Directory of a practicing physician list index. Handbook of a practicing physician (Ed. A. I. Vorobyov)
Year of manufacture: 2007
Genre: Therapy
Format: PDF
Quality: OCR
Description: In the book "Practitioner's Handbook" the chapter on poisoning was rewritten, the chapters on rheumatic diseases, obstetrics and women's diseases, sexual disorders. Accordingly, the list of authors and editors has been updated.
The practitioner's directory is addressed primarily to local, family and other doctors of “first contact” with the patient. The authors and editors strived to ensure that the reader could quickly find in this book brief information about typical manifestations, diagnostic criteria, basic principles and treatment regimens for the disease of interest. Special attention devoted to issues of diagnosis and treatment in out-of-hospital conditions. The team of creators of the Handbook did not set out to combine industry guidelines for specialists in it, therefore there are no details of laboratory and instrumental research or treatment methods that are carried out only by a medical specialist (for example, surgical intervention techniques).
Issues of general clinical significance (for example, about imaging diagnostics, principles of antibacterial therapy, etc.) are presented in the introductory section. Urological diseases are reflected in the chapters “Diseases of the kidneys and urinary tract”, “Skin and venereal diseases” and “Surgical diseases”. Laboratory indicators in all chapters of the Handbook are given without comparison with the norm; constants characterizing the norm, as well as recommendations for feeding children early age And necessary information on epidemiology and prevention infectious diseases are given in the Appendices.
The book "Practitioner's Handbook" is intended for doctors of all specialties, and will also be useful to a wide range of readers.
"Practitioner's Handbook"
BASICS OF ANTIBACTERIAL CHEMOTHERAPY -CM. Navashin, P.S. Navashin
PSYCHOTROPIC DRUGS IN SOMATIC MEDICINE -V.A. Raisky, V.A. Burmistrov
COMPATIBILITY OF MEDICINES -HER. Gogin
PRINCIPLES OF TREATMENT OF TERMINAL CONDITIONS -E.A. Damir
SEPSIS -A.I. Vorobyov, G.A. Klyasova
DISSEMINATED INTRAVASCULAR COLOGTING SYNDROME (DIC SYNDROME) -Z.S. Barkagan, A.I. Vorobyov, S.K. Kravchenko
DISEASES OF VITAMIN DEFICIENCY -F.I. Komarov, A.L. Grebenev
DAMAGE TO INTERNAL ORGANS DURING ALCOHOLISM -B.L. Elkonin
DIAGNOSTIC IMAGES IN MODERN MEDICINE -Sh.Sh. Shotemore
DISEASES OF THE CIRCULAR ORGANS -G.K. Alekseev, V.I. Borodulin, A.I. Vorobyov, V.P. Zhmurkin, A.I. Koblenz-Mishke, M.S. Kushakovsky, I.V. Martynov, A.A. Mikhailov, A.V. Topolyansky
RHEUMATIC DISEASES -V.A. Nasonova, E.L. Nasonov, Ya.A. Sigidin
RESPIRATORY DISEASES -V.G. Artamonova, A.I. Borokhov, E.M. Gorokhova, I.G. Danilyak, A.E. Rabukhin, A.V. Topolyansky, L.N. Tsarkova
DISEASES OF THE DIGESTIVE ORGANS -F.I. Komarov, A.L. Grebenev, A.V. Topolyansky
KIDNEY AND URINARY TRACT DISEASES -N.R. Paleev, G.P. Kulakov, N.A. Mukhin, L.R. Polyantseva
DISEASES OF THE BLOOD SYSTEM -A.I. Vorobyov, Z.S. Barkagan, M.D. Brilliant, A.V. Demidova, S.K. Kravchenko, Yu.Yu. Laurie
ENDOCRINE AND METABOLIC DISEASES -E.I. Marova, S.A. Butrova
OCCUPATIONAL DISEASES -A.M. Monaenkova, Yu.P. Evlashko, M.N. Ryzhkova
POISONING -V.G. Moskvichev
INFECTIOUS DISEASES -Yu.Ya. Vengerov, A.P. Kazantsev, V.K. Karnaukhov, V.N. Nikiforov, S.D. Nosov
In the practice of a general practitioner, one often encounters paroxysmal conditions accompanied by anxiety, fear of death, palpitations, a feeling of lack of air, and other mental and somatic manifestations. First of all, it is necessary to clearly determine whether the patient has a disease of the internal organs with a tendency to paroxysmal manifestations (for example, paroxysmal tachycardia, atrial fibrillation, bronchial asthma, sympathoadrenal crisis, etc.) or we're talking about about panic attacks with a variety of somatic symptoms associated with increased autonomic activity nervous system. In the first case, the emphasis is, of course, on the treatment of the underlying disease. Psychotropic drugs are given an auxiliary role, since an unstable emotional, anxious background can often provoke these attacks. At the same time, the general practitioner often comes across patients whose examination does not reveal any signs of organic or functional pathology, or they are minimal and cannot cause such conditions. In this case, one