__

251

__

: .

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2 01 6

.. ...

__

__

.


.

.: 22 007
:

27950 - 31.401
27950 - 31.402

: 27950 - 29.206
/ : hcdimitsana@gmail.com

ISBN 978-960-6827-14-3
MEDICAL GRAPHICS
10-12, ..:185 36 . .:210 4510874, fax:210 4528025
.. ...

__

__

()

&

19

(per os)
(im)
(iv)
(io)

23
24
24
26
27
27
27
28

29
31
32
33
35

Venturi
(Ambu)

36
37
37
37
38
38
39

41
44
52
54
56

, &

58

...

61

(OEM)


()

63
66
68
71

.. ...

__

__

-

1
2 (Mobitz I)
2 (Mobitz II)
3 ()

73
76
77
78
79
80

-




(AF)
(WPW)
(VT)
(Torsades de pointes)
(VF)

82
83
85
87
89
92
94
96
97

()

100
101
103
105
107
108

109
110
111
112
113
115

()

117
119
122
123
125
126

127
128
129
131

.. ...

__

__

133
135
136
138

-
&

140
141
142

143
145
146
147

149
151
152
154

156
158
160
161
162
163
165
166
167

169
171
173
192
195
197
199
200
201

shock

-

203
205
207
209

.. ...

__

__

- (b-blockers)



(CO)

211
214
215
216
217
218
219
220
221
222
223
224
225
226

...


()

227
228
229
239

-

G-6-PD

240
241
242
243
244
245
247
249

251

.. ...

__

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(..),
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__

__

Amlodipine: Norvasc /Amlopen, caps 5, 10 mg
Diltiazem: Tildiem / Dipen, tabl. 60 mg, inj. 100 mg/vial
Verapamil: Isoptin, amp. 5 mg/2 ml, tbs: 40, 80, 120, 240 mg.
Nifedipine: Adalat, caps 5 mg l0 mg.
Nisolpidine: Syscor, tabl. 10 mg.
.
Adrenaline: inj. sol. amp. l mg/ml.
Ethylphenylephrine: Effortil, amp. l0 mg /ml.
Dopamine: Giludop, amp. 50 mg / 5 ml.
Dobutamine: Inotrex, inj. sol. 250 mg /20 ml.
Isoproterenol: Isuprel, amp. 0,2 mg/ml.
Clonidine: Catapresan, tbs 0,150 mg, amp. 0,150 mg.
.
Amiodarone: Angoron, amp. 150 mg / 3 ml,
Adenosine: Adenocor, amp. 6 mg / 2 ml.
Disopyramide: Rythmodan, caps 100 mg,
Flecainide: Tambocor, amp. 10 mg/ml (15 ml), tabs. 100 mg.
Mexiletine: Mexitil, amp. 254 mg / l0 ml,
Verapamil: Isoptin, amp. 5 mg / 2 ml
Vernakalant: Brinavess, inj. sol. 20 mg/ml, vial 25 ml.
Xylocaine (Lidocaine): 1 fl = 50 ml. : 2% (20 mg/ml),
.
Acetylsalicylic acid: Aspirin, tabl. 500 mg, Salospir, tabl. 100, 325 mg.
Ticlopidine: Ticlid, tabl. 250mg,
Dipyradamole: Persantin, drag. 75 mg, amp. l0 mg / 2 ml.
Clopidogrel: Plavix/Grepid, tbs. 75 mg, tabl. 150 mg.
Ticagrelor: Brilique, tbs. 90 mg.
():
Atropine: amp. l mg / ml.
(-).
Enalapril: Renitec, tbs. 5 mg, 20 mg.
Captopril: Capoten, tabl. 25 mg & tabl. 50 mg,
Benazepril: Cibacen, tabl. 20 mg.
Quinapril: Accupron, tabl. 5 mg, 20 mg, 40 mg.
().
Valsartan: Diovan / Dalzad, tbs. 80, 160 mg.
Irbesartan: Aprovel / Lucidel, tbs. 75 mg, 150 mg, 300 mg.
Telmisartan: Micardis / Pritor, tbs. 40 mg, 80 mg.
Olmesartan: Olartan / Olmetec, tbs. 10 mg, 20 mg, 40 mg.
.. ...

__

10

__

.
Streptokinase: Streptase, inj. lyoph. 750.000 IU, 1.500.000 IU
Alteplase ( ): Actilyse: l amp. = 50 mg.
Reteplase: Rapilysin, inj.pd.ly. 0,56 gr (10 iu) / vial.
.
Heparine (UFH) 5000 IU/ml (l amp. = 5 ml = 25000 IU).
Enoxaparine (Clexane) 2000 iu/0,2 ml 10000 iu/1 ml
Tinzaparine (Innohep) 3500 iu/0,35 ml 20000 iu/2 ml
Fondaparinux (Arixtra) inj. sol. 2,5 mg / 0,5ml, 7,5 mg / 0,6ml, 10 mg/0,8ml.
:
: Digoxine, tabl. 0,25 mg, amp. 0,5 mg.,
: Lanitop, tabl. 0,1 mg,
.
Furosemide: Lasix, amp. 20 mg / 2 ml, tabl 30, 40, 500 mg.
Furosemide + Amiloride: Frumil, tabl (40+5) mg.
Bumetanide: Burinex, tabl. 1 mg, amp. 0,5 mg/ml
(b-blockers).
Metoprolol: Lopressor, tabl. 100 mg,
Atenolol: Tenormin, tabl. 100 mg, amp. 5 mg / l0 ml,
Propranolol: Inderal, tabl. 40 mg, amp. 5 mg / l0 ml.
Labetalol: Trandate, tabl. 100, 200, 300 mg, amp. 5 mg.
Esmolol: Brevibloc, inj. sol. 100 mg / 10 ml vial BTx5
Brevibloc, sol. inf. 10 mg/ml BTx1 (Bag. 250 ml).
:
Nitroglycerine: Nitrolingual, amp. 25mg / 25ml, Nitrolingual spray.
Isosorbide Mononitrate: Monosordil, tab. 20 mg, 40 mg. Imdur tab. 60 mg.
Isosorbide Dinitrate: Pensordil, subl. tab. 5mg, tab. 10 mg.

:

Nimodipine: Nimotop/Nimovac, inj. sol. 10 mg / 50 ml.

:
Piracetam: Nootrop / Oxynium, amp. 3 gr / l5 ml,
Bulfomedil: Loftyl, inj. sol. 50 mg / 5 ml.
: Daflon, tbs. 500 mg.
Pycnogenol, tbs. 20 mg & 50 mg.

.. ...

__

11

__

.

2 ( & ).

Salboutamol: Aerolin, resp.sol. 5 mg/ml.

Terbutaline: Dracanyl, 0,5 mg /dose
Salmeterol: Serevent, 25 mcg/dose, 50 mcg/dose
Formoterol: Foradil/Oxez, 9 mcg/dose, 12 mcg/dose.
Indacaterol: Onbrez, inh. Pd. caps. 150 mcg, 300 mcg.

().

Ipratropium: Atrovent/Zyrolen, inh. sol. 250 & 500 mg /2 ml, spray.

Aclidinium: Bretaris/Eklira, pd. inh. md. 322 mcg/dose.
Glycopyrronium: Seebri/Tovanor, inh. cap. 50 mcg/cap.

2 .

Ipratropium + Salboutamol: Berovent/Demoren, inh. sol. (0,5+2,5) mg /2,5 ml.

Aclidinium + Formoterol: Brimica/Duaklir, pd. inh. md. (340+12) mcg/dose.

( & ).

Budesonide: Pulmicort, 0,25 & 0,5 mg/ml/amp.

Beclometazone: Becotide, 50 mcg/dose, 250 mcg/dose.
Fluticasone: Flixotide, (neb) 0,5 mg/dose, 2 mg/dose.
Mometasone: Asmanex, 200 & 400 mg/dose.
Triamcinolone: Kenacort, inj. susp. 40 mg/ml (im).
Hydrocortisone: solu-Cortef, inj. sol. 250 mg/amp. 2 ml & 500 mg/amp. 4 ml.
Methylprednisolone: solu-Medrol, inj. sol. 40, 125, 500 mg / amp.

().

Aminophylline: Aminophylline, amp 250 mg / 10 ml,

Theophylline: Uniphyllin, amp. 240 mg / 4 ml.
Uniphyllin, supp. 100 & 350 mg/sup.

.. ...

__

12

__

.

, .
& : Klysmol Fluid rect. sol. 133 ml.
: Duphalac syr. 3,335 gr / 5 ml (300 ml).
: Parafin oil, Nujol oil.
: Milk of Magnesia 8,5% (340 ml).
Mannitol: sol. 20% (500 ml),
Glycerine: Supp. Bebe (0,6 gr), enf (l,2 gr), adult (2,4 gr).
/ (

):

Loperamide: Imodium caps 2 mg & Sir l mg / 5 ml,

Octamylamin: Octinum-D, drops,
Diphenoxylate + Atropine: Reasec, tabl (2,5 mg + 0,025 mg).

.
Metoclopramide: Primperan amp. l0 mg / 2ml.
Betahistine: Antivom tbs. 8, 16 mg. Ribrain tbs. 6 mg.
Promethazine: Titanox amp. 50 mg / 2 ml.
Chlorpromazine: Zuledine amp. 25 mg / 5 ml.
Ondansentron: Zofron amp. 4 mg / 2 ml.
.
: Simeco tabl., susp. aalx tabl, susp.
Milk of Magnesia oral susp. 425 mg/ 5ml.
&
:
Hyoscine--butylbromide: Buscopan, amp. 20 mg / l ml.
Trimebutine: Ibutin, tbs. 300 mg.
Mebeverine: Duspatalin, tbs. 200 mg.
2 .
Ranitidine: Zantac/Lumaren, tabl. 75, 150, 300 mg, amp. 50 mg / 2ml.
(PPI).
Esomeprazole : Nexium, inj. sol. 40 mg / amp.
Omeprazole: Losec / Lordin / Penrazol, inj. sol. 40 mg / amp.
Pantoprazole: Zurcazol / Controloc, inj. sol. 40 mg / vial
.
+ : Carbosylane, caps (140+45) mg,
: Ceolat tabl. 80 mg.
.. ...

__

13

__

.

.
Phenytoin: Epanutin, amp. 250 mg,
Midazolam: Dormicum, amp. 5 mg / 5 ml, l5 mg / ml.
Diazepam: Stedon, amp. l0 mg / 2 ml, tabl. 5 mg, l0 mg.
Levetiracetam: Keppra, amp. 100 mg / ml x 5 ml.
Sodium Valproate: Depakine, inj. sol. 400 mg /vial
.
Dimenhydrinate: Vertigo-Vomex, caps (120+75+30)mg, supp. (80+50+40)mg,
Vomex- amp. 100 mg / 2 ml,
Betahistine: Ribrain, tabl. 6 mg.
Antivom, tbs. 8 mg, 16 mg.
Ondansentron: Zofron / Onda, amp. 4 mg / 2 ml, 8 mg / 4 ml.
.
Sumatriptan: Imigran, amp. syring 6 mg / 0,5 ml, tbs. 50 & 100 mg.
Rizatriptan : Maxalt, Rapid sol. tab tbs. ling. 5 & 10 mg
Ergotamine + Caffeine : Cafergot, supp. (2+100) mg.
& .
Carbamazepine: Tegretol, tbs. 200 mg, 400 mg, syr. 100 mg / 5 ml.
Clonazepam: Rivotril, tbs. 0,5 mg, 2 mg, syr. 2,5 mg/ml
Pregabalin: Lyrica, tbs. 25, 75, 150, 300 mg.
:
Biperiden: Akineton, amp 5 mg / ml.
Benzhexol: Artane, tbs. 2 mg, 5 mg.

:
Nimodipine: Nimotop / Nimovac, inj. sol. 10 mg / 50 ml.

.. ...

