Blood transfusion and blood substitutes
. The range of therapeutic effect of the method is wide. It is particularly effective in acute anemia, shock, intoxication and stimulation of the immune reactions of the body. The accepted international classification refers to each blood group according to the presence or absence of two serum agglutinins in it, which are called alpha (a) and beta (b) and two erythrocyte agglutinogens, called A and B.
1. The first group of blood is determined by the fact that there are no agglutinogens in its red blood cells, and in the serum there are both agglutinin alpha and beta. Thus, the complete blood count of the 1st group: I (0ab).
2. In the blood of group II, the erythrocytes have only one agglutinogen - A, and the serum contains one agglutinin - beta. Thus, the complete formula of blood II group: II (Ab).
3. IIl blood group is characterized by the fact that erythrocytes have only one agglutinogen - B, and its serum contains only one agglutinin - alpha. Thus, the complete formula of blood III group: III (BA).
4. The IV blood group is distinguished by the fact that its red blood cells have both agglutinogens, A and B, and its serum does not contain agglutinins at all. Thus, the complete formula of blood IV group: (ABO).
At present, it is customary to designate blood groups by numbers and by the content of erythrocyte agglutinogens: I (0); II (A); III (B); IV (AB).
The content of agglutins and agglutinogens in human blood does not change constantly and throughout life. Agglutinin titer may fluctuate due to the state of the body, diseases.
Erythrocyte agglutinepops appear on the 3rd month of fetal fetal life, and serum agglutinins appear during the first year of life. The titer of agglutinin serum in children is low, which explains the fact that children tolerate blood transfusions (both single-group and universal) with a lower reaction. By selective adsorption, it was established that agglutinogen A has double species: A1 and A2, with A1 occurring in 95% of cases, and A2 in 5% of cases.
Consequently, it is possible to speak of six blood groups, but in practical work on blood transfusion they use the division of people into four groups. The distribution of blood groups among the population of different countries has some differences, but on average it is considered that people of the I (0) group - 41%, II (A) - 38%, III (B) - 18% and IV (AB) - 3% . The blood group is determined using standard sera or anti-A and anti-B cyclones.
Blood transfusion is performed according to the procedure after:
1. Definitions of the patient's blood group.
2. Determination of blood group of the donor.
3. Samples for individual compatibility.
4. Samples for biological compatibility.
Rh factor. In 85% of people, red blood cells have a special antigenic substance called the Rh factor. These people are considered as rezuspositive, and the remaining 15%, not having the Rh factor in the blood, are Rh-negative.
Transfusion of Rh-positive blood by Rh-negative patients leads to the development of Rh-antibodies in them. With repeated transfusions they experience a severe post-transfusion reaction, which can be fatal. To prevent this complication, a blood test for the Rh factor is necessary.
Rhesus-negative patients, as well as in all doubtful cases, it is possible to transfuse only rhesusotrnatel blood.
The effect of transfused blood on the patient. Nowadays, substitution, stimulating, hemostatic (hemostatic), neutralizing (detoxification), ilshunbiological and nutritional effects of transfused blood are prescribed.
Absolutely shown transfusions of seedlings in cases where it cannot be replaced by other methods of treatment, and the rejection of it will dramatically worsen or lead to the death of the patient.
Anti-inflammatory to blood transfusion should be considered:
1. Severe dysfunction 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, in some cases the blood transfusion produced in small doses, drip, can lead to an improvement in their functions.
2. Decompensation of cardiac activity with signs of edema, ascites, etc.
3. Lung disease, accompanied by severe stagnation in the pulmonary circulation.
4. Allergic conditions and diseases (for example, acute eczema, bronchial asthma, etc.).
5. Active tuberculous process in the stage of infiltration.
Blood for transfusion and the manufacture of its preparations is taken from donors, which can be any healthy adult person who voluntarily agreed to become one.
In addition to donor blood, it is possible to preserve and then apply an umbilical-umbilical, taken during therapeutic bleeding, autocrop, i.e. taken from the patient himself before the operation or with internal bleeding.
It has been established that in 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 sufficient effect can be obtained using blood substitutes. They are divided by their functional value for the body and the main therapeutic effect. Currently, the following groups of blood substitutes are distinguished: antishock, detoxification, regulators of water-salt and acid-base balance, preparations are being developed for oxygen transfer (hemoglobin solutions, fluorocarb 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 for fractures: 1. Damage to large vessels by the sharp ends of bone fragments. Bleeding leading to acute anemia or intracapital hematoma. 2. Shock or paralysis caused by injury to the nerve trunks of a bone fragment. 3. Infection of the fracture and development of phlegmon, osteomyelitis or general purulent infection (more often with open fractures). 4. Damage to vital organs (brain, lungs, liver, etc.).
