"Volsky Medical College named after. Z.I. Mareseva"

Leksina Oksana Nikolaevna
4th year student, group 141

The role of the FAP paramedic in the prevention of cervical cancer

Final qualifying work

in the specialty "General Medicine" (qualification - paramedic)

Scientific director
teacher Kochetova V.V.

2016

Introduction........................................................ ........................................................ ...............3

Chapter 1 Prevalence of gynecological oncological diseases.................................................. ........................................................ .............5

1.1 Frequency of malignant neoplasms in the Russian Federation and Volga Federal District………………………………………………………......5

1.2 Oncogynecological diseases in the structure of all cancers………………

1.3 Ways to improve the early diagnosis of cancer………………………

Chapter 2. Analysis of the frequency of oncogynecological pathology in the Ulyanovsk region……………………………………………………………………………………………….

2.1 Frequency of cancer in the Ulyanovsk region……………………………………………………………

2.2 Oncological diseases in the structure of cancerous diseases in the Ulyanovsk region...

2.3 Problems of early diagnosis of gynecological oncology…………………………..

Conclusion

List of used literature

Appendix 1 Statistical data on cervical cancer in the Russian Federation

Appendix 2 Algorithm “Taking a smear for cytological examination”

Introduction

According to Rosstat, about 500,000 people are diagnosed with cancer every year in Russia, and mortality from cancer remains in second place in the mortality structure after cardiovascular diseases. The urgency of solving this problem has become a priority and reducing mortality from cancer has been included in a number of tasks on a national scale. Oncological diseases are the mainthem causes of disability and death in developed and many developing countries of the world,annually claiming more lives than all other causes of death combined.As reducing mortality rates and increasing life expectancy in countries locatedfor more late stages of the epidemiological transition, there is a consistent displacementopinion exogenous (infections, external causes) determinants of mortality endogenous, like as a rule, associated with biological aging of the human body. In the most developed countries of the world, changes are occurring directly in the structure of mortality from non-infectious diseases, which leads to an increase in the proportion of dying people diagnosed with malignant neoplasms (MNT). At the same time, there are stable trends in changes in the structure of cancer morbidity and mortality itself.

In the context of the observed transformations in the structure of mortality by causes of death, according to many experts, will largely depend on medical advances and their implementation in public health practice. However, human behavior patterns are important risk factors for the occurrence of cancer and other non-communicable diseases.

Among the set of measures aimed at improving the quality of preventive measures, the role of the middle medical personnel(paramedics of the FAP) are not given due importance. It is forgotten that the FAP paramedic is a vital link in preventive work in rural areas.

Object of study:preventive activities of the FAP paramedic.

Subject of study:organization of work on the prevention of cervical cancer.

Target thesis – determine the role of the paramedic in preventing the development of cervical cancer and improving the process.

To achieve this goal, it is proposed to solve the following tasks:

• conduct an analysis of the prevalence of cervical cancer among cancer diseases in Russia and the Volga Federal District;
• conduct a study of the organization of cervical cancer prevention;
• conduct a study of practical work on the prevention of cervical cancer of a medical assistant at a medical clinic;
• offer recommendations for improving the preventive work of the FAP paramedic for the development of cervical cancer.

Chapter 1. Prevalence of gynecological cancers

1.1 Frequency of cancer in the Russian Federation and Volga Federal District

Tumors (neoplasms) are a group of diseases caused by the uncontrolled division, increase in number and spread of tumor cells. There are benign tumors, which are characterized by non-invasive growth and the absence of metastases, and malignant ones with infiltrating growth, destroying neighboring tissues, and the formation of metastases. The term “cancer” in Russian practice is used only in relation to epithelial tumors. Tumors of non-epithelial origin (usually from connective tissue) are called sarcomas.

Currently, the polyetiological theory of the origin of neoplasms predominates, i.e. the simultaneous role of several factors causing tumor transformation. However, doctors identify separate groups of causes and risk factors for cancer:

• genetic (hereditary) factor;
• behavioral factors:

• smoking;
• obesity due to consumption and poor dieting;
• sedentary lifestyle;
• excessive alcohol consumption;
• unprotected exposure to the sun;
• infections, in particular sexually transmitted infections;
• untimely and irregular visits to doctors, including for the purpose of screening procedures.

It is clear that cancers caused by behavioral and environmental factors are potentially preventable. A 2005 study in Japan found that about 57% of male and 30% of female cancer deaths were caused by preventable behavioral risk factors. The most significant factors were tobacco smoking, infections and excessive alcohol consumption. A similar study worldwide shows that 35% of cancer deaths in 2001 were due to nine major potentially avoidable risk factors.

In the world, about 15% of all cancers are associated with infectious origin, in developing countries it is 25% or more. There are at least ten main common infectious agents that can cause malignant neoplasms of one location or another (Table 1).

Table 1. Infections and associated forms of malignant neoplasms

The main sources of statistical information were the Russian database on fertility and mortality, Rosstat data (form C51 and demographic forecast data), world and European WHO databases on causes of death.

Since 2004, there has been a trend towards a steady increase in life expectancy, increasing by 5.7 and 3.7 years for men and women, respectively, over the period 2004-2014, reaching values ​​of 64.6 and 75.9 years. Decomposition resultschanges in life expectancy by age and cause of death classes show that the noted increase in life expectancy at birth in men was achieved mainly due to a decrease in mortality from external causes of death (43.7%) and diseases of the circulatory system (38.7%). The increase in women's life expectancy was also due to a decrease in mortality from CSD (61.6%) and external causes (24.1%). The contribution of the reduction in the mortality rate from neoplasms to the growth of life expectancy is insignificant for both men and women, and amounts to about 4%.

Class of causes of death under common name“neoplasms” are very heterogeneous, the level and dynamics of mortality from individual forms of cancer differ, and therefore mortality from malignant tumors of different localizations has different effects on changes in the life expectancy of men and women. To assess the contribution of mortality from the main oncological causes of death, a decomposition of life expectancy for these causes was performed. The calculation results (Fig. 1 and 2) show that the increase in life expectancy of men was achieved mainly due to a decrease in mortality from cancer of the trachea, bronchi and lungs and stomach cancer.

A negative trend was observed for prostate cancer and affected men over 60 years of age. In women, a negative contribution to the dynamics of life expectancy is associated with the mortality of women from cancer of the female genital organs and pancreas. It is important to note that negative trends in women’s mortality from genital cancer are especially pronounced in age group 30-45 years old.

Rice. 1. Contribution of changes in mortality from individual forms of cancer to the overall change in life expectancy of men by age groups, 2004-2014, years

Rice. 2. Contribution of changes in mortality from individual forms of cancer to the overall change in life expectancy of women by age groups, 2004-2014, years

The rate of active detection of malignant neoplasms was 18.7% (2013 – 17.3%). The rate of active detection of tumors in visual localizations should be considered low. Of the patients actively identified (95,401), 74.2% had stage I-II of the disease (2013 83,916, 69.9%). Tumors of visual localizations of stages I-II of the disease accounted for 48.0% (2013 45.2%) of all neoplasms identified during preventive examinations. The proportion of patients with stage I-II tumors identified during preventive examinations among all patients with this stage was 25.0% in 2014 (22.3% in 2013).

Analysis of indicators of active diagnosis of malignant neoplasms indicates a complete absence in a number of regions of a system of preventive and screening examinations of all categories of the population.

The lowest proportion of malignant neoplasms actively detected was recorded in the following territories (the Russian average is 18.7%): the Republic of Chechnya (0.6%), Kalmykia (1.1%), Adygea (1.2%), Jewish Autonomous region (1.3%), Republic of Tyva (4.3%), Ingushetia (4.5%), Kamchatka (4.7%), Stavropol (5.6%) territories, Yaroslavl region (5.9%) .

The maximum rates of active detection were noted in the following territories: Tambov region (49.7%), Chukotka Autonomous Okrug (47.7%), Kursk region (35.3%), Perm region (32.2%), Republic of Khakassia (29 .8%), Leningrad region (29.1%).

One of the main indicators that determine the prognosis of cancer is the extent of the tumor process at the time of diagnosis. In 2014, 26.7% of malignant neoplasms were diagnosed in stage I of the disease (25.6% in 2013), 25.3% in stage II (25.2% in 2013), 20.6% in stage III (2013 21.2%). 7,267 cases of cancer in the in situ stage were identified, which corresponds to 1.3 (2013 1.3) cases per 100 of all newly diagnosed cancer cases. Cervical cancer in the in situ stage was diagnosed in 4,418 cases (27.4 cases per 100 newly diagnosed malignant neoplasms of the cervix; 27.5 in 2013); breast 1,218 and 1.9, respectively (Appendix Table 1).

1.2 Oncogynecological diseases in the structure of all cancers.

Malignant tumors of the female genital organs occupy a special place in clinical oncology: they are the most common malignant neoplasms in women.

Every year, 12.7 million new cases of cancer are registered worldwide, more than 1 million of which are diseases of the female genital area. In Russia in 2014, the number of newly diagnosed diseases of the female genital organs reached 47.7 thousand (17% of all malignant tumors).

Status Data Analysis cancer care patients with cancer of the female genital organs showed that in 2014 in Russia the proportion of morphologically verified diagnoses for ovarian cancer (89.1%) was lower compared to the proportion of cervical (97.4%) and uterine body (96.5%) cancer . The distribution of patients with ovarian cancer by stage is significantly different from their distribution with cervical and uterine cancer, characterized by half the proportion of stages I-II among patients with the first time in their life established diagnosis and predominance III-IV stages diseases (Table 1). One of the ways to reduce mortality from malignant neoplasms is screening - detection of asymptomatic cancer through mass preventive examinations of the population. Early diagnosis of malignant tumors of the vulva, vagina and cervix is ​​possible using the simplest examination methods - inspection and palpation. Early recognition of endometrial tumors (body of the uterus) also does not require complex examination methods. Only ovarian tumors are less accessible for early diagnosis. Despite the fact that preventive examinations play a significant role in the diagnosis of cervical cancer (28.9% of cases in Russia are detected), over the past 10 years the proportion of patients identified during their conduct has increased by only 5%, the proportion for body cancer is significantly lower uterus (12.2%) and ovaries (10.2%). For every 100 newly diagnosed patients with cervical cancer, there were 44 deaths; this indicator was minimal in the group of patients with uterine cancer (31), the maximum in ovarian cancer (59).

Indicators of the state of oncological care for patients with cancer of the female genital organs in Russia (2000-2010)

Mortality in the first year from the moment of diagnosis of uterine cancer (10.9%) was 2.3 times lower than for ovarian cancer (26.3%, respectively). Comparison of the proportion of patients with stage IV tumors and mortality in the 1st year from the moment of diagnosis indicates an underestimation of the proportion of patients with stage IV tumors: the ratio of these indicators for cervical cancer was 1.9; for cancer of the uterine body - 1.7; for ovarian cancer - 1.2. During the period from 2000 to 2010, a slight decrease in the proportion of stage IV was noted.

A comparative assessment of the state of cancer care over time and in different regions is fraught with great difficulties due to the abundance of analyzed indicators. In this regard, a cumulative criterion was developed, which made it possible to reduce into one numerical value many private indicators of the service’s performance, which include morphological verification of the diagnosis, detection during preventive examinations, early detection of diseases, contingent accumulation index, their mortality, etc.

According to the cumulative criterion, the state of oncological care for patients with ovarian cancer is at the lowest level (0.71) compared to other localizations of malignant neoplasms of the female genital area (0.96-0.98). This is due to low verification of diagnosis, a large proportion of stage IV diseases, high one-year mortality, mortality among contingents and the maximum number of deaths per 100 cases.

In gynecological oncology, the so-called precancerous conditions and diseases have been studied and identified in most detail, the search for which through systematic mass preventive examinations has become a clear example of the importance of this form of prevention and early diagnosis of malignant tumors. In the United States, after the introduction of mass screening, in situ tumors began to be detected more often than invasive forms. In 2010, 4867 (in 2000 - 2343) patients with predilection were identified in Russia. invasive cancer. The bulk of such patients (2939) were localized in the cervix: 21 per 100 patients with invasive cancer of this localization.

Cervical cancer.

In 2010, 14.7 thousand patients with cervical cancer were registered in Russia (Table 2). During the period from 2005 to 2010, the increase in the absolute number of cases was 13.9%. Its share in the structure of the incidence of malignant neoplasms in the female population of Russia decreased from 7.0% (in 1989) to 5.3% (in 2010) (5th rank); in the age group of 15-39 years, among all malignant neoplasms in women, the maximum proportion of malignant neoplasms of the cervix (22.4%), in 40-54 years it is 9.4% (2nd place after breast cancer) (Table .3).

Dynamics of incidence of cancer of the female genital organs in Russia, 1989-2010.

* World standard, ten-year age groups.

Structure of the incidence of malignant neoplasms in the female population of Russia in different age groups (2014)*

* Non-melanoma skin tumors are excluded.

Every year, 529.4 thousand patients with cervical cancer are registered in the world (9% of all malignant neoplasms in women) and 274.9 thousand deaths. The widespread prevalence of cervical cancer is noted in developing countries, which account for 78% of cases, and its share reaches 15% of all malignant neoplasms in women (in developed countries - 4.4%). The increase in the incidence of cervical cancer in Russia is alarming (from 12.4 per 100 thousand female population in 1989 to 14.3 per 100 thousand in 2010 - 15.3%), while in Western countries, where Mass screening is being carried out to diagnose precancerous conditions and early forms of cancer; morbidity (and mortality) rates have decreased significantly over the past decade. The average age of cases in Russia decreased by 6 years: from 58 (in 1989) to 52 years (in 2010). The maximum age-specific incidence rates of cervical cancer were registered in the age group 50-64 years (31-32 per 100,000), uterine cancer - in the age group 60-64 years (91.9 per 100,000), ovarian cancer - in the age groups 60-74 and 70-74 years (40-41 per 100,000) (Fig. 1). An analysis of the dynamics of age-related incidence rates in Russia from 1990 to 2010 revealed a certain tendency towards a decrease in the incidence of cervical cancer in the age groups 60-69 years and 70 years and older and an increase in the number of cases of uterine and ovarian cancer at all ages (Table .3).

Figure 3. Age-specific incidence rates of female genital cancer in Russia in 2014 (per 100 thousand female population)

More than 6.2 thousand patients die annually from cervical cancer in Russia (4.6% among all malignant neoplasms in women) (Table 4). The average age of the deceased is 58 years (in 1991 - 64 years). The average mortality rate from cervical cancer in Russia in 2014 (5.2 per 100,000) was 2.8 times lower than the incidence (14.3 per 100,000). In women aged 15 to 40 years, cervical cancer is the leading cause of death among all patients with malignant neoplasms, reaching 19.5%; at 40-54 years of age, cervical cancer moves to 2nd place (9.7%).

Among the world's 50 countries, the highest death rates from cervical cancer were reported in Zimbabwe (43.1 per 100,000), Mali (25.4 per 100,000) and Colombia (18.2 per 100,000); minimal (less than 3 per 100,000) - in Australia, USA, Canada, Finland, Greece, Italy. In the developing world, standardized mortality rates were 3 times higher than in developed countries (9.8 and 3.2 per 100,000).

Survival rates vary, with good prognoses reported in countries with a low risk of cervical cancer (72% in the US, in European countries - 60%). Even in developing countries, where more advanced (advanced) cases of cervical cancer are diagnosed more often, survival rates reach 48%; the lowest rates are in Eastern Europe. Survival rates depending on the extent of the process are presented in Table. 5.

Indicators of 5-year relative survival of patients with malignant neoplasms identified in the USA in 1999-2005. (%)*

* Extent of prevalence of the process:

1. localized;
2. transition to surrounding tissues, regional metastases;
3. distant metastases.

Cancer of the uterus.

The geographic distribution of uterine cancer is similar to that of ovarian cancer. It is characterized by a greater annual number of new cases (188.8 thousand in the world) than deaths, which can be explained by the most favorable prognosis. In Russia, more than 19.8 thousand patients with uterine cancer are registered annually. During the period from 2005 to 2010, the increase in the absolute number of cases was 15.6%. The average age of patients with uterine cancer in Russia in 2010 was 62 years (of those who died - 68 years). The ratio of endometrial cancer to cervical cancer in European countries and the United States ranges from 1:2 to 1:7.

In developed countries, the incidence of uterine cancer (12.9 per 100,000 female population) was 2.2 times higher than in developing countries (5.9 per 100,000). In the CIS countries, the incidence of uterine cancer ranged from 4.5-9.9 per 100,000 (in Azerbaijan, Kyrgyzstan, Kazakhstan and Armenia) to 15.7-20.2 per 100,000 (in Russia, Belarus and Ukraine). During the period from 1989 to 2010, standardized incidence rates in Russia increased from 9.6 to 15.7 per 100,000 (an increase of 63.5%).

In the structure of cases, the share of uterine cancer reached 7.1%. In Russia, it ranked 3rd after the breast and cervix in the age group of 40-54 years (8.6%) and 2nd in the age group 55-69 years (9.7%); with increasing age, it moves to 5th place at 70-84 years old and its share decreases to 5%.

The incidence rates of uterine cancer in 2010 increased in all age groups, starting from 25 years. They were highest in the 60-64 age group (91.9 per 100,000). The intensity of the increase in incidence with age is well characterized by the index of accumulation of the age-related peak incidence to the incidence level at the age of up to 50 years, for example, at 45-49 years. For malignant neoplasms of the female genital organs, it ranged from 1.0 for cervical cancer to 3.7 for uterine cancer and 1.7 for malignant ovarian tumors.

Among 50 countries of the world, the highest mortality rates from uterine cancer (5-7 per 100,000) are in the Czech Republic, Slovakia, Kyrgyzstan, Cuba and Azerbaijan, the lowest are in China, Japan, Mali, Uganda (0.4-1.2 per 100,000 ).

Malignant neoplasms of the ovaries.

Every year, 225.5 thousand new cases of malignant ovarian tumors and 140.2 thousand deaths from it are registered in the world, in the USA - 22.3 thousand and 15.5 thousand, in Russia - 13.1 thousand and 7, 8 thousand. During the period from 2005 to 2010, the increase in the absolute number of cases was 6%. In many countries, this pathology ranks 5th among malignant neoplasms. Malignant ovarian tumors occur in women of all age groups, starting from infancy. In Russia, the proportion of ovarian cancer among malignant neoplasms ranged from 4.9% (in 55-69 years old) to 7.2% (in 40-54 years old) and 7.4% (in 15-39 years old). The incidence rate reached the highest value (41.2 per 100,000) in the age group 60-64 years. In England, Denmark, Finland, the Czech Republic, and Sweden, the incidence of this form of cancer was 9-15 (per 100 thousand female population, world standard). In developed countries, the incidence of ovarian cancer was 1.9 times higher than in developing countries (9.4 and 5.0 per 100,000). Standardized incidence rates of ovarian malignant neoplasms in Russia increased by 20.4% (from 9.3 to 100,000 in 1989 to 11.2 per 100,000 in 2010).

In 2010, 7.8 thousand patients died from ovarian cancer in Russia (5.8% among all malignant neoplasms in women). In the structure of deaths from malignant neoplasms, ovarian cancer is in 5th place. The maximum proportion of deaths is in the age group 40-54 years (9.2%, 3rd rank); with increasing age it decreases to 6.8% in the age group 55-69 years and 4.5% in the age group 70-84 years. The proportion of deaths from ovarian cancer was 35% among all malignant neoplasms of the female genital organs. The average age of cases in Russia was 59 years (of those who died - 64 years).

1.3 Ways to improve the early diagnosis of cancer

Prevention in oncology - a system of measures aimed at preventing the occurrence of malignant tumors and their progression.

One of the leading domestic oncologists, academician of the Russian Academy of Medical Sciences N.P. Napalkov (1932–2008) wrote several years ago: “There is no doubt that the consistent and widespread implementation of measures for the primary prevention of cancer, although very difficult, can quite realistically reduce the mortality rate of the country’s population from malignant diseases within one or two decades.” tumors, according to at least, by one third." (According to WHO estimates, only the population's adherence to a healthy lifestyle can prevent 40% of cancer cases; another 20% can be prevented by preventing chronic infections that lead to tumors). The experience of economically developed countries confirms this possibility.

At the same time, neither in Russia nor abroad is primary cancer prevention given due attention (although in economically developed countries this phenomenon manifests itself to a much lesser extent).

Various types of radiation, a huge number of carcinogens contained in both the air and drinking water, and in food products constantly exert their destructive, namely carcinogenic, effect. Carcinogenic substances are very diverse from simple ones (like carbon tetrachloride - CCl 4 ) to complex polycyclic heterocyclic compounds (methylcholanthrene or benzanthracene). Their effect is based on stimulating the proliferation of progenitor cells. Based on the information we know about carcinogenic factors, appropriate measures are being developed and implemented to eliminate the provocateurs of malignant growth, both externally and internally. internal environment. The basic principles of prevention are embedded in the healthy lifestyle of every person.

Prevention of carcinogenic effects of external and internal factors, normalization of nutrition and lifestyle, increasing the body’s resistance to harmful factors included in the concept of primary cancer prevention.This concept means, on the one hand, broad health measures on a state scale. The main sources of pollution of atmospheric air, soil, and water basins are enterprises of the metallurgical, coke-chemical, oil refining, chemical, pulp and paper industries, as well as transport.