__

14

__

.
( ):
:
Aloperidol: Aloperidin, amp. 5 mg / l ml, drops l0 mg / ml.
Chlorpromazine: Zuledin, amp. 25 mg / 5 ml.
Olanzapine: Zyprexa, amp. 10 mg/vial
Promazine: Sparine, fl. 50 mg / ml.
():
Alprazolam: Xanax, tabl. 0,25, 0,5, 1, 2 mg
Clorazepate: Tranxene, caps 5, l0, 20 mg.
Diazepam: Stedon, amp. l0 mg / 2cc, tabl. 5 mg, l0 mg
Lorazepam: Tavor, amp. 4 mg/ml

, &

& .

Diclofenac sodium: Voltaren, amp. 75 mg / 3 ml,

Indometacin: Indocid, inj. sol 1 mg/ml (amp. 3 mg)
Paracetamol: Apotel, amp. 600 mg,
Lysine acetyl-salicylate: Egicalm, inj. sol. l,8 gr,
Lornoxicam: Xefo, amp. 4 mg/ml,
Tenoxicam: Tilcitin, inj. 20 mg
Parecoxib: Dynastat, amp. 40 mg/vial.

Baclofen: Miorel / Vioridon, tabl. 10 mg

Orphenadrine: Norflex, amp. 60 mg / 2 ml
Thiocolchicoside: Musco-Ril, amp. 4 mg / 2 ml
Tizanidine: Sirdalud, tabl. 2 mg & 4 mg.

.


: Glucagon, inj. sol. 1 mg/amp.
:
Insuline Actrapid, 100 iu/ml,
Insuline Humulin Regular, 100 iu/ml.
Insuline Grargine (Lantus), inj. sol. 100 iu/ml, vial 5 ml.
.. ...

__

15

__

.
&

Morphine, amp. l5 mg, tbs. 10, 15 mg.

Pethidine, amp. 0,l gr.
Tramadol: Tramal, amp. 100 mg / 2 ml, tbs. 50, 100 mg.
Dextroproxyphen: Romidon / Zideron, amp. 75 mg / 2 ml.

.
& :
Proparacaine: coll. Alcaine 0,5%, fl. 15 ml.
Tetracaine: coll. Tetracaine 0,5%, fl. 15 ml.
Tobramycine + Diclofenac: coll. Tobrafen (0,1+0,3)%, fl. 5 ml.
:
Dexamethasone: coll. (ear/eye sol.) Decadron 0,1%, fl. 5 ml,
Prednizolone: coll. Adelone 1%, fl. 5 ml,
Fthoriometholone: coll. FML 0,1 %, fl. 5 ml.
:
: coll. Thilocof 1% fl. 7,5 ml.
Tobramycine: coll. Tobrex 0,3% fl. 5 ml.
Neomycin + Dexamethasone: Afacort (0,1+0,35)% fl. 5 ml.
Gentamicin + Dexamethasone: coll. Gentadex/Dexamytrex (0,1+0,3)% fl. 5 ml
Chloramphenicol + Dexamethasone: coll. Dispersadron (0,5+0,1)% fl. 10 ml.
:
+ : coll. Cosopt 2,5%.
+ : coll. Combigan (0,2+0,5)%
: coll. Dispercarpine / Isoptocarpine 2%.
: coll. Xalatan, 50 mcg/ml, fl. 2,5 ml.

.

:
Diydralazine: Nepresol, amp. 25 mg / 2 ml.
( ):
Isoxuprine: Duvadilan, tabl. 20 mg, amp. l0 mg / 2 ml,
Ritodrine: Yutopar, tabl. l0 mg, amp. 50 mg / 5 ml.
: :
Melhylergonovine: Methergin, drag. 0,125 mg,
Demergin: inj. 0,2 mg/ml, tabl. 0,2 mg.
:
: Oxytocin, amp. 5 IU/ml.
Betamethazone: Celestone chronodose, amp. 6 mg/ml.
.. ...

__

16

__

Atropine: amp. 1 mg/ml

Acetylocysteine: Parvolex / Flumil, amp. 2 gr/10 ml.

Bentonite: Bentonitum pd.oral.susp. 100 gr/vial.

Calcium Gluconate: amp. inj. sol. 10%

Dimercaprol: BAL inj. sol. 100 mg / 2 ml.

: Ultracarbon tabl. 250 mg

Flumazeline: Anexate amp. 0,5mg / 5 ml

Glucagon: inj. sol. 1 mg/amp.

Ipecacuanha 7%: Ipecavom syr. 1000 mg /15 ml (fl. l5 ml).

Methylene blue: amp. 1% (100 mg / 10 ml).

Naloxone: Narcan, amp. 0,4 mg / 1 ml.

Penicillamine: caps 250 mg.

Physostigmine: Neostigmine, amp. 2,5 mg / l ml, Prostigmine amp.

Pralidoxime: Contrathion amp. 200 mg.

Silibinin: Legalon inj. sol. 350 mg/vial.

Vitamine 1: Konakion amp. l0 mg / l ml.

. &
& ,
.
Almora n.
Dextrose Water - 35% [amp. l0 ml = 3,5 gr.]
Glucose (Dextrose Water) inj. sol. 5%, 10%
Potassium chloride (KCl) 10% [amp. l0 ml = 1 gr]
: Sir. Sopa ,
Water for injection [amp. l0 cc].
Gluconate calcium - 10% [amp. l0 ml = 1 gr].
Sodium chloride - 15% (NaCl 15%) [amp. l0 ml = l,5gr].
Sodium chloride - 0,9% (NaCl 0,9%) [amp. l0 ml]
Sodium chloride 0,9% (100, 500, 1000 ml)
Sodium Bicarbonate = 4 [amp. l0 ml = 0,4 gr.]
Ringers Lactate vial 1000 ml
Ringers Solution vial 1000 ml
Mannitol sol 20% (
).

.. ...

__

17

__

. &
.
:
Dexamethasone: Decadron / Dexaton, inj. 8 mg / amp. 2 ml.
Methylprednizolone: Solu-Medrol, inj. sol. 40 mg, 125 mg, 500 mg, l gr.
Prednizolone: Prezolon, inj. sol. 25 mg / amp. l ml
Betamethazone: Celestone chronodose, amp. 6 mg / l ml.
Hydrocortisone: Solu-Cortef, inj. sol. 250 mg/amp. 2 ml, 500 mg/amp. 4 ml.
:
Betamethazone: Betnovate, cream 0,1%,
Mometazone: Elocon, cream 0,1%.
.
Dimetindene maleate: Fenistil, amp. 4 mg / amp. 4 ml.
Promethazine: Titanox, amp. 50 mg / 2 ml.
Hydroxyzine: Atarax, inj. sol. 100 mg / 2 ml.

. &
:
Cefotaxime: Claforan, amp. l gr / vial.
Ceftriaxone: Rochephin, inj. sol. 2 gr / vial.
Penicillin G inj. sol. 1000000 IU.
(

).

Amoxicilline: Amoxil, inj. sol. l gr / vial.

Cefoxitine: Mefoxil, inj. sol. l gr / vial.
Ceftazidime: Solvetan, inj. sol. 500 mg, l gr, 2 gr / vial.
Cefouroxime: Zinacef, inj. sol. 750 mg & 1500 mg / vial.

:
Amikacine: Briklin, inj. sol. 500 mg / amp. 2 ml.
Netilmicin: Netromycin, inj. sol. 300 mg / amp. l,5 ml.
Tobramycin: inj. sol. 80 mg / amp. 2 ml.
:
Azithromycin: Zithromax, inj. sol. 500 mg / vial.
Vancomycin: Voncon, inj. sol. 500 mg / vial.
Aciclovir: Zovirax, inj. sol. 250 mg / vial.
:
: Betadine, sol. 240 ml 10%, surgical scrub 1000 ml.
(H2O2 - "").

.. ...

__

18

__

.
& &
1. Povidone iodine: cream Betadine 10, 20, 100 gr.
2. Amikacin: gel ext. use Likacin 5%, 10 gr, 30 gr.
3. Fusidic acid: gaze/cream/oint. Fucidin 2%.
4. Sulfadiazine Silver 1%: cream Sylfio 500 gr.
cream Flamazine 20 gr, 50 gr, 500 gr.
5. Mix: Sulfadiazine silver / Hyaluronic: cream Jalplast Plus 100 gr.
6. Mix: OGT / Aloe vera / Hyaluronic / Vit. E: cream Flogo calm 50 ml.
7. Mix: Hydrocolloid/Arginine/BCFA/E218/E216/EDTA: cream Flamigel 50 gr.
8. Mix: Alkanin/Shikonin/Pistacia lentiscus: cream Histoplastin Red 50 gr
9. Mix: Alcanna tinctoria/Calendula/Jojoba/vit. E/ : oint. Alkaderma 30 gr.
10. Mix: // : cream Sudocream 125 gr.
11. Mix: Zinc Oxide/Petrolatum/Mineral oil/Karaya: cream Conveen Critic Barrier, 50 gr
12. Mix: Hyaluronic/Oat/Panthenol/Glycyrrhetic Acid: cream/gel Flamosin Froika 55 ml.
13. Mix: Allantoin/Elastin/Collagen/Glycolic acid: cream Elicina 40 gr.

.. ...

__

19

__

&



.
(Levin) .
60 ml
Levin Nelaton.
.
(14G 24G).
( ).
("") .

.
(2 ).
. () .
. Venturi. .
.
Ambu ( ) set .
i-gel.
.
Set .
. .
. .
.
.

.
.

.. ...

__

20

__

. .
.
. (Artiflex, orthoban).
.
. .
.
.
() .
.

().
( )
.
, .
.
, .
.
.
: Lidocaine: fl (50 ml), : 2% (20 mg / l ml)
sol. 10%. .
.
set .

(Foley) .
.
Tiemann .
(3.0 nylon),
Tiemann.
( ).

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,
,

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.. ...

__

21

__

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.

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.. ...

__

22

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4. , ,
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.. ...

__

23

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,

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.
: .

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.
.
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, , , , .
(subl.)

.
.
,

. '
.
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, .
,
. :
. : Capoten, Adalat ( ).
: Pensordil.
: .
.. ...

__

24

__

2. (Intramuscular, im)
,
.

(.. )
(.. ).


(.. , ).
:
().

( ).
(-

).

,
,
,

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, ,
,
.

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,
,
.

.
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,
.
.. ...

__

25

__

:
1.
3.
2. ,
4. .

. ,
,
, .
, :



,

.
, ,
, . ,

.
, .
, . ,
shock.
.

14G (2,1 mm)

(45 mm)

1,47 mm

300 ml /

16G (1,8 mm)

(45 mm)

1,25 mm

200 ml /

18G (1,3 mm)

(45 mm)

0,85 mm

90 ml /

20G (1,1 mm)

(33 mm)

0,70 mm

61 ml /

22G (0,9 mm)

(25 mm)

0,55 mm

36 ml /

24G (0,7 mm)

(19 mm)

0,45 mm

15 ml /

24G , 22G 20G

.
14G () 20G () .
18G , 16G
14G,
( / ).

(, , ) .. .
.. ...

__

26

__

4. (Intraosseous, io)
,
, 6 , .

(ERC-2010),
(, ,
) .
,
2-3 .
,
.

( ,
shock, , , ...).
K
- (.: BIG Bone Injection Gun)
Jamshidi .

H , 1-2 .
( )
90 . H
,
.
.

, .
( 24 ),
.

.. ...

__

27

__

5.

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,
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, , ..).
,
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.
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.
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6.

.

.
,
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.
50%
,
.

7.
,
,
, , , , ,
2 2,5
.
(35 cm)


.
10 ml NaCl 0,9%
3-5 ambu
.

.. ...

__

28

__

8.

,
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. - ,
, ,
.
,
.
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,
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~~~~~~~~~~~~~~~~~~~

.

30 - 60

30 - 60

2-3

2-3

3-5

10-20

15-30

5-30

30-90

( )

.. ...

__

29

__

&
,
(
285-295 mOsm/lt)
(HES, , , )
.