should think that the patient has a mental disorder, manifested in the form of panic attacks, which are characterized by periods of severe fear or discomfort that suddenly arise and are combined with the following symptoms: tachycardia, sweating, body tremors, a feeling of lack of air or suffocation, chest pain or discomfort, nausea or stomach discomfort, dizziness, unsteadiness or weakness, a feeling of unreality, fear of losing control, fear of dying or going crazy, fever or chills. Such panic attacks rarely occur independently and in isolation; then they are considered within the framework of a panic disorder. Much more often they occur against the background of depression, combined with various specific phobias - pronounced and persistent or unreasonable fears, for example, fear of open (agoraphobia) or closed (claustrophobia) spaces, fear of social situations, public speaking(social phobia), etc. Panic attacks tend to recur 2-3 times a week, although they can occur much less frequently under strictly defined conditions. The course is chronic, with remissions and exacerbations; with treatment, the prognosis is favorable. IN initial stages diseases and with isolated panic attacks, pharmacotherapy of such patients can only be carried out with tranquilizers: diazepam (2-10 mg 2-4 times a day, to relieve an attack 5-10 mg sublingually), alprazolam (starting from 0.25 mg 3 times a day and up to 6–8 mg per day), clonazepam (starting from 0.5 mg 2 times a day and up to 80 mg per day), etc. Injections during vegetative crises should be avoided if possible, so as not to form a “dependence on the injection” in the patient " In the treatment of panic attacks, especially when they develop against the background of depression, combination with phobias, great value attached to the use of antidepressants such as Zoloft, Fevarin, Prozac, Anafranil, Aurorix, etc. Treatment These disorders are treated over a long period of time; the most effective is its combination with psychotherapy. To choose the most appropriate therapeutic tactics, a consultation with a psychiatrist is necessary.
The term “critical condition” is understood as a patient’s condition in which there are disorders of physiological functions and disturbances in the activity of individual systems that cannot spontaneously return to normal through self-regulation and require partial or complete correction or replacement. A resuscitator, as a rule, is faced not with specific diseases, but with a set of symptoms (syndromes). To the simplest extreme situations the following conditions should be included.
Fainting
Fainting is a brief loss of consciousness caused by a sudden sharp deterioration blood supply to the brain (hypoxia).
Reasons. Most often, fainting is a general reaction of the body to mental trauma. There may be other reasons: a change in body position, a hysterical reaction, etc. In this case, a reflex narrowing of the capillaries on the periphery and expansion of the vessels of the internal organs occurs, which leads to the accumulation of blood in them and depletion of the blood supply to the brain.
Treatment. It is enough to lay such a person on a plane with the head end down, let him smell ammonia, provide a flow of fresh air, and the fainting goes away.
Collapse
Another common reaction of the body is collapse. The collapse is based on temporary, sudden acute vascular insufficiency due to a drop in vascular tone. This is also a reflex reaction of the vasomotor center, leading to the redistribution of blood due to the expansion of capacitive vessels (veins), due to which the blood settles in internal organs, and cardiac output decreases sharply.
Reasons. Unlike fainting, which can develop in a healthy person, collapse occurs as a result of various pathological conditions (acute bleeding, poisoning, infectious diseases, etc.).
Symptoms It manifests itself as sudden pallor, cyanosis, small and rapid pulse, shallow breathing, drop in arterial and venous pressure, cold sweat, cold extremities, muscle relaxation. Consciousness during collapse can be obscured or preserved, often absent due to hypoxia(lack of oxygen) to the brain.
Treatment collapse is aimed at increasing vascular tone by administering various medications (mezatone, norepinephrine, caffeine) and restoring circulating blood volume (CBV) by injecting blood substitutes into a vein, which is especially important in case of significant blood loss.