Under the influence of radiation, malignant tumors can arise in all organs, but the highest risk of developing hemoblastoses, lesions of the skin, bones, lung, mammary and thyroid glands, salivary glands, and ovaries. The use of personal protective equipment in hazardous industries significantly reduces the incidence of malignant tumors.

Primary cancer prevention involves closing hazardous industries. The planning and construction of modern industries must be under control, provide for the processing of toxic products into harmless ones, waste disposal, and the construction of treatment facilities that protect against contamination harmful products environment. Improving the ecology of our country requires rational planning of cities, residential and public buildings. Good aeration in them eliminates human contact with carcinogens. Prevention of tumors should include measures of legislative control over maximum permissible concentrations of harmful effects (chemical, mechanical, radioactive, microwave, etc.). Prevent their harmful effects on people who come into contact with them at work and at home. Provision must be made for the implementation of appropriate measures for the rational protection of workers in hazardous industries. For example, wood dust and the use of paints and varnishes lead to the development of cancer of the sinuses in workers in the wood processing industry. Occupational factors more often cause tumors in those localizations that are characterized by direct contact with carcinogenic factors. All measures that exclude the impact of the listed factors on humans are the prerogative of the state.

On the other hand, every person should know that by observing the basic norms of a healthy lifestyle, he prevents the development of malignant neoplasms. For the organs of the oral cavity and pharynx, as well as the mucous membrane of the upper respiratory and digestive systems, it has been established that tobacco and alcohol are leading risk factors in the development of cancer. Appropriate explanatory work should be carried out everywhere. Information for the population should contain basic information about personal prevention of malignant tumors of different localizations, about the symptoms that a tumor manifests in the initial stages of the disease, about self-examination options for timely recognition of the most common tumors, etc. This information is placed on “silent information” stands in clinics, published in scientific and educational magazines and brochures, distributed in the form of leaflets. The necessary information can also be presented in the form of lectures on local radio or for the organized population.

Precancerous conditions are known for almost every cancer location. In this regard, appropriate preventive measures are known for a significant number of precancerous tumors, and therefore also malignant tumors. Thus, the basis for the prevention of lung cancer is the fight for the purity of inhaled air and the activation of self-cleaning processes of the lung. It is necessary to promote smoking cessation, recommend sports, and systematic physical activity in the fresh air. To prevent cancer of the gastrointestinal tract, it is necessary to observe the rules of food and oral hygiene. To prevent breast cancer, it is necessary to avoid abortion and uncontrolled use of hormonal contraceptives. Long-term, normal breastfeeding is very important. It is necessary to master self-examination techniques for the most common oncological diseases. Immunization to prevent infection with oncogenic types of human papillomavirus is also a strategy for the primary prevention of cervical cancer.

Vitamins play an important role in the prevention and treatment of cancer. A lack of fat-soluble vitamins often accompanies the development of precancerous pathology. In some cases, intensive vitamin therapy is the main component of the treatment of precancerous diseases. Preparations of fat-soluble vitamins, which play a huge role in the differentiation of epithelial cells, are especially often used for this purpose.

At the end of the 80s. last century, it was revealed that it is the combination of vitamins A, C and E that is the most important oxidant for human health. Some free radicals are formed during the oxidation process, when cells undergo an energy-releasing reaction involving oxygen. Small amounts of free radicals are necessary to fight bacteria and viruses, but large amounts of free radicals in the body are highly harmful. Free radicals are formed largely under the influence of pollutants such as tobacco smoke and ultraviolet solar radiation. Vitamins A, C, E are able to neutralize these particles before they can damage the body's cells. Antioxidants bind free radicals. A significant proportion of tumors arise without any noticeable connection with any carcinogenic effect.

In addition, there are a number of microelements that help fight free radicals. The first line of defense in the fight against damage caused by free radicals is through a group of enzymes that contain metal ions: Mg (manganese), Cu (copper), Zn (zinc), Se (selenium) - metalloproteinases. Their formation occurs with the participation of these vitamins. If vitamin deficiency is a consequence of impaired absorption and digestive functions of the gastrointestinal tract, then the inclusion of vitamin preparations in complex treatment is absolutely necessary.

Compliance with personal hygiene rules and timely treatment of chronic gynecological diseases serve as the prevention of cervical cancer. Numerous births with cervical rupture, promiscuous and early sexual life also contribute to the development of malignant tumors of the female genital organs.

Normalizing body weight is one of the important factors in the prevention of most malignant tumors, since obesity and physical inactivity actively contribute to the development of cancer, reducing immunity and activating DNA damage. Almost half of all cases of uterine and esophageal cancer in women are associated with obesity and overweight. Excess weight is associated with the development of kidney, prostate, pancreatic, ovarian cancer, leukemia, non-Hodgin lymphoma, breast and bladder cancer. The risk of breast and bladder cancer increases only in menopausal women. It is recommended to limit fried, smoked, and nitrite-containing foods as sources of carcinogens.

Individual cancer prevention for each person consists of knowledge and compliance with practical recommendations in order to reduce cancer risk. Awareness of signs or symptoms that may be cancer is important. Signs and symptoms that are not completely specific to cancer should not be ignored, but should serve as a warning to the person to consult and seek medical advice.

These are individual preventive measures for the most common human cancers, i.e. giving up bad habits and a balanced diet reduces, and in some cases eliminates, the risk of tumors. From the above measures for the prevention of malignant tumors, it follows that the basis of such primary prevention is compliance with the rules of personal hygiene, reducing contact with carcinogens, promoting the normal function of organs and systems of the human body, and increasing immune defense. Cancer is a long, multi-stage process. It is known that it takes 5-10 years for a tumor of the lung, stomach or mammary gland to reach a size of 1-1.5 cm in diameter. Most tumors begin between the ages of 25 and 40, and sometimes in childhood, so cancer prevention should begin as early as possible.

Toward secondary cancer preventionA number of measures apply in the presence of already developed excessive cellular growths with epithelial atypia and formed precancerous conditions. Patients suffering from precancerous diseases form high-risk groups, which is a promising direction in multifaceted medical cancer prevention. Multipurpose screening programs have been developed for this purpose. In terms of secondary prevention activities, monitoring of risk groups, identification and treatment of precancerous diseases and early diagnosis of cancer are carried out.

Screening refers to the use of various research methods that make it possible to diagnose a tumor at an early stage, when there are no symptoms of the disease. The goal of screening is to actively detect asymptomatic cancer early and treat it. It is necessary to distinguish screening from early diagnosis. Early diagnosis is the detection of a disease in individuals who, when symptoms of the disease appear, seek medical help. Cancer screening programs should be conducted taking into account their appropriateness for those forms of cancer that are an important public health problem in a country or region due to their high morbidity and mortality.

In Russia, screening for cervical cancer is considered advisable, since the incidence and mortality from this type of cancer remains high. To detect cervical cancer, a cytological examination of a smear from the surface of the cervix is ​​used. Currently, population-based cytological screening represents an ideal model for secondary prevention of cervical cancer: cytological examination of cervical smears is performed on all those who visit the clinic for the first time this year. As a result of this event, the detection of early forms of this disease has significantly increased.

The effectiveness of a particular screening method can be judged on the basis of a decrease in the frequency of detection of common forms of tumors of a given type and an increase in the frequency of early forms. The most significant reduction in mortality and improvement in survival from cancer is in the region where screening was carried out, compared with regions in which screening was not carried out. At present, the criteria for classifying certain categories of the population into high-risk groups for a particular cancer disease have not yet been finally determined for many diseases. At the same time, clinical practice shows that correct treatment conditions defined as precancerous, saves a person from the potential for cancer. In these groups, dispensary observation is carried out until it is established that the precancerous disease has been cured. This significantly improves the quality of preventive examinations, allows for the effective use of instrumental examination methods (fluoroscopy, radiography, endoscopy with biopsy, etc.), carries out a targeted search for the pathological process and ensures continuity in the diagnosis and treatment of patients. When conducting mass preventive examinations, the possibilities of diagnostic methods, their simplicity and economic costs.

The third stage of cancer prevention is to prevent the progression of an already existing malignant tumor (generalization, relapse) through the timely use of rational treatment methods, as well as qualified examination and special examination of persons who have received the full course of primary treatment and are observed without obvious signs of relapse and metastases, which are under dispensary observation. This also includes preventing new cases of tumor diseases in cured cancer patients. Typically these activities are carried out in specialized clinical or outpatient departments.

Thus, the cancer prevention system includes measures to combat bad habits, to identify and treat patients with precancerous diseases; those. identification and examination of “high-risk” groups, environmental protection, rational anti-cancer propaganda. To reduce mortality from tumor diseases, there are two approaches: reducing the number of new cases through primary prevention and increasing the cure rate and survival rate of those who have already developed cancer through early diagnosis and rational therapy. “However, it is better to prevent the disease than to treat it” (Davydov M.I., 2007). It is currently considered more appropriate than mass examinations to develop questionnaires that are filled out by examined patients, so that if warning symptoms characteristic of any disease are identified, a more detailed examination can be carried out. Certain features of the population's lifestyle are being studied that could affect the development of the most common tumors in a given region, and if such factors are identified, the main emphasis is on promoting relevant knowledge among the population.

Thus, conclusions can be drawn.

It has been revealed that primary prevention is aimed at identifying and eliminating or weakening the influence of unfavorable environmental factors on the process of the occurrence of a malignant tumor. First of all, this is the complete elimination or minimization of contact with carcinogens.

It has been established that secondary prevention is aimed at identifying and eliminating precancerous diseases and identifying malignant tumors in early stages process. Studies that can effectively identify precancerous diseases and tumors include: mammography, fluorography, cytological examination of smears from the cervix and cervical canal, endoscopic examinations, preventive examinations, determination in biological fluids level of tumor markers, etc.

It has been determined that tertiary prevention h consists of preventing relapses and metastases in cancer patients, as well as new cases of malignant tumors in cured patients. For the treatment of malignant tumors and tertiary cancer prevention, you should contactonly to specialized oncological institutions.

Chapter 2. Analysis of the frequency of oncogynecological pathology in the Ulyanovsk region.

2.1 Frequency of cancer in the Ulyanovsk region.

Malignant neoplasms in the Ulyanovsk region rank second in frequency and social significance among the causes of mortality in the population after cardiovascular diseases and account for up to 15% of all causes.

Rice. 3. Structure of the incidence of malignant neoplasms in the population of the Ulyanovsk region in 2011 (both sexes)

For 9 months of 2012 in the Ulyanovsk region:

• 3902 new cases of malignant neoplasms were identified (3% compared to 2011);
• 1856 people died from malignant neoplasms (5% compared to 2011);
• neglect – 24.8%;
• morphological verification - 30.6%;
• 67.6% of primary cancer patients were referred from primary oncology offices (POC).

Based on the data, table 2 can be constructed.

Table 2. Work of primary oncology clinics in the Ulyanovsk region

In 2013 in the Ulyanovsk region:

• 5,319 oncological diseases were identified, incl. in 35 children;
• 2,825 people died from malignant neoplasms, incl. 9 children.

At the end of 2013, the number of patients with malignant neoplasms amounted to 28,083 people, which is 2.2% of the region’s population. Of these, 51.8% of patients have been registered for 5 years or more. This figure increased compared to 2012 (2012 – 50.2%, Russian Federation 2012 – 51.1%). Cancer morbidity and mortality in the Ulyanovsk region significantly exceeds the Russian average. In the Volga Federal District, Ulyanovsk region at the end of 2013. ranks 3rd in terms of mortality from malignant neoplasms after the Orenburg and Nizhny Novgorod regions.The structure of the causes of overall mortality in the Ulyanovsk region for 2013 is presented in Fig. 4

Rice. 4. Structure of causes of overall mortality, Ulyanovsk region, 2013.

Malignant neoplasms are the second most common cause of mortality in the population after cardiovascular diseases and account for 16% of all causes.

The incidence of malignant neoplasms is higher than the regional average in the city of Novoulyanovsk, Bakzarnosyzgansky, Baryshsky, Veshkaimsky, Inzensky, Kuzovatovsky, Mainsky, Starokulatkinsky, Terengulsky districts, and Ulyanovsk.

The incidence rate is lower than the regional average in the following municipalities: Karsunsky, Melekessky, Nikolaevsky, Pavlovsky, Novomalyklinsky, Novospassky, Radishchevsky, Sengileevsky, Staromainsky, Sursky, Ulyanovsky, Tsilninsky, Cherdaklinsky districts, Dimitrovgrad.

Mortality from cancer is higher than the regional average in the following municipalities - Starokulatkinsky, Inzensky, Karsunsky districts, N. Ulyanovsk, Mainsky, Sursky, Baryshsky, Novomalyklinsky, Radishchevsky, Sengileevsky, Kuzovatovsky districts, Dimitrovgrad.Lower than the regional average - Melekessky, Pavlovsky, Terengulsky districts, Ulyanovsk, Baz. Syzgansky, Cherdaklinsky, Tsilninsky, Novospassky, Veshkaimsky, Ulyanovsky, Staromainsky, Nikolaevsky districts.

The first places in the structure of the incidence of malignant neoplasms of the male population of the Ulyanovsk region are distributed as follows: tumors of the trachea, bronchi, lungs (21.3%), skin (10.2%), prostate gland (9.5%), stomach (8.2 %). In 2013, prostate cancer moved from 4th place to 3rd place.

Malignant tumors of the breast (21.7%) are the leading oncological pathology of the female population of the Ulyanovsk region, followed by neoplasms of the skin (14.4%), uterine body (7.9%), colon (7.0%), and stomach ( 5.7%).

The neglect indicator in 2013 remained unchanged compared to the previous year – 25.2%. The indicator is higher than the Russian average and for the Volga Federal District.

There is a high level of neglect in the following areas: Kuzovatovsky, Bazarnosyzgansky, Staromainsky, Karsunsky, Baryshsky, Terengulsky, Mainsky, Veshkaimsky, Cherdaklinsky, Nikolaevsky, Tsilninsky, Novomalyklinsky.

In Ulyanovsk, the neglect of cancerous diseases was 24.8%. A high level of neglect in the Central Committee of the Medical Unit, clinic No. 1, Central City Clinical Hospital, clinic No. 2, and the departmental hospital of JSC Russian Railways (attached population).

One-year mortality compared to last year decreased by 2.0% to 30.8% (2012 CV -31.4%, RF 26.7%).

Among municipalities less than 80% coverage of preventive examinations was registered in Radishchevsky, Terengulsky, Staromainsky, Ulyanovsky, Baryshsky, Novospassky, Kuzovatovsky districts, Ryazanovskaya and Nikolskaya (the lowest) district hospitals. In Ulyanovsk, the lowest coverage is in city hospitals No. 3 and 4, the Central Committee of the Medical Emergency Service, and the departmental hospital of Russian Railways OJSC (attached population).

High detection rate of cancer in Ryazanovskaya, Mullovskaya district hospitals, Sursky, Novomalyklinsky, Novospassky, Terengulsky districts, departmental hospital of Russian Railways, city hospital No. 3, polyclinic No. 2.

Thus, an analysis of statistical data on the dynamics of malignant neoplasms showed the growth of this category of diseases not only in the Ulyanovsk region, but throughout Russia as a whole. In addition, the data indicates low preventive work and detection of cancer in the early stages in many districts of the Ulyanovsk region and hospitals in Ulyanovsk.

2.3 Problems of early diagnosis of gynecological oncology.

In modern preventive medicine, the concept of a two-stage examination system has been put forward. At stage I, primary identification and screening (“screening out” patients from healthy ones) is carried out. Persons who have passed through the diagnostic program are considered healthy. At stage II, in-depth diagnostic methods are used only if precancer or cancer of the reproductive system is suspected. A decrease in morbidity and mortality rates from cervical cancer was noted in regions where the majority of women are covered by cytological screening. In the whole country, only a decrease in these indicators for cervical cancer is detected, while the morbidity and mortality from EC, breast cancer and ovarian cancer are increasing. There is no doubt that a preventive examination should be replaced by a preventive examination, since in parallel with the examination it is necessary to use highly reliable and “sensitive” special techniques. The purpose of such an examination is to identify not only the initial stages of cancer, but also background processes, precancerous diseases and pre-invasive cancer. An exclusive role in the early diagnosis of precancer and cancer of the reproductive system belongs to the antenatal clinic doctor. Many women still avoid undergoing mass examinations, which is mainly due to lack of awareness about cancer and the possibilities of its early diagnosis and treatment. Meanwhile, almost every woman repeatedly visits a antenatal clinic doctor for various reasons (maintaining or terminating a pregnancy, contraception, gynecological diseases, etc.). This is a convenient reason for a cytological examination of cervicovaginal smears in all women and identification of risk factors for EC, OC and breast cancer using questionnaires. There are significant differences between methods for early detection and in-depth diagnosis of gynecological cancer. In order for a diagnostic technique to be accepted as a tool in a screening program, several criteria must be met. It is necessary that the technique be easily performed in an outpatient setting, be tolerated painlessly by the woman and not cause complications. Equipment and reagents do not have to be expensive. Once research material has been received, its evaluation must be completed quickly and with a minimum number of errors. It is appropriate to note here that methods for detecting primary cancer of the reproductive system should not give false negative conclusions, since underdiagnosis can lead to loss of time and progression of the disease. False-positive or presumptive conclusions (suspicion of cancer) are less dangerous, since overdiagnosis can be corrected at stage II of an in-depth examination, which, if necessary, is carried out in a hospital setting.

Results of a survey of women with risk factors for PE Let's consider the results of screening of 2204 women from risk groups. In any gynecology textbook you can read that uterine bleeding occurs in 98-99% of patients with endometrial cancer. Is it so? The most significant result of the study is that among women from risk groups who did not have gynecological complaints and symptoms, 124 patients with atypical hyperplasia (5.6%) and 69 with endometrial cancer (3.1%) were actively identified. When examining patients with Stein-Leventhal syndrome, glandular hyperplasia and often atypical hyperplasia are often detected. The risk of developing cancer increases in patients with sclerocystic ovary syndrome in combination with obesity and with a long clinical course. A predisposition to atypical hyperplasia and endometrial cancer is observed in patients with uterine fibroids in pre- and postmenopause in combination with obesity, diabetes mellitus and an estrogenic type of colpocytological reaction. Untreated glandular endometrial hyperplasia for 3 years or more may regress (40%), remain stable (55%), progress to atypical hyperplasia (2.6%) or cancer (1.7%). This determines the need for treatment of recurrent hyperplastic processes and dynamic monitoring of the condition of the endometrium. Continuing menstrual function after 50 years increases the risk of glandular and atypical endometrial hyperplasia. High frequency detection of asymptomatic hyperplastic processes and endometrial cancer with a karyopyknotic index value exceeding 40-50% indicates the advisability of examining the condition of the endometrium in this group of women. When diabetes mellitus and obesity are combined, severe disturbances of menstrual and generative functions are determined. The risk of atypical hyperplasia and cancer is highest with the onset of the development of diencephalic type obesity at puberty, the birth of large children (weighing more than 4000 g), and the detection of non-insulin-dependent diabetes mellitus in pre- and postmenopause. Thus, the pathogenetic approach to assessing factors and forming groups opens up new opportunities for early recognition of hyperplastic processes and endometrial cancer. The effectiveness of the undertaken examination of women suffering from endocrine-metabolic disorders could increase significantly if they were simultaneously subjected to mammography (to identify early forms of breast cancer) and pelvic ultrasound (to diagnose ovarian enlargement). If we turn to the specialized literature, it is easy to notice that each author strives to detail the methods of early diagnosis of any one cancer localization. In other words, there is a tendency to study in isolation the diagnosis and prevention of four main localizations of cancer of the reproductive system - CC, EC, OC and breast cancer. It is obvious that early diagnosis and prevention of these four tumors should be carried out according to a single program. The mandatory use of cytological examination in all women over 20 years of age makes it possible to resolve issues of early diagnosis of dysplasia, pro- and invasive cervical cancer. Opportunities for further improvement of preventive examinations are associated with the active detection of EC, OC and breast cancer in risk groups. Considering the similar orientation of endocrine metabolic disorders that play a certain role in the pathogenesis of EC, breast cancer and ovarian cancer, it seems promising to form general group risk for active detection of these three tumors. Each woman's risk factors may vary widely. The basic principle of forming a general risk group is the presence of 3 or more risk factors in women over 40 years of age and a combination of signs of hyperestrogepia with disorders of fat and/or carbohydrate metabolism. Next, an active search for oncological pathology should be carried out in three target tissues - the endometrium, mammary glands and ovaries. For this purpose, cytological examination of endometrial aspirates, mammography, and ultrasound examination of the pelvis are used.
An important preventive measure for the early detection of cervical pathology is a smear examination for oncocytology. As a rule, in healthy women at any age this analysis must be performed at least once a year. If there are changes in the cervix, cytological examination should be performed more often. Atprenatal preparation A smear for oncocytology is required.

24 hours before taking a smear, you should not douche, have sex, or inject vaginal suppositories, creams and gels. The smear must be taken no earlier than 5 days from the first day menstrual cycle and no later than 5 days before menstruation. Optimal time– 2 weeks before expected menstruation. If there is an inflammatory process in the vagina, then the information content of the study is sharply reduced.

When viewed with gynecological speculum The doctor first removes mucous discharge from the cervix with a tampon. Then, a special cytobrush is used to remove cells from the cervical canal and the outer surface of the cervix, followed by applying the material to a glass slide. To do this, he lightly presses the brush to the mucous membrane and twists it. There is no pain or discomfort. In some cases, with severe inflammation, slight bloody discharge is possible within a few minutes after taking a smear.

