Strangulation asphyxia

Strangulation asphyxia (SA) is one of the types of acute airway obstruction that occurs during direct compression of the trachea, blood vessels and nerve trunks of the neck. Characteristic of this type of asphyxia are rapidly growing hypoxemia and hypercapnia, deep disturbances of cerebral circulation by hemorrhagic type, hypoxic/anoxic encephalopathy. There are three main categories compression of the neck: hanging, ligature strangulation, suffocation by hands. The difference between these three concepts is explained by the cause of the external compression of the neck – either a tightening strip tensed by the gravitational weight of the body, or by part of the body; tightening strip provided by a force other than body weight (ligature strangulation); or external pressure by the arms, forearms, or other limbs (suffocation by the hands). “Hanging in falling from height (with a jerk)” is not a typical form of strangulation asphyxia and is not a suffocation subtype. The main clinical signs of strangulation in dependence to its duration: in the overwhelming majority of victims who were brought to the hospital alive, the level of consciousness by the Glasgow scale was defined as <8. In most of the surviving patients this indicator was more than 3 points. Obstruction of venous outflow from the brain leads to congestive hypoxia and loss of consciousness in just 15 seconds. Complications of strangulation asphyxia: post-hypoxic/post-anoxic encephalopathy; cases of temporary vision loss are known, in a number of cases – “tympanic membrane syndrome”; chondroperichondritis; damage to the cervical spinal cord is accompanied by appropriate neurological symptoms in the form oftetraplegia or tetraparesis, tetraanesthesia, respiratory disorders (in damage to the fourth cervical segment); laryngeal deformity, dysphonia, dysphagia, wheezing breathing, hoarseness can be observed. Prophylaxis: proper care of children, persons with disabilities and mental disorders (including the elimination of the technical possibility of hanging); compliance with safety precautions when working with rotating mechanisms; riding in cabriolets, motorcycles, mopeds, etc; prevention and treatment of alcoholism, drug addiction (drug dependency treatment); prevention and treatment of suicidal intentions and sexual perversions (psychological and psychiatric care)

Hypnotherapy in children with surgical pathology.

The article presents the data obtained during the examination of children with acute surgical pathology. The frequency of development, the severity of hyponatremia, and the effect of the syndrome of inadequate secretion of antidiuretic hormone on the development of hyponatremia have been established

Hypnotherapy in children with surgical pathology.

The article presents the data obtained during the examination of children with acute surgical pathology. The frequency of development, the severity of hyponatremia, and the effect of the syndrome of inadequate secretion of antidiuretic hormone on the development of hyponatremia have been established

Clinical and «Clip on» thinking at different training stages according to «General practice – family medicine» specialty.

There was carried out an anonymous questioning– a survey of 6th-year students who received an internship assignment in the specialty «General Practice – Family Medicine», interns and students doing courses in the same specialty in order to diagnose the pre­sence of «clip-on» thinking. M.B. Litvinova test method which is characterized by criterial and categorical validity and corresponds to reliability criterion was used. «Clip on» thinking was diagnosed in 36.5% of the surveyed students on training a budgetary basis and 37.8% of students studying on a contract basis, plus 38.5% of them were at risk. At the stage of postgraduate education (internship training), the percentage of «screen people» (with «clip» type of thinking) was significantly lower, but at the same time the share of the risk group on formation of a «clip» type of thinking was increased. The predominant increase in «people of the book» («long» thinking) among physicians with a certain length of service mainly is due to their age characteristics. Modern medical postgraduate education requires the formation of a qualitatively new approach to the educational process, based on the formation and development of clinical thinking, taking into account psychological characteristics of the modern youth and older colleagues. This phenomenon requires detailed social, andragogical and medical research, the creation of new educational technologies based on «live» communication

Problem Issues of Providing Modern Higher Medical Education to Future Specialists and Ways to Overcome them

Modern medical education requires the formation of a qualitatively new approach to the educational process, which will be based on the formation and development of clinical thinking, taking into account the psychological characteristics of modern youth. The "clip" way of working with information adds dynamism to the cognitive learning activity, which allows you to have time to complete the necessary tasks, sometimes even formally, in the conditions of a growing volume of educational material. "Clip" behavior allows you to see multifaceted, multivariate, ambiguous approaches to analysis or solving specific issues and tasks (such thinking helps the audience to better realize and understand the most diverse connections between phenomena and events). However, the negative consequences of this process cannot be neglected. The construction of the educational process in accordance with the needs of the educational program must take into account its own tasks against the background of progressive changes in the thinking of young people. The obtained results coincide with those that the professional training of students who are just mastering the basic disciplines and interns who have completed the basic training course gives similar, but at the same time, different data of the same survey. It is not possible to definitively determine in which group the level of "clip thinking" prevails. However, this fact indicates the irreversibility of changes in the "new thinking", which should be taken into account in teaching activities. The motivation of the professional choice of young people at the stage of admission to higher education is far from awareness. When choosing a future specialty, the generation of millennials mostly relies on the authority of their parents and the prestige of the specialty. The motivation to start becoming a specialist not at the clinical departments, but at the very initial stages of training is not effective enough due to the lack of interest of the teachers of the departments of basic disciplines. The motivation for professional choice when studying at clinical departments cannot be limited to a specific educational program. It is necessary to encourage students to work in student professional circles and professional societies, to elements of scientific work, etc. Multimedia technologies immeasurably expand opportunities in the organization and management of educational activities and allow the practical realization of the great potential of promising methodical developments within traditional education, which were previously ineffective