Reanimation
Resuscitation is the revival of the body. The task of the resuscitator is to restore and maintain the patient’s cardiac activity, breathing and metabolism.
Resuscitation is most effective in cases of sudden cardiac arrest with preserved compensatory capabilities of the body. There are three types of terminal conditions:
1) pregonal state;
2) agony;
3) clinical death.
Pregonal state. The patient is lethargic, there is severe shortness of breath, the skin is pale, bluish, blood pressure is low (60–70 mm Hg) or not determined at all, and a weak, rapid pulse.
Agony. A deep stage of the dying process, in which there is no consciousness, the pulse is threadlike or disappears completely, and blood pressure is not determined. Breathing is shallow, rapid, convulsive or significantly reduced.
Clinical death. Occurs immediately after breathing and circulation stop. This is a kind of transitional state from life to death, which lasts from 3 to 5 minutes, after which irreversible phenomena occur (primarily in the central nervous system), and true, or biological, death occurs. Cardiac arrest can be sudden or gradual due to a long-term chronic illness. In the latter case, cardiac arrest is preceded by preagonia and agony.
Reasons sudden cardiac arrest are: myocardial infarction, blockage (obstruction) of the upper respiratory tract foreign bodies, reflex cardiac arrest, cardiac injury, anaphylactic shock, electrical trauma, drowning, severe metabolic disorders (hyperkalemia, metabolic acidosis).
Signs cardiac arrest, i.e. clinical death, is the absence of a pulse in the carotid artery; dilated pupil that does not respond to light; respiratory arrest; lack of consciousness; pallor, less often – bluishness of the skin; absence of pulse in peripheral arteries; lack of blood pressure; absence of heart sounds. The time to establish a diagnosis of clinical death should be extremely short. Absolute signs are the absence of a pulse in the carotid artery and dilation of the pupil with its lack of reaction to light. If these signs are present, resuscitation should begin immediately.
Cardiopulmonary resuscitation consists of four stages:
1) restoration of airway patency – stage I;
2) artificial pulmonary ventilation (ALV) – stage II;
3) artificial circulation – stage III;
4) differential diagnosis, drug therapy, cardiac defibrillation - stage IV.
/ stage - restoration of airway patency.
Reason airway obstructions may include mucus, sputum, vomit, blood, and foreign bodies.
Symptoms The state of clinical death is accompanied by muscle relaxation: as a result of relaxation of the muscles of the lower jaw, the latter sinks, pulling the root of the tongue, which closes the entrance to the trachea.
Treatment. The victim or patient must be laid on his back on a hard surface, turn his head to the side, open his mouth and clean the oral cavity with a handkerchief or napkin. Then turn your head straight and throw it back as much as possible. In this case, one hand is placed under the neck, the other is located on the forehead, holding the head back. When the head is bent back, the lower jaw is pushed upward together
with the root of the tongue, and this makes the airways free for air to enter.
Stage II - artificial ventilation. It is carried out using the “mouth-to-mouth”, “mouth-to-nose” and “mouth-to-mouth-to-nose” methods. To carry out artificial respiration using the mouth-to-mouth method, the one who provides assistance stands on the side of the victim, and if the victim is lying on the ground, he kneels down, places one hand under the victim’s neck, puts the other on the forehead and throws it back as much as possible his head back, pinches the wings of the victim’s nose with his fingers, presses his mouth tightly to his mouth, and exhales sharply. Then he pulls away.
The volume of blown air is from 500 to 700 ml. Respiration rate – 12 times per 1 minute. If everything is done correctly, then movements of the chest are visible - inflation when inhaling and collapsing when exhaling.
If the lower jaw is damaged or tightly clenched, mechanical ventilation can be performed using the mouth-to-nose method. To do this, place the hand on the forehead, tilt the head back, grab the lower jaw with the other hand and press it tightly against the upper jaw, thus closing the mouth. Cover the victim's nose with your lips and exhale. In newborns, mechanical ventilation is carried out using the mouth-to-mouth and nose-to-nose method. The child's head is tilted back. Cover the child's mouth and nose with your mouth and exhale. The tidal volume of a newborn is 30 ml, the respiratory rate is 25–30 per minute. It is better to do ventilation through gauze or a handkerchief. Ventilation can be performed using an s-shaped tube and a face mask with an Ambu bag. These techniques are performed only by medical personnel.