In the laboratory, specially trained cytologists examine the smear under a microscope. The result is then delivered to the doctor. The following options are possible:

• the cytogram is without any features, which allows us to consider the woman healthy;
• cytogram of inflammation, which requires additional examination and treatment with subsequent repetition of the study;
• various degrees of cervical dysplasia, which require further examination and treatment in the cervical pathology office;
• cervical cancer, with which a woman is sent for treatment to an oncology clinic.

Regular cytological examination allows for the timely detection of precancerous changes, which is especially important in the presence of cervical erosion, infection with the human papillomavirus and when planning pregnancy. The algorithm for “Taking a smear for cytological examination” is presented in Appendix 2.

Annex 1

Information about the contingent of patients with malignant neoplasms,

registered with oncology institutions in 2014, cervix (p53)

Manipulation technique

Indications

Examination for cancer pathology of women aged 18 years and older

Contraindications

No

Place of manipulation

Examination (manipulation) room

Brigade composition

Examination room midwife

Nurse

Workwear

1. Clean work coat

2. Disposable: mask, cap

3. Disposable apron

Equipment

1. Gynecological chair

2. Observation lamp

3. Manipulation table

4. Mirror of Cusco

5. Tweezers

6. Sterile flares

7. Disposable cervix brush

8. Slide

9. Containers (capacities) for disinfection of medical devices and collection of medical waste

Hand treatment

Hygienic washing

Hygienic antiseptics

Using gloves

Sterile examination gloves

Technique

1. Preparation for the procedure

➢ Wash and dry hands (using soap or skin antiseptic)

➢ Obtain informed consent to perform the procedure

➢ Prepare everything necessary to complete the procedure

➢ Place a disposable napkin on the chair

➢ Explain to the patient the purpose and progress of the procedure. Help you find a comfortable position on the gynecological chair

2.Performing the procedure

➢ Carry out hygienic hand antisepsis

➢ Wear gloves

➢ Take a mirror in your right hand, use the thumb and index finger of your left hand to spread the labia majora, rotate the mirror 90 degrees and carefully insert it into the vagina

➢ Expose the cervix. If mucus is present, it should be removed with sterile balls.

➢ Take the brush in your right hand. Insert the brush into the vagina under eye control and carefully guide its cone into the cervical canal

➢ The material is taken from the junction zone (“transformation zone”) of the flat and columnar epithelium of the cervical canal, to a depth of 0.8 to 2.5 cm.

The “transformation zone” in women after 40 years of age, as well as after diathermocoagulation and cryodestruction, goes into the cervical canal 2.5 cm above the external uterine os, which dictates the need to take material for cytological examination from the cervical canal to a depth of 2.5 cm.

➢ After guiding, press the brush to the surface of the cervix and make 5 full circular movements - three times clockwise and twice counterclockwise

➢ Carefully remove the cervix brush from the vagina

➢ Carefully remove the speculum from the vagina

3.End of the procedure

➢ Apply the contents of the brush onto the glass slide using linear movements along the glass, using both sides of the brush.

➢ Put an identification number on the glass and accompanying direction

➢ Place glass and direction in different shipping containers

➢ Place the napkin, used material, single-use medical devices in containers for collecting (disinfecting) medical waste of class B

➢ Place reusable medical products in containers for disinfection.

➢ Place the brush in a puncture-proof container.

➢ Remove gloves and treat hands with liquid antibacterial soap or skin antiseptic.

Oncology: textbook for universities / Velsher L.Z., Matyakin E.G., Duditskaya T.K., Polyakov B.I. - 2009. - 512 p. -WITH. 110.Oncology: textbook for universities / Velsher L.Z., Matyakin E.G., Duditskaya T.K., Polyakov B.I. - 2009. - 512 p. - P. 135.

Oncology: textbook for universities / Velsher L.Z., Matyakin E.G., Duditskaya T.K., Polyakov B.I. - 2009. - 512 p. - P. 140.

Panchenko S.V. Report of the chief oncologist of the Ulyanovsk region "The state of the oncological service of the Ulyanovsk region in 2011 [Electronic resource]. - Access mode: http://yokod73.narod.ru/docum.html

The state of cancer care for the population of Russia in 2014. / Ed. HELL. Kaprina, V.V. Starinsky, G.V. Petrova. - M.: MNIOI im. P.A. Herzen branch of the Federal State Budgetary Institution "NMRRC" of the Ministry of Health of Russia, 2015. - 236 p.

1.1 The role of the paramedic in federal and regional programs for health improvement and primary health care for the rural population.

Accounting, analysis, organization of agricultural injury prevention. The role of the paramedic in first aid and transportation.

Current state of tuberculosis incidence. Preventive work of a paramedic to identify, medical examination, and prevent tuberculosis.

Current state of incidence of sexually transmitted diseases (syphilis, gonorrhea). The role of the paramedic in active detection. Medical examination, warnings. Standards.

Family approach to health care, elements, principles, primary health care in the work of a medical assistant, connection with health care reform.

Tasks of a paramedic in primary and secondary prevention hypertension.

Activities for primary and secondary prevention. Volume of treatment preventive measures during clinical examination of patients with cirrhosis of the liver.

Basics of health insurance. Principles. Types, purposes, levels of health insurance.

Chronic renal failure syndrome, causes, diagnostic criteria. Functional responsibilities of a paramedic when working with this group of patients.

Objectives and timing of clinical examination after discharge of patients who have undergone acute pneumonia. Features of pneumonia in the elderly.

Concept of health. Components of health. Health diagnostics.

Criteria for the diagnosis of angina pectoris. Scope of care at the prehospital stage, indications for hospitalization, transportation rules.

Criteria for the diagnosis of complications of the acute period of myocardial infarction, the scope of syndromic care for complications of the acute period of myocardial infarction, rules of transportation to the hospital.

Types of prevention: primary, secondary, tertiary. The role of the health worker in their implementation.

The scope of emergency care by a paramedic for acute manifestations of hemorrhagic diathesis against the background of blood diseases.

Coma in diabetes, diagnostic criteria, scope of care, indications for hospitalization. Transportation rules.

The concept of risk factors and primary prevention is the basis for ensuring the health of individuals, families, and society.

Criteria for the diagnosis of rheumatoid arthritis. The tasks of a paramedic in the medical examination of patients.

Criteria for the diagnosis of osteoarthritis. Tasks of a medical assistant for medical examination.

Emergency conditions in patients with heart defects and paramedic tactics for them.

Tactics of a paramedic during the initial meeting with a patient with arterial hypertension syndrome.

Criteria for the diagnosis of myocardial infarction. Scope of prehospital care for uncomplicated myocardial infarction. Transportation rules.

Acute vascular insufficiency syndrome. Diagnosis criteria. Scope of prehospital care. Indications, contraindications and transportation rules.

Chronic syndrome respiratory failure. Diagnosis criteria. Functional responsibilities of a paramedic during medical examination of this group.

Exercise:

1. Presumable diagnosis.

Professional task.

A 40-year-old patient with a peptic ulcer of 12 duodenum severe weakness, dizziness, shortness of breath, palpitations appeared, and blood pressure decreased. Blood analysis; HB 70 g/l; leukocytes 14*10 9 l.

Exercise:

1. Probable diagnosis.

2. Tactics. paramedic

Professional task:

Exercise:

Professional task.

A young woman with atopic bronchial asthma experiences attacks in the spring, during the flowering period of cereals. Sensitization to cereals was proven during an allergological examination.

Professional task.

Call to see a patient on the 2nd day of illness in serious condition. She became acutely ill, with diarrhea and frequent, profuse, watery stools. Vomiting soon followed. I was worried about dry mouth, thirst, and growing weakness. On examination, the temperature is 36.5", the skin is dry, with a cyanotic tint, gathered into a fold, does not straighten out well. The pulse is 130 beats/min. Thread-like, tonic spasms of the muscles of the hands occur periodically.

Exercise:

1. Probable diagnosis?

2. Paramedic tactics?

Professional task.

A mother and a 5-year-old child came to the FAP with complaints of fever, skin rashes, and itchy skin. During the examination, it was determined that the girl fell ill yesterday after returning from kindergarten. On the skin of the scalp, face, and torso there are polymorphic rashes in the form of spots, papules, vesicles, and itching. The pharynx is moderately hyperemic, nasal breathing is difficult, body temperature is 38.3 degrees, pulse is 120 beats per minute, respiratory rate is 25 per minute.

Exercise:

1. Make a preliminary medical diagnosis.

Professional task.

Exercise:

1. Make a presumptive medical diagnosis.

2. Model the tactics of a paramedic.

Professional task.

Calling a patient in serious condition on the 1st day of illness. She became acutely ill: repeated vomiting, abdominal pain, then frequent, loose stools mixed with greens. On examination: temperature 39, dry skin, cyanosis of the lips, pulse 120 per minute, weak filling. The abdomen is soft, moderately painful in the epigastric region and near the navel.

Exercise:

1. Probable diagnosis.

2. Paramedic tactics.

Professional task.

During a car accident, the driver hit his chest on the steering wheel, felt a sharp pain, and could not breathe deeply. On admission, he was in moderate condition, pale, and complaining of chest pain.

Exercise:

1. Probable diagnosis.

2. Paramedic tactics.

Professional task.

An elderly patient with bronchial asthma has a concomitant disease of prostate adenoma.

Which group of bronchodilators is contraindicated for this patient, and why?

Professional task.

A 23-year-old man complains of severe pain in the knee and ankle joints, increased body temperature up to 37.5 C, painful urination, purulent discharge from the urethra.

Exercise:

3. Paramedic tactics.

Professional task.

Exercise:

1. The most likely diagnosis.

2. Consultation with which specialists is necessary.

Professional task.

At the appointment, a patient came in with complaints of lack of appetite and weakness. From the anamnesis it is known; fell ill 10 days ago, a temperature of 37.5" appeared, fatigue. Then a decrease in appetite, nausea, pain in small joints appeared. Weakness increased, 4 days ago I noticed darkening of the urine, and yesterday light stools. On examination; the condition is relatively satisfactory, mild jaundice coloration of the sclera, enlargement of the liver 2 cm below the edge of the costal arch.

Exercise:

1. Presumable diagnosis.

3. Paramedic tactics.

Professional task.

A 3-month-old child is undergoing preventive care. No complaints. Healthy. In the anamnesis, at the age of 1 month, a short-term allergic reaction in the form of urticaria was noted; the causative allergen was not identified. In the maternity hospital he was vaccinated against tuberculosis.

Exercise:

1. What immunobiological preparations are appropriate to start immunization with?

Professional task.

Professional task.

A patient came to see the paramedic with complaints of poor vision - blurry vision, squint, difficulty speaking - nasal voice, difficulty swallowing, heaviness in the stomach. The day before I ate canned food from a bulging jar.

Exercise:

1. Presumable diagnosis.

2. Scope of pre-hospital emergency care.

Professional task.

In the kindergarten, the children received kefir for an afternoon snack. A nanny who had a boil on her hand took part in the distribution of food. The next morning, several children were admitted to the hospital in serious condition, with high fever, vomiting, and general toxicosis.

Exercise:

1. Presumable diagnosis.

2. What measures should be taken in the d/s in relation to the 3 links of the epidemiological process.

Professional task.

Child 2 years old. Is it possible to carry out a routine vaccination against mumps if there is a measles quarantine in the nursery group he attended? According to the medical history, the child had measles at the age of 1 year.

Professional task.

Analyze the birth rate in your area. Explain your reasons. Outline specific measures to improve this demographic indicator.

Professional task.

Analyze the abortion rate per 1000 women of fertile age in your area, outline specific measures to improve the indicator.

Professional task.

What is the incidence of tuberculosis in your area? What work are you doing for early detection and prevention of tuberculosis?

Professional task

Pregnant A., 30 years old, registered for pregnancy at 12 weeks of pregnancy, does not smoke, does not drink alcohol, weight 76 kg with a height of 160 cm. First pregnancy, myopia is noted among extragenital diseases. During examination, Hb was 86 g/l. The pregnancy was complicated by stage III nephropathy and fetal malnutrition.

Professional task

Pregnant K., 20 years old, registered for pregnancy at 6 weeks of pregnancy. Smoking is noted as a bad habit. This is my 2nd pregnancy, the first ended 2 years ago with premature birth. Among extragenital diseases, pyelonephritis is noted. During examination, Hb was 110 g/l. At 30 weeks Hb - 96 g/l, dropsy. At 38 weeks Hb - 110 g/l. There is no toxicosis phenomenon.

Professional task

A 20-year-old primigravida consulted a paramedic with bleeding from the genital tract; the bleeding continued for 2 hours and at times intensified. She is 30 weeks pregnant.

Exercise:

1. Preliminary diagnosis.

2. Your tactics.

3. Necessary first aid.

Professional task.

Exercise:

1. Model a paramedic's tactics on a priority problem.

Professional task.

On the bus, one of the passengers suddenly became ill. Severe pain occurred behind the sternum, radiating to the left arm and shoulder blade; feeling of lack of air, dizziness, weakness. On examination, the skin is pale, covered with cold sweat, pulse is 50-52 per minute, weak filling, breathing is shallow and rapid.

Exercise:
1. What is the cause of the serious condition?

Professional task.

Exercise:

1. Outline the paramedic’s tactics in this situation.

Professional task.

An 8-year-old child was diagnosed with bronchial asthma, atopic form. Increased sensitivity to household allergens was revealed. On the doctor's recommendation, pets (dog, cat), feather pillows, and indoor plants were removed from the apartment. But the child’s condition has not improved, despite regular medication use; asthma attacks persist 2-3 times a week, often at night.

Professional task.

Professional task.

The young man suddenly developed sharp pains in the upper abdomen. He reported that he had been suffering from a stomach ulcer for 5 years. He asks to give him atropine and analgin, which he previously took when experiencing moderate pain. Pale, pulse up to 120 per minute with weak filling. The abdomen is sharply painful, the patient does not allow the abdomen to be touched.

Exercise:

1. What complication can be suspected?

2. List the first aid measures.

3. Paramedic tactics.

Professional task.

A 3-month-old child is in foster care. The girl is exclusively breastfed, was born with a weight of 3200.0, length 53 cm, currently weighs 6200.0 length 60 cm. In response to communication, she smiles, gurgles, and waves her arms; holds the head well in a vertical position, with support from the armpits, rests well with legs bent at the knees and hip joints; fixes his gaze on stationary objects, being in any position. There is “gneiss” on the scalp, on the cheeks there is hyperemia, dry skin, peeling; slight redness of the skin in the inguinal folds.

2. Which pathological condition should be assumed based on skin manifestations and body weight.

3. Paramedic tactics.

Professional task.

Professional task.

Exercise:
1. The most likely diagnosis.

2. Paramedic tactics.

Professional task.

A patient with stage II hypertension took 1 tablet of clonidine 0.15 mg. regarding headaches with nausea, suggesting that her blood pressure had risen (she did not measure her blood pressure before taking the pill). 1 hour after taking the pill, I got out of bed and fell and lost consciousness. Relatives who arrived found pallor of the skin, cold sweat and a thread-like pulse, and called a paramedic.

Exercise:
1. Determine what caused the change in the patient’s condition, formulate a diagnosis?

2. Provide emergency assistance. Does the patient need transportation?

3. What advice would you give to the patient if you leave her at home?

Professional task.

A 42-year-old hunter was bitten in the area of ​​the left wrist joint by a fox while removing the animal from a trap.

Exercise:

1. The paramedic’s tactics in relation to all 3 links of the epidemiological process.

Professional task.

A 43-year-old patient came to the appointment with complaints of severe swelling right hand and the presence of an ulcer. Got sick 5 days ago. Approximately 7-8 days before the illness, I participated in cutting up the carcass of a forcedly slaughtered animal. An objective examination reveals pronounced painless swelling of the hand, the bottom of which is covered with a black, painless crust. The right axillary lymph node is enlarged.

Exercise:

1. Probable diagnosis.

2. Anti-epidemic measures.

3. Paramedic tactics.

Professional task.

Patient E., 18 years old, 1 day of illness. Complains of headache, pain in the eyeballs when moving the eyes, dry cough, scratching behind the sternum, temperature 39, bright face, injection of scleral vessels, rhythmic pulse 104 per minute, satisfactory filling, blood pressure 100/65 mm. rt. Art.

Exercise:
1. Presumable diagnosis.

2. Tactics.

3. Anti-epidemic measures.

3.1.1 Respiratory diseases.

Tracheitis, bronchitis, acute and chronic. Etiology, pathogenesis. Clinic, treatment. Prevention. Clinical examination.

Bronchial asthma, etiology, pathogenesis, clinical picture, treatment during an attack and in the inter-attack period, prevention, medical examination.

Acute pneumonia: lobar, focal. Etiology, pathogenesis. Morphology, clinic, diagnosis, treatment. Care and emergency assistance for complications. Prevention, medical examination.

The concept of pneumosclerosis and emphysema. Clinic, treatment, medical examination, patient care.

Bronchiectasis and chronic lung abscess, etiology, clinical picture, diagnosis. Leave conservative treatment in an outpatient setting without exacerbation. Prevention, medical examination.

The concept of acute and chronic respiratory failure.

Situational task.

A young woman with atopic bronchial asthma experiences attacks in the spring, during the flowering period of cereals. Sensitization to cereals was proven during an allergological examination. Give recommendations to the woman on how to prevent exacerbations. Formulate a diagnosis. Recommend the drug during a dangerous period for the patient.

Situational task.

An elderly patient with bronchial asthma has a concomitant disease of prostate adenoma. Which group of bronchodilators is contraindicated for this patient, and why?

3.2.1 Tuberculosis. Features of tuberculosis in childhood and adolescence.

Respiratory tuberculosis. Routes of infection. Medical and social significance, risk groups. Flow options. The tasks of a paramedic when conducting anti-relapse treatment. Life-threatening complications. Amount of assistance.

Tasks of a paramedic according to the dignity. epid. regimen and specific and nonspecific prophylaxis.

Modern features of diagnosis, course, prevention, treatment, medical examination, rehabilitation.

Methods for early detection of tuberculosis in children.

Methods for early detection of tuberculosis in adults.

3.3.1 Rheumatism. Rheumatic heart defects. Chronic circulatory failure

Rheumatism. Causes and predisposing factors. Clinical syndromes, diagnostic criteria for FAP. Features of treatment and diagnosis at the present stage. Tasks of the paramedic in primary and secondary prevention. Drug provision for patients with rheumatism in the conditions of the FAP.

Heart defects. Diagnostic criteria. Prevention of decompensation. Complications and help with them. The concept of conservative and surgical treatment.

Chronic circulatory failure. Causes. Diagnostic criteria. Stages Diet, regimen, drug treatment on an outpatient basis (paramedic tasks in this case).

Iron deficiency conditions. the work of a paramedic to prevent them. Screening programs to identify

Iron deficiency conditions. The work of a paramedic to prevent them. Screening programs for identification.

Prevention and early detection of vitamin B12 and folic acid deficiency.

Primary prevention of risk factors that inhibit bone marrow function.

3.13.1 Hemorrhagic diathesis. Hemoblastoses.

Hemorrhagic diathesis. Pathogenetic classification. Symptoms, local and general remedies to stop bleeding, medical examination.

Emergency care for bleeding due to hemophilia.

Emergency care for bleeding of platelet origin.

Signs of the skin and mucous membranes of thrombocytopenia.

Signs of the skin and mucous membranes of disorders of plasma coagulation factors.

3.14.1 Rheumatoid arthritis. Osteoarthrosis. Concept of Systemic diseases connective tissue.

Rheumatoid arthritis. Causes, signs, scope of examination. Tasks of a paramedic for medical examination and rehabilitation.

Osteoarthritis. The influence of professional conditions of livestock breeders and agricultural workers. Scope of examination, diagnostic criteria. Tasks of the paramedic in primary and secondary prevention.

The tasks of a paramedic in the primary and secondary prevention of musculoskeletal diseases in the rural population.

Brief concepts about Reiter's syndrome, Bechterew's disease and their place in the practice of a paramedic.

Situational task.

A 23-year-old man complains of severe pain in the knee and ankle joints, increased body temperature up to 37.5 C, painful urination, purulent discharge from the urethra.

1. The most likely diagnosis.

2. Consultation with what specialists is required.

3. Paramedic tactics.

4.1.1 Introduction. Organization of surgical care at the paramedic-midwife station. The concept of pain relief.

The main types of surgical care provided at the primary care stage in the conditions of a primary care facility.

Regulatory orders regulating surgical care for the rural population.

Methods of pain relief necessary in the practical work of a paramedic.

Ensuring phasing and continuity in the provision of surgical care.

Situational task.

In a 25-year-old patient, in the right mammary gland in the upper outer quadrant, 2 areas of compaction measuring about 1.5 cm are identified, which become denser and become painful in the premenstrual period. Upon examination, there are no symptoms of pathological changes in the skin, the lymph nodes are not enlarged, and the nipples are symmetrical.

1. The most likely diagnosis.

2. What specialists are needed to consult?

Methods of hand disinfection in a medical facility.

Rules for primary surgical treatment of wounds, taking into account their specifics.

Rules for storing sterile material.

Applying and removing sutures.

Ensuring infection safety of patients and health workers in surgery and traumatology.

