Assessment of the severity of the condition of patients in the provision of emergency therapeutic and surgical medical care at the prehospital stage.

6.Auscultation of the lungs.

7.Palpation of the abdomen.

8.Percussion of the abdomen and determination of “liver dullness”.

9.Checking the Shchetkin — Blumberg symptom of peritoneal irritation.

10.Auscultation of abdominal peristalsis.

11.Digital examination of the rectum.

12.Electrocardiogram registration.

13.Determining blood oxygen saturation using a pulse oximeter.

14.Assess the severity of the patient's condition.

All patients diagnosed with acute peritonitis after providing medical care at the prehospital stage should be taken to the on-duty surgical hospital.

Acute intestinal obstruction (AIO) is a disease characterized by impaired passage of intestinal contents through the gastrointestinal tract (GIT), which causes acute retention of stool and gases.

AIO classification:

1.Dynamic obstruction: a) spastic;

b) paralytic.

2.Mechanical obstruction:

a)strangulation (volvulus, nodulation, strangulation);

b)obstructive (intraintestinal form, extraintestinal form);

c)mixed (intussusception, adhesive obstruction).

Diagnosis of pathology at the prehospital stage fits into the following scheme:

1.Collection of complaints and medical history. Pay attention to a bloated stomach, vomiting, stool and gas retention.

2.Visual examination of the patient for general medical purposes and the abdomen. Pay attention to the presence of hernial protrusions, asymmetry of the abdomen, and visible peristalsis.

3.Body temperature measurement.

4.Heart rate measurement.

5.Blood pressure measurement in peripheral arteries.

6.Auscultation of the lungs.

7.Palpation of the abdomen. Pay attention to the presence of a swollen loop of intestine in the abdomen, above which high tympanitis is determined — Val's symptom.

8.Check Sklyarov's symptom — a splashing noise with a slight shaking of the abdomen (suscussion).

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9.Checking the Shchetkin — Blumberg symptom of peritoneum irritation.

10.Check Mondor's symptom — increased or absent peristalsis noise in different parts of the abdomen.

11.Check the Spasokukotsky — Wilms symptom — the noise of a falling drop.

12.Digital examination of the rectum, check Grekov's symptom — atony of the anal sphincter and a swollen empty rectal ampulla.

13.Determining blood oxygen saturation using a pulse oximeter.

14.Assess the severity of the patient's condition.

All patients with acute insufficiency, after receiving emergency medical care at the pre-hospital stage, should be taken to the emergency surgical hospital.

Acute pancreatitis.

Acute pancreatitis is initially aseptic inflammation pancreas which is based on necrobiosis (edematous pancreatitis) and necrosis of the gland itself and surrounding tissues, followed by the addition of an endogenous infection and accompanied systemic disorders. This disease has stages the course of a process during which a natural and sequential change of phases of inflammation with the emergence of specific for each stage of pathomorphological changes. Swelling and necrobiosis underlies edematous pancreatitis, while for destructive pancreatitis, the pathomorphological basis is necrosis.

The classification of acute pancreatitis is based on the Atlanta-92 classification, proposed in 2011, modified by the Russian Society of Surgeons (2014):

1.Mild acute pancreatitis, which is characterized by swelling of pancreatic tissue and has a completely reversible character (abortive course). Multiple organ failure for this form does not develop.

2.Moderate acute pancreatitis, characterized by the presence of one of the local manifestations of the disease: parapancreatic infiltrate, pseudocyst, delimited uninfected and/or infected (abscess) fluid accumulation with the development of common manifestations of multiple organ failure (up to 48 hours).

3.Severe acute pancreatitis, characterized by the presence of non-delimited infected (purulent-necrotic) pancreatitis and/or the development of multiple organ failure (more than 48 hours).

Pancreatic necrosis (destructive pancreatitis): a) hemorrhagic;

b) fat;

c) mixed.

By prevalence, small-focal, large-lobed and total pancreatitis are distinguished.

Purulent pancreonecrosis causes:

1) uninfected and infected sequesters;

2) gland abscess;

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3)phlegmon of the gland;

4)abscess or phlegmon of the gland with purulent parapancreatitis;

5)purulent parapancreatitis.

Complications of purulent pancreatitis:

−fistulas of the pancreas and hollow organs;

−arrosion of large vessels;

−sequestration of the gland;

−false purulent cysts;

−sepsis.