:
Na+: 135-145 mEq/L,
K+: 3,5-4,5 mEq/L,
Mg++ : 1,5-2,5 mEq/L,
Cl - : 95-110 mEq/L,
Ca++: 4,5-5,5 mEq/L,
HCO3-: 24-28 mEq/L.
,
. ,
,
. ,
,
(,
, ...).
,
, ( Na-).
H ,

.
240 340 mOsmol/L .
340 mOsmol/L
240 mOsmol/L .

, 1000 ml D5 W
80 ml. 1000 ml N/S
275 - 300 ml 1000 ml
600 ml .

.
.
,
.

,
.

.
( ),
.

, ,
.
,
.
, ,
.
.. ...

__

30

__

,
, ,
.

shock .

,
shock
,
, .

, 4 ml / kg ,
.
(
shock ) ,
( ),
.
.
.
,
.
.
,
.
,
,
.
(HES)
,
, .
(Voluven, Tetraspan 6%)
.
(~5 ) ,
.
,

24 ,
.
23/10/2013, , ,
(PRAC)
, (HES)
,

.
.

.. ...

__

31

__

, :

NaCl 0,9% - (: 308 mOsmol/L - pH: 5,5)

Na+: 154 mEq/L Cl-: 154 mEq/L.
NaCl . 1000 ml
N/S 275 ml 875 ml.
.
.

NaCl 7,5% - (: 2567 mOsmol/L - pH: 5,7)

,
(
) Na+ / Cl-.
Na+ . 2
.
, .
250 ml NaCl 7,5% 4 ml/kg
1000 ml
. ,
, .
-
( ) .
.

Ringers Solution - (: 309 msmol/L)

K+, Na+, Cl- Ca++,
. : Na+:147 mEq/L, Cl-: 155 mEq/L,
K+: 4 mEq/L, Ca++: 4,4 mEq/L.
R/S ,
.
, .

Lactate Ringers - (: 273 mOsmol/L - pH: 6,5)

.
: Na+: 130 mEq/l, Cl-: 109 mEq/l, K+: 4 mEq/l, Ca++: 3 mEq/l, : 28 mEq/l.
,

, . H
.
, ,
, . R/L
(Ca++)
. R/L

.

.. ...

__

32

__

(5%, 20%)
, 80%
.
65-69 kD,
12 18 .
Human Albumin 5% (: 309 mOsmol/L
: Na+:130-160 mEq/l, Cl-:100-130 mEq/l K+ < 2 mEq/l),
(, ,
, )
...

.
N/S R/S
(Ringer Solution) Human Albumin 20%
4 . ,
, .

. 35
[Haemaccel (: 274 mOsmol/L, pH:7,3)] [Gelofusine
(: 274 mOsmol/L, pH:7,4)]
(, , shock).
( 20-25 kD)
(2-3 ). 80%
,
. 1,5 lt
, .
.

.

(HES)

( --
.:165 kD),
6% 10%, NaCl 0,9%. (. > 450 kD)
.
.
6% 100%,
10% 130%
.
6%
[Voluven 6% Tetraspan 6%, (:308 mOsmol/L, pH:5,0)]
.
, ,
,
.
, 2 lt ,
30-40 ml/kg/24
4-6 .
, .
.. ...

__

33

__

()
D/W 5% - (: 252 mOsmol/L - pH: 4,5)
. 2
. ,
170 kcal/L.

.
1000 ml D5W
80 ml. CO2
.
D/W 10% - (: 505 mOsmol/L)
, 2 340 kcal/L.
,
.
,
.

.

-


/ .

.
,
.
, ,
, .
1 ml 3 ml
,
,
. " 3 1".

.

.


.

, , ,
. ,
,
.
.. ...

__

34

__

,

SHOCK
.

.
,
:
25% 5%
5%.
5%.



.
shock .
SHOCK
.

. ' ,
2
, .
( Tetraspan 6%)
shock shock.
( ,
, ,
) .

( Ringers Lactate)
( 24 ).
( )
:
1. 50% (BSA).
2. 24 .
3. .

.. ...

__

35

__

( )
. .. 1000 ml 4 ,
250 ml/.
,
( )
.
2-3 ,
. , ,
.

ml. ,
,
50-60 ml, 8-20 ml.


:
/min = [ (ml/h) x / ml] / 60 (min )..
.. 1000 ml 8 30 = 1 ml,
: /min = [1000/8 x 30] / 60 = 62,5 /min.

.

.

.
.
, , :
, ,
.
30 min, 15 min.
(..
), .
,

,
.
.
.

.. ...

__

36

__

. ,
, pH
.
.
14 - 18 /
40/. ( 2)
21% (CO2). 2
CO2
.

.


SaO2 > 90%, Hb
. 2
,
.
() ,
.
, 2 (..
100% 2 12 60% 2 36 )
( Lorrain-Smith).
2
.
:
1. , (.. , ,
, , , ..)
2. (.. , shock, )
3. (.. , , , ..)
4.
5.
6. (.. , , -)
7. ,
8.
2

2 (FiO2). :
I. 2
()
()
i.
ii.
a)
b)
II. 2
O2 Venturi
.. ...

__

37

__

1 .
, .
FiO2 = 0,24 - 0,40
1 6 L/min. FiO2 :
FiO2 = 20% + [4% x[ 2]..
:
1 L/min 24% 2
2 L/min 28% 2
3 L/min 32% 2

4 L/min 36% 2
5 L/min 40% 2
6 L/min 44% 2.

4 L/min ,
, 2
.
.
2
2
. .

2
() , ,
. (-)
.
.
2 35-60% ( FiO2 0,6) 5-10 L/min.
.
(, , ).
.
FiO2 ,
FiO2 60%.
.

2
FiO2
> 0,60. 2 80-90% 6-10 L/min.
750-1200 ml .

.

-.
FiO2

2 CO2.

2.
,
.
.
.. ...

__

38

__

2
, , 2
( )
FiO2 > 0,5. 8-12 L/min.
FiO2 = 1,0 2 (10 L/min)
.
FiO2.
,
2 2
.
FiO2.
, -
.

FiO2 0,9.
.

.
.

2 VENTURI
2
15 .
Venturi
.
2 FiO2
0,24-0,5
. .

2
.
2 FiO2.
.. ...

__

39

__

FiO2 .

:
2 FiO2,
.

( ) FiO2.
2 .
.
.
2 (> 0,5)
,
.

2 (AMBU)

,


.
().
1300-1500 ml,
< 5 300-500 ml.
, ,
.
.. ...

__

40

__

- -
,
.
, .
,
. .
2 15 L/min FiO2 = 1,0.
2 ambu
2,5 L. ambu FiO2 < 0,5.

(Tidal Volume - VT)

6-10 ml/ kg , 450-750 ml
.
( ) (
), .
, 12-14 / min,
.
paCO2 paO2, ,
. > 20 / min
.
Ambu
2.
.
,
, ,
SpO2 > 90%.
, ambu
OBESE:
Obese...
Beard
Edentulous
Snoring/oSa...
Elderly > 55y. > 55 .
.. ...

__

41

__

.

. , , , .
2011
..
() -,
.

,
.
( , ).
.
,
.


.

.
.
,
,
.

. .
.
,
,
.
:
, , :
:

,
,
.
, :
/ / .
.. ...

__

42

__

.

.
, .

.
25%,
.
,
.

& .

.
,
,
.

,
.

:

.. ...

__

43

__

.


, .

& .

,
.

.

, .
.
.
.

.

.
ICD-10 .

.

. :
[29/2/2016].

, ..
.. ,
/ .

.
(.. , ),
.

.

, .
.. ...

__

44

__

, .. Ceclor ().
:

Rp.

caps. Ceclor MR 750 mg, bt No II ().

S:

1 x 2, 10 .

bt boite = , bt No II ()
. caps . 1x2
1 ( 12 ).
Ceclor , :

Rp.
S:

Sirop Ceclor 375 mg, bt No I ().

7 ml x 2 ( 12) 7 .

(
) Ceclor :
Caps. 500 mg,
sirop. 250 mg,
tabl. retard 750 mg,
sirop. 375 mg.
sirop. 125 mg,
Tabl retard .
Voltaren ().
:
tabl. 25 mg,
tabl. retard 100 mg,
tabl. 50 mg,
amp. 75 mg,
tabl. disp. 50 mg,
supp. 50 mg,
tabl. retard 75 mg,
gel 1%
Amp. = , supp. = , gel = .
:

Rp.

supp. Voltaren 50 mg, bt No I ().

S:

1x2, 2-3
1x1 3 .

;
2001,
( ) ,
() .
.. .., .., , ,
, , , , ...

.
.. ...

__

45

__

, , ..
, , , .
.
.
.

, .
.. 30 tabl. tabl. tabl.
, 60 , 2 . 10 tabl.
1 tabl. , 3 .
,
. ( , !
, ,
).

28-30 . 5 .
25 .

,
., , .., .., ...,
.
.
- -.
, , ,
( ), .
,
. .. , , , , , ...

.
2 . 2 .
,
6-12 .

! ,
.
, .. , .
.. ...

__

46

__

" ";

. .
, :
Xanax, Tavor, Lexotanil, Hipnosedon, Stedon, Gardenal, Diphenal, Halcion,
Librax, Loramet, Sival-b, Stilnox, Tramal, Zaldiar, ...
(Lonalgal, Lonarid-N),
tabl. Lonarid-N
.
200 mg , ( 2 ):
1 Lonarid-N tbl. (10 mg , 200 mg 20 )
1 Lonarid-N supp. (20 mg , 120 mg).
400 mg ,
( ) ( 3 ):
2 Lonarid-N tbl. (400 mg),
3 Lonarid-N supp. (360 mg),
1 Lonalgal tbl. (30 mg , 300 mg 10 ).
400 mg (
).

, .

.. , .
, , . ,
36 .
12 , 3 . 36
36 ...
,
.

30
;

30 .
5 . 25 .
.
. .. ,
10 ,
.

.
(
).
,
.

.. ...

__

47

__

, , .
.. , ,
- - ..
,
!
,
,
.
:
1. 25 30 ( 5 )
2. ( ,
).
3. .. 20 .
. 25-30
.
4. ...

, ;

.
2-5 (
) 10% (
25%) .

.
!!! .
.. , .. Lasix
10%, . ,
( ) .
(
).

:
1. ,
, .
2.
, .
' ,
.
..
.
3. ,
.
4.
(
).
.. ...

__

48

__

,
(

).

,
, .

, , .

(
).
.
o
,
. ,
( ) ,
.
, .

!
. ,
,
.
,
.

.
.. (3 ).
.
:
:
tab. Glucophage 850 mg, 1x2 tab. Diamicron 1x2
3 .
1. 3
3

3 .
.. ...

__

49

__

2. 2 Glucophage (x 30) 1
Diamicron (x 60). .
3. - , ....
4. (
).
5. :
" - . 1 No 2 No 3" ( 1, 2 3
). .
23 , 23
, 23 23 ( 5 ).
.

,
. 3
.
.
( 6).

'
.
,
, ,
.

, .

, / / .

(.. . , 3002).

.
.
()
.
.

/
. . , ,
- , .

.
.. ...

__

50

__

;
0% 10% ;
(0 %)

,
, 10%

, :
(0%) :
, .
.
.
, & - ,
.
5. .
6. .
7. ( ).
8. ( ).
9. ( , ).
10. C.
11. Wilson ( ).
12. .
13. Gaucher.
14. - - .
15. , 3 4.
16. ,
17. Niemann Pick C
18.
19. ( )
1.
2.
3.
4.

,
, .

(AIDS), .
,

, .

.
,

, ,
....
,
,
, .
.. ...

__

51

__

( 1 0 % )
10% :
1. Parkinson
2.
3. (, ,
...),
4.
5.
6.
7.
8. Wilson ( )
9. Burger
10.
11.
12. , Alzheimer
13. Charcot.
10%

,
. , .
,
.
.
,
. . .
, ,
(
),
, !!!
.. ...

__

52

__

3 ,
.
.. "
, " ( ).