4.3.1 Types of bleeding. Signs, complications (fainting, collapse, shock), emergency care. Organization of donation at the FAP.

Types of external bleeding. Signs. Complications. Paramedic tactics.

Types of internal bleeding. Signs. Complications. Paramedic tactics.

Situational task

The patient is 28 years old, long time suffering from constipation, over the last month they began to appear, bloody issues during the act of defecation. There was a history of occasional light blood in the stool. Upon examination, no pathology was revealed in the anal area.

1. Probable diagnosis.

2. Which specialist’s consultation is needed.

3. What instrumental examination is necessary.

Methods of using hemostatic agents.

Pre-medical diagnosis and assistance for hemorrhagic shock.

4.4.1 Injuries: types of injuries and injuries. Issues of prevention of agricultural injuries. Desmurgy, types, requirements for dressings: wounds, burns, frostbite.

Pre-medical diagnosis of mechanical injuries, principles of organizing pre-hospital care.

Pre-medical diagnosis of thermal injuries, principles of organizing pre-hospital care.

Situational task.

A 30-year-old patient complained of pain in the area of ​​the second finger of the right hand and noted that he injured his finger with a needle 3 days ago. The temperature was 37.2. Locally, there is an infiltration in the injection area; a drop of pus is visible under the epidermis.

1. What complicated the finger injury?

2. What does the presence of temperature indicate?

3. Paramedic tactics.

Pre-medical diagnosis of burns and frostbite by degree.

Prehospital care for burns and frostbite.

4.5.1 Acute and chronic surgical infection.

Pre-medical diagnosis, development of the correct tactics for acute and chronic surgical infections.

Clinical examination. Medical and social rehabilitation of patients who have had a surgical infection.

Situational task.

In a patient with a boil of the forearm, 2 days after the onset of the disease, painful stripes of skin hyperemia appeared, heading towards the elbow, and an increase in temperature was noted.

1. Probable diagnosis.

2. Paramedic tactics.

Clinical examination of surgical patients with acute and chronic infection.

Indications for urgent hospitalization for local surgical infection.

4.6.1 Tumors, classification by stage, early signs of tumors of different locations, the role of targeted medical examinations.

Early detection of visually localized tumors at stage I.

Clinical examination and organization of care for incurable patients.

Situational task.

A 30-year-old man complained of swelling and pain in the area of ​​the right shoulder blade. Upon examination, a round tumor-like formation with a diameter of 2 cm is determined, associated with the skin, there is a pore, palpation in this area is painful.

1. Probable diagnosis.

2. Paramedic tactics.

Situational task.

A 25-year-old patient complained of the presence of a tumor-like formation in the suprascapular region, causing a cosmetic defect. Upon examination, a round, doughy consistency, mobile formation, not connected to the skin, measuring 10x12 cm, lobulated in structure, painless on palpation, the skin over it is not changed, is determined in this area.

1. Probable diagnosis.

2. Paramedic tactics.

The role of the paramedic in the early and timely diagnosis of tumors.

4.7.1 Injuries and diseases of the head, spine, pelvis. Spondylitis, spina bifida. Injuries and diseases of the neck, trachea, larynx, esophagus.

Pre-medical diagnosis of traumatic brain injuries of the spine, transportation rules.

Clinical examination and medical and social rehabilitation after spinal injuries, after traumatic brain injury.

Rules for transportation in case of traumatic brain injury.

Rules for transportation in case of spinal injury.

Prevention and management of life-threatening complications from traumatic brain injury.

4.8.1 Injuries and diseases of the limbs.

Developing the correct tactics for a paramedic in relation to a patient with acute limb injuries.

Medical examination for vascular diseases of the extremities.

Situational task.

A 72-year-old patient was brought in from the street after falling on her right side. The patient complains of pain in the groin area; the leg is in a position of incomplete external rotation, shortened by 2 cm. The most likely diagnosis. Paramedic tactics.

Principles of transport immobilization.

Clinical examination and medical and social rehabilitation for injuries and diseases of the limbs.

4.9.1 Injuries and diseases of the chest organs.

Closed chest injuries.

Open chest injuries.

Breast disease.

Situational task.

During a car accident, the driver hit his chest on the steering wheel, felt a sharp pain, and could not breathe deeply. On admission, he was in moderate condition, pale, and complaining of chest pain. Probable diagnosis. Paramedic tactics.

Pneumothorax. Types of diagnostic criteria. Pre-medical care at the primary care stage.

4.10.1 Injuries and diseases of the abdominal organs.

Situational task.

A 40-year-old patient with duodenal ulcer developed severe weakness, dizziness, shortness of breath, palpitations, and decreased blood pressure. Blood analysis; HB 70 g/l; leukocytes 14*10 g/l. Probable diagnosis. Tactics. paramedic

Situational task.

As a result of a car accident, a stomach injury occurred. The victim is in serious condition. The skin is sharply pale, the number of respirations is up to 22 per minute, the pulse is up to 120 per minute, and the filling is weak. There is a wound up to 10 cm long on the anterior surface of the abdominal wall on the left. A loop of intestine protrudes from the wound and there is profuse bleeding.

1. Presumable diagnosis.

2. List the first aid measures.

3. How to apply a bandage to the wounded area?

Situational task.

A young man complained of abdominal pain that lasted for 6 hours. He vomited twice, which did not bring relief, and his body temperature rose to 37.7* C. The pain is localized in the lower right half of the abdomen. There was no chair. The abdomen is sharply tense, its palpation is sharply painful.

1. Presumable diagnosis.

2. Indicate the scope of first pre-medical aid.

3. Does the patient need emergency hospitalization?

Situational task.

The young man suddenly experienced sharp pain in the upper abdomen. He reported that he had been suffering from a stomach ulcer for 5 years. He asks to give him Maalox, which he previously took when experiencing moderate pain. Pale, pulse up to 120 per minute with weak filling. The abdomen is sharply painful, the patient does not allow anyone to touch his abdomen. What complication can be suspected? List the first aid measures.

Early diagnosis acute abdomen and abdominal injuries, transportation rules.

4.11.1 Damage and diseases of the genitourinary organs. Acute urinary retention syndrome.

Closed injuries of the genitourinary organs.

Open injuries to the genitourinary organs.

Acute urinary retention. Paramedic tactics.

Implementation of the nursing process by a chronic urological patient.

The role of the paramedic in the medical examination and rehabilitation of patients who have suffered surgical operations on the genitourinary organs.

4.12.1 Diseases of the teeth and oral cavity.

Inflammatory diseases of the oral mucosa.

Diseases of hard dental tissues. Prevention.

Diseases of the jaw and perimaxillary region.

5.1.1 Infection control. Introduction.

Ensuring infection safety of the patient and paramedic.

Compliance with the sanitary, hygienic and anti-epidemic regime of the FAP.

Carrying out immunoprophylaxis.

Providing a system for interaction between FAP and sanitary and epidemiological institutions, filling out documentation.

Carrying out anti-epidemic measures in the event of a source of infection.

Collection and delivery of biological material for laboratory research.

5.2.1 Intestinal infections.

Situational task.

A patient came to see the paramedic with complaints of poor vision - blurred vision, squint, difficulty speaking - nasal voice, difficulty swallowing, heaviness in the stomach. The day before I ate canned food from a bulging jar. What should you think about? Helping a sick person? Paramedic Tactics?

Situational task.

In the kindergarten, the children received kefir for an afternoon snack. A nanny who had a boil on her hand took part in the distribution of food. The next morning, several children were admitted to the hospital in serious condition, with high fever, vomiting, and general toxicosis. What should you think about? What measures should be taken in the d/s?

Situational task.

Call to see a patient on the 2nd day of illness in serious condition. She became acutely ill, with diarrhea and frequent, profuse, watery stools. Vomiting soon followed. I was worried about dry mouth, thirst, and growing weakness. On examination, the temperature is 36.5", the skin is dry, with a cyanotic tint, gathered into a fold, does not straighten out well. The pulse is 130 beats/min. Thread-like, periodically tonic spasms of the muscles of the hands occur. Presumable diagnosis. Paramedic tactics.

Situational task.

A 45-year-old patient, a plumber by profession, came in on the 7th day of illness with complaints: fever, headache, insomnia, slight cough. The disease began gradually - chills, malaise, a rise in temperature, which by the 5th day became high 39.0 "On examination: the patient is lethargic, somewhat lethargic, pale, pulse 80 beats/min, blood pressure 100/60, tongue coated with a dark coating, abdomen moderate painful in the right iliac region, rumbling in the abdomen, enlarged spleen. Probable diagnosis. Tactics of the paramedic.

Situational task.

Call to a patient in serious condition on the 1st day of illness. She became acutely ill: repeated vomiting, abdominal pain, then frequent, loose stools mixed with greens. On examination: temperature 39, dry skin, cyanosis of the lips, pulse 120 per minute, weak filling. The abdomen is soft, moderately painful in the epigastric region and near the navel. Probable diagnosis. Paramedic tactics.

5.3.1 Viral hepatitis. Leptospirosis. Brucellosis. Psittacosis. Foot and mouth disease.

While caring for a 3-month-old child, the paramedic drew attention to the mother’s complaints of weakness, decreased appetite, bitterness in the mouth, nausea, and heaviness in the right hypochondrium. When examining the mother, there is slight yellowness of the sclera. History of difficult labor with blood loss and blood transfusion. Presumable diagnosis. Paramedic tactics.

A patient, a worker in the slaughterhouse of a meat processing plant, on the 2nd day of illness with complaints of high fever, chills, severe headaches, pain in the calf muscles, in the right hypochondrium and in the lumbar region. Upon examination; moderate condition, temperature 39.0, face hyperemic, puffy, injection of scleral vessels, herpes with hemorrhagic contents on the lips. Moderate stiffness of the neck muscles, the liver is enlarged by 2 cm, painless, palpation of the muscles is sharply painful. Probable diagnosis. Paramedic tactics.

A pig farm worker consulted a doctor with complaints of general weakness, sweating, poor sleep, a temperature of up to 39, which she noticed by chance, pain in the shoulder and knee joints, muscles. Premature farrowings were observed on the farm. Presumable diagnosis. Paramedic tactics.

Clinical examination, rehabilitation, convalescents.

Admission of convalescents to preschool institutions, schools, and work.

Prevention of viral hepatitis B and C, identification and treatment of patients as part of the implementation of the Priority National Project in the field of health care.

5.4.1 Respiratory tract infections.

Situational task.

The patient, 17 years old, applied on the 5th day of illness. She became acutely ill. Temperature 38.5, enlarged posterior cervical, occipital, axillary, and inguinal lymph nodes. There is hyperemia in the pharynx, the tonsils are enlarged and painful, there is pus in the lacunae. An enlarged spleen is palpated, the liver is 2 cm. Presumable diagnosis. Paramedic tactics.

Situational task.

Patient E., 18 years old, 1 day of illness. Complains of a headache. pain in the eyeballs when moving the eyes, dry cough, scratching behind the sternum, temperature 39.0", bright hyperemia, injection of scleral vessels, rhythmic pulse 104 beats/min, satisfactory filling. Blood pressure 100/65 mm Hg. Presumable diagnosis Paramedic tactics.

Situational task.

A kindergarten teacher came in with complaints of malaise, cough, runny nose, sore throat, and high body temperature up to 38", she has been sick for 4 days. On examination - hyperemia of the pharynx, the tonsils are enlarged, swollen, a moderate enlargement of the submandibular lymph nodes is palpable. In the lungs there is b/ changes. The patient said that in the nursery where she works for the last 2 weeks, children have been experiencing an illness that occurs with high fever, cough, runny nose, conjunctivitis. Presumable diagnosis. Tactics of the paramedic.

Clinical examination, rehabilitation of convalescents.

Admission to preschool institutions, school, and convalescent work.

5.5.1 Blood infections.

Situational task

Calling to a patient in serious condition. From the anamnesis it is known that he was sick for 5 days, temperature 38-39", severe headaches. Then nausea, vomiting, pain in the abdomen and lumbar region. There was nose bleed. Diuresis decreased. On examination, the face is hyperemic, there is an injection of scleral vessels, and there are multiple hemorrhagic rashes on the skin. The abdomen is moderately painful, near the navel. Positive symptom Pasternatsky on both sides. On the day of illness, he returned from building a summer house in a suburban area.

Presumable diagnosis.

Situational task.

District patient K., 45 years old. When collecting anamnesis, it turned out that he had been ill for the 3rd day. the disease began suddenly, with stunning chills, headache, muscle pain, temperature 40", after a few hours the temperature dropped sharply to 36". The patient sweated profusely, fell asleep, felt well for 2 days, and had a normal temperature. This morning, sharp chills reappeared, the temperature rose to 40", headache. The epidemiological history includes a recent business trip to Central Asia. What should you think about? What diagnostic method can confirm the diagnosis? Presumptive diagnosis. Paramedic tactics.

Activities in relation to the 3rd links of the epidemiological process.

Clinical examination, rehabilitation of convalescents and bacteria carriers.

Admission to preschool institutions, school and work.

5.6.1 Infections of the external integument.

Situational task.

A 43-year-old patient came to the consultation with complaints of severe swelling of the right hand and the presence of an ulcer. Got sick 5 days ago. Approximately 7-8 days before the illness, I participated in cutting up the carcass of a forcedly slaughtered animal. An objective examination reveals pronounced painless swelling of the hand, the bottom of which is covered with a black, painless crust. The right axillary lymph node is enlarged. Probable diagnosis. Anti-epidemic measures. Paramedic tactics.

Situational task.

A 42-year-old hunter was bitten in the area of ​​the left wrist joint by a fox while removing the animal from a trap. Tactics of a paramedic in relation to all 3 links of the epidemiological process.

Tactics of a paramedic in relation to the 3rd links of the epidemiological process for anthrax.

Tactics of a paramedic in relation to the 3rd links of the epidemiological process for tetanus.

Tactics of a paramedic in relation to the 3rd links of the epidemiological process in case of rabies.

5.7.1 HIV infection.

Prevention of HIV infection at the paramedic station.

The causative agent of HIV infection and routes of transmission.

Current state of the problem of HIV infection.

Etiology, epidemiology, clinic, treatment, prevention.

Prevention of HIV infection in the conditions of a paramedic and midwife station.

Prevention of HIV infection, identification and treatment of HIV patients as part of the implementation of the Priority National Project in the field of health care.

6.1.1 Organization of obstetric and gynecological care in Russia. Obstetric care for pregnancy pathologies.

The tasks of the FAP in organizing obstetric and gynecological care for the rural population.

Federal and regional programs for maternal health.

Preventive orientation of the work of a paramedic.

Strategy for improving women's health taking into account risk factors.

Toxicoses of the first and second half of pregnancy. The role of the paramedic in their prevention.

Directions of preventive work of a paramedic on pre- and perinatal prevention within the framework of a priority national project in healthcare, legal framework

6.2.1 Pregnancy and childbirth with extragenital pathology. Miscarriage. Tasks of a paramedic in family planning. Abortion and its consequences.

Extragenital diseases and pregnancy. Identification of risk groups for extragenital pathology. Principles of management of pregnant women with extragenital pathology.

The role of the FAP paramedic in the management of pregnant women with extragenital pathology.

Advisory and explanatory work of a paramedic on family planning.

Solve a situational problem.

Pregnant A., 30 years old, registered for pregnancy in the weeks of pregnancy, does not smoke, does not drink alcohol, weight 76 kg with a height of 160 cm. First pregnancy, myopia is noted among extragenital diseases. During examination, Hb was 86 g/l. The pregnancy was complicated by stage III nephropathy and fetal malnutrition. Calculate points and determine the risk group.

Solve a situational problem.

Pregnant K., 20 years old, registered for pregnancy at 6 weeks of pregnancy. Smoking is noted as a bad habit. This is my 2nd pregnancy, the first ended 2 years ago with premature birth. Among extragenital diseases, pyelonephritis is noted. During examination, Hb was 110 g/l. At 30 weeks Hb - 96 g/l, dropsy. At 38 weeks Hb - 110 g/l. There is no toxicosis phenomenon. Calculate points and determine the risk group.

6.3.1 Emergency care during childbirth. Obstetric (maternal) traumatism.

Rupture of the perineum of the cervix. Classification by degree. Management in the postpartum period.

Clinic, course of labor, delivery.

The role of the paramedic in the prevention of childbirth complications.

Uterine rupture (mechanical, histopathic), their prevention.

Clinic of threatening, ongoing, accomplished uterine rupture. Urgent Care.

6.4.1 Bleeding during pregnancy, childbirth and the early postpartum period. Blood transfusion and blood substitutes in obstetrics. Asphyxia of the fetus and newborn.

Bleeding during pregnancy and childbirth. Causes. Clinic. Emergency help. Transportability criteria.

Solve a situational problem:

A 20-year-old primigravida consulted a paramedic with bleeding from the genital tract; the bleeding continued for 2 hours and at times intensified. She is 30 weeks pregnant. Preliminary diagnosis? What's your tactic? Necessary first aid?

Paramedic tactics for various types of obstetric hemorrhage.

Asphyxia of the fetus and newborn, prevention.

Comparison of the Algover-Burri shock index with the volume of blood loss.

Index 0.8 or less - the volume of blood loss is equal to 10% of the total blood circulation.

Index 0.9-1.2 - the volume of blood loss is equal to 20% of the total blood circulation.

Index 1.3-1.4 - the volume of blood loss is equal to 30% of the total blood circulation.

6.5.1 Obstetric operations. Postpartum septic diseases.

Postpartum infectious diseases. Classification, clinical forms. Principles of treatment.

The role of the FAP paramedic in the prevention of postpartum septic diseases.

Postpartum mastitis as a manifestation of nosocomial infection. Clinical forms, principles of treatment, prevention.

Sazonov-Bartels classification of postpartum infectious diseases.

Prevention of cracked nipples.

6.6.1 Gynecology. Inflammatory gynecological diseases. Physiology and pathology of the menstrual cycle. Modern methods of contraception.

Classification, diagnosis, treatment of nonspecific inflammatory diseases of the female genital area.

Classification, diagnosis, treatment of specific inflammatory diseases of the female genital area.

Pathology of the menstrual cycle.

Primary and secondary prevention of inflammatory diseases of the female genital area.

Normal menstrual cycle.

6.7.1 Benign neoplasms of the female genital organs. Precancerous diseases and malignant neoplasms of the female genital organs.

Complications of benign tumors, paramedic tactics.

Clinical examination of background and precancerous diseases at the FAP.

Targeted medical examinations for early detection of neoplasms of the female genital organs.

Primary and secondary prevention of neoplasms in the work of a paramedic.

Classification of neoplasms of the female genital organs.

6.8.1 Acute abdomen.

A young woman developed acute pain in her lower abdomen 4 hours ago. Then dizziness appeared, “flickering spots” appeared before the eyes, a feeling of lack of air. It is known that the patient has a delay of menstruation by 2-3 weeks. On examination: the patient is sharply pale, pulse up to 110 per minute, somewhat weakened. The abdomen is moderately tense, palpation in the lower parts is painful.

What pathology can be assumed in this patient? List the first aid measures and the method of transportation to the hospital. Probable diagnosis. Paramedic tactics.

Anamnesis collection, sequence of examination by a paramedic for suspected acute abdomen.

Organizational tactics of a paramedic in case of suspected acute abdomen.

"Acute abdomen" syndrome with disturbed ectopic pregnancy. Clinic, diagnostics, first aid.

"Acute abdomen" syndrome with ovarian apoplexy. Clinic, diagnostics, first aid.

7.1.1 Organization of medical and preventive care for children at the medical and obstetric station. Anatomical and physiological characteristics of a newborn, care for him.

Organization of treatment and preventive care for children in rural areas.

Paramedic care for newborns.

Federal and regional programs for child protection.

Signs of term and prematurity according to WHO criteria.

Peculiarities of care for newborns and premature babies in the conditions of a primary care facility.

7.2.1 Physical and neuropsychic development of the child. Screening program for monitoring the health status of children.

Factors influencing the physical development of children.

Methods for assessing the physical development of children.

Timing of assessments of neuropsychic development of children.

Comprehensive assessment of children's health.

Hereditary diseases. Neonatal screening – concept, nosology, regulatory framework.

7.3.1 Diet for infants and toddlers.

Anatomical and physiological features of the digestive tract in children.

Principles for successful breastfeeding.

The role of the paramedic in the prevention of hypogalactia in the mother.

Nutrition of children with manifestations of food allergies.

The role of the FAP paramedic in organizing rational nutrition for children of different ages.

7.4.1 Features of the structure and function of organs and systems in a child of early and preschool age. Hygiene of children and adolescents.

Organization and control of nutrition at school. The role of the paramedic.

Medical supervision of a paramedic physical education and schooling.

Early detection of deviations in the physical and mental development of adolescents at FAP.

Development and implementation of routine preventive examinations of young men, the role of the paramedic.

Sanitary and hygienic control of decreed groups in children's institutions, the role of the paramedic.

7.5.1 Features of caring for a sick child. Diseases of newborns. Hereditary diseases in children.

Features of collection and delivery of material for laboratory research in children, the role of a paramedic.

Purulent-septic diseases of newborns. Features of the flow. Paramedic tactics.

Clinical observation of newborns who have had sepsis.

Risk factors for hereditary diseases. Early diagnosis, prevention at FAP.

Organizing care and nutrition for a sick child at home.