Stage III - artificial blood circulation is carried out using cardiac massage. Compression of the heart allows you to artificially create cardiac output and maintain blood circulation in the body, restore blood circulation to vital organs (brain, heart, lungs, liver, kidneys). There are closed (indirect) and open (direct) cardiac massage.
In everyday life, as a rule, a closed massage is performed, in which the heart is compressed between the sternum and the spine. The patient is placed on a hard surface or a shield is placed under his chest. The palms are placed one on top of the other at right angles, placing them on the lower third of the sternum and retreating 2 cm from the place of attachment of the xiphoid process to the sternum. By pressing on the sternum, it is shifted towards the spine by approximately 4–5 cm. Cardiac massage is carried out by continuously rhythmic pressure on the sternum with straight arms approximately 60 times per 1 minute. In children under 10 years of age, cardiac massage is performed with one hand, making approximately 80 pressures per minute. In newborns, external cardiac massage is performed with two fingers approximately 120 times per minute.
Open (direct) cardiac massage is used for operations on the chest, chest injuries, and ineffective external massage. To do this, the chest is opened, the hand is inserted into the chest cavity, and a massage is performed with rhythmic compression of the heart. During operations when rib cage wide open, open cardiac massage can be performed by squeezing the heart with both hands. If one person is reviving, he stands to the side of the victim. After cardiac arrest is established, the oral cavity is cleaned, 4 injections are made into the lungs using the “mouth-to-mouth” or “mouth-to-nose” methods, then 15 pressures are made on the sternum, then 2 injections into the lungs. From time to time you need to check whether pulsation has appeared in large vessels. If two people provide assistance, they stand on one side of the victim. One performs cardiac massage, the other performs mechanical ventilation. The ratio between mechanical ventilation and closed massage is 1: 5, i.e. one injection into the lungs is carried out every 5 pressures on the sternum. As soon as a pulse appears on the carotid artery, cardiac massage can no longer be done, but mechanical ventilation must be continued until medical workers arrive. Newborn resuscitation is carried out by one person. You need to consistently do 3 blows into the lungs, and then 15 pressures on the sternum.
Stage IV - making a diagnosis, drug treatment– carried out only by medical specialists. At this stage, manipulations such as electrocardiographic examination, intracardiac administration of drugs, and cardiac defibrillation are performed.
Coma
One of the most severe types of critical conditions that almost all doctors have to deal with is coma.
Coma is a state of sudden inhibition of higher nervous activity, which is manifested by a deep loss of consciousness and dysfunction of all internal organs.
Main reasons comatose states are alcohol intoxication with deep intoxication; acute poisoning with barbiturates, opium drugs and other psychotropic drugs; skull trauma, including intracranial bleeding (about 25% of cases), and acute disorders cerebral circulation; infectious meningitis and encephalitis; uremia and other metabolic disorders; diabetes mellitus(hypoglycemia and hyperglycemia); hypoxia during shock and respiratory failure; epilepsy; gestosis of pregnant women.
Symptoms Respiratory depression, which is accompanied by bluish skin, requires mechanical ventilation. Suppression of blood circulation requires measures to restore it.
The presence of elevated temperature may indicate an infectious process (meningitis, pneumonia or septicemia), indicating the possibility of heatstroke or deep disorders in the central nervous system. Reduced temperature may occur when drunkenness, poisoning with sleeping pills. Both very rare and very frequent pulses (over 160 beats per minute) can in themselves be a sign of coma.
Tachypnea (rapid breathing) and hyperpnea (deep breathing) are characteristic of respiratory failure and oxygen starvation.
Deep rare breathing (Kussmaul type) observed in diabetes, as well as in case of poisoning with methyl alcohol and ethylene glycol.
With diseases of the central nervous system, hemorrhages and brain tumors, irregular breathing can be seen more often Cheyne–Stokes type.
Important information for assessing the condition and searching for the causes of coma is provided by an external examination of the patient. Blueness of the skin indicates oxygen starvation; the bright scarlet color of the blood is characteristic of carbon monoxide and methane poisoning. Edema, a pronounced venous pattern on the abdomen and chest wall indicate the possibility of cirrhosis of the liver and hepatic coma. Hot, dry skin can be caused not only by a heat exchange disorder, but also by blood poisoning. An examination (including x-ray) of the skull is mandatory to rule out injury.