,
&

/ : .
:

/ : .
: .
: ...
: .

Rp.

1. ...
( )
2. .
3. .
(. )

-
: . / / .

.
( )
3 .
:
.. ...

__

53

__

1. ,

( Stamey - Meares)
, .
2. Gram (-) .
3. .
4. , ,
(3 ).
5. , ,
HIV .
6. ( ).
7. .
8.
( ).
9. [ (..
, , Sjogren)].
3 (, )






.
3 ,
,
HIV .

,
.
, (
).

, .

,
.

. , , (..
..).

, ,
.

.
.. ...

__

54

__

,
, . O



.
O
.
H (
)
.
(, , )
' ( ).


.
6-12 pH
2
. (1-3 )
.. ,
.

, ,
:
1. , ,
.
.
2.
.
.
3.


.
4.
.
.
5.
G-6-PD.
6.
.
7.
.
.. ...

__

55

__

8.

.
9.
(21077.93.777).

O

.
T
mg/kg.
.

.
.
H 70 kg 1,8 m2.
:

.. = [ (m2) / 1,8] x . .


.


.

1
3
6
12
2
3
4
5
7
8
9
10
11
12

(kg)
3,4
4,2
5,6
7,7
10
12,5
14
16,5
19
24
27
29,5
32,3
35,5
37
70
56

(cm)
50
55
59
67
75
87
94
102
108
120
129
134
139
144
148
173
163

(m2)
0,23
0,26
0,32
0,40
0,47
0,55
0,62
0,68
0,73
0,88
0,92
0,97
1,10
1,18
1,25
1,80
1,60

(%)
12
15
18
22
25
30
33
37
40
50
57
62
65
69
75
100
100

.. ...

__

56

__

1. , ..
, ,
. :
A.
,
B. ,
, .
2. :


, . ,

,
,
.
3. :


. (1) (2)
. (3)
- .
4. ) , )
) :
A.

.
B.

.
5. T :


(10%).
.
.
6.
25% :

25%,

.
7. M
: ,

.
.. ...

__

57

__

8.
:
(. INNOHEP syr 2 X 0,45 X 4500 IU
INNOHEP syr. 10 X 0,45 X 4500 IU)


. ( 2 INNOHEP syr. 10 X 0,45 X
4500 IU: P 10 amp. / 0,45 X
4500 IU BT () 20 2).
9. .. ..
: .
.. ..

.. ..
.
10. .. ..
: .. ..
,
.
.
11.
:
.
12. :

[ (3) ]
(. 2)
.
13. :
-
2 3
.
.

.
14. :

.
, 0% 10%

.

.. ...

__

58

__

, &


(..) (..), ,
. ,
,
.
(
),
:

, ,

..
,
(
/ 5749/56).
,
.
.. ,
,
.
[ 3/. 11681 / 28-8-1984 ( 602)]
, ,
(N. 2071/92).

, ,
,
(3/ 11681/84).

. 5 2 . 121/2008 ( 83A) ,

.

.., ,
.. ,
( 1397/83, 18).

,

,
.

..
..
.

,

, ( 3487/55).

.. ...

__

59

__

. , 3487/55 / 5749/56
,


.
,
, .

(
)
,
(
)
.

, 2012, :

:
1.
(,
)
,
, ( ).

, ,
,
.
2. , ,
,
.

:
1. .

,
.
2.

.

.. ...

__

60

__

27 66 . 3984/2011 ( 150)
[: 4-5]
, (7) .

,
, 7
(5 , 1 , 1 - ).
,
,
, ,
.

.
[ 1.v 1. 4 . 3868/2010

( 129)]

. (4, 8, 12, 14, 15, 16, 17, 18
) ()
.

24 . 3599/2007 ( 176) .
.....
(3)
, ,
. 21 8 . 3868/2010 ( 129) .
. 11 . 8 7 . 3329/2005 (
81)
.

.. 24 .

.. ...

__

61

__

. . .
,
,


.
, ,
. /
, ,
, ,
, .
, .
, / , .
,
. ,
,
, , .
,
- - A, B, C, D, E
(. . ).
.

, ,
,
.
, .


.. / ..

: : , ;
:
1. .
2.
( )
( ).
3.
.
4.
.
, ,
( )
.
...
: ,
, ECG
.
,
.. ...

__

62

__

, /
.
,
.
, :
( < 90 mmHg),
(/ > 200/110 mmHg),
( > 150 /min),
(HR < 40 /min),
( > 30 /min),
( < 10 /min),
(SpO2 < 90%)
, ,
, :


,
,

,
/
(shock)

,
.
,
.
:
1. ().
2. ()
3.
(C).
4. (D).

--C-D-E
.

( , ,
)
A-B-C-D-E
, .
, ,
( , ,
, ).

.
, .

.

.. ...

__

63

__

[, , ,
, , (, )].
: 25% , 10%
!
: ( , , LBBB).
ST (STEMI) ST (non-STEMI).
, .

STEMI

,
,
.
: , ,
, , , , ,
, ..

1. 1 tab. 500 mg () .
2. per os 300-600 mg (4-8 tbs. Plavix 75 mg),
.
, , .
(Brilique, tbs. 90 mg), - ASA NSTEMI (
-ST) 90 mg x 2, per os.
3. 2 2-4 lt/min
, SpO2 > 90-92%.
4. 250 ml N/S.
, ( 2 s)
1-2 amp. Zantac 1 amp. Nexium .
.. ...

__

64

__

5. , 250 ml N/S D5 W
1 amp. Nitrolingual (NTG) 25 mg, 5-30
.. > 100 mmHg. (
).
6. , 4-5 iu Actrapid 250 ml D5 W.
7. (UFH), : 60-80 iu/kgr iv bolus (: 1 ml =
5000 i.u). : 12 iu/kg/h, . max 1000 iu = 0,2 ml UFH 500 ml
N/S 1 . ( UFH D5W).
(Clexane) 1 mg/kgr .. (sc).
(UFH)
1 amp. Fondaparinux (Arixtra) 2,5 mg.
8. , (1 amp. 1 ml
14 ml N/S 3 ml ).
.
9. ,
5 mg 2-3 (. 1 amp. 5 mg 10 ml N/S).
(max:15 mg), 5-15 .
10. ,

.
11. .
monitoring .
12. ,
, .

6

12 .
,
ACC/AHA t ( 90
min), 15 mg iv-bolus, 50 mg 30
min 35 mg 60 min. .
:

1,5 106 IU
D5W N/S
30-60 min

(iv)
SK
24-48

(tPA)
(Actilyse)

a) 15 mg, iv bolus
b) 0,75 mg / kg 30 min, iv
c) 0,5 mg / kg 60 min, iv
( 100 mg)

(iv) 24-48

(r-PA)

10 IU + 10 IU (iv)
30 min

(iv) 24-48

( - tPA)

0,5 mg/kg iv bolus

(iv) 24-48

(SK)
(

APSAC)

.. ...

__

65

__

.. ...

__

66

__

-
: >180 mmHg >100 mmHg,
. ,
.
: > 220 mmHg >120 mmHg,
(,
, ). .
, ,
, , , ..
.
A.Y. .
.
: ( ../...,
, / , ..,
.), .

1. ..., ..
. .
2. 1 tabl. Lexotanil 1,5 - 3 mg p.o., .
3. : 1 tbl. Normolose 50 mg, p.o. 30-45
, .
4. , : amp. 1 amp. Catapresan (im).
2-
. .
5. 15-25% 1-2 .

...

1. 2 4-8 lt/min.
2. ... . (
...
). [ : ..., ].
3. 3way 1000 ml N/S R/L 3 amp. Nootrop.
4. ( >220 mmHg >120 mmHg)
, : 1 amp. Catapresan 100 ml N/S 15-30
, : 10-20 mg (2-4 amp.) Trandate 100 ml N/S
5-10 . 250 ml
N/S D5W, 1 amp. Nitrolingual (NTG) 25 mg 5-20
170-180 mmHg.
5.
..180/110 mmHg, : 1 fl. Nimotop
10 mg (iv) , .
6. Foley 14-16 fr .
7. -
.. - 20% 60 .
.. ...

__

67

__

1. ..., .
. 2 SpO2 > 92%.
2. 2 6-10 lt/min Venturi.
3. 3way 250 ml D/W 5% 250 ml N/S,
1 amp. NTG (Nitrolingual) 25 mg 5-30 , ..
4. , . 1-3 amp. Lasix (iv-bolus) .
5. Foley .
6. , , 1 amp. Aerolin 1 amp. Atrovent,
3 ml N/S 2 6 lt/min.
7. , .

1. ..., .
. , .
2. . .
3. : 1 amp. Trandate 5 mg iv-bolus 10-20 mg
(2-4 amp. Trandate) 250 ml N/S, , 5-20 .
4. 250 ml D/W 5% 1 amp. Nitrolingual 25 mg 10-40 .
5. , - ( )
(Brevibloc) 500 g/kg (. Brevibloc
100mg/10ml 3,5-5 ml 35-50 mg) 1 .
6. 4-30 mg/min.
7. 100-120 mmHg (
60-75 mmHg) .
8. .

1. (/ >150/100 mmHg), 2
4-8 lt/min .
2. ... .
3. 3way : - 1 amp
Nepresol 25 mg, 100 ml N/S 10-20 ,
30-40 .
.
4. : 10-20 mg (2-4 amp.) Trandate 100 250 ml N/S
5-10 , .
5. , 2-4 gr MgSO4 25% 5-10
( 2-4 gr MgSO4 100 ml N/S, iv ).
1 gr MgSO4 .
MgSO4 ,
.
1 amp. 10 ml .
6. 1530 .

.
.. ...

__

68

__

( , , ,
) ( , 3 ,
, , )
.

, (...) shock.
, ,
, , , .
, .
.
(, , ...)

1. 2 100%, 4 - 8 lt/min, .
2. 1-3 amp. Lasix 250 ml D/W 5% (

iv bolus ).
3. 30-60
, .
:
A.
B.
C.
D.
E.
F.
G.

B Blockers

(-)..
,
. :
a)
b)
c)
d)
< 40%,
.
2
.

.
1. (Renitec), tabs. 5, 20 mg. : 10 20 mg / 24h.
2. (Normolose), tabs. 50 mg. : 50 450 mg / 24h.
3. (Accupron), tabs. 5, 20, 40 mg. : 20 40 mg / 24h.
4. (Coversyl), tabs. 4 mg. : 4 8 mg.
5. (Triatec), tabs. 1,25, 2,5 mg. : 5 10 mg.
.. ...

__

69

__

..
,
-V
NYHA. ()
( )
. .
( ) .
0,5 kgr /24h.
:
1. + (Moduretic 50+5 mg) : 1 - 2 tab. / 24h.
2. + (Frumil 40+5 mg) : 1 - 2 tab. / 24h.
3. (Lasix), tabs. 40, 500 mg & amp. 20 mg.
: 1 - 2 tabs. 40 mg / 24h, 7 - 15 .
(, ) (
) 6
,
. .
.
10 .

+
-
.
- ,
.
1.
2.
3.
4.
5.
6.

Cibadrex ( + )
Co-Renitec ( + )
Superace, Uresan ( + )
Accuretic ( + )
Zestoretic ( + )
Preterax ( + )

()
.
.
:
a) tabs. Aldactone 25 mg, 100 mg 50 100 mg / 24h, max: 200 mg/24h
b) tabs. Inspra 25 mg, 50 mg, 25 mg /24h.
< 2,5 mg/dl
< 5,0 mmol/l. 12,5 mg
25 mg < 5,0 mmol/l
.
.
.
.. ...

__

70

__

..

-. -

.
- .
.
, -,
.

[h]

[mg]

Losartan

Cozaar

2h

50 100 mg

Eprosartan

Teveten

5h

400 800 mg

Valsartan

Diovan / Dalzad

6h

80 320 mg

Candesartan

Atacand

9h

4 32 mg

Irbesartan

Aprovel / Karvea

1115 h

150 300 mg

Olmesartan

Olartan / Olmetec

1416 h

10 40 mg

Telmisartan

Micardis / Pritor

24 h

40 80 mg

B Blockers.
,
30% 25% .
II-IV NYHA
, -. :
a)
b)
c)
d)
e) .

