).
5. Active tuberculosis process in the stage of infiltrate.
Blood for transfusion and the manufacture of its preparations is taken from donors, who can be any adult healthy person who voluntarily agreed to become one.
In addition to donated blood, it is possible to preserve and then apply umbilical cord placenta taken with therapeutic bloodletting, autocrop, i.e. taken from the patient himself before surgery or with internal bleeding.
It has been established that for a number of diseases it is possible to transfuse not whole blood, but its components (erythrocyte, leukocyte, platelet mass plasma, serum), and in some cases a sufficient effect can be obtained using blood substitutes. They are divided according to their functional value for the body and the main therapeutic effect. Currently, the following groups of blood substitutes are distinguished: anti-shock, detoxification, regulators of water-salt and acid-base balance, preparations are being developed for oxygen transfer (hemoglobin solutions, fluorocarbon emulsions), as well as means of complex action.
Fracture. Violation of bone integrity caused by violence or pathological process (tumor, inflammation, etc.). The following complications are possible with fractures: 1. Damage to large vessels with the sharp ends of bone fragments. Bleeding leading to acute anemia or intracape cap hematoma. 2. Shock or paralysis caused by trauma to the nerve trunks of a bone fragment. 3. Infection of the fracture and the development of phlegmon, osteomyelitis or general purulent infection (more often with open fractures). 4. Damage to vital organs (brain, lungs, liver, etc.).
According to the condition of the integumentary tissues, the fractures are divided into open and closed. By origin - into congenital (intrauterine) and acquired, which in turn are traumatic and pathological. According to the features of the fracture line - on the transverse, oblique, helical, comminuted, hammered, etc.
Fractures are noted without displacement and with displacement of bone fragments. Without displacement, subperiosteal fractures often occur when the whole periosteum holds bone fragments. Such fractures are more common in children, because with significant elasticity of children's bones, they often break like a green branch, that is, with preservation of the periosteum. Most fractures are with displacement of fragments, which happens: at an angle, lateral, in length, displacement along the periphery in connection with the rotation of the fragments around the axis (rotational).
With the healing of fractures, three periods are distinguished: a) changes caused directly by trauma and the development of aseptic inflammation; b) the period of bone formation; c) bone marrow remodeling. This division is conditional, since in each period processes are noted that are characteristic not only for him, but partially for the period following him.
Clinical symptoms of fractures. Local: pain, deformation of the organ, impaired function, abnormal mobility, shortening of the limb and bone crunch (crepitus). Of the common phenomena, intoxication can be observed, shock, developing in connection with severe pain in the fracture area; absorption of decay products of injured tissues may be accompanied by impaired renal function. In these cases, protein, droplets of fat, blood cells, etc. appear in the urine, and the temperature rises to 3738 ± С.
Pain occurs at the time of a bone fracture, of varying duration and intensity. When injuring nerve trunks with bone fragments, the development of large hematomas, it can be very strong, especially during movement, and decreases at rest. Even careful palpation causes severe pain localized along the fracture line. This symptom facilitates the diagnosis in the absence of other signs of fracture and in bone fractures. It is very important for fractures of bones deeply covered by soft tissues or not giving a large displacement of fragments while holding them in a normal position by an adjacent intact bone (cracks and fractures of ribs, fibula, etc.).
An important sign is dysfunction. Only with injected fractures, it is weakly expressed, and with fractures of bones of the extremities with a shift, it is usually so sharp that attempts to move the limb cause sharp pains. The appearance of abnormal, pathological mobility throughout the bone. With fractures of flat and short bones, it is weakly expressed, on the contrary, with a fracture of long tubular bones, it is clearly visible.
The displacement of bone fragments under the traction of spastically contracted muscles leads to a shortening of the limb.
When bone fragments are displaced in relation to each other, bone crunch (crepitus) appears. It is felt by the hand when shifting the victim, when trying to move, when applying a bandage. It is impossible to specifically cause crepitus by artificial friction of bone fragments against each other, since this leads to additional tissue trauma and can cause fat embolism.
Recognition:It does not cause any difficulties. Only in some patients with the absence of some of the symptoms can present significant difficulties. It is not enough to diagnose a fracture, it is necessary to accurately determine the direction, nature of the displacement of the central and peripheral fragments, their relative position, type of fracture, etc. To solve these diagnostic problems, a complete clinical examination of the patient is necessary and an x-ray in two mutually perpendicular planes is required.