Breath odor assessment is important. Diabetes as a cause of coma is usually characterized by the smell of acetone from the breath. In hepatic coma, you can smell the smell of mold; in uremic coma, the patient smells like urine. The smell of alcohol is well known.
If poisoning is suspected in a patient with a coma, the gastric contents should be examined for the presence of harmful substances. To do this, a probe is inserted into the stomach, and the resulting contents are sent for analysis, after which the stomach is thoroughly washed with therapeutic purpose. In case of coma, the cause of which could not be determined, it is necessary to examine the blood sugar level.
Treatment. Coma occurs most often with deep disturbances in the functioning of the brain and the whole body, and therefore the following measures are taken.
1. Preventing airway obstruction and ensuring breathing efficiency (using different body positions or using air ducts, toileting the pharynx and trachea, etc.). If necessary, the patient is transferred to mechanical ventilation.
2. Constant monitoring and maintenance of optimal blood pressure levels to ensure cerebral blood flow.
3. Maintaining normal water-salt and protein balance in the body. The fight against water-salt balance disorders can be carried out with the help of diuretics.
4. Maintenance normal temperature bodies. Use drugs that reduce elevated body temperature (aspirin), superficial cooling of the skin, craniocerebral hypothermia (cooling the head) in order to reduce the metabolic rate of the brain and protect it from lack of oxygen.
5. Calming treatment (diazepam, seduxen).
6. Nootropics (drugs that improve metabolism in the brain): piracetam, postronil, enbutol.
When a seizure occurs, anticonvulsants and drugs that relieve muscle spasms are administered. To treat and prevent cerebral edema, diuretics are used (for example, furosemide, the dose of which can range from 40–60 to 400–800 mg per day, mannitol, urea).
In addition to the above general program treatment of a patient in a coma, it is necessary to emphasize the following. All patients who do not respond to verbal treatment and pain should undergo tracheal intubation; they need, if possible, early normalization of blood pressure.
All patients in a coma due to skull trauma and brain damage should be consulted by a surgeon, who must first determine whether surgery is necessary. Treatment of cerebral edema can be carried out only after establishing the absence of intracranial hemorrhage.
Transcendent coma, or brain death, is a condition characterized by irreversible damage to the brain with continued satisfactory functions of a number of other organs and systems, which allows organs to be removed for the purpose of transplanting them into another organism.
To confirm brain death, it is necessary to exclude such potentially reversible conditions as overdose of drugs (sedatives, narcotics, etc.) and deep hypothermia(decrease in body temperature), which can stimulate brain death. The diagnosis of brain death can be made based on four main clinical signs. These signs must be observed for a sufficient period of time. They are determined at least twice with a two-hour interval to exclude conditions simulating brain death and to avoid errors.
Signs of brain death are the following.
1. Complete absence consciousness and spontaneous movements.
2. Absence of any reflexes carried out through the cranial nerves. Absence of blinking movements to a threat, noise reactions or reactions to pain (pinches, pin pricks) in the trigeminal nerve area, absence of reflexes from the root of the tongue. Lack of eye movement. The pupils on both sides are dilated, in the middle position and do not react to light.
3. Lack of spontaneous breathing.
4. Lack of bioelectrical activity on the EEG. The EEG recording must be technically flawless, at least twice, with a recording duration of at least 10 minutes.
The main indicators of brain death are the same in most legislations developed countries, although there are differences in minor points of the relevant instructions.
If a diagnosis of brain death is absolutely established, a decision may be made to discontinue life-sustaining measures.
Shock
One of the most severe critical conditions is shock.
Shock is a collective concept, it is used when they want to characterize an extreme state that arose as a result of an extremely strong or prolonged impact, due to which everything was disrupted. important functions body (blood circulation, breathing, brain function).
And yet the main thing here is the state of deep circulatory depression. As a result, blood flow becomes insufficient to properly supply tissues with oxygen, nourish them and cleanse them of metabolic products. If the development of shock does not stop spontaneously (which is practically unlikely) or is not interrupted by appropriate therapeutic measures, then death occurs. To prevent this from happening, you need to normalize blood circulation in the body as soon as possible. Currently, in accordance with reasons It is customary to distinguish three categories of shock: hypovolemic, normovolemic, hypervolemic (cardiogenic).
Hypovolemic shock occurs when there is a decrease in BCC (circulating blood volume) due to bleeding, burns, loss of salts from the body, various forms dehydration, etc. healthy people a 25% decrease in blood volume is compensated by a redistribution of blood flow. Early replacement of lost blood or plasma volume reliably prevents the development of shock.