2 (start low - go slow).

(Lobivon): 1,25 mg x1 10 mg x1
(Dilatrend): 6,25 mg x1 25-50 mg x2
(Lopresor): 25 mg x1 100 mg x2
(Pactens): 1,5 mg x1 10 mg x1

().

. V
, .
3
> 75 .
( )
.
.. ...

__

71

__

()
.

.
:
(.. ), (),
, , ,
, (, , )
, , , , ...
: ,
, , , (TRALI:
transfusion relating lung injury) , , ARDS ...
, :
, ( ), , ,

. ,
.
(

)
.
, , / .
, .
,

.
,

, ,
(S3),
.
(.., , SpO2, , , GCS, Gluco-stick).
R ,
(
).



,
.
.
( ).
/ .

.. ...

__

72

__

1.
A-B-C-D .
2. 2 100% 4-8 lt/min 12 lt/min,
. ,
1 amp. Aerolin 1 amp. Atrovent, 3 ml N/S .
3. ,
,
.
4. 3way (18 G-).
5. , 2-4 amp. Lasix 20 mg (iv bolus) (
) 1-3 amp. 15 ..
(3-5 amp. Lasix 250 ml N/S)
80 mg
. 5 - 160 mg/.
6. > 120 mmHg,
(1 amp. Nitrolingual 25 mg 250 ml D5 W N/S, 5-30 ~ ),
, (.. ... .).
7. Foley (14-16 fr), .
8.
.
1 amp. (15 mg) 9 ml Cl 0,9%.
1,5 mg/ml. Xo 1 ml (iv) 5 10-20 mg.
(! PCO2
50 mmHg).

9.

- 1 amp. Digoxin 0,5 mg, , .

10. <100 mmHg, 3-10

g/kg/min (iv) (4 amp. Giludop 50 mg/5ml 250 ml D5 W 10-20
). 2-3 g/kg/min ,
.
, , 1 fl. 20 ml
250 mg (Inotrex) 250 ml N/S, 1 mg/ml.
50 g Inotrex.
5-10 ml/h, 20-30 .
. (
) .
11. , : 1 amp. Uniphillin (iv) 250 ml N/S
( 30-40 ),
3 .
12. , monitoring , SpO2 .

.. ...

__

73

__

60 /min.
P PR 1/1 (-) .

:
1. ( , , ).
2. ( Ca++, b-blockers, ,
, , , ).
3. ( , ,
, , ,
, , , Ebstein,
, .).

,
, , , , .

.. ...

__

74

__

1. .
,
24 48 .
2. ,
250-500 ml N/S .
3. monitoring SpO2.
4. , Ventouri.
5. 0,5-1 mg iv-bolus,
3-5 3 mg
( max : 3 amp. ).
6. ,

, .
[ 0 mA,
. 50-80 mA.
(1-2 mg Tavor iv)
2-4 mg iv.
(Dormicum, amp. 5 mg / 5 ml)
amp. 100 ml N/S :0,5-1 mg,
: 4-6 mg < 60 ].
7.
* :
iv (5 amp. Isuprel 0,2 mg/ml 250 ml D5 W, 10-30
).
2-10 g iv (2 amp Adrenaline 500 ml N/S 5-10 ).
3-10 g/kg/min iv (4 amp. Giludop 50 mg/5ml 250 ml D5W
10-20 ). 1
, .
:
,
( ) .
8. -,
0,05-0,15 mg/kg (1-3 amp. Glucagen 100
ml N/S).
.
9. Foley (14-16 fr), .
10. ( monitoring)
, (SSS).

0,5 mg !

.. ...

__

75

__

.. ...

__

76

__

PR ( > 0,20 sec).
,

.

(
10-30%) .
, PR
QRS ,
.
300 ms
QRS ,
.

P-R
(RBBB) (LBBB),

His .

( - ), , ,
, , , -blockers
...

1. .

1 - .
.
2. 0,5 1,0 mg iv-bolus,
3-5 3 mg .
.. ...

__

77

__

2 Mobitz I
( Luciani-Wenckebach AV block)

PR QRS
.
.
-
- , .
His-Purkinje,
QRS .

.
, ,
, , .

1.
2.
3.

4.

,
.
0,5 mg iv bolus, 3-5
3 mg (3 amp. Atropine 1 mg) .
,
. 500 ml N/S.
( ).
,
.
.. ...

__

78

__

2 Mobitz I

PR
. (
) ( ).

(-) , His ,
- .

QRS .

Mobitz II -
( ,
).
- Mobitz -

( Adams-Stokes).

Mobitz II - 2:1
Mobitz I - , 0,5 mg Atropine iv bolus,
Mobitz I 1 .

1. (, , SpO2, ).
2. 2-6 lt/min, Ventouri.
3. 250-500 ml N/S.
4. 0,5-1,0 mg iv bolus, 3-5
3 mg (. max = 3 amp. Atropine 1 mg).
5. , (5 amp.
Isuprel / Isoprenaline 0,2 mg/ml 250 ml D5W, 10-30 )
.
6. SpO2 monitoring

, - .
.

7. Foley (14-16 fr), .

8. , , monitoring.

.. ...

__

79

__

3 ()

(P) (QRS).

.
- (
45-60 /) ( 30-40 /)
, .

-
QRS
.
( )
QRS ( Lenegre).
-
, ,
, , , , , .
15-30%
Adams-Stokes.
,
, 15 sec, , .
60 sec .

1. .
2. 3-way 0,5 mg iv-bolus,
3-5 3 mg .
3. 4-8 lt/min, Ventouri.
4. ,
(5 amp. Isuprel / Isoprenaline 0,2 mg/ml 250 ml D5 W N/S,
10-30 , ).
0,2 mg (. 1 amp. Isuprel).
5. ( QRS),
.

.
[ 0 mA,
. 50-80 mA.
(1-2 mg Tavor iv)
2-4 mg (iv).
(Dormicum) amp.
5 mg / 5 ml : 1 mg, : 3,5-7 mg
< 60 ].
6. monitoring
.
.. ...

__

80

__

(AV Junctional Escape Rhythm)

, - - ,
35-60 /,
.

.

, QRS-T
, , aVF aVR.
, QRS.
QRS PR 0,12 sec.

(
),
, (), , ,
.


.
,
.
.. ...

__

81

__

,
60-100 /
.

1. .
2. ,
.
3. 3-8 lt/min,
Ventouri, SpO2 > 90%.
4. 0,5-1 mg
(iv-bolus), 3-5 ,
3 mg Atropine ( 0,04 mg/kg).
,
.
5.
-
.
[ 0 mA,
. 50-80 mA.
(1-2 mg Tavor iv)
2-4 mg iv].

.. ...

__

82

__

>100-180 /.
PR . aVF.

. :
1. (, , stress, ).
2. (, , ).
3. (, , , ,
[ ], , ).

1. .
2.
.
,
, ,
,
...
3. ,
(.. ),
.
b-blocker (tab.
Inderal 40 mg, 1x1 1x2, ).
4. (Procoralan, If) 5
mg 7,5 mg ,
-,
.
5.
, .
.. ...

__

83

__

(90%
)
His.

100-250 / , ,
, .
( , ,
) , , ,
, .
,
, .

1. ,
.
:
,
10 .
.
Valsalva: 10
20 ml
10 ml.
.
:
5-10 .
.
2. .
(1 amp. Adenocor 6 mg, iv-bolus) bolus 20 ml
.
,
. 1-2 .
.. ...

__

84

__

H .
(
), 2 3 , ( < 100
mmHg), . ,
.
.
3. 2
12 mg (2 amp. Adenocor 6 mg, iv-bolus).
12 mg 2
.
50% (Isoptin),
(Tildiem), - .
4. QRS
, 5-10 mg
( 2 amp. Isoptin 5 mg 10-15 cc N/S
15-60 sec).
,
3-5 ml 10% 5 .
15 30 mg.
5.
( 2 amp. Angoron 150 mg 250 ml N/S
10 ).
6. ( , )
, 25-50 Joule.
7. .

- (ablation)
- .
90%,

.
, .. .
.. ...

__

85

__

100-160 / (
100 bpm
,
).
1. ,
, 3 .
.
,
, , aVF aVR.
2. , PR RR.

.
(60-85%
), ,
, , ,
, , , .
, ,
, ( > 45%) .
, , ,
.

.. ...

__

86

__

1. E /

(.. , ,
).
2. 2 gr (MgSO4)
2-5 ( 2 gr MgSO4 50 ml N/S, bolus iv .
3. (iv) . . 500 ml N/S
6 gr MgSO4 6 (. 1 g/h).
,
( , , ).
4.
. ,
(
2 amp. KCl 250 ml N/S D5W 1 ).
+ 4 mEq/L
.
5. g++ K+ , -
2-5 mg bolus iv 2
. 15
. H ( B1-blocker)
70-100% .
6. ( ) 5-10 mg
( 1-2 amp. Isoptin 5 mg 10-15 cc N/S
1-2 ).
( ) 0,15 mg/kg
(3 amp. Isoptin 250 ml N/S, 15 ).
7. .

.. ...

__

87

__

.
250-350 /.
, .

, aVF ( ) V1 ( ).

2:1 ,
().

.
, , , , ,
, (), ,
, , , ...

Valsalva
- , .

.. ...

__

88

__

1. ,
/
.
,
.
2. (
) 48 ,
50 Joule
50 J, .
,
(1-2 mg Tavor iv) (2-4 mg, iv).
3. ( 48
)
( 2 amp. Angoron 150 mg, 250 ml N/S
10 ).
4. 0,01mg/kg ( 1
amp. Corvert 10 ml 100 cc N/S) 10 (
60-80%). ,
.
5.
48 (UFH: 80 iu/kg iv-bolus
18 iu/kg/h).
3-4
.
6. (
)
5-10 mg ( 1-2 amp. Isoptin 5 mg 10-15
cc N/S 1-2 ).
, 10 ml
10% (1 amp.) 5-10 .
7. ( )
0,5 mg (. 1 amp. Digoxin 0,5 mg
100 cc N/S). (150 mg
100 ml N/S 10 ).



,

.

( Ia, c, & )

,

.
.. ...

__

89

__

(AF)
300-600 / , .
(. QRS)
160-180 / , - .

V1,
V2, V3, aVF.

1-2%
, 12%
.

( ,
). (lone)
.

H
, , , ,
, , , ..
( : PIRATES)

I
R
A
T
E
S

P.E., Pneumonia, Pericarditis

Ischemia (CAD & MI)
Rheumatic heart disease, Respiratory failure
Alcohol, Amyloidosis
Thyrotoxicosis
Endocrine (Ca++), Enlarged atria (mitral valve disease, cardiomyopathy)
Sepsis, Stress (fever), SSS.

5% ,
30% 80 .
.. ...

__

90

__

.
.
. 1 ,
. 1 ,
.

1. , (, , SpO2, C),
SpO2 > 90%.
2. 48
.
3. ( 48
)
( 2 amp. Angoron 150 mg 250 ml N/S
10 ).
4. (100-200 J)
48 .
(Tavor 1-2 mg, iv)
(2-4 mg, iv).
5.
48 (UFH: 80 iu/kg iv-bolus
18 iu/kg/h) .
U/S
. 3
.
6. ,
.
5-10 mg ( 1-2 amp. Isoptin
5 mg 10-15 ml N/S 1-2
). ,
10 ml 10% (1 amp. 100 ml
N/S) 5-10 .
7. , ( )
0,5 mg 15-30 (. 1 amp. Digoxin
0,5 mg 100 ml N/S).
8.
(. 1 amp. Angoron 150 mg 100 ml N/S
10-15 ), .

~ ~~ ~ ~ ~ ~~ ~ ~ ~ ~ ~~ ~ ~ ~ ~ ~ ~~ ~ ~ ~
(ablation)


.