First aid for fractures is the beginning of their treatment, as it prevents such complications as shock, bleeding, infection, additional displacement of fragments, etc.
When providing first aid to a victim with an open fracture, the main task is to prevent infection. For this purpose, impose an aseptic ligation.
With closed fractures, it is important to prevent bone fragments from being displaced and injuring surrounding tissues by applying tires: special standard or improvised (cardboard, plywood, planks, etc.) that are bandaged to a damaged limb.
The material used should be strong enough to, despite muscle contraction, make the joints motionless and limit the mobility of bone fragments as much as possible. The tire is shaped (as far as its elasticity allows) of the fixed limb. From this point of view, Kramer’s and pneumatic wire tires are very convenient, which consist of long “bags” glued from transparent plastic. If for some reason a tire cannot be applied, then when carrying the patient it is necessary, with a slight extension of the injured limb, to hold the fracture site with your hands. It is safer to carry and transport the patient after the introduction of painkillers (pantopon, morphine, etc.). Removing shoes and clothes from a damaged limb causes severe pain, so it is recommended to cut them along the seam.
Treatment:Conducted in a hospital or clinic. Fixation of bone fragments in the correct position can be carried out by various methods: a) plaster cast, b) traction or c) surgery.
Stretching allows you to provide immobility of bone otlomkop while maintaining joint mobility and muscle function. The limb is not squeezed by a bandage, blood circulation is not disturbed, which accelerates the formation of bone callus, prevents atrophy, the formation of pressure sores and other complications. The diseased limb is accessible for examination, and movements begin from the first days of treatment. The inconvenience of the method is that the patient is forced to bedridden.
Devices for extrafocal comparison and fixation of fractures (Ilizarova, Gudushauri, Volkova-Oganesyan and others) were widely used for the treatment of fractures.
Surgical treatment is indicated: 1. In case of non-fused or incorrectly fused fractures. 2. With the following fresh fractures: a) the medial femoral neck; b) transverse thighs; c) tear-off, when there is a large discrepancy in bone fragments; d) interposition - getting between bone fragments of muscles, fascia, which interfere with the healing and formation of bone callus; e) with pressure from the fragments on vital or vital organs (the brain, bladder, large nerves, blood vessels, etc.).
Contraindications to surgical intervention are a serious general condition (shock, acute blood loss, etc.), the presence of a general or local infection.
To accelerate the healing of the fracture, methods are used that improve local and general blood circulation and normalize the body's vitamin metabolism. The patient is prescribed a high-calorie diet rich in proteins, vitamins and calcium salts, provide peace and good care.
In case of limb fracture, care for maintaining the function of muscles and joints is carried out from the first days through the use of physiotherapy exercises, active and passive movements in the joints, and later on with walking with a crutch without loading the limb. Reliance on it can be resolved only after the complete consolidation of the fracture, which, like the restoration of disability, in case of fractures of different bones occurs at different times.
Periostitis. Inflammation of the periosteum. Most often, it occurs as a complication after an injury or an inflammatory disease, especially if hypothermia, infectious diseases, etc. have contributed to this.
Symptoms and course:Periostitis begins with severe pain, increasing edema in the affected area. Quite often, an abscess forms under the periosteum. Edema spreads to the surrounding tissues, the pains are diffuse. An abscess can spontaneously break through the skin, then there is an improvement in well-being. If the disease proceeds without a purulent infection, then it can be treated on an outpatient basis: antibiotic therapy, cold, painkillers. In the presence of pus - surgical treatment.
Peritonitis. Inflammation of the peritoneum, accompanied not only by local changes in the peritoneal cover, but also by a severe general reaction of the body to purulent intoxication. In the vast majority of cases, it develops a second time as a complication of a purulent disease or a violation of the integrity of any organ of the abdominal cavity (appendix, stomach, gall bladder, intestines, etc.). In rare cases, the primary cause is not even found at autopsy, and such peritonitis is called cryptogenic.
Depending on the principle underlying, the following classifications of peritonitis are distinguished.
I. By etiology: 1) aseptic and 2) infectious.
II. By the type of pathogen: 1) staphylococcal, 2) streptococcal, 3) caused by Escherichia coli; 4) caused by mixed flora, etc.