7.6.1 Digestive and nutritional disorders in children.

The role of the paramedic in the prevention of digestive and nutritional disorders in rural conditions.

The concept of the syndrome of functional disorders of the digestive tract in children, the role of the paramedic in rehabilitation.

Chronic eating disorders in children, their prevention and treatment at FAP.

Gastroenteritis, gastritis, cholecystitis in children. Risk factors. Primary and secondary prevention.

Prevention of helminthic infestations in children, the role of the paramedic.

7.7.1 Borderline conditions in young children

Risk factors for constitutional anomalies. Primary prevention at FAP.

Features of the organization of care and nutrition for allergic diathesis.

Features of medical examination for neuro-arthritic and lymphatic-hypoplastic diathesis.

Specific and nonspecific prevention of rickets on FAP.

Risk factors for hypovitaminosis, early manifestations, prevention at FAP.

7.8.1 Respiratory diseases in children.

Anatomical and physiological features of the respiratory system in children of different ages.

Features of the course of upper respiratory tract diseases in children of different ages, paramedic tactics.

Acute nonspecific lung diseases in children. Risk factors, primary and secondary prevention at FAP.

Respiratory allergies in children of different ages, risk factors, primary and secondary prevention for FAP.

Recurrent chronic lung diseases, primary and secondary prevention at FAP, rehabilitation.

Situational task.

A 6-year-old boy was discharged from the hospital, where he was first diagnosed with bronchial asthma, atopic form, moderate course. At the time of examination, he has no complaints, PSV, the morning indicator is 85% of the required values. Receives basic therapy intal, if symptoms of suffocation appear, it is recommended to use a salbutamol metered-dose inhaler. When visiting the child at home, the paramedic noted that the apartment was smoky (the father smokes), there was a lot of dust, there was a cat, and the rooms had fleecy flooring.

1) Model a paramedic's tactics on a priority problem.

Situational task.

A 10-year-old boy has been suffering from bronchial asthma for 2 years. Currently, he has no complaints, is active, has no cough or shortness of breath. Over the past month, there have been no attacks of suffocation; peak flow measurements range from 80% to 95% of the expected values. He receives basic therapy (intal, zaditen), but takes medications irregularly, and believes that he has recovered.

1) Outline the paramedic’s tactics in this situation.

Situational task.

An 8-year-old child was diagnosed with bronchial asthma, atopic form. Increased sensitivity to household allergens was revealed. On the recommendation of the doctor, pets (dog, cat), feather pillows, houseplants. But the child’s condition has not improved, despite regular medication use; asthma attacks persist 2-3 times a week, often at night.

Situational task.

A 7-year-old child was diagnosed with bronchial asthma; the doctor prescribed a Berotek metered-dose inhaler to relieve asthma attacks. While visiting a child at home, the paramedic found out that the patient had difficulty using an inhaler and could not take a deep breath during an attack.

7.9.1 Diseases of the cardiovascular system, musculoskeletal system and kidneys in children.

Anatomical and physiological features of the cardiovascular system in children.

Congenital heart defects. Classification, early diagnosis. Primary and secondary prevention and rehabilitation at FAP.

Rheumatism and inflammatory lesions of the membranes of the heart, features of the course in children. Primary and secondary prevention at FAP.

Risk factors, primary and secondary prevention of glomerulonephritis in children.

Risk factors, primary and secondary prevention of pyelonephritis in children.

7.10.1 Diseases of the blood and hematopoietic organs in children.

Risk factors and features of anemia in children. Primary and secondary prevention at FAP.

Risk factors and features of leukemia in children. Primary and secondary prevention at FAP.

The concept of comas in diabetes. Features of the provision of first-aid care at the FAP.

Risk factors and features of hemorrhagic diathesis in children. Primary and secondary prevention at FAP.

Risk factors and characteristics of diabetes in children. Primary and secondary prevention at FAP.

7.11.1 Emergency syndromic care for children in the conditions of a paramedic and obstetric station.

The main syndromes that threaten the life of a child. Features of the course in children of different ages.

Features of CPR for children of different ages. Implementation of CPR at the first aid station.

Features of poisoning in children. The most common poisonings and their prevention.

Peculiarities medication assistance for life-threatening syndromes of the child, single dosages by age.

Organization of emergency syndromic care for children in the conditions of a primary care facility.

7.12.1 Intestinal infections, acute viral respiratory infections in children.

Situational task.

Call to a patient in serious condition on the 1st day of illness. She became acutely ill: repeated vomiting, abdominal pain, then frequent, loose stools mixed with greens. Upon examination; temperature 39.0", dry skin, cyanosis of the lips, pulse 120 beats/min. weak filling. The abdomen is soft, moderately painful in the epigastric region and near the navel. Probable diagnosis? Paramedic's tactics?

Situational task.

At the appointment, a patient came in with complaints of lack of appetite and weakness. From the anamnesis it is known; fell ill 10 days ago, a temperature of 37.5" appeared, fatigue. Then a decrease in appetite, nausea, pain in small joints appeared. Weakness increased, 4 days ago I noticed darkening of the urine, and yesterday light stools. On examination; the condition is relatively satisfactory, mild jaundice coloring of the sclera, enlargement of the liver 2 cm below the edge of the costal arch. Presumable diagnosis? Anti-epidemic measures? Paramedic tactics.

Features of the course of intestinal infections in children of different ages, possible complications.

Features of the course of acute respiratory infections viral diseases in children of different ages, possible complications.

Organization of oral rehydration therapy for children of different age groups with acute intestinal infections.

7.13.1 Measles. Rubella. Scarlet fever. Diphtheria.

Situational task.

Patient Grigorieva, 15 years old, diagnosed with diphtheria, was injected with toxic serum for therapeutic purposes. After 20 minutes, the patient complained of weakness, dizziness, and nausea. On examination, she is pale, there is a rather abundant, itchy, large-spotted rash on the skin of the face and limbs, pulse is 104 beats/min, rhythmic blood pressure is 90/40. Diagnosis of the condition that has arisen? Paramedic tactics?

Scarlet fever. Epidemiology. Main symptoms, syndromes, measures in the outbreak, treatment, care, prevention.

Measles. Epidemiology. Main symptoms, syndromes, measures in the outbreak, treatment, care, prevention.

Rubella. Epidemiology. Main symptoms, syndromes, measures in the outbreak, treatment, care, prevention.

Situational task.

The paramedic visited the refugee family for the first time. There are three children in the family, the youngest, a 3-year-old child, has been sick for two days now; he is worried about fever, weakness, lack of appetite, and pain when swallowing. The history of the child’s development is lost; according to the mother, the child is not vaccinated.

On examination: body temperature is 38.5 degrees, the skin is clean, hot to the touch, there is faint hyperemia of the arches in the pharynx, the tonsils are swollen, covered with a grayish coating, and when trying to remove the plaque, they bleed. Pulse – 130 beats per minute, respiratory rate – 30 per minute.

1) Make a presumptive medical diagnosis.

7.14.1 Chicken pox. Parotitis. Meningococcal infection.

Situational task.

A mother and a 5-year-old child came to the FAP with complaints of fever, skin rashes, and itchy skin. During a nursing examination, it was determined that the girl fell ill yesterday after returning from kindergarten. On the skin of the scalp, face, and torso there are polymorphic rashes in the form of spots, papules, vesicles, and itching. The pharynx is moderately hyperemic, nasal breathing is difficult, body temperature is 38.3 degrees, pulse is 120 beats per minute, respiratory rate is 25 per minute.

1) Make a preliminary medical diagnosis.

2) Model the tactics of a paramedic.

Whooping cough. Epidemiology, main symptoms, syndromes, treatment, care, prevention.

Parotitis. Epidemiology, main symptoms, syndromes, treatment, care, prevention.

Chicken pox. Epidemiology, main symptoms, syndromes, treatment, care, prevention.

Meningococcal infection. Epidemiology, main symptoms, syndromes, treatment, care, prevention.

7.15.1 Practical lesson. Anatomical and physiological characteristics of a child at different age periods, care for him. Sanitary and hygienic regime of preschool institutions.

Situational task.

The child is 5 months old. Mass,0; length 65 cm. The girl distinguishes loved ones from strangers, recognizes her mother’s voice, distinguishes between strict and affectionate intonation of speech addressed to her, clearly takes a toy from the hands of an adult and holds it, lies on her stomach, leaning on the forearms of her outstretched arms, does not roll over from her back to her stomach ; stands straight but unsteady with support under the arms; He hums for a long time and eats semi-thick food from a spoon.

Situational task.

A 12-month-old boy is undergoing preventive care. During the year I suffered from acute respiratory infections 5 times. The child's family lives in the hostel. Examination by a pediatrician and pathology specialists internal organs did not reveal. Receives preventive vaccinations according to an individual calendar. No complaints. Weight kg, 600 g, length cm. walks independently, performs learned actions with toys, speaks 8 easy words, understands the word “no”, carries out instructions (bring it, close it, etc.), drinks from a cup independently.

2) Determine the health group with justification.

Situational task.

A 3-month-old child is in foster care. The girl is exclusively breastfed, was born with a weight of 3200.0, length 53 cm, currently weighs 6200.0 length 60 cm. In response to communication, she smiles, gurgles, and waves her arms; holds the head well in a vertical position, with the support of the armpit rests well with the legs bent at the knee and hip joints; fixes his gaze on stationary objects, being in any position. There is “gneiss” on the scalp, on the cheeks there is hyperemia, dry skin, peeling; slight redness of the skin in the inguinal folds.

2) What pathological condition should be assumed, taking into account skin manifestations and body weight.

3) Paramedic tactics.

Situational task.

Patronage for a newborn at the age of 14 days. Born from the first pregnancy, term birth, weight 3200.0, length 52 cm. The mother has chronic pyelonephritis, which was repeatedly aggravated during pregnancy. The condition of the newborn is satisfactory, he sucks actively, and there is sufficient lactation. Physiological reflexes are alive, skin and mucous membranes are clean, of normal color. The umbilical wound is wide, the edges are thickened, there is no hyperemia of the skin, there is a serous discharge at the bottom of the wound. Body temperature 36.6 degrees.

1) Make a preliminary medical diagnosis. Determine your child's risk group.

2) Paramedic tactics.

7.16.1 Practical lesson. Sanitary and hygienic regime for children at school.

Situational task.

A 6-year-old girl is attending a Healthy Children's Day appointment. Getting ready to go to school. During the year I suffered from acute respiratory infections 5 times. Weight kg, length 119 cm, there are two permanent teeth. Attends kindergarten and successfully completes the program. There are no speech defects. During a routine examination by a pediatrician and specialists, no pathology was identified. Results of psychophysiological testing:

1. Kern-Ierasek test – 8 points

2. Verbal - association test - 3 errors (20%)

3. Circle cutting test – 1 min, 30 sec, 3 mistakes

Situational task.

A 1-year-old boy is being enrolled in a nursery school. Born from the first pregnancy at 36 weeks, from 2 months of age he was bottle-fed, suffered mild rickets, 4 acute respiratory infections, obstructive bronchitis. Lives in a family with low material income, the mother is forced to go to work and therefore wants to send the child to a nursery. The child's body weight is 8500.0 cm, length 0.5x0.5 cm, 2/2 teeth. Nervous and mental development lags behind in terms of general achievements: he walks holding objects with his hands. Vaccinations according to an individual calendar: received BCG vaccination, I DTP and LCV vaccination.

1) Give a forecast of a child’s adaptation in a preschool institution with justification.

2) Identify potential problems for the child if placed in a nursery.

3) Create a plan for paramedic observation and care.

Situational task.

A 3-year-old child was enrolled in kindergarten 7 days ago. The child has a history of frequent acute respiratory viral infections and exudative-catarrhal diathesis. The child’s physical and neuropsychic development corresponds to his age. The mother is concerned about changes in the child’s behavior: the girl has become capricious, sleeps poorly at night, is reluctant to go to kindergarten in the morning, does not play with children in the group, refuses to eat, does not sleep during the day, often cries, and asks to go home.

On examination: the skin is pale, there is strophulus on the extensor surfaces of the arms, scratching. Body temperature 36.6 degrees, pulse 110 beats per minute, respiration 25 per minute, body weight 12.5 kg, length 96 cm.

1) Determine the severity of the child’s adaptation to kindergarten.

2) Identify the child's current and potential problems.

3) Create a paramedic observation and care plan.

7.18.1 Practical lesson. Immunoprophylaxis.

Planning preventive vaccinations at FAP. Records management.

Drawing up an individual plan for preventive vaccinations.

The role of a paramedic in organizing and conducting professional vaccinations for children at risk.

Normal course of post-vaccination reactions and complications. Paramedic tactics.

Additional volume and new directions of work of a paramedic on immunization in order to implement a priority national project in healthcare, regulatory framework

Situational task.

A 3-month-old child is undergoing preventive care. No complaints. Healthy. In the anamnesis, at the age of 1 month, a short-term allergic reaction in the form of urticaria was noted; the causative allergen was not identified. In the maternity hospital he was vaccinated against tuberculosis.

1) What immunobiological preparations are appropriate to start immunization with?

Situational task.

A 4.5-month-old child experienced a strong reaction after the second DTP vaccination - an increase in temperature to 40.5 degrees.

1. Outline the paramedic’s tactics for further immunization against diphtheria, tetanus, and whooping cough.

Situational task.

A 6-month-old child suffered from whooping cough; I was not vaccinated against diphtheria, tetanus and whooping cough due to honey. bends.

1. What vaccines should a child be vaccinated against diphtheria and tetanus?

8.1.1 The role of the paramedic in the prevention of household and professional eye injuries.

Ensuring continuity of ophthalmological care for the rural population.

Injuries to the orbit and damage to the adnexa of the eye. Diagnostic criteria damage to the orbital bones. Tactics of a paramedic in case of damage to the orbit, eyelids and lacrimal ducts.

Penetrating and non-penetrating injuries of the eyeball. Defects of the corneal epithelium, foreign body of the cornea, penetrating wounds of the eyeball, diagnostic criteria. Paramedic tactics. Emergency care at the prehospital stage.

Thermal, chemical and radiation burns of the eyes. Diagnostic criteria. Paramedic tactics. Emergency care at the prehospital stage.

Eye injuries. Kinds. Diagnosis at the prehospital stage. Volume of assistance, hospitalization. Transportation.

8.2.1 Eye diseases.

Functional responsibilities of a FAP paramedic in organizing ophthalmological care for the population.

Stages of providing ophthalmological care to the rural population.

Acute peridocyclitis. Causes. Clinical picture. Diagnostic criteria. Differential diagnosis. Urgent Care. Indications for hospitalization.

Acute attack of glaucoma. Clinical picture. Diagnostic criteria. Differential diagnosis. Urgent Care. Paramedic tactics.

Acute inflammatory diseases of the eyelids, conjunctiva and lacrimal apparatus. Diagnostic criteria for acute blepharitis, dacryocystitis, conjunctivitis, treatment. Paramedic tactics.

9.1.1 Diseases of the ear, nose and throat.

Acute inflammatory diseases of the pharyngeal tonsils. Types of sore throats. Complications of tonsillitis. Indications for hospitalization.

Acute diseases of the larynx and trachea. Clinic of laryngitis, tracheitis and laryngeal tonsillitis (submucosal laryngitis). Diagnostic criteria for laryngeal stenosis.

Emergency care for stage I-II-III and IV stenosis.

Acute ear diseases. Clinical picture of acute otitis media in adults and children. Complications of acute otitis.

Diagnostic criteria for acute mastoiditis. Indications for hospitalization.

9.2.1 Emergency otorhinolaryngology.

Nosebleeds. Causes. Paramedic tactics. Indications for anterior and posterior nasal tamponade. Anterior and posterior tamponade techniques.

Foreign bodies of the nose, pharynx. Diagnostic criteria. Paramedic tactics.

Foreign bodies of the ear. Diagnostic criteria. Paramedic tactics.

Injuries of the larynx, trachea. Diagnostic criteria. Paramedic tactics.

Foreign bodies of the trachea, larynx. Diagnostic criteria. Paramedic tactics.

10.1.1 Organization of the fight against skin diseases, the role of the medical and obstetric station.

Organization of the fight against skin diseases.

The role of the paramedic-midwife station in the prevention of skin diseases and medical examination.

Pustular skin diseases in adults, etiology, pathogenesis, treatment symptoms, care, prevention.

Fungal skin diseases, nosological forms, symptoms, sanitary and epidemiological regime, treatment, care.

Pustular skin diseases in children, etiology, pathogenesis, symptoms, treatment, care, prevention.

10.2.1 Skin diseases.

Eczema, itchy skin diseases, dermato-occupational diseases, psoriasis. Causes, symptoms, treatment, care, prevention, medical examination.

Lichen planus, lichen rosea, causes, symptoms, treatment, care, prevention, medical examination.

Early detection of malignant skin tumors at a paramedic-midwife station.

10.3.1 Organization of the fight against venereal diseases, the role of the paramedic-midwife point.

1 Syphilis, routes of infection, clinic, forms, diagnosis, treatment, complications, prevention.

2 Soft chancroid. Causes, symptoms, treatment.

3 Gonorrhea, routes of spread, features of the course in men and women. Clinical forms, methods, prevention, medical examination.

4 Trichomanosis, causes, routes of infection, features of the course in men and women. Diagnostic methods. Treatment, prevention, medical examination.

5 Chlamydia, signs, consequences, diagnosis, prevention.

11.1.1 Modern principles of organizing medical care for the population during emergency situations and disasters.

Responsibilities of medical workers in emergency situations depending on the phase of development of the emergency.

Definition of the concept of "emergency".

Medical and tactical characteristics of emergency situations.

Disaster Medicine Service. Tasks. Structure at the federal and territorial level.

Basic principles of organizing medical care for the population in emergency situations (ES). Stages of medical support.

11.2.1 Basics of cardiopulmonary resuscitation.

Definition of the concept of “terminal states”. Types of terminal conditions.

Stages of cardiopulmonary resuscitation.

Techniques for restoring airway patency.

Technique of mechanical ventilation and NMS.

Duration of resuscitation. Assessing the effectiveness of resuscitation.

11.3.1 Emergency care for extreme impacts: drowning, suffocation, electrical injuries, thermal injuries, long-term crush syndrome. Features of providing assistance in emergency situations.

Drowning, suffocation. Diagnostic criteria. The volume of assistance to victims at the first stage of treatment and evacuation support.

Frostbite, diagnostic criteria. The scope of assistance to victims with frostbite at the first stage of treatment and evacuation support.

Electrical injury. Diagnostic criteria. The volume of assistance to victims at the first stage of treatment and evacuation support.

Heat stroke, diagnostic criteria. The volume of assistance to victims at the first stage of treatment and evacuation support.

Situational task:

The victim is under the influence of electric current; from a distance, cyanosis of the face, convulsions, and lack of respiratory movements of the chest are visible.

Exercise:

1. Name the cause of circulatory arrest due to electrical injury

2. Create an algorithm for providing emergency care.

11.4.1 Emergency care for comatose patients. Features of providing care to comatose patients in emergency situations.

The Glasgow scale and the Glasgow-Pittsburgh scale as criteria for diagnosing coma.

A list of mandatory measures carried out at the prehospital stage if the patient has a superficial and deep coma.

The main causes of the development of comatose states.

Features of examination of patients in a comatose state.

Coma. Definition. Diagnostic criteria for coma. Depth of coma. Signs characterizing a deep coma.

11.5.1 Emergency care for acute poisoning. Features of the organization of emergency medical care in case of mass poisoning with potent toxic substances.

Classification of poisonings. Classification of poisons.

Definition of the concepts “poison”, “toxicity”, “poisoning”.

General principles of treatment of poisoning.

Methods of active detoxification used in the prehospital stage.

Stages of acute poisoning. Features of the pathogenesis of acute poisoning depending on the route of entry of the poison into the body.

11.6.1 Emergency care for the most common acute poisonings.

Clinic, diagnosis and treatment of acute poisoning with psychotropic drugs.

Clinic, diagnosis and treatment of acute poisoning with alcohol and its substitutes.

Clinic, diagnosis and treatment of acute poisoning with organophosphorus compounds.

Clinic, diagnosis and treatment of acute poisoning with cauterizing poisons.

Clinic, diagnosis and treatment of salt poisoning heavy metals and arsenic.

Clinic, diagnosis and treatment of acute poisoning by poisons of plant and animal origin.

11.7.1 Acute allergic reactions.

Types of acute allergic reactions. General mechanism their development.

Clinical picture of urticaria. Diagnostic criteria. Differential diagnosis. Tactics of the FAP paramedic.

Quincke's edema. Clinical picture. Diagnostic criteria. Tactics of the FAP paramedic.

Prevention of immediate allergic reactions to FAP.

Anaphylactic shock. The mechanism of its development. Clinical picture. Treatment.

12.1.1 Practical lesson. Medical informatics. Application of computers in medicine.

Computer capabilities, application in the educational process.

Concept of the Internet.

Electronic directories (Consultant Plus, etc.). The importance of using computer networks in the educational process.

Modern computer. Basic computer blocks.

The central and peripheral parts of the computer, their significance.

Computer networks. Local, global networks.

13.1.1 Occupational hazards. The concept of occupational disease.

Occupational hazards as risk factors for diseases.

Primary prevention of occupational diseases in the work of a paramedic.

Occupational diseases associated with exposure to dust, their prevention.

Features of organizing examinations and clarifying diagnoses for occupational diseases.

Safety precautions when working with pesticides.