,
.
.. ...

__

91

__

:


,
CHADS2 (Cardiac failure, Hypertension, Age, Diabetes, Stroke 2).
, , >75
(1) .
(2) .
CHADS score: > 2

( ) R 2-3 2,5.
CHADS score: 0-1 CHADS2VASc. (CHADS2VASc score: 0) (Salospir) 75 325 mg .
(CHADS2-VASc score: 1)
,
.
CHADS2-VASc score: 2 .

INR 15 30 ...
Dabigatran (Pradaxa) , ,
. 150 mg

, ,

. Dabigatran 110 mg ,
,
.
H Rivaroxaban (Xarelto)
Xa . Xa
,
. H Rivaroxaban
20 mg ,
, ,
,

.

,
(monitoring)
. ,
IR.
,
.


,
100-325 mg 75 mg .

.
.. ...

__

92

__

(Wolff - Parkinson - White)

(
- ).
, .:
1. PQ
2. ()
3. QRS ( PQ)
4. ( ST ,
R).
WPW, . ,
R ,
, Kent
.

QS
.
Kent .

.. ...

__

93

__

WPW :
I. (5%)
II. (10-20%)
III. (40-80%).

WPW
, 80-90% QRS,
10-20% QRS.

1. ,
.
:
,
10 .
.
Valsalva: 10
.
.
2. WPW QRS
()
.
(1 amp. Adenocor 6 mg, iv-bolus) bolus 20 ml
.
2
12 mg (2 amp. Adenocor 6 mg, iv-bolus).
12 mg 2
.
3. QRS
, 5-10 mg (
2 amp. Isoptin 5 mg 10-15 ml N/S
15-60 sec).
, 3-5 ml 10% 10 ml
10%, 5-10 .
15 30 mg.
4. WPW QRS ()

.
50-100 J.
5. .
100 mg 5
(. 1 amp. 10 ml Pronestyl 100 mg/ml, 1 ml 10 ml N/S
1 . 5
1 gr Pronestyl 1 amp).

,
(ablation)
, Kent
.
.. ...

__

94

__

() 3
>100 /.

.
,
(, ), - ,
.

:
1. QRS.
2. QRS.
3. 140-200 bpm.
4. QRS.
5. , .
6. .

.
shock (, , ,
, , , ).

VT

, .


.

(< 7 )
4% > 65 .
,
, ,
.
.. ...

__

95

__

1. 3way ,
(O2 6-10 lt/min) Venturi
/ , (..
, , ..).
2. 200 Joule.
3. ,
(200-360 J).
(1-2 mg
Tavor, iv) (2-4 mg, iv).
4.
.
100 mg 5 ( amp. Pronestyl 100 mg/ml 10 ml,
1 ml 10 ml N/S 1 ).
5 1 gr
Pronestyl 1 amp).
5.
( 2 amp. Angoron
150 mg, 250 ml N/S 7-10 ).
6. (60-100 mg Xylocaine,
3-5 ml Xylocaine 10 ml N/S, 60-100 sec).
2 iv-bolus 5-10 .
, 3 mg/kg.
( ).

(, ),
. ,
( ),
1 35%
.
()
(90%)
(98%).
:

.
.

. ,
(.. )
.
, 95% .

.. ...

__

96

__

(Torsade de Pointes)

() QRS
.
QT.

.
(, , ), (, )
(, , , ),
, , .
, .

1. QT. QT
, .

.
2. QT.
3. 3way (6-10 lt/min O2
SpO2 > 90%),
(.: ).
4. 1-2 gr (MgSO4) 2-5
( 1-2 gr MgSO4 50 ml N/S, iv-bolus ).
5. 500 ml N/S 6 gr MgSO4
6 ( : 1 gr/h).
6. 1 (MgSO4),
(1-2 amp. KCl 250 cc N/S D5W 1 ).
+ ,
4 mEq/L,
.
7.
.
200 Joule.
.. ...

__

97

__

.
QRS, R.
300-4000 ,

.
.

.
, , , -
, .

,

.
,
.

1. 200 J.
300 J
360 J.
2. ,
ALS/ACLS.
(
, .
).
3.
( i-gel). (8-12 lit/min).
4. 3way 1000 ml N/S.
5. 1 mg (1 amp.) iv-bolus
20 ml N/S, .
6. 360 J, 30-60 sec.
7. - 2-5 .
.
8. 3 , 300 mg (
2 amp. Angoron 150 ml 20 ml N/S D5W) iv-bolus .
.. ...

__

98

__

&

-

.

,
(
).
,
.

, - , ,
.

,

,
.

,

.

, placebo ,
, ,
VF.

,
!

(MgSO4)
torsades de pointes.

(NaHCO3)
, .
.

,
, , , .

, ,
, ,
. , D
.

.. ...

__

99

__

.. ...

__

100

__

.

.
.
, .
, .
/
(85%)
:
,
,
,

,
,

.
,
, , ,
.
,
.

:
,
,
,
,
/
,
,


,
(, ) .
,
, .

.

.
,

, , .

.
.. ...

__

101

__

: ,
.

.
, ,
. ,
.

FEV1 12% 200 ml.

, , .
:
, , . :
,
, , ,
. .
.
, .
, , .
[ (RR) > 25 / . (HR) > 120 / ].
: , ,
, , , ,
(, -),
(85% ), ..
, , ,
,
, , FEV 1
PEF
.
: /
. /
(),
(), , ,
, - , ,
( ) ..

1. 1 amp. Berovent (Aerolin + Atrovent)
1 amp. Pulmicort 2 5-8 lt/min.
2. .. (HR) (SpO2)
. ,
10 , .
3. ,
15-20 1 amp. Aerolin Berovent
1 amp. Pulmicort 2 () 5-8 lt/min.
Ventouri.
.. ...

__

102

__

4. 15-20 ,
250-500 ml NaCl 0,9% ,
1 amp. Solu-Cortef () 250 500 mg, .
5.
, MgSO4 1-2 gr 250 ml N/S (iv),
20-30 , 30-60 .
6.
,
-1 amp. .
7. ( PEFR,
, )
monitoring ,
.
:

.
/
.
:

, 5-10
: tabs. Medrol 16 mg, 1x2 .
, 2
,
,
, .

, .

.. ...

__

103

__

:
,

.
,
. 30
. 20
. > 75%
.
85% .
15% .
. :

.

( 1).

1/3 .
:
, ,
, ,
.
, ,
, ,
. . .
SpO2 < 90% , ,
. [ (RR) > 25/. (HR) > 120 / ].
Sp2
PaO2
100 %
90 mm Hg
90 %
60 mm Hg
60 %
30 mm Hg
50 %
27 mm Hg
, , ,
, .

,

, .

1. .
2. (, , , SpO2, , )
GCS.
3. , 2 2-5 lit/min,
Venturi 28%. SpO2 88-94%.
4. 1 amp. Berovent (Aerolin+Atrovent)
1 amp. Pulmicort 2 3-6 lt/min, .
5. Venturi
24% 4 lt/min 1-3 lt/min.
SpO2: 90-94% / PO2 > 60 mmHg, PCO2 >10 mmHg
p<7,25 ( ).
6. GCS, SpO2 .
.. ...

__

104

__

7. SABA
(Aerolin) SAMA (Atrovent) ICS (Pulmicort) , 10 15 .
8. 500 ml NaCl 0,9% ,
1 amp. Solu-Cortef () 250 500 mg, .
9. , , Aminophylline (1 amp. 250 ml N/S)
30-40 .
> 120 / / .
10.
(UFH) 60-80 iu/kgr iv-bolus ( 1 ml = 5000 i.u) LMWH
[ (Clexane) 1 mg/kgr .. (sc)].
11.
, .
:
1. ,
. , 5
(Pneumo-23) .
2. , 2- [LABA: (Salmeterol-Serevent,
Formoterol-Foradil, Indacaterol-Onbrez) SABA (Salbutamol-Aerolin)
] [SAMA (-Atrovent) LAMA
(-Spiriva -Tovanor -Bretaris)] 10-15 .
2 FEV1 60 %
(ICS) LABA+ICS (Seretide
Pulmoton) / -4 (Roflumilast-Daxas 500 mg).
3. () per os, 7-14
, (tbs. Prezolon 5 mg, 2x4 x3d 2x3 x3d 1x4 x2d 1x3 x2d).
4.
, 3
Anthonisen, , ,
, 2 ,
.
, , 7-10 .
Amoxi/Clav ( 3-5 )
(, ).
5. : Inmunoferon
,
NK ,
, .
6. /
.
:
.
/ .
.
.
.
.

.
(, ).
.
.
.. ...

__

105

__

: , ()
. ,
, .

! , ..
,
,
.
, ,
, ,

.
. ,
(DVT), ,
, ,
..
, , , ,
, , , ,
, , , ...

Wells. Well' s ,
.
&

DVT (, , )

+3

..

+3

.. DVT

+1,5

> 100 bpm

+1,5

( 30 )

+1,5

+1

+1

, Wells
7 , 2-6
0-1 .
. ,
, , , ,
,
. ,
>38,9 C ..
... , 70% ..
, .
ST .
(V1-V3) ..
( strain).
, S , Q
(. SI, QIII, TIII - McGinn-White).
.. ...

__

106

__

, , , D-dimers,
..., , NT- proBNP
..
,
..
.. (10% ), (30-40%) (67-87%).

1.
2.
3.
4.

5.

6.
7.

8.

.
2, 100% .
.,
, , SpO2 .
500-1000 ml NaCl 0,9%
. ( shock ).
(
) (UFH), 80 iu/kg
iv-bolus (: 1 ml = 5000 i.u).
, 3
12-20 . UFH iv-bolus .
,
,
GFR < 30 ml/min.
UFH , , 18
iu/kg 6 aPTT.
10000 iu UFH (iv) 1000 ml N/S ( D/W 5%).
, (Clexane) 1 mg/kgr .. (sc)
Fondaparinux (Arixtra) 7,5 mg (sc) 60-100 kg.
-1 amp. iv 100 ml N/S.
/
. < 90 mmHg,
4 8 amp. 50 mg (Giludop) 250 500 ml N/S, .
(
monitoring BP/HR/RR/SpO2), .

.

,
,
.

, ,
,


. , ,

.
.. ...

__

107

__

, ,
/ .

,
.
; , , ,
( ), ,
!
, ;

, ,
.
.
: , .
: , ,
, , , ,
, , ..

, : tab. Clarityne 10 mg, 1x1

: tab. Xozal 5 mg, 1x1 .
: tab. Rupafin 10 mg, 1x1 .

,
, (, , ).

(Ronal) 1-2 8-12 .

, (Otrivin) 8-12 .
5-7 ,
, ,
.
.

(Nasonex): 2 8 .
(Nasatrim): 2 8 .
+ :
Nasal spray Dexarhina, 2 6-8 , 4-5 .

(Montelukast 10 mg)
, .. , .
5-7 . , :
/ .
( , ).
.
IgE .
.. ...

__

108

__

()

() .
10 50 .
.
, .
Kiesselbach 90%
( ), 10%.
. ,
, , , ,
, ..
:
1. , .
2.
.
3. .
4. .
5. ( , , ).
6. .

1.
. 5-10 .

. .
2. .
3.
.
4. , spray
(1:1000) .
5.
10% . (:
, ,
).
6. ,
Jellonet 24-36 .
(Merocel, Rapid-Rhino, Nasapore).
7. (Augmentin, Ceclor) .
8. ,
Bellocq -.

Foley 10-14 fr,
, ()

.
. ,

.
( !)
( Brighton).
.. ...

__

109

__

H - ,
- A (GABHS).
.
. 24 72
.
.

, , , ,
, .
, ,
, , ,
- (GABHS).
, , , ,
, >10%
.

