Prevention Trihomonoza

Preventive measures include public Trihomonoza prevention (Trihomonozom detection, treatment, check-up), as well as personal prevention.
Features trihomonoza girls. Girls trihomonadny vulgovaginit occurs, usually between newborns and puberty. Between novorozhdennosti contamination occurs during the fruit of an infected mother's ancestral ways. The possibility of contamination Trihomonoza at this time, according to many researchers, due to the fact that the vagina a newborn girl is different from that of an adult woman (layered flat epithelium, secret pH 4.5 - 4.0, the accumulation of glycogen in the epithelium). Girls between the ages of 1 month. and before puberty in connection with the peculiarities of the state of the vagina during this period (single epithelium, neutral or alkaline reaction secretion, the low content of glycogen, lactic acid, etc.), in which there are no conditions for the existence of trihomonad even if they fall into sexual way , The disease is extremely rare. Therefore, if found trihomonad in vaginal swabs from the girls need to re-study and careful history taking (Clarification of the possible ways of contamination). In pubertatnom period due to an increase in the concentration of estrogen in the body, girls state vaginal epithelium is approaching that of adult women. During this period, girls may experience trihomonadnogo kolpita, and ways of infection and clinical picture is not different from those in adults.

TRIHOMIKOZ PODMYSHECHNY

Trihomikoz axillary (trichomycosis axillaris, palmellina; Greek .. thrix, trichos hair mykes mushroom-osis; sin.: Triho-nokardioz podkryltsovy, knotty trihomikoz Patterson) - superficial psevdomikoz affecting the inner lining of hair podmyshechnoy pit and lobka. The disease first described Pakston (FV Paxton) in 1869, the term «trihomikoz axillary» proposed Peak (Ph. J. Pick, 1875). Depending on the color Uzelkov, damaging hair, distinguished yellow, red and black Trihomikoz axillary. The yellow version is found throughout the world, the red and black - in the subtropical and tropical climates. Causative agent - Nocardia tenuis Castellani, 1912 (syn. Trichosporum minutissimum Ducrey, 1912), generally found in association with pigment-forming cocci (Micrococcus Castellani and Micrococcus nigres-cens), which makes hair color affected. Some researchers refer to the cause Trihomikoza podmyshechnogo Corynebacterium tenue, because they are among some patients. In the microscopic study Uzelkov visible thin (up to 0.8 microns in diameter), short filaments, bacillary and kokkovye form. When sowing on blood agar agents form a small gray or yellowish color of the colony.

Heart massage

The cause of inefficiency closed cardiac massage is the loss of cardiac muscle tone. In such cases it is necessary vnutriserdechnoe introduction of drugs, eliminates atoniyu myocardium. Needle length of 10-12 cm, put on the syringe, dotted heart in the third or fourth mezhrebere, retreated 2 cm from the edge of the sternum. Heading vkola needles strictly vertical. It should establish that the needle is in the heart cavity (in the syringe should be easy to do blood) and there is no danger to introduce the drug in the column myocardium. Only then impose vnutriserdechno 0.3 - 1 ml 0.1% solution of adrenaline or noradrenaline, divorced in 10-15 ml isotonic solution of sodium chloride, and 5-10 ml 10% solution chloride or calcium gluconate.
Open heart massage shown in severe chest trauma and multiple rib fractures, sometimes with myocardial atonii if vnutriserdechnoe introduction of the above drugs did not lead to recovery of peripheral blood circulation. Industrial perednebokovuyu torakotomiyu left in the fourth or fifth mezhrebere. Heart compress between palms of hands or surfaces of two palm and palm surface 1 fingers of one hand. It is necessary to avoid contraction of heart ends of fingers, as well as with the traumatic myocardium.
Cessation of heart massage and resuscitation of other activities can be considered justified if a patient who is in a state of clinical death, can not be achieved through the restoration of cardiac massage peripheral blood circulation within 20-30 minutes. If properly implemented massage IVL pulsation of the heart and carotid arteries and peripheral absent pupils remain extended, breathing and cardiac activity is not restored, skin pale patient remained sharply tsianotichnymi or may be ascertained biological death and resuscitation activities cease.