Preventive work of a paramedic to protect the population from pesticides.

Preventive work of a paramedic to protect the environment from pesticides.

14.1.1 Chronic alcoholism. Organization of drug treatment assistance to the rural population.

Alcoholism social meaning, causes, stages. Signs. Alcohol-induced personality changes.

The role of alcohol in the development of diseases, injuries, accidents.

Acute alcoholic psychoses. Emergency assistance and examination for the presence of alcohol.

Addiction. Terminology. Causes, clinical stages. Exodus. Prevention.

Substance abuse. Terminology. Causes, clinical stages. Exodus. Prevention.

Prevention of hypertension, which is a chronic progressive vascular pathology, is a difficult task.

Given its widespread prevalence, a special role in working with patients belongs to paramedics, in particular paramedics at first aid stations and health centers. The most important prerequisite effective treatment- thoughtful individual work with patients. First of all, it is necessary to instill in the patient the need for systematic (and not just when blood pressure increases!) taking medications for many years, and also, most importantly, a decisive improvement in their lifestyle, i.e., eliminating, if possible, risk factors for arterial hypertension.
Prevention of hypertension is aimed at early detection of the disease by measuring blood pressure in people over 30-35 years of age during periodic medical examinations carried out at enterprises and institutions. People who are found to have increased blood pressure should be taken under medical supervision. The paramedic working at the paramedic station monitors the blood pressure of these people, actively visits them, and monitors the effect of antihypertensive drugs.
Prevention of hypertension occupies a paramount place in solving the problem of longevity, in maintaining mental and physical performance in adulthood. Thus, it is known that the presence of arterial hypertension shortens life expectancy by an average of 10 years (in the group of people over 45 years of age). Such a frequent complication of hypertension as hypertensive crisis causes a fairly high mortality rate, a high percentage of temporary loss of ability to work and disability. Huge labor losses are caused by another complication - myocardial infarction. It is practically important that the prevention of hypertension and the prevention of coronary artery disease largely coincide.

The most promising is the identification of persons with risk factors, i.e. those people in whom the development of hypertension is highly likely (hereditary burden, abuse of table salt, animal fats, liquids and alcoholic beverages, improper work and rest regime, endocrine changes, intake oral contraceptives).

Primary prevention of hypertension should begin in childhood. It is necessary to organize a medical examination in children's institutions, schools, universities with regular measurement of blood pressure in children and young people 2-3 times a year. This needs to be given special attention at first aid stations, in pre-medical appointment rooms in outpatient clinics, etc.
Primary prevention efforts must take into account all risk factors. Rational muscle load is necessary already in childhood, it is necessary to exclude unjustified exemptions from physical education at school, overfeeding of children and adolescents is unacceptable, especially salt eating (increased consumption of table salt). If moderate hypertension does not cause pain, then only a health regimen should be recommended. Night work, as well as work associated with sudden nervous overloads, bending of the head and torso, and lifting heavy objects, is contraindicated for these persons. It is not recommended for a patient with hypertension to sharply tilt the head or body, as this increases the pressure in the cerebral vessels; You should keep your head as straight as possible or move it slightly back. Not acceptable overtime work, it is necessary to limit exposure to industrial and household noise as much as possible. Sitting in front of the TV for many hours is contraindicated, especially for elderly obese people after eating. Let us remember that it causes thrombosis of the small veins of the legs. It is necessary to combat hypokinesia.

You should exclude from the diet foods that can increase vascular tone and irritate the nervous system (rich meat soups, fried meat, strong coffee, alcoholic drinks, hot and spicy dishes). The fight against obesity is of great importance. Persons with overweight body, it is recommended to periodically resort to fasting diets. Systematic control of body weight is a necessary prerequisite for a proper diet.
Persons predisposed to hypertension should accustom themselves to low-salt foods (no more than 4-5 g of table salt per day in total) and to limit liquid intake; It is necessary to avoid drinking coffee and strong tea altogether; The last meal and liquid should be at least 1 hour before bedtime. This is especially important during premenstrual days and menopause. If for some reason the food regime turns out to be disrupted, then the next day it is necessary to arrange a fasting day (rice, kefir, apple), and perform an additional set of physical exercises - always until you sweat. If excess fluid was taken the day before, it is recommended to take 0.02 g of brinaldix or 0.05 g of hypothiazide in the morning. It is advisable for the physician to explain the usefulness of these dietary restrictions to all persons over 40-50 years of age.
It is of great importance to limit, if possible, long-term neuropsychic overloads at work and at home without subsequent physical release. It is accompanied by stress erythrocytosis, thrombocytosis, i.e. risk factors for arterial hypertension. It has been proven that the nature of responses to external stimuli, including long-term, negative ones, is determined mainly by the reactivity of the body at the time of the stressor. In particular, creating a stable positive emotional background is of great importance. The right choice of profession (work should bring satisfaction) and a friendly microclimate in the work team are also very important. However, a lot depends on a person’s own culture and on the sensitivity of the people around him.
The elimination of family conflicts and mutual understanding between spouses and children are of no small importance. The harmony of sexual life is of undoubted importance for normal neuropsychic function, and the paramedic must take this aspect into account when carrying out sanitary educational work.
It is necessary to recommend hardening (cool shower in the morning), rational use of working time, and exclusion (if possible) of occupational hazards. According to a number of authors, keeping indoor dogs and cats plays a certain “anti-stress” role.
Normal sleep is very important. It has been established that for people over 50 years of age, 7 hours of sleep at night is sufficient, but the depth of sleep and the absence of unpleasant emotions in case of difficulty falling asleep are decisive. The paramedic should explain that the fear of insomnia is more harmful than the insomnia itself. It is better to avoid sleeping pills; as a last resort, use herbal preparations - valerian root, peony tincture, etc. The speed of falling asleep is determined mainly by the depth muscle relaxation and the degree of “disconnection” of consciousness from daily worries.
To improve sleep, it is recommended to wash your feet with cool water and wash your face. hot water(42...45 °C) before bedtime. A foot massage (3-5 minutes) before bed using a special massage roller or rolling a round wooden stick has a noticeable calming effect. It is advisable not to read while lying in bed before going to bed.
Acupressure self-massage according to Dineika helps to shorten the phase of falling asleep: using light pressure, massage the “anti-stress point” under the chin, muscle relaxation points in the corners of the mouth, in the center of the upper lip and along the midline of the fronto-parietal zone. Self-massage can be supplemented with soothing breathing exercises: after a shallow inhalation (count up to 4), exhale as long as possible (count up to 12), then hold your breath for 2-3 seconds, actively causing yawning, and repeat such cycles without deep breaths during subsequent breathing .
The complex is useful autogenic training to fall asleep. It is recommended, for example, repetition(at a slow pace with a long exhalation) phrases like: “I’m getting more and more sleepy” (pause). “The eyelids are getting heavy” (pause). “I’m falling asleep” or “My blood pressure is returning to normal” (pause). “The heart is beating slowly” (pause). “The heart works calmly,” etc. The text of self-hypnosis phrases is clarified by a psychotherapist; Appropriate “sleeping pills” tape recordings can be used.
The bed should be quite hard, the pillow should be low 2, the legs should be slightly elevated, the air in the room should be clean, cooled (but not lower than + 18 ° C). It is better to sleep with your head to the north. The paramedic should explain the absolute harm of daytime sleep, especially after a heavy meal or drinking alcohol. Such a dream is fraught with the danger of thrombosis and other circulatory disorders.
Particular attention should be paid physical culture, since it is a kind of protective measure that trains the neurovascular system and significantly reduces the consequences of neuropsychic overload. Physical exercise can also help relieve harmful effects hypokinesia experienced by urban residents in economically developed countries. Schools and universities recommend physical education breaks between classes. Unfortunately, to reduce neuropsychic agitation, many resort to smoking or drinking alcohol. These bad habits should be abandoned immediately and irrevocably. Gamabasin, reflexology and psychotherapy help to quit smoking. The most physiological method of relieving negative emotions and nervous excitement is physical exercise performed at an appropriate pace.
Various warm-up exercises are recommended - stretching, rotating the hands, turning and bending the body in combination with deep breathing through the nose, and squats. They are performed in the evening hours, 1 "/g-2 hours after meals and at least 1-2 hours before bedtime for 30-40 minutes. The pace of movement is gradually increasing, the number of repetitions is determined by how you feel (a feeling of “fullness” should appear "muscles, "muscular joy"), pulse (in middle-aged people the pulse rate should not exceed 130-140 beats/min, in elderly people - 100-110 beats/min) and breathing. Adequate physical activity should be accompanied by light sweating. It is advisable that young people used weights (dumbbells, etc.). Elderly people should first consult a doctor, an ECG test is required. It is not recommended for people who have not previously trained to begin intensive aerobic exercises.
Persons of “sedentary” professions are especially advised to exercise with a wrist expander and squats as they improve blood circulation in the joints of the hands and legs, where involutive changes occur early in people of these professions. Systematic exercises for the abdominal muscles are very useful - rotational movements with straight legs while lying on your back, imitation of cycling, etc.

After warming up, you need to wipe yourself with water up to your waist or take a shower (gradually lower the water temperature) and firmly rub the skin (especially the posterior cervical area and spine) with a rough towel, which has a normalizing effect on vascular tone.
In fact, after every stress, it is necessary to perform a set of exercises (squats, breathing exercises, movements with self-resistance, etc.) to utilize excess adrenaline, cholesterol, glucose, carbon dioxide and other biologically active substances released during stress. Outdoor sports games are shown - volleyball, tennis and table tennis, jogging (the speed and duration of running is increased gradually!). It is advisable to walk 4-6 km daily at a fast pace (until you sweat). With a properly structured training regimen, there should be no fatigue, insomnia, or severe muscle pain after exercise.
Chess is contraindicated if it has a stimulating effect, and losing leads to pronounced negative emotions.
Patients over 50 years of age, especially if they have not previously engaged in therapeutic exercises, must strictly adhere to the following rules: bend the body (especially forward and backward) incompletely, avoid swinging movements of the arms and legs, after particularly difficult movements of the body and squats, rest for 30-30 years. 40 s sitting, leaning back in a chair. It is useful to do morning exercises for 10-15 minutes, then, after resting for 2-3 minutes in a sitting position, proceed to water procedures (wiping with water at room temperature with self-massage or shower). In the 1st week of classes, the water should be heated (by 5...6°C). After the water procedure, you need to wipe your body dry with a soft towel, then begin self-massage.
Sitting on a chair, make circular movements over the chest and abdomen with a hard terry towel; massage your back lengthwise and crosswise, your arms - in one direction from the hand to the shoulder joint in a circular motion. Perform the massage at a calm pace, do not hold your breath, breathe evenly. The duration of self-massage is 5-7 minutes.
Persons with borderline hypertension should be under medical supervision. Their medical examination is required. Training physical activity is recommended. If within 6-12 months their blood pressure steadily returns to normal or remains in the border zone, then observation is continued for another year. When complaints (headache, insomnia, etc.) appear in people at risk, drug treatment is started; 6-blockers and sedatives are usually prescribed.

However, the paramedic must convince every patient with hypertension that without eliminating risk factors, drug treatment will give an incomplete and short-lived effect. It is precisely in patients’ lack of understanding of this circumstance, as well as in the irregularity of taking antihypertensive drugs, that lie the reasons for the relatively high incidence of hypertension and its complications, including deaths (stroke, myocardial infarction). Experience of some foreign countries shows that persistent work with patients, individually selected and regular antihypertensive therapy can reduce the incidence of myocardial infarction and hemorrhagic strokes in the population by 20-30%.
Thus, in 1980, the results of “total” treatment and prevention of hypertension in Finland were published, according to which it was possible to reduce its frequency in the population by 2 times (the “North Karelia” protocol).

Therefore, the paramedic must carry out preventive work with people prone to hypertension in order to reduce the risk of morbidity. Although prevention is also necessary for people with hypertension. It is easier to prevent a disease than to treat it! And the paramedic plays a huge role in this.

Introduction
Brain diseases are a topical area of ​​clinical medicine and have not only medical but also social significance, as they are one of the leading causes of morbidity, mortality and disability in the world. Russian Federation. Over the past decade, there has been a significant increase in the number of vascular diseases of the brain in young and middle-aged people, which are difficult to objectify in the early stages, and to treat effectively in the later stages.
Relevance of the topic: annual morbidity and mortality rates from stroke in the Russian Federation (RF) are one of the highest in the world. It is known that in our country about 450-500 thousand people annually suffer one or another type of stroke, i.e. every 1.5 minutes one of our compatriots suffers a cerebral infarction or hemorrhage in the brain. About 500 thousand Russians die every year due to a stroke. In the first month after the disease develops, 35% die, and within a year another 15%.
In the Russian Federation (RF), more than 1 million people live with the consequences of this disease, 80% of them are disabled, of which a third are people of working age. Only every fourth patient returns to work. Stroke affects an increasingly younger population—every fifth person is under 50 years of age. At the same time, mortality rates are higher in patients aged 30 to 50 years. There is a rejuvenation of stroke with an increase in its prevalence in people of working age - up to 65 years.
In the Republic of Bashkortostan, the dynamics of stroke incidence over the past 10 years is characterized by a tendency to increase rates from 1.6 to 2.3 per 1000 people. Moreover, in the structure of general morbidity, the number of cases of hemorrhagic stroke is increasing, which indicates insufficiently effective detection and treatment of arterial hypertension as one of the leading risk factors for the development of acute cerebrovascular accidents.
Thus, stroke is a state medical and social problem Therefore, real efforts to organize effective preventive measures and improve the system of providing medical care to patients with a stroke are so significant and important.
Research problem: acute cerebrovascular accidents is a very important problem in neurology and has not only medical, but also social character. This is due to the widespread prevalence of stroke among the population, as well as the significant negative consequences for their health.
The purpose of the thesis: to determine the role of the paramedic in the prevention of complications of acute cerebrovascular accidents
Object of study: patients with acute cerebrovascular accidents
Subject of study: the role of the paramedic in the prevention of complications of acute cerebrovascular accidents
Research hypothesis: let us assume that the paramedic’s performance of the main duties in relation to patients with stroke will help increase patients’ awareness of existing risk factors, possible complications and methods of dealing with them
Research objectives:
1. Study the theoretical aspects of acute cerebrovascular accidents
2. To study the role of the paramedic in the prevention of stroke complications.
3. Conduct a comparative analysis of the incidence of stroke in the territory of the city of Tuymazy and the village of FAP. Duslyk, draw conclusions.
4. Conduct a survey among patients who have suffered a stroke and analyze data on the incidence of stroke over the past 3 years.
5. Develop preventive measures aimed at preventing the consequences of strokes and methods of combating existing complications and risk factors.
6. Introduce measures to prevent complications of strokes in the conditions of a paramedic and obstetric station.
Theoretical significance: a comprehensive study of medical awareness about their disease and the presence of complications in stroke patients and existing risk factors was assessed. Preventive materials have been developed for the prevention of stroke complications, which can be recommended for use in a medical and preventive institution.
Practical significance: the introduction of individual training programs for the prevention of stroke complications for rural residents will help establish a trusting relationship with the patient, acquire self-control skills, and will allow for a comprehensive and individual approach to each patient; forms a change in behavior, style and lifestyle, giving up bad habits, improving the prognosis and quality of the residents of the Tuymazinsky district.
Research methods: analysis and synthesis of specialized literature,
Internet resources, personal data, medical documentation, statistical data.
Structure of the work: corresponds to the logic of the study and includes an introduction, a theoretical part, a practical part, a conclusion, a list of references and applications.

CHAPTER 1. Theoretical aspects of acute cerebrovascular accidents

1.1. Concepts of acute cerebrovascular accidents, classification of stroke, pathogenesis, clinical picture

Acute disorders cerebral circulation is a group clinical symptoms, which develop due to an acute disorder of the blood supply to the brain.
Stroke (Late Latin insultus - attack) is an acute disturbance of blood circulation in the brain with the development of persistent symptoms of damage caused by a heart attack or hemorrhage in the brain matter. Transient ischemic attack is a transient disorder of cerebral circulation in which neurological symptoms regress within 24 hours.
This term combines conditions of different etiology and pathogenesis, the implementing element of which is acute vascular catastrophe of both the arterial and venous beds.
Stroke includes acute disorders of cerebral circulation, characterized by the sudden (within minutes, less often - hours) appearance of focal neurological disorders (motor, speech, sensory, coordination, visual, cortical functions, memory) and/or general cerebral disorders (changes in consciousness, headache , vomiting, etc.), which persist for more than 24 hours, or lead to the death of the patient in a shorter period of time due to a cause of cerebrovascular origin.
Classification:
A. Initial manifestations of insufficiency of blood supply to the brain:
1. Initial manifestations of insufficient blood supply to the brain.
2. Initial manifestations of insufficiency of blood supply to the spinal cord.
B. Transient cerebrovascular accidents (24 hours):
1. Transient ischemic attacks (TIA)
2. Hypertensive cerebral crises
B. Stroke:
1. Subarachnoid non-traumatic hemorrhage
2. Hemorrhagic stroke - non-traumatic hemorrhage in the brain (depending on location):
2.1. Parenchymal (in brain tissue)
2.2. Intraventricular (into the ventricles of the brain)
2.3. Subarachnoid (space between the arachnoid and the pia mater)
2.4. Subdural (subdural space of the brain)
2.5.Epidural (the space between the periosteum and the inner surface of the integumentary bones of the skull - most often the parietal)
3. Cerebral infarction (ischemic stroke):
3.1. Cerebral ischemic stroke
3.2. Spinal ischemic stroke
According to the mechanism of development, five main subtypes of ischemic stroke are traditionally distinguished:
1) atherothrombotic - which is based on the formation of a blood clot at the site of an atherosclerotic plaque;
2) embolic - in which emboli from the heart or atherosclerotic plaque of a large vessel are transferred with the bloodstream to smaller cerebral vessels and clog them;
3) lacunar - develops against the background of arterial hypertension, which is characterized by narrowing of small arteries as a result of atherosclerosis;
4) hemodynamic - occurs when two factors are combined: a sharp decrease in blood pressure (BP), due to a temporary deterioration in cardiac activity, stenosis (narrowing) of one of the large vessels of the brain;
5) hemorheological occlusion (blockage) of cerebral vessels occurs with increased blood clotting and (or) hyperaggregation (increased ability to stick together) of platelets.
4. Minor stroke (3 weeks).
5. Consequences of a previous cerebral stroke (more than 1 year).
There are several periods of ischemic stroke:
The most acute period is the first 3 days. Of these, the first three hours were defined as a “therapeutic window”, when it is possible to use thrombolytic drugs for systemic administration. In case of regression of symptoms during the first day, a transient ischemic attack is diagnosed;
acute period - up to 4 weeks;
early recovery period - up to six months;
late recovery period - up to 2 years;
period of residual effects - after 2 years.
Pathogenesis
The main pathogenetic condition of ischemic stroke is insufficient blood flow to a certain area
brain with subsequent development of a focus of hypoxia and necrosis. The limitation of the focus of ischemic stroke is determined
the possibility of developing collateral (bypassing the main artery or vein) blood circulation, which sharply decreases in old age. The need for blood redistribution between different areas of the brain arises
how in physiological conditions increasing functional activity, as well as in pathology caused by stenosis and thromboembolism of the vascular lumen. The rapid development of collateral circulation is
an important condition for effective cerebral blood flow. High sensitivity ganglion nerve cells of the brain
to the factor of hypoxia and ischemia determines a short time period of restoration of blood circulation by dilating collateral vessels. Untimely development of collateral
blood circulation leads to the formation of a focus of ischemia with death
brain tissue (Figure 1). The possibility of developing adequate blood flow depends, first of all, on the rate of occlusion of the vessel lumen. Yes, when
high rate of development of vessel blockage (for example, with embolism, focal symptoms are usually observed; on the contrary, with
slow closure of the artery lumen and, accordingly, good
development of collateral circulation, clinical symptoms may be transient). Development of ischemic stroke
often preceded by transient cerebrovascular accidents. The most common occurrence of ischemic stroke is during sleep or immediately after sleep. It often develops
during myocardial infarction.
Hemorrhagic stroke, as a rule, is etiologically caused by hypertension. However, most often it occurs in hypertension in combination with atherosclerosis.
The development of anatomical changes (lipohyalinosis - decreased elasticity of the vessel wall, fibrinoid necrosis - impregnation of affected tissues with fibrin) in the perforating arteries of the brain and the formation of microaneurysms against the background of arterial hypertension are the most common prerequisites for the occurrence of stroke. Hemorrhage occurs due to rupture of the altered perforating
arteries (Figure 2). In this case, the vascular wall is impregnated
blood plasma with disruption of its trophism, formation of microaneurysms, rupture of blood vessels and exit
blood into the brain matter. When an artery ruptures or a microaneurysm (pathological protrusion) bleeding continues from several minutes to several
hours until a blood clot forms at the rupture site. Hemorrhage caused by arterial hypertension is localized mainly in the basins of the perforating arteries of the brain in the area
basal ganglia, thalamus, white matter of the cerebral hemispheres
brain, pons, cerebellum.
Hemorrhages can occur as a hematoma - with
rupture of a vessel or by the type of hemorrhagic impregnation. The hematoma is well demarcated from the surrounding tissues and is a cavity filled with liquid blood and its clots. For hemorrhages
in the brain caused by a ruptured vessel, in 80-85% of cases there is a breakthrough of blood into the subarachnoid space or into the ventricles.