Symptoms On early stages hypovolemic shock, blood loss is compensated by releasing a significant volume of blood from the skin, muscle vessels and subcutaneous fatty tissue in favor of the cardiac, cerebral, renal and hepatic blood flow. The skin becomes pale and cold, the blood supply to the cervical vessels decreases. If blood loss continues, blood circulation in the kidneys, heart, brain and liver also begins to deteriorate. At this stage of shock, thirst, decreased diuresis, and increased urine density are observed. Tachycardia (increased heart rate), instability of blood pressure, weakness, agitation, confusion, and sometimes even loss of consciousness may be observed. Blood pressure gradually decreases. The pulse quickens and becomes weak. The nature of breathing also changes, becoming deep and rapid.
If bleeding does not stop and hypovolemia is not corrected immediately, cardiac arrest and death may occur.
Treatment hypovolemic shock (main stages):
1) a plastic catheter of sufficient caliber is inserted into the vein to allow rapid administration of the medication;
2) polyglucin and rheopolyglucin are administered, which occupy an important place in treatment. They remain in the circulatory system for quite a long time and are able to change the properties of the blood: they reduce blood viscosity and significantly improve peripheral circulation. One of the most important properties of these drugs is to maintain normal renal blood flow;
3) begin a jet or drip (depending on the circumstances) transfusion of 500 ml of same-group, Rh-compatible blood, heated to 37 ° C, after which 500 ml of plasma, protein or albumin are poured in;
4) administer drugs that normalize the acid-base balance of the body;
5) large quantities (up to 1 liter) of isotonic sodium chloride solution or Ringer's solution are administered, which have a satisfactory effect;
6) together with the beginning of blood replacement, a large dose of hormones (prednisolone - 1–1.5 g) is administered intravenously. Hormones not only improve the contractile function of the heart muscle, but also relieve spasm of peripheral vessels;
7) oxygen therapy is used, which is of great importance in the treatment of shock. With massive blood loss, oxygen transfer is significantly affected. Lack of oxygen in the blood, along with spasm of small vessels, is the cause of oxygen starvation of tissues during shock.
It is important that urine output is normal, the optimal level is at least 50–60 ml/h. A small amount of urine discharge during shock primarily reflects a lack of blood in the bloodstream and directly depends on it; only in the later stages of shock is it possible due to damage to the kidney tissue.
Cardiogenic shock
Reasons. It occurs as a result of a decrease in cardiac output and the development of the so-called small output syndrome. Insufficient blood ejection from the heart occurs during acute myocardial infarction. Mortality from cardiogenic shock is high, reaching 90%.
Vladimir Iosifovich Borodulin, Alexey Viktorovich Topolyansky
Handbook of a practicing physician. Book 1
PREFACE
In the tenth edition of the Practitioner's Handbook (which was first published in 1981 and has been revised several times in subsequent editions), the chapter on poisoning has been rewritten, and the chapters on rheumatic diseases, obstetrics and women's diseases, and sexual disorders have been revised. Accordingly, the list of authors and editors has been updated.
The directory is addressed primarily to local, family and other doctors of “first contact” with the patient. The authors and editors strived to ensure that the reader could quickly find in this book a brief summary of the typical manifestations, diagnostic criteria, basic principles and treatment regimens for the disease of interest. Particular attention is paid to the issues of diagnosis and treatment in out-of-hospital conditions. The team of creators of the Handbook did not set out to combine industry guidelines for specialists in it, therefore there are no details of laboratory and instrumental research or treatment methods that are carried out only by a medical specialist (for example, surgical intervention techniques).
Issues of general clinical relevance (eg, imaging diagnostics, principles of antibiotic therapy, etc.) are presented in the introductory section (Part I). Urological diseases are reflected in the chapters “Diseases of the kidneys and urinary tract”, “Skin and venereal diseases” and “Surgical diseases”. Laboratory indicators in all chapters of the Handbook are given without comparison with the norm; constants characterizing the norm, as well as recommendations for feeding young children and the necessary information on the epidemiology and prevention of infectious diseases are given in the Appendices.
A. Vorobiev, V. Borodulin
Chapter 1. BASICS OF ANTIBACTERIAL CHEMOTHERAPY
In modern chemotherapy of bacterial infections, the leading place is occupied by antibiotics, their semi-synthetic and synthetic analogues and derivatives, synthetic medicines(sulfonamides, quinolones, etc.); drugs from medicinal plants and animal tissues.