Cardiac massage

During the first 30-60 with resuscitation should establish the effectiveness of cardiac massage, as evidenced synchronous with massage push pulsation carotid and peripheral arteries, when measuring blood pressure - the disappearance of such a ripple in systolic pressure of not less than 60 mm Art. Art. , Narrowing pupils, porozovenie patient's skin and other signs of recovery in peripheral blood circulation. Evidence of high efficiency cardiac massage is the restoration of consciousness and breathing.
Effective cardiac massage and allow IVL sustain life without the patient's cardiac activity sufficiently long time needed for ambulance crews arrived and the delivery of patient in a hospital, not allowing the development of irreversible changes in the body, primarily in the cerebral cortex. We should not stop the heart massage and IVL, if not managed to quickly restore heartfelt work and self-breathing, heart massage while longer - heavy physical work, quickly tire reanimatora. It is desirable therefore perform cardiac massage alternately by 2-3 medical workers, providing optimum conditions for the effectiveness of massage, if necessary, carry out its long (there are special devices for automatic external cardiac massage). If a closed heart massage can not quickly restore the peripheral blood circulation, it should be immediately give reasons for its ineffectiveness, the easiest way to do that with the help of electrocardiography. Part of the reason is the inefficiency of heart massage ventricular fibrillation, successfully fight that I can, using only electrical defibrillyatsiyu.

Medical care

The patient must be stowed on a hard surface - on the floor, land, solid shield. Massage at the heart of soft beds maloeffektiven. Reanimator becomes such a way that his arms perpendicular to descend in a live situation in the patient's chest. If the patient lies on the floor or on the ground, reanimator becomes to its knees if the patient lies on the bed with a shield - Rises to any stand. Otherwise reanimator will not be able to use the force of gravity of the upper half of its body, would be compelled to work only with your hands, quickly ustanet and will not be able to achieve effective cardiac massage.
The hands have one to the other palms downwards. Prokamalnuyu bottom of the palm placed on the bottom third of the sternum (over the area of heart ventricles), slightly lift your fingers. Direct hands tolchkoobraznye make the push to the lower third of the sternum, shifted it to 5 - You should not see pressure on them to avoid rib fracture Tremors do with the frequency of 60 in 1 minute, avoiding a break! in massage more than 5 with. At the same time are beginning IV Ratio massage jolting and artificial breath depends on the number of aid. If a reanimator, he makes 12-15 jolting massage, then quickly changed the situation and makes 2 rapidly following one after the other man might inhale greater depth, then makes the heart massage (12-15 jolting) and so on until when) Yes reanimatora second. If resuscitation hold two people, the rhythm of another: after every 5-6 push massage hold breath.

Cardiac arrest

When terminal states, ie predagonii, agony and clinical death, only immediate resuscitation activities aimed primarily at restoring breathing and blood circulation, can return to the life of the patient. Primary resuscitation event is sometimes known as cardio-pulmonary resuscitation: they include IVL and heart massage. When cardiac arrest is extremely important to immediately begin resuscitation, as well as a period when the reversibility of clinical death lasts no more than 4-5 minutes.
It is vital to development of all health workers and people skills of primary resuscitation. Only then caught at the scene even before people can visit health care worker to begin resuscitation. All the more important for each health care worker learn resuscitation techniques.
Massage is aimed at restoring cardiac blood circulation in the face of unemployed heart. Restoring the pumping heart and thus blood circulation in the massage occurs as a result of heart tolchkovogo compression between the front and rear surface of the thorax. Indications are lack of heart massage on the pulse of peripheral and carotid arteries, the expansion of pupils, or lack agonalny type of breath, sharp poblednenie skin, unconscious state. In the hospital should not wait for the disappearance of electrical activity of heart if the patient is on the monitor surveillance. Electrical complexes on ECG and even tones weakened heart can be preserved, while the peripheral blood circulation has stopped.