According to the prevalence of the necrotic process, the pancreas is divided into:

1.Interstitial edema of the pancreas (multiple microscopic necrosis, not visualized by ultrasound and CT).

2.Small-focal pancreatic necrosis (the volume of damage to the pancreas according to ultrasound and CT is less than 30 %).

3.Large-focal pancreatic necrosis (the volume of damage to the pancreas according to ultrasound and CT is from 30 to 50 %).

4.Subtotal pancreatic necrosis (the volume of damage to the pancreas according to ultrasound and CT data is from 50 to 75 %).

5.Total pancreatic necrosis more than 75 % (lesions of the entire pancreas according to ultrasound and CT). The spread of the process beyond the pancreas.

All patients diagnosed with acute pancreatitis should be taken to the surgical department on duty after receiving pre-hospital medical care.

Diagnosis of acute pancreatitis at the prehospital stage fits into the following scheme:

1.Collect complaints and medical history, pay attention to Mondor's symptom — epigastric pain, vomiting, flatulence.

2.Visual examination of the patient for general medical purposes and the ab-

domen.

3.Pay attention to the presence of spots of cyanosis on the lateral areas of the abdomen — Gray — Turner symptom, yellowness of the sclera and skin.

4.Body temperature measurement.

5.Heart rate measurement.

6.Blood pressure measurement in peripheral arteries.

7.Auscultation of the lungs.

8.Auscultation of abdominal peristalsis.

9.Palpation of the abdomen.

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10.Check the Mayo — Robson symptom — pain on palpation of the left costovertebral angle.

11.Check Kerthe's symptom — transverse painful resistance of the anterior abdominal wall in the projection of the pancreas.

12.Check Voskresensky's symptom — absence of pulsation of the abdomi-

nal aorta.

13.Determination of painful infiltrate in the epigastric region.

14.Check the Shchetkin — Blumberg symptom of peritoneal irritation.

15.Electrocardiogram registration.

16.Decoding, description and interpretation of electrocardiographic data.

17.Studying blood glucose levels using an analyzer.

18.Determining blood oxygen saturation using a pulse oximeter.

19.Assess the severity of the patient's condition.

Acute appendicitis is an acute inflammation of the appendix.

Clinical manifestations of acute appendicitis increase gradually over several hours and in most patients begin with dyspepsia and Kocher's (or Kocher — Volkovich) symptom, when pain occurs in the epigastric region, and then after 2–3 hours moves to the right iliac region. Somewhat less often, pain appears immediately in the right iliac region. The pain is constant and its intensity is usually moderate. As the disease progresses, the pain intensifies somewhat, although it may also subside due to the death of the nervous apparatus of the appendix during gangrenous inflammation. The pain intensifies when walking, coughing, or changing body position in bed. Irradiation is not observed in the typical form of acute appendicitis and is characteristic only of atypical forms. The appearance of nausea and vomiting before the onset of pain is not typical for acute appendicitis. Body temperature rarely rises above 37–37.4 °C (low-grade fever).

Classification of appendicitis:

–acute uncomplicated appendicitis: catarrhal (simple, superficial) and destructive (phlegmonous, gangrenous);

–acute complicated appendicitis: perforation of the appendix, appendicular infiltrate, abscesses (pelvic, subphrenic, interintestinal), peritonitis, retroperitoneal phlegmon, sepsis, pylephlebitis;

–chronic appendicitis (primary chronic, residual, recurrent).

Diagnosis of acute appendicitis fits into the following scheme:

1. Collection of complaints and medical history. Pay attention to the Kocher — Volkovich symptom — movement of pain from the epigastric to the right iliac region of the abdomen.

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2.Visual examination of the patient for general medical purposes and the ab-

domen.

3.Body temperature measurement.

4.Heart rate measurement.

5.Blood pressure measurement in peripheral arteries.

6.Auscultation of the lungs.

7.Auscultation of abdominal peristalsis.

8.Palpation of the abdomen.

9.Checking Rovsing's symptom — increased pain in the right iliac region when the left iliac region is shaken.

10.Checking the Voskresensky “shirt” symptom — increased pain with sliding movements over the right iliac region.

11.Checking Sitkovsky's symptom — the appearance of nagging pain in the right iliac region when the patient turns on his left side.