Stress adaptation of training participants in the specialty of Anesthesiology under the conditions of the pandemic and martial law

The catastrophic events that shook Ukraine in recent years had a significant damaging effect on the psychological stability of the population, including medical workers. The general index of constructiveness of anesthesiologists in 2019-2021 was at a high level, but with the beginning of a full-scale war, despite some increase in the activity of assertive coping strategies, this characteristic significantly decreased due to the increase in aggression. In today's dangerous conditions, the need of anesthesiologists to communicate and cooperate is quite natural, and the growth of aggression is natural and is characterized by a much lower level than in other segments of the population

Respiratory Support in Severe Traumatic Brain Injury (Literature Review)

Patients with traumatic brain injury (TBI) are the largest group of victims at the emergency departments. Up to 20% of patients with severe TBI require endotracheal intubation and prolonged mechanical ventilation. The ventilation parameters choice should be focused on the normal arterial blood gas composition. Hypoxia causes secondary damage to the brain tissue, and hyperoxia carries risks of oxygen toxicity. Hypercapnia leads to cerebral vasodilatation, increased intracranial pressure (ICP) and the risk of cerebral edema. Hypocapnia promotes cerebral vasoconstriction, which reduces cerebral blood flow and ICP, but also leads to cerebral tissue ischemia, so prolonged hyperventilation in TBI is not currently recommended. Patients with TBI often require sedation to synchronize with the respirator. The drugs of choice are propofol and midazolam. Routine use of muscle relaxants is not recommended. The initial ventilation mode should provide a certain respiration rate to achieve normocapnia, while allowing the patient to make breathing attempts. Support ventilation modes are used while weaning from mechanical ventilation. Promising in predicting extubation success is the assessment of the VISAGE score, which includes visual pursuit, swallowing, age, and the Glasgow coma score. Modern principles of respiratory support in severe TBI include: tracheal intubation by Glasgow coma score ≤8 ; early mechanical ventilation; PaO2 80-120&nbsp;mm&nbsp;Hg (SaO2 ≥95%); PaCO2 35-45 mm Hg; tidal volume&nbsp;≤8&nbsp;ml/kg; respiratory rate ≈20/min; PEEP&nbsp;≥5&nbsp;cm&nbsp;H2O; head elevation by 30°; sedation in poor synchronization with the respirator; weaning through support ventilation modes; extubation when reaching 3 points on the VISAGE scale; early (up to 4 days) tracheotomy in predicted extubation failure

Perfectionism in the anesthesiological environment

Abstract Background Perfectionism today is understood as an individual's psychological conviction that the ideal can and should be achieved, and the imperfect result of work (physical, intellectual, etc.), in their opinion, has no right to exist. The purpose of the study Our goal was to investigate levels and types of perfectionism among anesthesiology interns in comparison with the indicators of practicing anesthesiologists. Materials and methods An anonymous survey of 92 anesthesiology interns and 124 practicing anesthesiologists was conducted according to the Big-Three Perfectionism Scale (BTPS). Results The mean general level of perfectionism was average, with the total BTPS score of 124,38 ± 14,47 out of 225 in interns and 105,97 ± 10,31 in practicing anesthesiologists (p < 0,05). Both interns and practicing doctors leaned toward rigid perfectionism (mean score 32,32 ± 3,32 out of 50 in interns and 33,33 ± 3,23—in practicing doctors, p < 0,05) and self-critical perfectionism, with the average score of 52,08 ± 4,37 out of 90 in interns and 42,87 ± 4,76 in postgraduates (p < 0,05). Narcissistic perfectionism is the factor with the least relative score in both groups (39,99 ± 7,61 out of 85 in interns and 29,77 ± 4,20 in practicing doctors, p < 0,05). Conclusions Neither anesthesiology interns nor practicing anesthesiologists in general exhibited high levels of perfectionism. In both groups there was a moderate leaning towards rigid and self-critical perfectionism, which indicates a tendency for the individuals to set high standards for themselves and base their own self-worth on meeting these standards. In interns, the general perfectionism levels were significantly higher than in practicing doctors. Also the self-critical type was more prominent among interns. This might indicate a sense of pressure to meet unrealistic outside expectations and an impostor syndrome which is common for the people at the start of their careers, but it’s also a significant risk factor for future burnout