Treatment

Tech tracheal intubation: a patient stowed on the back, introducing laringoskopa blade in his mouth (leaving the language left of the blade) and under the supervision of his move to the base epiglottis (curved blade end enters between the roots of language and epiglottis, straight blade and taking lifts epiglottis). Then, trying not to pressure on the patient's teeth, give epiglottis Above, shifted in the direction of blade laringoskopa up to the patient's legs, while in the field of view is the voice crack. Under the supervision of a crack in the voice introducing intubatsionnuyu tube, promoting its end in the trachea at 5-7 cm, followed that inflatable cuff fled for voice bundle. Laringoskop removed, in a test tube doing expiratory breath, to see her in the right position, then connect it to the apparatus. Sign of falling intubatsionnoy esophagus is a tube in the absence of visible movements of chest and respiratory noise while inhaling, exaggerating the stomach while continuing attempts to artificial lung ventilation.
Please check in the right position to the tube, to fix her head to avoid falling sick or slip into the respiratory tract, leading to lumen off bronchitis (usually the left). To avoid perezhataya sick tube teeth in his mouth impose rasporku (folded gauze doily 3-4 cm in diameter, Air-Ducts), which is fixed to intubatsionnoy tube.
Artificial pulmonary ventilation APV hold one of the available methods. Optimal use special devices for automatic or manual APV (suitable for anaesthesia machines, all kinds of respirators, including portable). In the absence of vehicles APV spend expiratory way.

Lung ventilation

The most simple and accessible way of acute respiratory distress ARD, applied to the clinical death in the absence of necessary technical equipment is expiratory, ie insufflation air, exhaled a doctor in the patient's lungs. To improve cross-respiratory tract zaprokidyvayut maximize the patient's head, lift the chin and conclusions Above the lower jaw forward. Having opened his mouth patient, convinced that in the oral cavity no food masses crowding of blood, etc. If there are, remove them and shall be oral cavity. Then, through the scarf, or wipe your mouth directly obhvatyvayut priotkryty patient's mouth, nose clamped his hand and make the patient's breath into the lungs, watching the movement of the thorax. Chest wall when inhaling artificial should go up. You can hold breath from mouth to the nose, mouth clasps and making the patient breath in the nose. The ratio of time inhale and pause (exhaled) should be 1:2 at a frequency of 12-16 in 1 min.
A more effective artificial pulmonary ventilation APV through special apparatus, the simplest of which is Ambu bag with a mask and irreversible valve. There may also be applied to any apparatus APV available to the doctor.
The most effective way to maintain patency of the respiratory tract, with an APV tracheal intubation, for which necessary: laringoskop with lighting set intubatsionnyh tubes with airbags cuffs, connecting element for connecting tubes to intubatsionnoy apparatus for APV. Through intubatsionnuyu tube can be an artificial lung ventilation expiratory way (by mouth into the phone).

Acute respiratory distress ARD

When kislorodoterapii patient with acute respiratory distress ARD should monitor the depth and frequency of breathing. Stopping breathing or gipoventilyatsiya with oxygen inhalation shows a severe state of hypoxia, requiring artificial pulmonary ventilation (APV).
APV should be initiated with gross violations of breath, signs of severe hypoxia and hypercapnia (confused consciousness, the commencement or braked, bagrovo-blednotsianotichny or skin color, or bradikardiya tachycardia, hypertension, sometimes, on the contrary, hypotension, shortness of breath over 40 respiratory movements in 1 min, humidity skin).
Treatment of patients with ARD should be conducted to develop anesthesiology - Reanimathology in the office of resuscitation and intensive care. At the prehospital phase, including transporting a patient in the hospital, it is necessary to hold intensive therapeutic activities, if there is evidence - APV. Such testimony is stop breathing, clinical death, critical forms of ARD.