As integumentary tissues, fractures are divided into open and closed. By origin - 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, impacted, etc.
Fractures are noted without displacement and with displacement of bone fragments. Without displacement, subperiosteal fractures often occur when the whole periosteum holds the bone fragments. Such fractures are more common in children, because with significant elasticity of children's bones, they often break like a “green sprig”, i.e. with the preservation of the periosteum. Most of the fractures - with the displacement of fragments, which happens: at an angle, lateral, along the length, offset along the periphery due to the rotation of the fragments around the axis (rotational).
When fusion fractures allocate three periods: a) changes caused directly by trauma and the development of aseptic inflammation; b) the period of bone formation; c) restructuring of callus. This division is conditional, since in each period there are processes that are characteristic not only for him, but also partially for the period following him.
Clinical symptoms of fractures. Local: pain, organ deformity, impaired function, abnormal mobility, shortening of the limb and bone crunch (crepitus). From the common phenomena intoxication, shock, developing due to severe pains in the area of the fracture can be observed; absorption of decay products of injured tissues may be accompanied by impaired renal function. In these cases, protein appears in the urine, fat droplets, blood cells, etc., and the temperature rises to 3738 ± C.
Pain occurs at the time of a bone fracture, of varying duration and intensity. When injured nerve trunks bone fragments, the development of large hematomas, it is very strong, especially during movement and decreases with rest. Even cautious palpation causes severe pain, localized along the fracture line. This symptom facilitates the diagnosis in the absence of other signs of fracture and bone fractures. It is very important for fractures of bones, deeply covered with soft tissues or not giving a large displacement of fragments while keeping them in a normal position by the adjacent intact bone (cracks and fractures of the ribs, fibula, etc.).
An important sign - dysfunction. Only with impacted fractures, it is weakly expressed, and for fractures of bones of the extremities with displacement, it is usually so severe that attempts to move the limb cause sharp pain. The appearance throughout the bone abnormal, pathological mobility. With fractures of flat and short bones, it is weakly expressed, on the contrary, with fracture of long tubular bones, it is clearly visible.
The displacement of bone fragments under spastic muscle contraction leads to shortening of the limb.
At displacement of bone fragments in relation to each other, a bone crunch (crepitus) appears. It is felt by the hand when transferring 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 injury and may cause fat embolism.
Recognition:It is not difficult. Only in some patients, in the absence of a part of the symptoms, can present considerable difficulties. 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 mutual location, the type of fracture, etc. To solve these diagnostic problems, a complete clinical examination of the patient is necessary and an X-ray picture is required in two mutually perpendicular planes.
First aid for fractures is the beginning of their treatment, as it prevents such complications as shock, bleeding, infection, additional shifts of fragments, etc.
When providing first aid to the victim with an open fracture, the main task is to prevent infection. For this purpose, impose an aseptic dressing.
With closed fractures, it is important to prevent displacement of bone fragments and injury to surrounding tissues by means of applying tires: special standard or improvised (cardboard, plywood, planks, etc.), which are pinned to the injured limb.
The material used must be strong enough to, despite the contraction of the muscles, to make the joints motionless and to limit the mobility of the bone fragments as much as possible. The tire is shaped (as its elasticity permits) of a fixed limb. From this point of view, Kramer's tires and pneumatic tires are very convenient, which consist of long “bags” glued together from transparent plastic. If for some reason it is impossible to impose a tire, then while carrying the patient it is necessary, with a slight stretching of the injured limb, to hold the place of the fracture by hand. It is safer to transfer and transport the patient after administering painkillers to him (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) a plaster cast, b) stretching or c) an operation.
Traction allows you to ensure the immobility of the bone fragments while maintaining joint mobility and muscle function. The limb is not compressed by the bandage, the blood circulation is not disturbed, which accelerates the formation of callus, prevents atrophy, the formation of bedsores and other complications. Sore limb is available for inspection, and movements begin from the first days of treatment. The inconvenience of the method is that the patient is forcedly "bedridden".
Apparatus for extra-focal matching and fixation of fractures (Ilizarov, Gudushauri, Volkov-Oganesyan, etc.) have been widely used for the treatment of fractures.
Surgical treatment is indicated: 1. In case of non-accreted or incorrectly accreted fractures. 2. With the following fresh fractures: a) the medial femoral neck; b) transverse thigh; c) detachable, when there is a large discrepancy of bone fragments; d) interposition - contact between bone fragments of muscles, fascia that interfere with healing and the formation of callus; e) with the pressure of fragments on vital or important organs or organs (brain, bladder, large nerves, blood vessels, etc.).
Contraindications to surgery are a serious general condition (shock, acute blood loss, etc.), the presence of a common or local infection.