Figure- 1. Ischemic area of ​​the brain

Figure-2. Hemorrhage from a ruptured vessel
Clinic
Ischemic strokes are characterized by a sudden onset with the acute development of persistent (lasting more than 24 hours) focal symptoms (paresis of the muscles of the arms, legs, face, blindness in one eye, speech impairment, sensory impairment, etc.). With a thrombotic stroke, symptoms often develop at night, and the patient already wakes up with paresis or aphasia. If a stroke occurs during the daytime, then gradual progression of the neurological defect is characteristic over several hours.
General cerebral symptoms (headache, depression of consciousness), as a rule, are expressed to a much lesser extent than with cerebral hemorrhage, or are absent. Pronounced cerebral manifestations are more typical for extensive hemispheric ischemic strokes, extensive infarctions of the brainstem, cerebellum - severe ischemic stroke.
- Aphasia (loss of speech)
- Apraxia (violation of purposeful actions, with damage to the left hemisphere)
- Anosognosia (impaired spatial orientation and inattention to the opposite half of space, lack of critical assessment its defect in case of damage to the right hemisphere).
- Loss of the right and left halves of vision (homonymous hemianopsia) and abduction of the eyeballs towards the lesion. On the side of hemiparesis, weakness of the lower part of the facial muscles of the genioglossus muscle, which pushes out the tongue, is usually observed (manifested when the tongue protrudes, deflecting it towards the paresis).
Clinically, embolic stroke is characterized by a sudden development of symptoms. Sometimes a patient who has rapidly developed paresis falls to the floor without having time to grab the nearest support. The neurological defect is maximal already at the very beginning of the disease; loss of consciousness and epileptic seizures are common. Limited embolic strokes can manifest themselves, for example, as isolated sensory aphasia (in this case, the patient does not understand the speech addressed to him, and his own speech is meaningless). The deterioration of the condition of such patients for the first days after a stroke may be due not only to swelling, but also to hemorrhage in the infarction area.
Characteristic feature ischemic stroke is the predominance focal symptoms over the general cerebral ones.
Among the focal symptoms of ischemic strokes, the development of central hemiparesis (weakness in the arm and leg on one side of the body) is often observed. IN acute stage As a rule, muscle tone and tendon reflexes in a paralyzed arm and leg are reduced, but the Babinski reflex is detected. Patients with stroke are characterized by increased muscle tone mainly in the flexors of the arm and extensor of the leg, as a result of which a hemiparetic gait develops, the peculiarity of which is that the paretic leg describes a semicircle when walking (circumduction), and the paretic arm is bent and brought to the body.
Hemorrhagic stroke is characterized by a rapid increase in neurological symptoms. The disease occurs more often during the day,
during physical activity or emotional stress
and is manifested by a characteristic combination of cerebral and focal symptoms. Sudden sharp headache, vomiting, impaired consciousness, psychomotor agitation, tachycardia, hemiparesis
or hemiplegia are the most common initial symptoms of hemorrhage. Impaired consciousness ranges from mild stupor,
stupor to deep atonic coma. All reflexes are lost, the breathing rhythm changes, the skin becomes hyperemic,
often profuse sweating, tense pulse, arterial
pressure increased to 180-200 mmHg. and higher. Gaze paresis, anisocoria, divergent strabismus, hemiplegia,
sometimes meningeal symptoms, sensorimotor aphasia. In 10% of cases, generalized epileptic seizures develop. The disease is usually accompanied by
hyperthermia. Hemorrhages from arterial aneurysms are clinically characterized by the rapid development of the meningeal symptom complex: stiff neck, Kernig and Brudzinski symptoms, photophobia, general hyperesthesia, and sometimes disorders
psyche such as confusion, disorientation, psychomotor agitation.
In the acute period, there is an increase in temperature to 38-39°C, signs of increased intracranial pressure - nausea, vomiting, and sometimes congestion in the fundus. Mild symptoms of focal brain damage often develop - paresis of the limbs, speech disorders, sensory disturbances.
Consequences and complications of stroke
The course of a stroke is divided into periods:
1) acute - lasts up to 1 month. after a stroke;
2) restorative - from 1 month. up to 1 year;
3) residual - after 1 year;
Exactly at residual period the consequences of a stroke are formed. In other words, the consequences of a stroke are the result of treatment and recovery after a stroke in the acute and recovery period.
1. Paralysis and paresis - the most common consequences of a stroke are movement disorders, usually unilateral hemiparesis.
2. Changes in muscle tone in paretic limbs - usually this is an increase in spastic tone, much less often - muscle hypotonia (mainly in the leg). Spasticity often increases the severity of motor disorders and tends to increase within 1 month after a stroke, often leading to the development of contractures.
3. Post-stroke trophic disorders: atrophy of the joints of paretic limbs; “painful shoulder syndrome” associated with a violation of the position of the spine with a displacement to the right, left, up or down; muscle atrophy, bedsores. Most often, in patients in the first 2 weeks after a stroke, “painful shoulder syndrome” occurs, in the genesis of which two factors can play a role - trophic disorders (arthropathy) and prolapse of the humeral head from the glenoid cavity due to stretching of the joint capsule, which occurs under the influence of the severity of the paretic hands, as well as due to muscle paralysis.
4. Sensory disorders - among the sensory disorders often combined with hemiparesis, highest value has a disorder of muscle-joint sensation - this makes it difficult to restore walking and self-care skills, making it impossible to perform subtle targeted movements.
5. Central pain syndrome - approximately 3% of patients who have had a stroke experience pain of central origin. Thalamic syndrome includes: acute often – burning pain on the half of the body and face opposite to the lesion, sometimes worsening with changes in weather, touch, emotional stress, pressure; reduction of all types of sensitivity; hemiparesis. Thalamic syndrome often does not develop immediately after a stroke, but after several months and tends to further increase pain.
6. Speech disorders. Aphasia is observed in more than a third of patients. There are types of aphasia: motor (impaired own speech), sensory (impaired understanding of the speech of others), amnestic (forgetting individual objects and actions), sensorimotor (impaired own speech and understanding of the speech of others), total aphasia. Another type of speech disorder is dysarthria - a violation of the correct articulation of sounds while maintaining “internal” speech, understanding the speech of others, reading and writing.
7. Violation of higher mental functions - cognitive impairment (decreased memory, intelligence, concentration of attention. The following may also develop: apatico-abulia syndrome (lack of one’s own motivations for activity - abulia), interest in life (apathy), decrease in volitional functions (abulia), depression accompanied by asthenia occurs in 40–60% of post-stroke patients.
8. Visual impairment– most often this is homonymous (unilateral) hemianopsia (loss of the left field of vision with lesions in the right hemisphere of the brain and vice versa). Oculomotor disorders: paresis of the eye muscles, double vision, gaze paresis.
9. Post-stroke epilepsy develops in some patients in 6-8% of cases, within a period of 6 months to 2 years after stroke.
Impaired balance, coordination and statics make it difficult to restore walking functions and self-care skills.

1.2.The role of the paramedic in the prevention of complications of acute cerebrovascular accidents

1.2.1.The role of the paramedic in diagnosing stroke and providing emergency care

The paramedic is the primary link in providing assistance to persons with acute cerebrovascular accidents; he must know the basic principles of providing pre-hospital emergency care at the prehospital stage in order to prevent the development of many complications.
The paramedic must be able to distinguish between cerebral infarction and hemorrhagic stroke, as this is important for providing qualified patient care (Table 1).
Table 1 - Differential diagnostic characteristics of strokes
Factors and symptoms Hemorrhagic stroke Ischemic stroke (cerebral infarction)
History of arterial hypertension Atherosclerosis of cerebral vessels
Age Young and middle Elderly and senile
Onset Acute sudden Slower
Consciousness Sudden or very quickly depressed (to the point of coma) Gradual depression
Headache Very severe Not pronounced
Vomiting Often Unusual
Blood pressure Increased Normal
or downgraded
Neck stiffness Characteristic Absent
Facial hyperemia Typical Absent
Liquor Mixed with blood No blood
Pulse and respiration Sudden changes No sudden changes
Anisocoria Characteristic Absent
Retinal hemorrhage Characteristic Absent
Dynamics of condition Progressive deterioration Gradual deterioration
When making a diagnosis, the paramedic must use the standard of first aid - orders. Order No. 930 of November 30. 2009 “On the procedure for organizing monitoring of the implementation of measures aimed at improving the provision of medical care to patients with vascular diseases.” Order No. 389-m “On approval of the procedure for providing medical care to patients with acute cerebrovascular accidents” and the “Guidelines for emergency medical care” emanating from them.
The paramedic conducts an examination and physical examination of the patient: assessment of the general condition, consciousness, breathing; visual assessment: carefully examine and palpate the soft tissues of the head (to identify traumatic brain injury), examine the external auditory and nasal passages (to identify cerebrospinal fluid and hemorrhea); study of pulse rate and rhythm (>60); measures blood pressure (increase); auscultation of the heart: the presence of a murmur of mitral valve prolapse or other cardiac murmurs and takes an ECG.
When examining the neurological status, the paramedic should pay special attention to the presence of the following signs:
o Motor disturbances in the limbs: it is necessary to ask the patient to hold the raised limbs for 10 s, the paretic limb will fall faster (Barre test).
o Speech disorders (dysarthria, aphasia): with dysarthria, the patient’s own speech is unclear, while the understanding of the addressed speech is completely intact, and there is a feeling of “porridge in the mouth”; with aphasia, the patient may not understand spoken speech, and there may be no speech production of his own.
o Disorders of cranial innervation: facial asymmetry (“distortion” of the face when asked to show teeth or smile), dysphagia (swallowing disorders - choking when taking liquid or solid food).
o Sensitivity disorders: when symmetrical areas of the limbs or torso tingle, a unilateral decrease in pain sensitivity is detected.
o Decreased level of consciousness (stunning, stupor, coma).
o Visual field defects (most often hemianopsia - loss of the right or left visual fields in both eyes).
If the paramedic identifies obvious symptoms of acute cerebrovascular accident, he does the following:
- must carry out neuroprotective therapy: Mexidol - intravenously in a stream for 5-7 minutes (4-8 ml) or drip 0.2 g (4 ml) in 100 ml of 0.9% sodium chloride solution; Semax - 2-3 drops of a 1% solution in each nasal passage; glycine from 8-10 tablets under the tongue, if the patient is conscious; Ceraxon – 1000 mg (10 ml) IV slowly.
If the patient is unconscious:
- it is necessary to carry out sanitation of the upper respiratory tract (removal of dentures), ensuring free breathing(unfasten the tight collar, avoid hyperextension or excessive bending of the head), turn it on its side to prevent aspiration of saliva and vomit and the further development of aspiration pneumonia.
- oxygen inhalation. Mechanical ventilation is indicated for bradypnea (respiratory rate 35-40 per minute), increasing cyanosis.
- in the presence of arterial hypertension (systolic blood pressure >200 mm Hg, diastolic blood pressure >110 mm Hg), a slow decrease in blood pressure is indicated (by no more than 15-20% of the initial values ​​within an hour, because a sharp decrease or blood pressure below 160/110 mm Hg, dangerous by worsening cerebral ischemia): enalapril 0.625-1.25 mg IV (1-2 ml) in a slow stream;
magnesium sulfate - iv 1000-2000 mg (10-20 ml), administered slowly (the first 3 ml over 3 minutes) over 10-15 minutes;
- when it occurs convulsive syndrome: diazepam IV in an initial dose of 10-20 mg (1-2 ml), subsequently, if necessary, 20 mg IM or IV drip. The effect takes several minutes to develop and varies among patients.
- urgent hospitalization of patients in the unit intensive care or to the neurosurgical department (for hemorrhagic stroke).

1.2.2. The role of the paramedic in the prevention of stroke

The most important prerequisite for effective treatment is: timely provision of emergency qualified medical care to patients with developed acute cerebrovascular accidents and thoughtful individual work with patients with stroke, i.e. elimination, if possible, of risk factors and the development of possible complications of stroke.
A FAP paramedic may encounter stroke not only at the stage of diagnosis and emergency care, but also work with patients to prevent stroke and take part in the rehabilitation of patients after stroke.
The FAP paramedic should know that there are two groups of risk factors for the development of stroke:
1) Modifiable, which can be influenced and reduce the incidence of stroke;
2) non-modifiable, which cannot be changed, but you can, knowing about them, take preventive steps, especially in the presence of other risk factors.
Non-modifiable risk factors:
1. Age - after 55 years, the risk of developing a stroke doubles every 10 years. In the age group over 60 years old, 70% of all stroke cases are registered.
2. Gender - men are more likely to suffer from stroke than women (4:1 ratio).
3. Hereditary predisposition (in first-degree relatives) - the likelihood of developing a stroke increases by 2 times if one of the parents had this disease. It is believed that a hereditary tendency to strokes is more often transmitted through the maternal line.
Modifiable risk factors:
1.Hypertension (35%) - high blood pressure is the most common risk factor for stroke and TIA.
2. Diabetes mellitus - increases the risk of stroke by 3 times. This disease occurs in 8% of the population. In patients with ischemic stroke diabetes observed in 15-33% of cases.
3.TIA or previous stroke - increases the risk of developing a subsequent stroke by 10 times.
4. Obesity (27%) - defined as exceeding the body mass index (BMI) by more than 30 kg/m2. BMI is determined using Quetelet’s formula: body weight (in kilograms) must be divided by height (in meters) squared (Table 2).
Table 2 - Classification of obesity by BMI (WHO)

4. Coronary heart disease - a previous myocardial infarction increases the risk of stroke by 3 times.
5.Disturbance of lipid metabolism - an increase in the content of total cholesterol in the blood (not > 5.2 mmol/l) and low-density lipoproteins in combination with a decrease in high-density cholesterol leads to the development of atherosclerosis of blood vessels.
6. Stenosis of the carotid arteries - severe atherosclerotic lesions of the carotid arteries in the form of vascular stenosis are the cause of 5-7% of cerebrovascular accidents annually.
7. Heart rhythm disturbances - atrial fibrillation, regardless of the cause that caused it, increases the likelihood of a stroke by 3.6 times.
8.Heart failure - regardless of the cause, increases the risk of stroke by 3 times.
9. Smoking (> 20 cigarettes per day) - accelerates the process of vascular damage and increases the influence of other risk factors.
10. Alcohol abuse - chronic alcoholism is a risk factor for all subtypes of stroke.
11. Use of tablet contraceptives (oral contraceptives) containing more than 50 mg of estrogens and postmenopausal hormonal therapy. Taking these medications increases the likelihood of developing cerebrovascular accidents only if there are other risk factors, especially smoking and high blood pressure.
12. Long-term negative psycho-emotional and psychosocial stress (9%).
To combat risk factors for the development of stroke, the FAP paramedic is obliged to: promote a healthy lifestyle; carry out regular health education work among the entire population; actively involve rural residents in undergoing medical examination of the adult population.

1.2.3. The role of the paramedic in the residual period of acute stroke

Due to the possible development of a large number of complications in the residual period of a stroke, patients require appropriate care and an individual rehabilitation plan for each patient. The FAP paramedic must be directly involved in this.
The main tasks of a paramedic in the rehabilitation of patients with stroke:
1. Training patients suffering from stroke and their relatives, as well as persons at risk for this disease, in the rules of measuring blood pressure;
2. Monitor the strictness of taking recommended medications;
3. Train relatives in the prevention of bedsores; the basic principles of passive gymnastics and massage of paralyzed parts of the body;
4. To prevent thromboembolism, relatives of bedridden patients should be advised to purchase compression stockings or bandage their legs elastic bandage- this will help minimize the risk of blood clots - thrombi;
5. Conduct a conversation with relatives about the need to maintain a “healthy psychological climate” in the family and that this is the key to more successful restoration of lost functions;
6. Another important point in the rehabilitation of patients with stroke is proper nutrition; the paramedic is obliged to give everything necessary recommendations on nutrition;
7. Conduct conversations with patients about the need to comply with therapeutic exercises, training patients suffering from stroke to perform a daily complex of therapeutic physical training;
8. Organizing and conducting conversations among patients with stroke, as well as among the healthy population, about the dangers of alcoholism and smoking; recommend that patients with this nosology adhere to a work-rest regime, and recommend avoiding stressful situations.
9. Know the basic principles of treatment of stroke, for timely preventive treatment with medications prescribed by a doctor and monitoring the intake of medications by patients who have suffered a stroke.
Basic principles of drug treatment after stroke:
1. Antiplatelet agents: Aspirin cardio as prescribed by a doctor;
2. Lifelong antihypertensive therapy - Captopril as prescribed by a doctor;
3. Antioxidants and Nootropics: Mexiprim, every six months as prescribed by a doctor;
4. Antidepressants: Prozac;
5. Anticoagulants: Fraxiparine, Clexane;
6. B vitamins: Thiamine, Pyridoxine.
Thus, stroke is a very serious health problem, causing harm to the health of patients and leading to the death of patients.
The paramedic must know the standards of diagnosis and emergency care, and know the main risk factors for the development of the disease. To be able to carry out their primary prevention and, in the event of the appearance of patients with acute stroke at the FAP, to participate in their rehabilitation, to know the basic principles of drug treatment of patients with stroke.

CHAPTER 2. Empirical study of the role of the paramedic in the prevention of complications of acute cerebrovascular accidents

2.1.Organization of the base and research methods

Our study was conducted on the basis of the FAP in the village of Duslyk, Tuymazinskaya Central District Hospital of the Republic of Bashkortostan. The study involved 21 patients suffering from stroke. The study was conducted from May 4 to May 13, 2016, which consisted of four research stages.
At the first stage of the study, a comparative analysis of the incidence of stroke in the city of Tuymazy and the village was carried out. Duslyk for 2013-2015.
At the third stage of the study, an analysis was carried out of the degree of awareness of patients about their disease, existing risk factors, existing complications and the degree to which patients followed all the doctor’s prescriptions and recommendations (Appendix A).
After the sociological study, we carried out sanitary and educational work with stroke patients and their relatives, namely: a conversation with stroke patients separately on the complications they had, which provided information about the characteristics of stroke, methods of dealing with risk factors, existing complications and the prevention of recurrences. stroke attacks (Appendix B); conversation with relatives of bedridden patients about the prevention of bedsores and the principles of skin care, recommendations were given on methods of combating pneumonia, in case of disorders of the large intestine (Appendix B). A booklet was also released on the topic “Say no to the consequences of a stroke” to increase patients’ awareness of their disease and the basic principles of preventing complications (Appendix D); memo “20 simple exercises for walking patients who have had a stroke” (Appendix E); A health bulletin has been issued (Appendix K).
At the fourth stage, a repeated analysis was carried out of the degree of awareness of patients about their disease, existing risk factors, complications of a stroke, and the degree to which patients followed all the doctor’s prescriptions and recommendations (Appendix I).
In order to analyze the activities of a paramedic at a medical and obstetric station in the prevention of stroke complications, the subjects were asked to conduct a questionnaire survey.
Questioning as a research method allows for short term obtain the maximum possible amount of information about any disease, find out public opinions on certain issues and in other similar cases.

2.2. Comparative analysis of statistical data of stroke patients in the city of Tuymazy and the village of Duslyk

For more complete information about the incidence of stroke and comparative analysis, we studied and analyzed statistical data on the incidence in the city of Tuymazy (Table 3) and the village. Duslyk (Table 6) for the last three years from 2013 to 2015.
Table 3 - Incidence of stroke in the city of Tuymazy for 2013-2015.

Year Registered patients with this disease

Are registered at the dispensary
Total Men Women Diagnosis established for the first time in life
2013 802 641 161 802 643

2014 642 513 129 642 415
2015 844 675 169 844 716
Conclusion: the incidence of stroke in the city of Tuymazy increased sharply in 2015, so in 2013 the number of patients was 802 people, in 2014 - 642 people, and in 2015 already 844 people. It can be assumed that this is due to frequent stressful situations due to the difficult economic situation in the country. Of these, the incidence among men and women is (ratio 4:1), so in 2013 there were 641 men, 161 women; in 2014 there were 513 men, 129 women; in 2015 there were 675 men and 169 women.
Table 4 - Statistical data on the incidence of stroke among people of working age in Tuymazy from 2013 to 2015
2013 2014 2015
Subarachnoid
hemorrhage 6 5 9
Intracerebral and other intracranial hemorrhage 54 36 56
Cerebral infarction 497 410 419
Stroke not specified as hemorrhage or cerebral infarction 9 8 4
Let's present the results obtained in the form of a diagram (Figure 3):
Figure 3. Statistical data on the incidence of stroke among people of working age in Tuymazy from 2013 to 2015
Thus, the number of stroke cases in people of working age in 2013 was 566 people, in 2014 - 459 people, in 2015 - 488 people.
Table 5 - Statistical data on the incidence of stroke among people of retirement age in Tuymazy from 2013 to 2015
2013 2014 2015
Subarachnoid
hemorrhage 1 1 1
Intracranial and other intracranial hemorrhage 30 32 35
Cerebral infarction 138 162 318
Stroke not specified as hemorrhage or cerebral infarction 9 6 3

Let's present the results obtained in the form of a diagram (Figure 4):

Figure 4. Statistical data on the incidence of stroke among people of retirement age in Tuymazy from 2013 to 2015
Thus, the number of stroke cases in people of retirement age in 2013 was 178 people, in 2014 - 183 people, in 2015 - 357 people.
We studied the medical documentation of the FAP: form No. 025/у medical records of an outpatient; magazine dispensary observation form No. 030/у. The study revealed the following data on the incidence of stroke over the last 3 years from 2013 to 2015, among people living in the village. Duslyk.
Table 6 - Incidence of stroke in the village of Duslyk for 2013-2015.
Diagnosis made for the first time in life Are undergoing follow-up with a diagnosis of stroke Total patients who have had a stroke
2013 5 5 5
2014 7 7 7
2015 7 9 9
Let's present the results obtained in the form of a diagram (Figure 5):

Figure-5. Incidence of stroke in the village of Duslyk for 2013 – 2015.
As can be seen from the data shown in Table 4 and Figure 1, the incidence of stroke in the village of Duslyk is increasing every year. If in 2013 there were 5 people with stroke, in 2014 there were already 7 people, and in 2015 there were 9 people.
Let us present the analysis of the gender composition of identified patients in the form (Table 7):
Table 7 - Gender composition of identified patients
Of which men, of which women
2013 4 1
2014 5 2
2015 7 2
Analyzing the data in Table 7, we see that the incidence of stroke among men is higher than among women. So in 2013, 4 men and 1 woman suffered a stroke, in 2014, 5 men and 2 women, in 2015. 7 men and 2 women.
Now let's present an analysis of the prevalence of stroke types (Figure 6).