1. , .
2. Centor
Strep test ( 85-91%,
90-96%). O ASTO .
3. Centor, :
) ,
) ,
) ,
) ,
:
-
(GABHS) ,
GABHS.
Strept test.
4. , :
V (Ospen), 1.500.000 i.u. / 8, , [ 20 ml oral susp. x 3,
per os], 1 , 10 ,
, (Amoxil) 500 mg x 3, 10 , p.o.
(Klaricid) 250 mg x 2, 10 , p.o.
(Zithromax) 500 mg / 24 3 , p.o. 2 gr .
5. +
(Augmentin) 625 mg 1x3 p.o. + (Begalin) 375 mg, 1x3
p.o. .
6. ( Strep-test) ,
( ) ,
(Dalacin) 300 mg 1x4, p.o. 7-10 ,
: Ultralevure 250 mg, 1x2 .
7. : .. 500-650 mg x 4 ,
, 6 Octonion 10 ml x 3.
.. ...

__

110

__

, ,
, , ,
. .
.
.
7 3- 4 .
Streptococcus
pneumoniae, Haemophilus influenzae Moraxella catarrhalis.

.

, 10 ,
6-10 ,
.
1. :
Amoxi-Clav (Augmentin) 1 gr 1x2 p.o., 7-10
Cefprozil (Procef) 500 mg 1x2 p.o., 10
Cefuroxime (Zinadol) 500 mg 1x2 p.o., 10
Loracarbef (Lorbef) 500 mg 1x2 p.o., 10
Cefditoren (Spectracef) 400 mg 1x2 p.o., 10 .
2. , ( -), :
Clarithromycin (Klaricid) 500 mg, 1x2 p.o., 10-14
Azithromycin (Zithromax) 250 mg, 2x1 p.o., 3
Doxycycline (Vibramycin) 100 mg, 1x2 p.o., 10 .
3. ( 4 )
( 3), :
Moxifloxacin (Avelox/Octegra) 400 mg 1x1, (p.o), 10
Levofloxacin (Tavanic/Evoxil) 500 mg 1x3, (p.o), 10
Ceftriaxone (Rocephin) 1 gr 1x1 (im), 5-7
Metronidazole (Flagyl) 500 mg 1x3 (p.o), - ,
10
Clindamycin (Dalacin) 300 mg 1x4 (p.o), - ,
, 10 .
( ) Sccharomyces
bulardii (p.o) (Ultralevure 250 mg, 1x1 1x2 p.o) 30-60 .
4. (spray)
,
.
5.
.
6.
. , ,
, 7
, .
.. ...

__

111

__

: .
H 3 Anthonisen,
,
. E Anthonisen,
,
.
.
,
. . ,
, .

: Haemophilus influenzae, Haemophilus parainfluenzae, Streptococcus
pneumoniae Moraxella catarhallis, (Chlamydia
pneumoniae) .
.

.

1. .. SpO2 .
2. 1 amp. Berovent 1 amp. Pulmicort 2 4-6 lt/min.
3.
3 ,
,
.
, ,
1 , ( ):
Klaricid 500 mg 1x2 (p.o.) 10 ,
Zithromax 250 mg 2x1 (p.o.) 3 .
4.

:
Amoxi/Clav (Augmentin) 625 mg, 1x3 (p.o.) 7-10
(Vibramycin) 100 mg, 1x2 (p.o.) 7-10 .
(Ceclor) 1 gr, 1x3 (p.o.) 7-10
(Zinadol) 500 mg, 1x2 (p.o.) 7-10

5.
, ,
15 .
6.

( ) per os, 7-10 .

Sachs. Trebon- 600 mg, 1x1 (p.o)
Syr. Mucosolvan, 30 mg / 5 ml, 1x2 1x3.

.


.
.. ...

__

112

__

()
.
: Streptococcus pneumoniae, Haemophilus influenzae,
Moraxella catarrhalis.
().
; (.., ..).
.

Pseudomonas aeruginosa.
( )
.
.


.
Staphylococcus aureus, Pseudomonas aeruginosa .
.

10 (
6).
1. / (tabs. Augmentin 625 mg, 1x3, p.o.
10 ), [ : 30 mg/kg/8 p.o.],
:
2. (tabs. Procef 500 mg, 1x2 p.o. 10 )
(tabs. Ceclor MR 750 mg, 1x2 p.o. 10 )
(caps. Cetrizin 500 mg, 1x2 p.o. 10 ),
[ 10-20 mg/kg/12 p.o.]
3. (tabs. Klaricid 500 mg, 1x2, p.o. 10 ),
(tabs. Zithromax 500 mg / 24h, p.o. 6 ).
( >30%)
, .
4. , , 3-5 , .
Nasal spray Dexarhina, 2 , 6-8 , 3-4 .
5. per os (
) ' ( /Ceftoral 400 mg),

in vitro.
6. 21
.

.. ...

__

113

__

, ,
. ,
.
6 .
. 60-85%
.
, .
,
30% .

.
: > 60 , (, , ,
, , , ).
< 60
:
Streptococcus pneumoniae (20-60%)
Legionella pneumophila (2-8%)
Haemophilus influenzae (3-10%)
Mycoplasma pneumoniae (1-6%)
Chlamydia pneumoniae (4-6%)
Staphylococcus aureus (3-5%)
(Moraxella, Gram (-) , (7-18%)
: , , , , , ,
, , (, ,
).
,
:
- (, )




( )
(300-500 ml )
(
)
:
( )
/ ( Legionella)
CRP


( Legionella)
...
,

, , ( Legionella)
( Legionella).
.. ...

__

114

__

CURB-65. ,
.
Confusion ( GCS < 8)
Urea 40 mg/dl
Respiratory rate 30/min
Blood pressure ( < 90 mmHg < 60 mmHg)
65 .
0-1: 1,5%. .
2: 9,2%. .
3: 22%. .

3-4
.
.
.
1. (, , SpO2, , GCS).
2. , score CURB-65 2,
6-8 lt/min SpO2 > 90%
1000 ml NaCl 0,9% .
3.

(1g /6) (.: ):
Tab. Amoxil 1 gr, 1x4 10 ,
Tab. Klaricid 500 mg, 1x2 10 .
, - (
- ) (.: ):
Tab. Augmentin 1 gr, 1x2 10 ,
tab. Spectracef 400 mg, 1x2 10-14 ,
Tab. Zithromax 250 mg, 2x1 3 .
4. ,
:
(Tavanic) tab. 500 mg, 1x2 10 ,
(Avelox/Octegra) tab. 400 mg, 1x1 10 .
, ,
10 .
5.
(, -, , , , ,
)
.
6. (
, iv , , ...)
< 60 ,

. .
(Zinadol) tab. 500 mg 1x2 10 ,
(Dalacin) tab. 300 mg 1x3 10 .
.. ...

__

115

__

,
, .

.
.
5 2
1 3 3 12 .
,
(80-90%),
,
(60-80%),
,
/ (40-60%),
, ,
(20-70%),
, ,
(20-25%),
.
(
), 40 C,
. .
(10-20%),
(20-30%), (20-60%) (20-60%).

5% (,
/, , ). :
( ), ,
, , , , ,
.
... , , ,
, .
H ,
. H
( ,
), ( 99mTc 67Ga citrate)
MRI.

12 .
) , )
, .
) ,
, .
, -
(),
- ,
, , , , ...

Wright. Wright
7 - 10 . PCR
. B.
melitensis 70-80% ,
B. abortus B. suis,

.. ...

__

116

__

(30-50%). Wright,
1/160 .
1/40-1/80 .
1/160 ,
(.. , , ),
.
IgG IgA.
IgG IgA .

, , ( ), .

, :
1. 1 :
: tbs. Vibramycin 100 mg, 1x2 (p.o), 6 ,
: amp. inj. Streptomycin 1 gr, 1x1 (im) 3 .
:
: tbs. Vibramycin 100 mg, 1x2 (p.o), 6 ,
: amp. inj. Garamycin 80 mg, 1x3 (im), 2-3 .
8
6 , (
).

( 3 ).
2. 2 :
: tbs. Vibramycin 100 mg, 1x2 (p.o), 6 ,
: tbs. Rifadin 900 mg, 1x1 (p.o), 6 .
:
3 .

.

,
,
.
: tbs. Vibramycin 100 mg, 1x2 (p.o), 3-4 ,
: tbs. Rifadin 900 mg, 1x1 (p.o), 3-4 .
(, )
2-3 .
: amp. inj. Streptomycin 1 gr, 1x1 (im) 3
: amp. inj. Garamycin 80 mg, 1x3 (im), 2-3 .
: (Tabrin) 400 mg /12 p.o,
(Cirpoxin) 750 mg 1g /12 p.o.
(
) Jarisch-Herxheimer,
.
, , ():
tab. Prezolon 5 mg, 4x3 3x3 (p.o), 7-10 ( ).
.. ...

__

117

__

(AEE) ,
,
24 , .
; , (Transient Ischaemic Attack);

.
( ).
:
/ , / ,
/ , .
:
, , ,
.

( - Transient Ischaemic Attack)

, < 60 ,
.
60%
.

(80%), .
, , ,
, , , .
, ,
status epilepticus.

[ (20%)],
40-60 .
, , ,
.
( ).

..; ;
. . ;
.
, .
(/, ,
Babinski, ,
). (G.C.S.).

Cincinnati. (3)
.
1. (
).
2. (
).
3. (
, ).
.. ...

__

118

__

1. A, B, C, D,
.
. .
.
2. 2 4-8 l/min SpO2 > 90%.
3. 3way 500-1000 ml N/S R/L, .
D/W 5% (
).

/ 220/110 mmHg, 3way 250 ml D5 W
1 amp. Nitrolingual 25 mg, 170-180 mmHg.
4. 24
,
(, , )
.
90 mmHg,
. [: = + ( x 2) / 3].
,
( b-blocker) , :
1-3 amp. Catapresan, 250 ml N/S 20-60 , .
10-20 mg (2-4 amp.) Trandate 100 ml N/S 2-5 .
5. 3-4 amp. Nootrop 1 amp Nootrop iv bolus.
, 1 fl Nootrop (iv) 20-30
( ).
6.
, 1 amp Dexamethasone 8
mg (Decadron) iv im ( , , ).
7. 2 amp. (Zantac - iv bolus) 1 amp. .
8. 1 amp (Primperan iv bolus)
( ) .
9. Levin, .
10. Foley (
) .
11. 1 amp. (Stedon) 10 mg iv
100 ml N/S 1 amp. Aloperidin 1 amp. Zuledin (im).
12. 1 amp. (Stedon)
10 mg iv 100 ml N/S. 3 amp. Epanutin
500 ml NaCl 0,9%, 10-20 mg/min (. 40-60 ).
13. ,
. 180/110 mmHg,
, . 1 fl. Nomotop 10 mg / 50 ml, .

.
14.
30.
(Stroke Units).
.. ...

__

119

__

(?)

, ,
.
(?)





(, , ).






.
(..
Meniere, , ).
,
.
.

. ,

.

,
.
. ,
.
/, Romberg. (
.
). Dix-Hallpike
, ,
,
, .
,
.
,
.
Triplex
CT / MRI .
,

.
.. ...

__

120

__

1.
2.
3.
4.

. :
500 ml N/S 3 amp.
(Nootrop / Oxynium) , 60 , 1 amp Nootrop, bolus.
, 1 amp. Vomex-A (im).
1-2 amp. Zantac 1 amp. Primperan (iv im).
, .
. :

1. -1 amp. Stedon 10 mg (im) 250 ml N/S (iv), 30 .

2. , 3 amp. Nootrop
30-60 ( ).
3. 15-20 oral-drops (Stugeron) p.o.
. :

,
.
Caps. Vertigo-Vomex (120/75/30) mg, 1x2, 5-7 ,
Supp. Vomex-A 100 mg, 1x2 1x4, 5 ,
Tabs. Antivom 8 mg, 1x2, 7-14 ,
(, , ).
Syr. Nootrop tabs. Nootrop 1200 mg, 1x3 1x4.
Stugeron tbs. 25 mg 1x3 caps. 75 mg 1x1, 5-7 .