III. According to the prevalence of the process: 1) general (diffuse), when the peritoneum is affected, 2) diffuse, part of the peritoneum is affected, but the process has no clear limitation, 3) the local, affected area of the peritoneum is isolated from the abdominal cavity by commissures.
IV. For reasons of occurrence: 1) with inflammatory and destructive processes of the abdominal organs; 2) perforated; 3) traumatic;
4) postoperative; 5) hematogenous; 6) cryptogeppy, etc.
Peritonitis is also distinguished by the source of origin (appendicular, after perforation of a stomach ulcer, etc.), by the clinical course (acute, chronic), by the nature of the exudate (serous, serous-fibrinous, purulent, hemorrhagic, putrefactive, etc.).
Symptoms and course:Peritonitis is secondary, therefore its clinical picture is superimposed on the symptoms of the primary disease. The patient’s complaints are reduced to abdominal pain, nausea, vomiting, weakness, jazed, shortness of breath, etc. Inspection allows you to notice the pointed features of the face of a gray-earthy color, sunken eyes, difficult breathing, immobility of the abdominal wall, bloating, preservation of consciousness with some inhibition reactions to various stimuli, a dull voice. Dry mucous membranes, dry, coated tongue, repeated vomiting, regurgitation are also noted. On palpation of the abdomen, tension and soreness of the abdominal wall are observed, which are almost always expressed slightly more in the area of the source of peritonitis.
Treatment:Patients with purulent peritonitis need immediate hospitalization and emergency surgery. Complex treatment is carried out, including surgical and conservative methods. The objectives of the operation are to eliminate the primary focus of infection, remove pus and ensure not only a single, but also repeated administration of antibiotics into the abdominal cavity (through drainage). If it is impossible to eliminate the focus of infection, drainage is performed to create a reliable outflow of pus from the abdominal cavity.
Conservative tactics include: 1) the fight against microflora and intoxication; 2) an increase in the immunobiological forces of the body; 3) improving the functions of the organs and systems of the patient.
Recognition:Patients with suspected peritonitis should not use drugs, a cold or a heating pad on their stomach, as this can obscure the clinical picture, and the reduction of pain can lead to tragic delay. Inadmissible are also measures and taking drugs that enhance intestinal motility.
Treatment:The diagnosis of purulent peritonitis is an absolute indication for surgery. Refusal of surgical intervention is permissible only in exceptional cases with an extremely serious condition of the patient (confused consciousness, lack of pulse, blood pressure below 60 mm Hg. Art., Etc.), i.e. essentially in an agonalp or pre-agonal state.
Before antibiotics appeared, patients with pneumococcal and gonococcal peritonitis were treated only conservatively, counting on the rationalization of the process. Currently, the vast majority of surgeons consider the surgical method indicative in all cases of peritonitis. This point of view is based on the fact that, firstly, before the operation it is difficult to be absolutely sure of the presence of an infection, and secondly, removal of pus from the abdominal cavity and the direct administration of antibiotics (streptomycin, oxytetracycline dihydrate, etc.) significantly reduce the risk of death.
The basis of prevention is emergency emergency care, early hospitalization and timely treatment of patients with acute surgical diseases and trauma of the abdominal organs.
Flat foot. Deformation of the foot, with a flattening of its arches. Distinguish between longitudinal and transverse flattening, there may be a combination of them. With transverse flatfoot, the transverse arch of the foot is flattened, its front section rests on the heads of all five metatarsal bones, and not on 1 and V, as is normal. With longitudinal flat feet, the longitudinal arch is flattened and the foot is in contact with the floor over almost the entire area of the sole. Flatfoot is congenital (rarely) and acquired. The most common causes are injuries, clubfoot, muscle-ligamentous apparatus weakness, paralysis, and wearing tight shoes.
The earliest signs of flat feet: aching pain when walking, fatigue of the legs. By evening, swelling of the foot may appear, disappearing during the night. Shoes in patients with flat feet usually wear out on the inner surface of the soles and heels. An important role in the prevention of flat feet is played by the right choice of shoes, children's correct posture, as well as daily gymnastics, sports, walking barefoot.
Treatment:For signs of flat feet, you need to contact an orthopedist. In some cases, special gymnastics is enough, sometimes special arch support is used, in advanced cases - orthopedic shoes and even surgical treatment.