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The development of problems of combat pathology is a constant focus of scientific interests of scientists of the S.M. Kirov Military Medical Academy. With the beginning of a Special military operation, it received a new impetus for development both due to the large clinical material and due to changes in the structure and nature of modern combat pathology. The relevant teams have joined forces to develop the most priority tasks. Based on the analysis of the mortality of wounded on the battlefield, the principles of “tactical medicine” were developed and implemented in practice, aimed at combating the most common causes of death at the pre-hospital stage, and training cycles for instructors for the whole country were organized in the established Center for Tactical Medicine. Principles of anesthesia and shock control at the stages of medical evacuation have been developed. Based on the study of the structure of combat surgical pathology, the tactics of screening diagnosis of hidden injuries during medical triage are proposed, the principles of staged surgical treatment of wounds (the principle of damage control) are clarified, an integrated system of treatment of wounded with injuries of the musculoskeletal system is developed. At the hospital stage, improved methods for the prevention of thromboembolic complications, treatment of phantom pain syndrome, and stress-associated mental disorders are proposed. The spectrum of wound infection pathogens and existing antibiotic resistance has been studied, new wound dressings have been developed. A prototype of the system of professional psychological selection and support of operators of unmanned aerial vehicles has been formed. Guidelines on military field surgery and military field therapy have been developed, more than 50 methodological recommendations on the most in-demand issues of organization and provision of medical care. Thus, in a little more than 900 days, the scientists of the S.M. Kirov Military Medical Academy has carried out a huge amount of work only in scientific terms, introducing the results into the practice of military doctors. This makes it possible to achieve the best performance indicators of the medical service of the Armed Forces of the Russian Federation in comparison with previous conflicts.
The development of problems of combat pathology is a constant focus of scientific interests of scientists of the S.M. Kirov Military Medical Academy. With the beginning of a Special military operation, it received a new impetus for development both due to the large clinical material and due to changes in the structure and nature of modern combat pathology. The relevant teams have joined forces to develop the most priority tasks. Based on the analysis of the mortality of wounded on the battlefield, the principles of “tactical medicine” were developed and implemented in practice, aimed at combating the most common causes of death at the pre-hospital stage, and training cycles for instructors for the whole country were organized in the established Center for Tactical Medicine. Principles of anesthesia and shock control at the stages of medical evacuation have been developed. Based on the study of the structure of combat surgical pathology, the tactics of screening diagnosis of hidden injuries during medical triage are proposed, the principles of staged surgical treatment of wounds (the principle of damage control) are clarified, an integrated system of treatment of wounded with injuries of the musculoskeletal system is developed. At the hospital stage, improved methods for the prevention of thromboembolic complications, treatment of phantom pain syndrome, and stress-associated mental disorders are proposed. The spectrum of wound infection pathogens and existing antibiotic resistance has been studied, new wound dressings have been developed. A prototype of the system of professional psychological selection and support of operators of unmanned aerial vehicles has been formed. Guidelines on military field surgery and military field therapy have been developed, more than 50 methodological recommendations on the most in-demand issues of organization and provision of medical care. Thus, in a little more than 900 days, the scientists of the S.M. Kirov Military Medical Academy has carried out a huge amount of work only in scientific terms, introducing the results into the practice of military doctors. This makes it possible to achieve the best performance indicators of the medical service of the Armed Forces of the Russian Federation in comparison with previous conflicts.
The purpose of the study. To analyze the structure of the incoming flow in conditions of conducting large-scale military operations at the stage of emergency specialized surgical care and to determine the predictors of an unfavorable outcome in patients with severe combined wounds. Materials and methods. A retrospective cohort study of medical data was performed in seriously wounded during a special military operation who were admitted to the department of anesthesiology, intensive care and intensive care of a level 3 military medical organization with severe combined wounds and trauma in 45 seriously wounded. Depending on the outcome of treatment, the seriously injured and injured were divided into 2 groups: survivors (n=30, 66.6%) and deceased (n=15, 33.4%) within a 30-day period from the moment of injury. Results. In the structure of seriously injured people in need of resuscitation, gunshot wounds predominate 84.5% (fragmentation — 95.4%, bullet — 4.6%), surgical diseases account for 7.2% of cases, closed trauma occurs in 5.1% of cases, thermal lesions — 3.2%. Combined and multiple wounds were diagnosed in 96.2% of cases. Upon admission, the predictors of death are hypothermia (p-value=0.011), the time elapsed from injury to qualified surgical care (p-value=0.035), the severity of the condition on the APACHE II scale (p-value=0.047). During treatment at the stage of emergency specialized surgical care, the predictors of death are the laboratory assessment of total bilirubin (p-value=0.006), the SOFA scale (p-value=0.015), an increase in creatinine levels (p-value=0.018), the appearance of metabolic acidosis (p=0.022), an increase in the dose of norepinephrine (p-value=0.015).value=0.033), as well as an increase in potassium levels (p-value=0.041). Conclusion. The result of the study showed a high frequency of combined injuries admitted to the OARIT. The predictors of an unfavorable outcome at admission were hypothermia; the time elapsed from the moment of injury to the provision of qualified surgical care; the severity of the condition on the APACHE II scale. And during intensive therapy, the predictors were: an assessment on the SOFA scale, an increase in creatinine levels, total bilirubin, potassium levels and metabolic acidosis.
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