Voenno-medicinskij žurnal

The aim of the study is to analyze and evaluate the structure of modern combat surgical trauma, the volume and nature of surgical care provided to the wounded in military medical units and organizations designed to provide qualified medical care in a modern military conflict. The analysis was based on the study of case histories of the wounded who were treated at the Military Medical Academy from February 2022 to July 2023, who underwent several stages of medical evacuation, including level 2 of the qualified medical care stage. The structure of the flow entering this stage was dominated by wounded, with shrapnel wounds and blast injuries (73.8%). Among emergency and urgent surgical interventions, the most common were operations aimed at eliminating external (50.5%) and internal (28.9%) bleeding, acute respiratory failure (8.3%). An important feature of medical support is the deployment of the second level of the stage of providing qualified medical care because of the delay in evacuation to the stage of providing specialized medical care because of the risk of being hit by enemy fire. At the second level of the stage, qualified surgical care was provided to 81.5% of those admitted: emergency operations accounted for 14.4%, urgent – 31.5%, delayed – 54.2%. Given the complexity of surgical interventions, it is necessary to strengthen this stage with traumatologists, vascular surgeons, and resuscitators.

The purpose of the study is to, based on the methods of system and content analysis, as well as the principles of an iterative approach to the analysis of regulatory legal acts of the Russian Federation, modern publications of domestic and foreign authors, to reveal the conceptual issues of organizing the interaction of the subjects of the All-Russian Disaster Medicine Service in responding to threats and facts of occurrence and elimination emergency situations. The collection, systematization and analysis of regulatory legal acts of the Russian Federation, domestic and foreign scientific publications were carried out, which set out the issues of organizing interaction in the All-Russian Service for Disaster Medicine for the period from 2000 to 2023. A flow chart for organizing the interaction of medical services, medical forces and means was formed by ministries, federal agencies and services of Russia involved in carrying out measures to prevent and eliminate emergency situations. The main directions for improving the organization of interaction are presented.

Two clinical cases of successful surgical treatment of patients with gunshot penetrating shrapnel wounds to the chest using video-assisted thoracoscopic surgery in the area of a special military operation are presented. For the performance, an endovideosurgical complex manufactured by Karl Storz with a thoracoscope with a 30° optical system and a set of endosurgical instruments were used. Intraoperative fluoroscopy was performed using a Siemens Cios Alpha C-Arm X-ray machine. During this procedure were shown the possibilities, safety, and efficiency of rendering specialized and high-tech medical care in the military medical organization of the 3rd level. This helps to eliminate life-threatening consequences and prevent complications in victims with penetrating gunshot wounds to the chest.

A clinical case of acute myocarditis in a 55-year-old military man with an outcome of dilated cardiomyopathy is presented. During the examination, magnetic resonance imaging with a paramagnetic contrast agent was performed – the main instrumental diagnostic method, which is the most informative for visualizing foci of inflammation, damage and necrosis of cardiomyocytes. Intravital diagnosis of myocarditis was carried out through histological confirmation of the diagnosis by performing endomyocardial biopsy. During the examination, coronary heart disease and amyloid cardiomyopathy were excluded. The patient was selected for anti-inflammatory, antiarrhythmic therapy, and was prescribed treatment for heart failure with low ejection fraction (quadruple therapy, including an angiotensin receptor and neprilysin inhibitor, beta blocker, mineralocorticoid antagonist, sodium-glucose co-transporter type 2 inhibitor). The patient experienced significant positive changes, such as improved tolerance to physical activity, reduction in lower extremity edema, and decreased shortness of breath during walking.

The results of the analysis of the system currently in force in the Russian Armed Forces for ensuring the safety of military service in the aspect of the general theory of hygienic regulation are presented. It has been concluded that the existing system model does not meet the requirements of the modern army and navy. It is reactive in nature, addressing issues after they occur instead of taking proactive measures to prevent them. The life and health of military personnel remained outside the interests of the military leadership: their activities are aimed exclusively at eliminating the consequences of accidents, catastrophes, deaths and injuries of personnel. The authors propose adjusting the security system of military service in accordance with the teachings of Professor Koshelev N.F.

The possibility of using oral water-salt loads to prevent disorders of water-electrolyte metabolism and increase the resistance of divers to hyperbaric factors was investigated. 88 men aged 19–23 years were examined. Prevention of disorders of water-electrolyte metabolism, renal function and hormonal status in the subjects was carried out using water-salt loads developed by the authors (potassium chloride and sodium chloride, as well as calcium lactate). It was revealed that the use of loads with solutions of sodium chloride and potassium chloride will not reduce resistance to the unfavorable factors of hyperbaria in subjects who initially have high hyperbaric values. The intake of these water-salt loads is accompanied in such subjects by an increase in hydration of body tissues, manifested by a decrease in urine excretion, an increase in its osmolality and an increase in the content of sodium and chlorides in it. The prophylactic use of a water-salt load with sodium chloride solution by subjects with moderate and low resistance to the adverse factors of hyperbaria increases the number of persons with low resistance to decompression gas formation and the toxic effects of oxygen and increases the number of subjects with high resistance to hypoxic hypoxia and the toxic effects of nitrogen. Carrying out a water-salt load with a solution of potassium chloride reduces the number of subjects with medium and low resistance to decompression gas formation, and also increases the number of people with high resistance to the toxic effects of oxygen, the toxic effects of nitrogen and hypoxic hypoxia. Using a calcium lactate solution increases the subjects’ resistance to decompression gas formation and slightly reduces the resistance to hypoxic hypoxia.

The authors devoted the article to the analysis of the range of drugs manufactured in pharmacies of military medical organizations. The authors revealed that 302 types of drugs are most often manufactured there. They have established that most extemporaneous drugs are individual and unique and have no industrial analogues. It is shown that in order to improve the production activities of military pharmacies, quality management system documents must be developed and implemented, including standard operating procedures for the manufacture of the most important drugs.

A clinical case of successful staged surgical treatment of a victim who received multiple injuries in combat conditions because of an armored vehicle hitting the abdomen, pelvis, and lower extremities is considered. The injuries were accompanied by a prolapse of the rectum, traumatic detachment of the soft tissues of the perineum, right gluteal region, and right thigh. A negative pressure system was used. At the end of treatment, the patient showed no signs of dysfunction of the pelvic organs. The outcome is complete recovery. This treatment option for a traumatic detachment of soft tissue of the perineum allows wound healing to be achieved in the shortest possible time without removing a colostomy and, accordingly, does not require additional surgical interventions.

The article is devoted to the development of the military medical service in the USSR during the period when Efim Ivanovich Smirnov (1904–1989) was appointed head of the Military Sanitary Directorate of the Red Army, currently known as an outstanding organizer of military health care, professor, doctor of medical sciences, Hero of Socialist Labor, academician of the Academy of Medical Sciences, colonel general of the medical service. In 1938, he was a young military doctor aged 35, having graduated from the Military Medical Academy only 6 years earlier. Already in the pre-war period, his talent as a skilled organizer of military health care was evident. The article focuses on the activities of E.I.Smirnov in the first period of the Great Patriotic War – defensive, the most difficult for the country and the Red Army. Then it was possible to create an effective system of medical support for troops in defense and attack, ensuring the main directions of its further improvement.