Fighting Acute respiratory insufficiency

Fighting Acute respiratory insufficiency (ARI) paresis or paralysis in the gastrointestinal tract, violating the provisions of the diaphragm and mobility probe is in the introduction to evacuate the contents of the stomach and giving the patient upland situation.
Treatment ARI with lung edema detail, see chapter ЂБолезни bodies кровообращенияЂ. In addition to drug therapy is needed kislorodoterapiya and the establishment of a permanent high pressure in the respiratory tract-(RT), high resistance at the end of exhaled (PDKV), which is often effective. Has valves and related devices, in the absence of which use the simplest device to oxygen inhaler or narkozno-contained breathing apparatus. For this hose exhaled placed in a vessel with water to a depth of 5-6 cm, the patient makes breath through a mask of the breathing apparatus of the bag. Breath of semi-conducting system (breath of the apparatus, breath outwards), which requires the flow of gas mixture, slightly exceeding the minute amount of breath.
If acute respiratory distress causes or exacerbates a sharp pain when breathing (chest injury, acute abdominal process), analgesic drugs can be applied only after diagnosis. It must be made blockade intercostals nerves. When implementing novokainovuyu rib fractures blockade place fracture, paravertebral blockade, if damaged, more than 2 ribs - vagosimpaticheskuyu blockade.

Causes acute respiratory distress

In order to diagnose the causes of Acute respiratory insufficiency (ARI) conduct a physical and x-ray study of the thorax (identification pneumatic, gidrotoraksa, rib fractures, pneumonia and other violations). It was also an investigation of gaseous composition of blood to determine the extent of hypoxia and hypercapnia. Until further explanation (ARI) categorically forbidden to enter patient medication opium, sedatives or neyrolepticheskogo actions, as well as drugs.
In identifying pneumothorax to treat (ARI) should drenirovat pleura cavity through the introduction of the second line parasternalnoy mezhrebere on silicon rubber or drainage, which connects to the suction valve or underwater. In the cluster of large quantities of fluid in the pleura cavity (or gem-gidrotoraks, empiema oesophagus) by removing its needle puncture through or troakar.
Violations patency upper respiratory tract require immediate inspection of the mouth and the entrance to the larynx through laringoskopa, the release of their contents and foreign body. If the obstacle is located below the entrance to the larynx, to eliminate the need obturatsii bronhoskopiya (preferably with the help fibrobronhoskopa), during which remove solid foreign body from the trachea and bronchi, and if the bronchial system pathological contents (blood, corrupt, mass food) produce rescue , With t.. washing (lavage) bronchi. The use of modern fibrobronhoskopov to allow clearance under the control of individual segments bronchial tree, offers the best curative effect against the backdrop of injection lung ventilation. Washing bronchi (lavage) apply at the impossibility of a simple liposuction contents bronchi, when their lumen are dense mucous-purulent mass (for example, when severe asthmatic condition). Cleaning traheobronhialnogo tree of liquid mucous-Purulent masses can be achieved by liposuction them with a sterile catheter input alternately in right and left through intubatsionnuyu bronchitis or traheostomicheskuyu or tube through the nose (blind). If you can not apply the above activities to restore patency of the respiratory tract and conduct rescue bronchial produce traheostomiyu.

The principles of treatment of critical states

The most important in everyday medical practice are matters of critical states treat such as respiratory failure, circulatory insufficiency critical and cardiac arrest, state of shock.
Acute respiratory insufficiency (ARI). The most frequent causes: trauma chest and respiratory, accompanied by rib fractures, pneumatic or gemotoraksom, violation of the provisions of the diaphragm and mobility;
disorders of the central regulation mechanisms of breathing with injuries and brain diseases; violations patency respiratory tract, reducing lung functioning surface with pneumonia or lung atelektaze; circulatory disorder in a small circle (bypass, the development of so-called shock lung, pulmonary thromboembolism branches of arteries, lung edema).
Signs of acute respiratory insufficiency: breathlessness, cyanosis (with no bleeding and anemia), tachycardia, stir, then progressing braked, loss of consciousness, skin moisture, bagrovy their shade, traffic nose wings, supporting the inclusion in breathing muscles. When progressive respiratory insufficiency hypertension replaced hypotension, often develop bradikardiya, arrhythmia, and with the phenomena of cardiovascular failure is death. Resuscitation activities in the terminal phase of ARI ineffective, therefore especially important timely intensive care ARI.