12.Checking Obraztsov's symptom — increased pain in the right iliac region when raising the straight right leg in a lying position at 40°, without straightening the knee.

13.Checking the Shchetkin — Blumberg symptom of peritoneal irritation.

14.Digital examination of the rectum, determination of pain and overhang of the anterior wall of the rectum.

15.Assess the severity of the patient's condition.

All patients with suspected acute appendicitis should be taken to the emergency surgical hospital.

Acute cholecystitis.

Acute cholecystitis is an acute inflammation of the gallbladder.

Acute calculous cholecystitis is an inflammation caused by obstruction of the cystic duct with a stone, which leads to stagnation, infection of bile, hypertension in the gallbladder, destruction of its wall and peritonitis.

Clinical manifestations. The disease usually begins with an attack of pain in the right hypochondrium. The pain radiates upward to the right shoulder and scapula, the right supraclavicular region. It is accompanied by nausea and repeated vomiting. Characteristic signs are the appearance of a bitter sensation in the mouth and the presence of bile in the vomit.

In the initial stage of the disease, the pain is dull; as the process progresses, it becomes more intense. In this case, there is an increase in body temperature to 38 °C, and sometimes there is chills. Mandatory collection of epidemiological history — contact with hepatitis A.

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Diagnosis of acute cholecystitis at the prehospital stage fits into the following scheme:

1.Collection of complaints and medical history. Pay attention to cholecystocoronary Botkin syndrome.

2.Visual examination of the patient for general medical purposes and the ab-

domen.

3.Pay attention to the presence of yellowness of the sclera and skin.

4.Body temperature measurement.

5.Heart rate measurement.

6.Blood pressure measurement in peripheral arteries.

7.Auscultation of the lungs.

8.Auscultation of abdominal peristalsis.

9.Palpation of the abdomen, pay attention to the enlargement of the gallbladder in the right hypochondrium.

10.Percussion of the abdomen and determination of “liver dullness”.

11.Checking the phrenicus symptom (Mussi — Georgievsky symptom) — pain when pressing with a finger on the right supraclavicular fossa between the legs of the sternocleidomastoid muscle.

12.Check Ortner's symptom — pain when tapping the right costal arch.

13.Check Ker's symptom — pain on palpation of the point of the gallbladder when inhaling.

14.Checking the Shchetkin — Blumberg symptom of peritoneal irritation.

15.Check Murphy's symptom — involuntary holding of breath upon palpation of the gallbladder point.

16.Electrocardiogram registration.

17.Decoding, description and interpretation of electrocardiographic data.

18.Studying blood glucose levels using an analyzer.

19.Determining blood oxygen saturation using a pulse oximeter.

20.Assess the severity of the patient's condition.

2.12.EXAMINATION OF THE CONDITION OF THE URINARY SYSTEM

Diagnosis of emergency conditions of the urinary system has its own characteristics, but fits into the scheme of specific conditions, so in patients with acute urinary retention, the working diagnostic scheme contains the following stages:

1. Collect complaints and medical history, pay attention to dysuric disorders, pain in the scrotum and lumbar region.

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2.General medical visual examination of the patient and the abdomen, pay attention to swelling on the face, an increase in the size of the scrotum.

3.Body temperature measurement.

4.Heart rate measurement.

5.Blood pressure measurement in peripheral arteries.

6.Auscultation of the lungs.

7.Auscultation of abdominal peristalsis.

8.Palpation of the abdomen.

9.Checking Pasternatsky's symptom — the appearance of pain when tapping the lumbar region in the projection of the kidneys.

10.Visual examination of the glans penis.

11.Palpation of the testicles and epididymis through the scrotum.

12.Digital examination of the rectum and prostate.

13.Visual inspection of urine in container.

14.Assess the severity of the patient's condition.

Many EMS calls are made to patients with renal colic. To diagnose this condition, it is advisable to adhere to the following scheme:

1.Collect complaints and medical history, pay attention to dysuric disorders, pain in the scrotum and lumbar region.

2.General medical visual examination of the patient and the abdomen, pay attention to swelling on the face, an increase in the size of the scrotum.

3.Body temperature measurement.

4.Heart rate measurement.

5.Blood pressure measurement in peripheral arteries.

6.Auscultation of the lungs.

7.Auscultation of abdominal peristalsis.

8.Palpation of the abdomen.

9.Checking Pasternatsky's symptom — the appearance of pain when tapping the lumbar region in the projection of the kidneys.