Figure- 6. Prevalence of types of stroke from 2013 to 2015 in the village of Duslyk
Analyzing the data in Figure 6, we see that the incidence of ischemic stroke prevails over the incidence of hemorrhagic stroke. So, if the difference between ischemic and hemorrhagic stroke in 2013 is 3 people, then in 2014 and 2015 it is 5 people.
The age composition is presented in Figure 7:

Figure- 7. Age of patients
Thus, of the respondents, 15% of patients aged 30-40 years, 20% of patients aged 40-50 years, 35% of patients aged 50-60 years and 30% of patients over 60 years of age suffered a stroke.
Conclusion: after a comparative analysis of statistical data for the city of Tuymazy, data from outpatient cards patients, a journal of clinical observation and questioning of patients in the village of Duslyk, the following conclusions can be drawn:
1. The incidence of stroke increases with each passing year, we assume that this is due to an increase in the number of people suffering from heart disease, lack of awareness of the population about the risk factors for developing the disease; with insufficient coverage of clinical examination of patients with risk factors for developing the disease. Heredity also plays an important role in the increase in the incidence of stroke.
2. Most often, men suffer strokes than women, perhaps this is due to the fact that men, unlike women, are more susceptible to stress and the harmful effects of bad habits, smoking and alcohol; the presence of sexual intercourse in women also plays an important role the hormone estrogen, which protects the vascular walls and maintains their elasticity until the onset of menopause, on average up to the age of 50.
3. Ischemic stroke develops more often than hemorrhagic stroke, perhaps this is due to age-related changes in the body;
4. The number of stroke patients of working age is increasing; it can be assumed that the “rejuvenation” of stroke is associated with an increase in the number of patients with high blood pressure, frequent stress, the presence of bad habits, and ignorance of risk factors for stroke.

2.3. Characteristics of the paramedic and obstetric station in the village of Duslyk

The medical and obstetric center in the village of Duslyk is the largest in the entire Tuymazinsky district. Consists of: waiting room, paramedic's office, midwife's office, treatment room, storage room for cleaning supplies. The FAP staff includes three employees: a manager - a paramedic, a paramedic and a midwife, two with the highest category, one excellent student in healthcare. The FAP serves: a school, one kindergarten, a bakery and shops.
Documentation of the paramedic and obstetric station is presented in Appendix G.
Basic orders regulating the work of the paramedic-midwife station. Duslyk.
OST 42-21-2-85 “Sterilization and disinfection of medical products, methods, means, regimes”;
Order No. 770 “On the introduction of an industry standard.” OST 42-21-2-85 "on sterilization and disinfection";
Order No. 170 “On measures to improve the prevention and treatment of HIV-infected people in the Russian Federation”;
Order No. 720 “On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections”;
Order No. 342. “On strengthening measures to prevent epidemic typhus and combat lice”;
3.1.5.2826-10 “Prevention of HIV infection”;
SanPiN 2.1.3.2630-10 Sanitary and epidemiological requirements for organizations engaged in medical activities;
SanPiN 2.1.7.2790-10 Sanitary and epidemiological requirements for the management of medical waste;
Order No. 36. “On improving measures for the prevention of diphtheria.”
The number of population served for 2016 is 2181 people, of which 1063 are men, 1118 are women, 426 are children.
FAP paramedic s. Duslyk is obliged:
1. Conduct outpatient appointments and home care for the assigned population according to the established schedule.
2. Provide urgent and emergency pre-hospital medical care for conditions that threaten human life and health.
3. Carry out the doctor’s prescriptions in a timely manner and in full when organizing dynamic monitoring and treatment of the patient at the place of residence.
4. Carry out dynamic observation, including control over the organization of timely treatment, of patients with socially significant diseases (tuberculosis, sexually transmitted diseases, mental and drug addiction diseases, oncological pathology, diabetes).
5. Participate, under the guidance of doctors from medical institutions, in conducting preventive and dispensary examinations of decreed groups of the population and patients registered at the dispensary. Maintain control charts (form No. 030/u) for dispensary patients in the prescribed manner and ensure their timely attendance at medical specialists, carry out preventive measures among dispensary patients according to the recommendations of doctors.
6. Carry out activities for active early identification of patients and persons with risk factors for the development of diseases: filling out initial patient examination cards + Stage I of targeted medical examination, organizing a fluorographic examination of the attached population, cytological examination of women, measuring blood pressure for persons over 16 years of age, measuring intraocular pressure for persons over 40 years old, etc.
7. Provide patronage to pregnant women (in the absence of a midwife), postpartum women and children under the age of 1 year; carry out dynamic monitoring of children in the first year of life who are at risk, prevent rickets, anemia, promote rational feeding, participate in work with socially disadvantaged families on reproductive health and family planning.
8. Conduct preventive vaccinations for the population in a timely and high-quality manner in accordance with the vaccination calendar; know permanent and temporary contraindications to them.
9. Carry out, under the guidance of doctors from medical institutions and specialists from the Federal State Health Institution, a set of sanitary, hygienic and anti-epidemic measures in the event of an unfavorable epidemiological situation in the service area. Know the clinic of especially dangerous infections and the tactics of nursing staff when identifying them.
10. Regularly conduct door-to-door visits in order to actively monitor the condition of the assigned population and early detection of diseases, including infectious ones.
The FAP paramedic has the right:
1. Within the limits of their competence, conduct an examination, establish a diagnosis, prescribe treatment, perform medical procedures and preventive measures.
2. Use all approved instructional and methodological materials published by health authorities of the Russian Federation and the Republic of Belarus concerning the activities of the FAP.
3. Make proposals to improve the work of the FAP and improve the system of medical care in the service area.
4. Improve professional qualifications through advanced training courses in postgraduate education institutions at least once every five years in accordance with the established procedure.
5. Enjoy established benefits in accordance with current legislation.

2.3.1. Medical examination of stroke patients at the FAP

Patients with stroke are subject to mandatory medical examination on the basis of Article 46 Federal Law dated November 21, 2011 No. 323-“On the basics of protecting the health of citizens of the Russian Federation.”
A FAP paramedic if the head of a medical organization entrusts him with certain functions of the attending physician, including conducting dispensary observation, in the manner established by order of the Ministry of Health and Social Development of the Russian Federation dated March 23, 2012 No. 252-n.
Depending on the diagnosis, patients belong to one or another dispensary group: patients with transient cerebrovascular accidents with focal neurological symptoms belong to group D III; patients who suffered a cerebral stroke with complete restoration of impaired functions during the first 3 weeks (“minor stroke”) Group DIII; patients with residual effects of cerebral stroke group DIII.
Documentation of medical examination of patients with stroke:
1. The main medical document, which reflects the dynamics of dispensary observation of the patient, is the “Outpatient Medical Card” form No. 025/u; the letter D or the disease code is placed on the spines so as not to confuse this card with another document.
2. For each patient, the “Medical examination record card” form No. 131/u-86 is filled out. It is kept by the local therapist.
3. The “Dispensary Observation Log” form No. 030/u is also filled out.
The FAP paramedic in relation to stroke patients is obliged to:
- conduct dynamic monitoring of patients with stroke 4 times a year;
- organize a doctor’s call 2 times a year;
- motivate patients to recover by conducting preventive conversations with patients and their relatives;
- increase awareness among patients about risk factors and principles of combating them;
- carry out procedures prescribed by a doctor at home (injections);
- provide training to patients and their relatives in the basic principles of care.

2.4. Results before the study

To the question, “From what sources did you receive information about your disease?” The following results were obtained (Figure 8):

Figure- 8. Source of information about stroke
Thus, 50% of respondents were not at all interested in information about stroke, 15% received information from friends or acquaintances, 15% from medical professionals and television shows, and 5% from books or magazines.
After analyzing the personal data, the following results were obtained: to the question “Do you smoke?” 70% of respondents answered that they smoke, 30% do not smoke; to the question “Do you drink alcohol?” 40% of respondents answered “yes, I use”, 60% answered negatively; to the question “are you often exposed to stressful situations”, 45% of respondents answered “often”, 55% “rarely”;
To the question “Do you adhere to the principles proper nutrition or are you on a diet? The following results were obtained (Figure 9):

Figure-9. Compliance with the principles of proper nutrition or diet
Analyzing the data in Figure 9, we see that only 25% of the patients surveyed follow the principles of proper nutrition or adhere to a diet, 25% of them sometimes adhere and 40% do not adhere at all.
To the question, “What cardiovascular diseases do you have?” The following results were obtained (Figure 10):

Figure- 10. Presence of cardiovascular disease
Thus, 70% of respondents have a history of hypertension, 20% have had a myocardial infarction, and 10% have arrhythmias.
To the question “Do you have a history of a previous stroke?” The following results were obtained (Figure 11):

Figure- 11. Presence of a previous stroke
As can be seen from the data presented in Figure 11, among the respondents, 10% have a history of stroke, 80% do not.
To the question “Do you follow all the doctor’s prescriptions and recommendations?” the following data were obtained (Figure 12):

Figure- 12. Compliance with doctor’s prescriptions and recommendations
Thus, only 47% of respondents comply with all doctor’s prescriptions.
To the question “Do you perform physical therapy at home and how often?” The following results were obtained (Figure 13):

Figure- 13. Performing physical therapy
Thus, 45% of respondents sometimes perform physical therapy at home, 35% of them do not perform physical therapy at all, and only 20% conduct physical therapy classes.
To the question, “What consequences are you concerned about today?” the following data were obtained (Figure 14):

Figure- 14. Presence of complications
Analyzing the data in Figure 14, we see that 20% of respondents have a complication in the form of sensory disturbances in one half of the body, 15% have sensory disturbances in the arms, another 15% have sensory disturbances, 15% have sensory disturbances in both legs, 15% have impaired speech, reading and writing, 13% of patients have a bad mood and fatigue, 6% of patients have pain of various localization and nature, 6% of patients have congestive pneumonia.
To the question “Do you need help performing basic activities: eating, washing, bathing, dressing, moving?” The following results were obtained (Figure 15):

Figure- 15. Need for outside help
Thus, from Figure 15, we see that 55% of the surveyed patients need help in performing basic activities, 45% do not need outside help.
To the question “Are you willing to learn lost self-care skills?” the following data were obtained (Figure 16):

Figure- 16. Teaching lost skills
Thus, from Figure 16, we see that 40% of the surveyed patients are not willing to learn self-care skills, 60% of them are willing to learn self-care skills.
After the sociological study, we carried out health education work, namely a conversation with patients who had suffered a stroke, which provided information about the characteristics of a stroke (Appendix B); A conversation was held with relatives of stroke patients, where available information about such a formidable complication as bedsores was presented and recommendations for skin care were given (Appendix B). Patients were also provided with booklets on the topic of preventing stroke complications, which describe available information about stroke and the basic principles of preventing complications (Appendix D); a reminder that describes simple physical exercises for the prevention of paresis and contractures (Appendix D); Sanitary Bulletin (Appendix K).

2.5. Results after the study

The main results of the survey of patients after the above measures to prevent stroke complications are presented in Table 8.
Table 8 - Results of patient surveys after the study.
No. Question Result
Yes, % No, % I doubt it
Sometimes, %
1 Do you want to quit smoking and drinking alcohol? 80% 10% 10%
2 Do you fight stress and develop stress resistance? 75% 20% 5%
3 Do you follow the principles of proper nutrition or diet? 60% 30% 15%
4 Do you follow all the prescriptions and recommendations of the doctor and paramedic? 80% 10% 10%
5 Do you control your blood pressure and take medications regularly? 80% 10% 10%
6 Do you perform physical therapy at home regularly? 50% 35% 15%
7 Are you willing to try to learn all the lost skills? 70% 20% 10%
As can be seen from the data given in Table 8, 80% of the subjects want to quit smoking and drinking alcohol, fight stress and develop stress resistance in themselves 75% of the subjects, follow the principles of proper nutrition or diet 60% of the subjects, follow all the doctor’s prescriptions and recommendations and 80% of subjects are paramedics, control their blood pressure and take medications regularly for 80% of subjects, regularly perform physical therapy for 50% of subjects, and willingly try to learn all lost skills for 70% of subjects.
Thus, after training, patients know that it is useful to eat right, exercise, and follow all doctor’s prescriptions, as this will help improve health and prevent subsequent complications.
The main goal in the prevention of complications of a stroke in the conditions of the paramedic and obstetric station in the village of Duslyk: preventing recurrent cases of the disease, increasing the ability of patients to work.

Conclusion
Brain diseases are a topical area of ​​clinical medicine and have not only medical but also social significance, as they are one of the leading causes of morbidity, mortality and disability throughout the world. Over the past decade, there has been a significant increase in the number of vascular diseases of the brain in young and middle-aged people, which are difficult to objectify in the early stages, and to treat effectively in the later stages.
The analysis of the studied literature indicates that acute cerebrovascular accidents occupy a leading place among other diseases. The relevance of the study was confirmed and the need for preventive measures in patients with stroke was substantiated. The most important task in the prevention of stroke complications is the family environment, nutrition, adherence to work and rest schedule, blood pressure control, taking all medications prescribed by the doctor, following all the advice and recommendations of the paramedic and doctor on
performing physical therapy and learning all lost skills.
A special role in the prevention of complications of acute cerebrovascular accidents is given to the average medical worker, who must help patients deal with existing and possible consequences and prevent recurrent attacks of the disease.
To analyze the role of the paramedic in the prevention of stroke complications, we conducted an empirical study on the basis of the FAP in the village. Duslyk, Tuymazinsky district of the Republic of Bashkortostan.
The study took place in four stages:
At the first stage, we studied statistical data and conducted a comparative analysis of the incidence of stroke in the city of Tuymazy and the village. Duslyk for three years from 2013 to 2015. We came to the following conclusions:
5. The incidence of stroke increases with each passing year, we assume that this is due to an increase in the number of people suffering from heart disease, lack of awareness of the population about the risk factors for developing the disease; with insufficient coverage of clinical examination of patients with risk factors for developing the disease. Heredity also plays an important role in the increase in the incidence of stroke.
6. Most often, men suffer strokes than women, perhaps this is due to the fact that men, unlike women, are more susceptible to stress and the harmful effects of bad habits, smoking and alcohol; the presence of sexual intercourse in women also plays an important role the hormone estrogen, which protects the vascular walls and maintains their elasticity until the onset of menopause, on average up to the age of 50.
7. Ischemic stroke develops more often than hemorrhagic stroke, perhaps this is due to age-related changes in the body;
8. The number of stroke patients of working age is increasing; it can be assumed that the “rejuvenation” of stroke is associated with an increase in the number of patients with high blood pressure, frequent stress, the presence of bad habits, and ignorance of risk factors for stroke.
At the second stage, we studied the organization of the work of the FAP village. Duslyk.
At the third stage of the study, an analysis was carried out of the degree of awareness of patients about their disease, existing risk factors, existing complications and the degree to which patients followed all the doctor’s prescriptions and recommendations.
Then we developed preventive measures aimed at preventing the consequences of strokes and methods of dealing with existing complications: a conversation with stroke patients, which provides information about the characteristics of a stroke (Appendix B); conversation with relatives of bedridden patients about the prevention of bedsores and the principles of skin care (Appendix B). Booklets were also published on the topic “Say no to the consequences of a stroke” to increase patients’ awareness of their disease and the principles of preventing complications (Appendix D); memo “20 simple exercises for patients who have had a stroke” (Appendix D); a health bulletin was issued (Appendix K) and implemented in the conditions of the paramedic and obstetric station.
At the fourth stage, a re-analysis of the degree of patient compliance with all doctor’s prescriptions, the degree of control over risk factors and existing complications of a stroke was carried out (Appendix I). Results of repeated questioning: 80% of the subjects want to quit smoking and drinking alcohol, fight stress and develop resistance to stress 75% of the subjects, follow the principles of proper nutrition or diet 60% of the subjects, follow all the prescriptions and recommendations of the doctor and paramedic 80% of the subjects, control their blood pressure and take medications regularly for 80% of subjects, regularly perform physical therapy for 50% of subjects, and willingly try to learn all lost skills for 70% of subjects.
After carrying out a set of preventive measures, the subjects’ awareness of their disease improved, and the number of patients complying with the recommendations of the doctor and paramedic increased.
Based on the results of the study, the following recommendations can be made for the population:
Monitor your blood pressure levels;
Give up bad habits;
Fight with overweight;
Follow the principles of proper nutrition or the diet prescribed by your doctor;
Perform physical therapy exercises regularly;
Build stress resistance in yourself;
Take regularly medications prescribed by the attending physician.
Thus, the research hypothesis was confirmed; the paramedic’s performance of the main duties in relation to patients with stroke will help increase patients’ awareness of existing risk factors, possible complications, and methods of dealing with them.
The goal has been achieved, the tasks have been achieved.

Bibliography:
1. Balunov O.A., Kuginirenko Ya.N. Dynamics of the functional state of patients who have suffered a stroke // Journal of Neurology and Psychiatry No. 6. 2014, pp. 8-17;
2. Vilensky B.S. Stroke, prevention, diagnosis and treatment. - St. Petersburg, 2011, pp. 120-126;
3. Worlow C.P., Dennis M.S., Gain J. et al. Stroke. Practical guide for the management of patients - St. Petersburg: Politekhnika 2013, p. “254-257.;
4. Vereshchagin N.V., Varakin Yu.Ya. // Stroke. Adj. to the journal Neurol. And psychiat - 2014 No. 1-s. 34-40;
5. Gusev E.I. , Skvortsova V.I. Cerebral ischemia. - M: Medicine, 2012. -328 pages;
6. Publication: Journal of Neurology and Psychiatry. Stroke, 2013, No. 12 p. 72-76. Authors: Novikova L.B.;
7. Edition: Magazine Clinical pharmacology and therapy, 2014, volume 13, number 5, p. 55-60. Authors: V.S. Moiseev;
8. Publication (Scientific and Practical Journal Medical Care /edited by Musalatov H. A.), 2013, number 3, pp. 20-25.
9. Stroke/ P.A. Fadeev-M.: Omnisk Publishing House LLC, 2012 - 160 p. (Encyclopedia of Medical Knowledge);
10. Scientific and practical journal for doctors “Medical Council” Neurology, 2015/No. 5;
11. Lisovsky V.A., Evseev S.P., Golofeevsky V.Yu., Mironenko A.N. Comprehensive disease prevention and rehabilitation of sick and disabled people. Tutorial. / Ed. Prof. S.P. Evseeva. - 2nd ed., 2014 - p. 320;
12. Nervous diseases: a textbook for secondary medical schools/ (A.M. Sprints and others); edited by A.M. Spritz. – 3rd ed., add. and correction - St. Petersburg: SpetsLit, 2011- 431 p.;
13. Acute cerebrovascular accidents: Guide. -- 3rd ed., revised. and additional - Troshin V.D., Gustov A.V.: M.: Medical Information Agency LLC, 2014. - 432 pp.;
14. Guide to neurology.:/ Ed. Lawrence R.M.: Medicine, 2013, pp. 290-301;
15. Guide to emergency medical care / edited by A. L. Vertkin, A. G. Miroshnichenko - M.: GEOTAR-Media, 2013. - 816 pp.;
16. Mortality rate of the population of the Russian Federation, 2012. (statistical materials) - M.: Ministry of Health of the Russian Federation, 2012;
17. Smusin A.Ya., Rybina I.Ya., Slezin V.B. Features of clinical manifestations of the disease in right-sided and left-sided ischemic stroke // Journal of Neurology. and psychiatrist. 2014 - No. 3, pp. 50-51;
18. Usenko L.V., Maltseva L.A., Tsarev A.V., Cherchenko V.G. Ischemic stroke through the eyes of an anesthesiologist: modern approaches to intensive care. (Monogram) - 2012 - 140 pp.;
19. Fritas G.R., Boguslavsky D.Zh. Primary prevention of stroke // Journal of Neurology. and psychiatrist. 2014 - issue 1 - pp. 52-56;
20. Wiebers D.O., Feichin V., Brown R.D. Guide to cerebrovascular diseases. - M., 2012, pp. 200-203;