ANTIBIOTICS. The group of antibiotics combines chemotherapeutic substances formed during the biosynthesis of microorganisms, their derivatives and analogues, substances obtained by chemical synthesis or isolated from natural sources(animal and plant tissues) that have the ability to selectively suppress pathogens in the body (bacteria, fungi, protozoa, viruses) or delay the development of malignant neoplasms. In addition to the direct effect on pathogens, many antibiotics have an immunomodulatory effect. For example, cyclosporine has a pronounced ability to suppress the immune system, which is used in organ and tissue transplantation and the treatment of autoimmune diseases.
Currently, about 200 antibiotics belonging to 30 different groups are used in Russia. The most widely used are betalactams (penicillins, cephalosporins, carbapenems, monobactams), aminoglycosides (gentamicin, tobramycin, amikacin, etc.), quinolones and fluoroquinolones, macrolides (erythromycin, oleandomycin, etc.), lincosamides (lincomycin, clindamycin), glycopeptides (vancomycin ), ansamacrolides (rifampicin), tetracyclines (tetracycline, doxycycline), etc.
Through chemical and microbiological transformation, so-called semi-synthetic antibiotics have been created, which have such valuable properties as acid and enzyme resistance, an expanded spectrum of antimicrobial action, better distribution in tissues and body fluids, and fewer side effects.
Based on the type of antimicrobial action, antibiotics are divided into bacteriostatic and bactericidal. Bactericidal antibiotics irreversibly inhibit the growth of microorganisms, acting on a proliferating cell (beta-lactams, rifampicin) or on a resting cell (aminoglycosides, polymyxins). Antibiotics with bacteriostatic action (tetracyclines, chloramphenicol, macrolides, lincomycin) only temporarily stop the growth of bacteria, and eradication (removal from the body) of microbes is carried out due to the immune system of the macroorganism. This division has practical significance when choosing the most effective remedy therapy. For example, in case of immune disorders or severe septic processes, it is necessary to use antibiotics with a pronounced bactericidal type of action.
The significance of the mechanism of action of antibiotics at the cellular and molecular levels makes it possible to judge not only the direction of the chemotherapeutic effect (“target”), but also the degree of its specificity. For example, beta-lactams (penicillins, cephalosporins) act on specific proteins of the bacterial cell wall that are absent in animals and humans. Therefore, the selectivity of the action of beta-lactams is their unique property, which determines the high chemotherapeutic index (pronounced gap between therapeutic and toxic doses) and low level toxicity, which allows these drugs to be administered in large doses without the risk of side effects.
The first edition of the reference book was published in 1981. Since the first release of the book, diagnostic capabilities, methods and treatment regimens for many diseases have changed significantly; this has been taken into account in the latest editions. Thus, part I includes sections devoted to the principles of treatment of sepsis, disseminated intravascular coagulation syndrome, etc.; The sections on treatment with antibacterial and psychotropic drugs have been completely revised. Part II includes a chapter on occupational diseases and material on HIV infection (AIDS). In Part III, the chapters on childhood and surgical diseases, materials on alcoholism and drug addiction have been completely revised. Applications include basic disinfection products; constants are given in old and new units.
This edition includes additional materials in the section “Diseases of the circulatory system”, a revised application related to anti-epidemic measures and bacterial and viral drugs.
The directory is addressed primarily to the district physician and other doctors of “first contact” with the patient. The authors and editors strived to ensure that the reader could quickly find in this book a brief summary of the typical manifestations, diagnostic criteria, basic principles and treatment regimens for the disease of interest. Particular attention is paid to the issues of diagnosis and treatment in out-of-hospital conditions. The team of creators of the directory did not set themselves the goal of combining industry-specific manuals for specialists in this directory, so there are no laboratory details here. torto-instrumental research or treatment methods that are carried out only by a medical specialist (for example, surgical intervention techniques).
Issues of general clinical significance (principles of antibacterial therapy, chemotherapy of tumor diseases, etc.) are presented in Part I (introductory). Laboratory indicators in all chapters of the reference book are given without comparison with the norm; constants characterizing the norm are given in Appendix 1. Urological diseases are described in the chapters “Diseases of the kidneys and urinary tract”, “Skin and venereal diseases” and “Surgical diseases”.