10.Visual examination of the glans penis.

11.Palpation of the testicles and epididymis through the scrotum.

12.Digital examination of the rectum and prostate.

13.Visual inspection of urine in container.

14.Assess the severity of the patient's condition.

In patients with nonspecific hematuria, the scheme has its own characteristics:

1. Collect complaints and medical history, pay attention to dysuric disorders, pain in the scrotum and lumbar region, symptoms of poisoning with poisons and mushrooms.

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2.Visual examination of the patient is general therapeutic, pay attention to swelling on the face, legs, bruises, wounds, skin rashes, enlarged lymph nodes.

3.Body temperature measurement.

4.Heart rate measurement.

5.Palpation of the pulse in the peripheral arteries of the lower and upper extremities.

6.Blood pressure measurement in peripheral arteries.

7.Auscultation of the lungs.

8.Auscultation of abdominal peristalsis.

9.Palpation of the abdomen.

10.Checking Pasternatsky's symptom — the appearance of pain when tapping the lumbar region in the projection of the kidneys.

11.Palpation of the testicles and epididymis through the scrotum.

12.Digital examination of the rectum and prostate.

13.Visual inspection of urine in container.

14.Assess the severity of the patient's condition.

In patients with oliguria or anuria, it is advisable to adhere to the following regimen:

1.Collect complaints and medical history, pay attention to dysuric disorders, pain in the scrotum and lumbar region, symptoms of poisoning with poisons and mushrooms.

2.Visual examination of the patient is general therapeutic, pay attention to swelling on the face, legs, bruises, wounds, skin rashes, enlarged lymph nodes.

3.Body temperature measurement.

4.Heart rate measurement.

5.Palpation of the pulse in the peripheral arteries of the lower and upper extremities.

6.Blood pressure measurement in peripheral arteries.

7.Respiration rate measurement.

8.Auscultation of the lungs.

9.Auscultation of abdominal peristalsis.

10.Palpation of the abdomen.

11.Checking Pasternatsky's symptom.

12.Palpation of the testicles and epididymis through the scrotum.

13.Digital examination of the rectum and prostate.

14.Visual inspection of urine in container.

15.Electrocardiogram registration.

16.Decoding, description and interpretation of the electrocardiogram.

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17.Detection of ketone bodies in urine using a test strip.

18.Assess the severity of the patient's condition.

Diagnosis of acute prostatitis, orchitis, epididymitis:

1.Collect complaints and medical history, pay attention to dysuric disorders,

pain in the scrotum and lumbar region.

2.General medical visual examination of the patient and the abdomen, pay attention to swelling on the face, an increase in the size of the scrotum.

3.Body temperature measurement.

4.Heart rate measurement.

5.Blood pressure measurement in peripheral arteries.

6.Auscultation of the lungs.

7.Auscultation of abdominal peristalsis.

8.Palpation of the abdomen.

9.Checking Pasternatsky's symptom — the appearance of pain when tapping the lumbar region in the projection of the kidneys.

10.Visual inspection of the glans penis.

11.Palpation of the testicles and epididymis through the scrotum.

12.Digital examination of the rectum and prostate.

13.Visual inspection of urine in container.

14.Test for blood in urine.

15.Assess the severity of the patient's condition.

All patients with acute urological diseases, after providing medical care at the prehospital stage, are taken to the emergency urological hospital.

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3. SCALES FOR ASSESSING THE GENERAL CONDITION OF PATIENTS AND INJURED AT THE PREHOSPITAL STAGE

3.1. GLASGOW COM SCALE

To determine the initial assessment criterion for patients with severe head and brain injury, the Glasgow Coma Depth Scale (GCS) was developed in 1974. It evaluates clinical signs of impaired consciousness, taking into account eye opening, speech and motor reactions (Table 3). The sum of the scores for the three parameters gives the final indicator of the patient's condition. The maximum (favorable) possible indicator is 15, the minimum (unfavorable) is 3. In the medical history, along with the final general indicator, it is recommended to provide data on individual parameters (for example, E2V3M5 = GCS10). The GCS scale is widely used throughout the world, since the procedure it provides for examining the victim is simple and gives reliable results. A thorough assessment of the patient should be performed before intubation and/or administration of sedatives and analgesics.

Table 3

Glasgow coma depth scale (GCS)

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