To accelerate the healing of a fracture, methods are used to improve the local and general blood circulation and normalize the body's vitamin metabolism. A high-calorie diet rich in proteins, vitamins and calcium salts is prescribed to the patient, and peace and good care are provided.
In case of fracture of the limb bones, the preservation of the function of muscles and joints is carried out from the first days through the use of physical therapy, active and passive movements in the joints, and later - with the help of walking with a crutch without a load of the limb. Reliance on it can only be resolved after complete consolidation of the fracture, which, like the restoration of working capacity, with 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. 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 surrounding tissues, pains are diffuse. The abscess can spontaneously break through the skin, then there is an improvement in health. If the disease proceeds without a purulent infection, then it can be treated on an outpatient basis: antibacterial 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 most cases, it develops again as a complication of a purulent disease or a violation of the integrity of an organ of the abdominal cavity (appendix, stomach, gallbladder, intestine, etc.). In rare cases, the primary cause is not found even at an 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 type of pathogen: 1) staphylococcal, 2) streptococcal, 3) caused by E. coli; 4) caused by mixed flora and others.
Iii. According to the prevalence of the process: 1) common (diffuse), when the peritoneum is affected, 2) diffuse, part of the peritoneum is affected, but the process is not clearly limited, 3) local, affected part of the peritoneum is isolated from the abdominal cavity by adhesions.
Iv. For the causes of: 1) in the inflammatory and destructive processes of the abdominal organs; 2) perforative; 3) traumatic;
4) postoperative; 5) hematogenous; 6) cryptoheppe and others.
There are also peritonitis by source of origin (appendicular, after perforation of gastric ulcer, etc.), by clinical course (acute, chronic), by the nature of the exudate (serous, serous-fibrinous, purulent, hemorrhagic, putrid, etc.).
Symptoms and course:Peritonitis is secondary, therefore its clinical picture is layered on the symptoms of the primary disease. Complaints of the patient are reduced to pain in the abdomen, nausea, vomiting, weakness, jazede, shortness of breath, etc. Examination allows you to notice pointed features 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, deaf voice. There are also dry mucous membranes, dry, furred tongue, repeated vomiting, regurgitation. On palpation of the abdomen there is tension and soreness of the abdominal wall, which are almost always more pronounced in the area of the source of peritonitis.
Treatment:Patients with purulent peritonitis need immediate hospitalization and emergency surgery. Comprehensive treatment, including surgical and conservative methods. The tasks of the operation are the elimination of the primary focus of infection, the removal of pus and the provision of not only single, but also repeated administration of antibiotics into the abdominal cavity (through drainage). If it is impossible to eliminate the source of infection, drainage is performed in order to create a reliable outflow of pus from the abdominal cavity.
Conservative tactics include: 1) combating 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, cold or a heating pad on the stomach, as this may obscure the clinical picture, and a decrease in pain can lead to tragic delay. Events and taking medications that increase intestinal motility are also unacceptable.
Treatment:The diagnosis of purulent peritonitis is an absolute indication for surgery. Refusal of surgical intervention is permissible only in exceptional cases in case of an extremely serious condition of the patient (confusion, lack of pulse, arterial pressure below 60 mmHg, etc.), i.e. essentially agonal or pre-diagonal.
Before the advent of antibiotics, patients with pneumococcal and gonococcal peritonitis were treated only conservatively, counting on the accumulation process. Currently, the vast majority of surgeons consider the operative method to be indicative in all cases of peritonitis. This view is based on the fact that, firstly, before the operation it is difficult to be absolutely sure that there is an infection, secondly, the removal of pus from the abdominal cavity and the direct introduction 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 abdominal trauma.
Flat foot. Deformation of the foot, with the flattening of its arches. There are longitudinal and transverse flattening, maybe a combination of them. With transverse flatfoot, the transverse arch of the foot flattens, its anterior section rests on the heads of all five metatarsal bones, and not on 1 and V, as is normal. With longitudinal flat-footedness, the longitudinal arch is flattened and the foot touches the floor with almost the entire area of the sole. Flatfoot is congenital (rare) and acquired. The most frequent causes are: injuries, clubfoot, weakness of the musculo-ligamentous apparatus, paralysis, wearing close shoes.
The earliest signs of flatfoot: aching pain when walking, fatigue of the legs. By evening, foot edema may appear, disappearing overnight. Shoes in patients with flat feet usually wear on the inner surface of the soles and heels. An important role in the prevention of flat-footedness plays the right choice of shoes, children's observance of correct posture, as well as daily gymnastics, sports, walking barefoot.
Treatment:For signs of flatfoot, refer to the orthopedist. In some cases, special gymnastics are enough; sometimes special instep supports are used, in advanced cases - orthopedic shoes and even surgical treatment.