,
. Epley Semont
80% .
,
. ,
Hamid
10 .

.. ...

__

121

__

.
()
.

.
.
(2)

(..
, , , , ...).
Status Epilepticus:
,
,
, / 30 .
, ,
20 , 10 5
.
.

-
- ( ,
, ).

. ,
; ( , , ,
, , , ..).

.

(..
, ).
;

:
(, , ), ,
, (), ,
( , ..).

5-10

(status epilepticus)
.
() (
80%) 30
.
.
,
.
.. ...

__

122

__

1. , ,
Status Epilepticus.
2. ,

.

(Mounder-Spencer)
(Excell-Spencer) .
, .

.
3. 2 4-8 lt/min, SpO2 > 90%
SpO2 ( ).
4. Dextro-stick ,
. (, , , ).
5. 3way 500 ml D/W 5%.
6. 1-2 amp (Stedon 10 mg/amp) (iv) 100 ml NaCl 0,9%,
(iv) .
, 1-2 amp. Tavor 4 mg/amp
100 ml N/S (iv) .
(Dormicum) 1 - 2,5 ml ( amp. 5 mg / 5 ml).
. [
(Anexate)].
7. , 2-4 amp. Epanutin
500 ml NaCl 0,9%, 20-30 mg/min (. 40-60 ),
(: N/S,
).
8. Status Epilepticus, , 1-2
tab. Gardenal 100 mg 15-20
Lumidrops .
(
).

.. ...

__

123

__

.
: ,
/ , , ,
, -- ,
/ . !
, , :





, .
.
. 30%
, .
. . .
.. -, , ,
, , .
: , , ...,
, , , ,
, .
:
: . .
: , ,
.
: , .
: 4-24 . 48-72 .
: .
: , , ,
, , , .


:
.
40 .
.
.
.
.
, .
.
.

.
(
).

.. ...

__

124

__

. :
1. 3way 250 ml N/S 1 amp. Apotel
1 g 1 amp. Dynastat 40 mg, 10-15 .
2. ,
1-2 amp. (Zantac) PPI (Nexium, Zurcazol) .
3. , 1 amp. Primperan.
4. 500 ml N/S 3 amp. (Nootrop / Oxynium)
, 30-60 , 1 amp. Nootrop, iv-bolus.
5. ,
1 amp. Vomex-A (-im).
6. A , :
1-2 tbs. Zaldiar ( + ) per os,
1 sach. Premig ( + ) per os,
1 amp. Apotel-plus 600/20 mg, 1 amp. Musco-Ril (im),
1 amp. Xefo 4 mg, 1 amp. Norflex 60 mg, (im).

. :
1. 1 amp. Imigran 6 mg (sc). ,
1 , 2 24 .
, 1 tb. Imigran 50 mg p.o. ,
1 , 300 mg / 24h.
2. , DHE, . 1 amp. Dihydergot ( iv),
1 amp. Primperan (iv) .
3. ( + ) supp. Cafergot 102 mg.
, Cafergot
2-3 , 2 / 24.
4. , - 1 amp. Romidon Tramal (im).
. :
1. : tab. Maxalt 10 mg , .
2. , : 1 amp. Imigran 6 mg, .
( ,
..- .., , >65 , ).
3. - (tbs. Inderal 40 mg, 1x3 80 mg 1x2).
4. (Topamac) tab. 25 mg 100 mg / .
5. S.S.R.I. (, ).
6. , .
.
, : start low, go slow.

, , ,
(, , ), , , , , ...
: ,

( ) ..
.
.
.. ...

__

125

__

. Bell.
Bell
.

" ".
, :
-/
Guillian-Barre
(Ramsay-Hunt),

/


.
:
1. .
2. .
3. .
4. .
5. .
6. .
7. .
,
, , , , .
C/T .
,
1-2 .

1. (), , :
tbs. Prezolon 5 mg, 10 (2x4 x5d - 2x3 x2d - 1x4 x2d - 1x3 x1d).
():
tbs. Medrol 4 mg, 10 (2x4 x5d - 2x3 x2d - 1x4 x2d - 1x3 x1d).
2. , :
tbs. Zovirax 400 mg 1x5, 7
tbs. Famvir 500 mg 1x3, 7 .
3. , . syr. Nootrop 1-2 .
4. , , :
gel. Dacrio Gel 2 x 3, 15-30 ,
coll. Celluvisc 2 drops x 3,
coll. Vidilac 2 drops x 3.
, .
5. , 8-12 , 7-10 .
6.
.
,
.
15-20 ,
.
7. ... .
.. ...

__

126

__

, 50 , 3/2
.
60% 2
/ 3 ( ).
30 , .
!!

,
, , , , ,
, (tic doloureux) ..
.
.
, ,
.
.
,
MRI ,
, .
(MRA)
.

1. , 1-2 amp (Rivotril) 1 mg, 250 ml
NaCl 0,9%, 30 - 45 .

:
2. , tabs. 200 mg
(Tegretol) 3-5 , .
(Trileptal 300 mg, 1x3 2x4)
, .
3. , (Neurontin): caps. 300 mg, 1x3
1x5, 2x4, .
4. : tbs. Baclofen 10 mg, 1x4 2x4, 10-20 ,
.
5. .

/ .
:
,
,
.
,
Gamma Knife.

.. ...

__

127

__

,
.

( )

(.. , , ,
, , , ..)
. 10-15
.
( ) ,
,
, .
, ,
, !
. .
. stress,
.
.
: , - ,
, /, .

:
,
() . , ,
. ,

.

1. ,
, A-B-C-D-E. .
2. .
3.
, .
(.. ).
4. , :
1-2 tab. Alprazolam (Xanax) 0,25 mg (per os),
1 tab. Bromazepam (Lexotanil) 1,5 mg 3 mg (p.o).
5. :
1 amp. Diazepam (Stedon) 10 mg (im iv 100 ml N/S).
:
, :
tab. Lorazepam (Tavor) 1 mg, 1x3 10-15 ( ).
Tab. Buspirone (Bespar) 10 mg. 5 mg x3 ,
45 mg .
.. ...

__

128

__

( 15 ),

.
( )
, ,
, ,
( ).
, ,
, , ( ).
, ,
, , , .
. (
).
, ;
.
, .

a.
b.
c.
d.
e.

(F23.0)
(F23.1)
(F23.2)
, (F23.3)
(F23.8).

1. stress
, .
.

1 - 2 amp. Aloperidin
1 amp. Akineton
1 amp. Zuledin

(im), .

2. , - 1 amp. Stedon (im), .

3.
, .
1 amp. Zyprexa 10 mg (im).
2-3 .
4.


.



,

.
.. ...

__

129

__

.

,
.

,
.

.
.

: ,
, , , .

. ,
, , , , , .
.

( Holiday Heart
Syndrome).

, .
,
.
.

1. ,
(), ()
(C), (D) ().
2.

45-60 .
3. .
- -

(.. ).
< 70 mg/dl 1000 cc D/W 5%,
( - ).
4. ,
(B1) (100-250 mg - iv) 1 amp. MVI (Evaton), ,
Wernicke.

.. ...

__

130

__

5. Foley 14-16 fr, ,

[ !]

, .
6.
(Anexate) 2 ml = 0,2 mg (iv-bolus) 15 sec
60 sec 1 mg = 10 ml.
1-2 amp. Anexate
1000 ml D/W 5% 10%, 0,3-0,4 mg/h,
.
7. , 1-2 amp. Naloxone (iv).
, ,
/
, .
8. 1-2 amp. (Zantac) 1 amp. ,
.
9. (Primperan)
, .
10. , ,
34 C.
.
,
.
11. ( , ..
) ,
12 .

- :
- ,
, , , , , .
,
. ,
, ,
.
,
. ,
.
,
-
, , .
.. ...

__

131

__

.
, , 6 24
24 48 .

, 48 .

, ,

.
(delirium tremens)
,
.
..
( 2 3 )
( ).
5 15 .
:
( ,
, ), ,
,
, ,
( ) ,
,
,
(, ,
, ),
, , , .

(status epilepticus)
.
, .

1. ,
.
2. 3-way 1000 ml D5W,
2 amp. NaCl 0,9% 1-2 amp. KCl
3. 1 amp. Soluvit Evaton 500 ml NaCl 0,9%
[ (B1)
Wernicke,
].
.. ...

__

132

__

4. 1 amp. (MgSO4).
1 gr MgSO4 6 2-3 (
).
5. (2 amp. Stedon 10 mg).
, 10 mg
6 4 , 5 mg 6 8 .

GABA (- ) ,
.
.

.
,
(Tavor: tab. 1 mg tab. 2,5 mg amp. 4 mg/ml),
.
6. 1 amp. Aloperidin 1x1 (im) 1 amp. Akineton 1x1 (im).
,
.
7. , ,

.
1 amp (Catapresan)
100 cc N/S, 15-30 .
, , , ,
, , .
, 1-3 amp. (Narcan) iv-bolus.
8. , , 15-30 , amp. Neurobion (B1, B6, B12)
1x2 (im), (tbs. Filicine 5 mg, 1x1)
(Trofocard, 1x1).
9. , ,
.

.
,
.
.. ...

__

133

__

,
(
) .
- .
1-2%
, (20-50%)!


. :

Graves (80%)
(, )
/

/
/

.

. :
( 40-41 oC), , ,

( , ,
), (- ,
- , , , ),
(, delirium, , , stupor, , , ).
H 3 4

. ,
:

4 3
TSH

CPK

.. ...

__

134

__

, .., ,
( ), .. (
), , ,
, , ,
.

1.
LMA i-gel.
2 4-8 lt/min
Ventouri (A, B).
2. 3-way (C).
3. GCS (D)
(E).
4. .,
, , SpO2, ,
, .
.
5. , : 1000 ml NaCl 0,9% 1000 ml R/L,
,

().
6. ( , )
. :
: 1 amp. Apotel 1 gr, 100 ml N/S (iv), 10 .
,

.
7. , :
10-15 tabs. Prothuril 50 mg,
2 tabs. Unimazole 20 mg, ( Levin).
8. , :
8-10 Lugol, per os 6,
20-50 ml ( Levin).
1-2
(PTU / Prothuril), 4
PTU.
9. , :
(Inderal): tabs. 40 mg / 6.
10. 3 4, :
(Dexaton): 2 mg / 6,
(Solu-Cortef): 250 mg (iv-bolus) 100 mg / 8.
11. ( monitoring)
.
.. ...

__

135

__

< 60 mg/dl.
, , ,
, ( )
, , ,
, , ( ).


() ,
/,
, Addison, , dumping ...
: .. ,

.

1. , , 2
4-6 lt/min (, , C).
GCS AVPU (D).
2. , (
) 1-5 amp. (10 ml) inj. sol. 35% (Dextrose), .
3. , 1000 ml D/W 10%,
, 15-20 .
4. , (iv, im
sc), , 0,5-1 mg (15 mg / kg .. )
15-20 (
5-20 ).
(Glucagen) .
[1] - [2].
5. , -1 amp. (Solu-Cortef)
500 mg, 8 mg (Dexaton) .
6. (, ),
1-2 amp. (Soluvit Evaton) 500 1000 ml N/S, Wernicke .
7.
/ (.. Lantus,
Levemir, Tresiba, ...) 24-48 .
.. ...

__

136

__

: () ,
, 5%.
().
.. 1 ..
2 , ,
.
:
(25%), (40%), , , ,
, , , ,
(, , )
(
, , , , )
, ,
, .

(15%).
: (
24 )
( ),
. , , ,
( )
Kussmaul
, .
,
, .
: .., ,
, , (,
), ,
, ( ) ,
...
, :
(Glu > 300 mg/dl 1000 mg/dl)
pH < 7,25 HCO3- < 15 mEq/L
(.: / = 12 2 mmol/l)
(
MUD PILES Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde,
Iron - Isoniazid, Lactacidosis, Ethanol - Ethylenoglycol, Salicylates - Strychnine)
> 340 mOsm/L ( ).
.
Hct ( )
WBC ( )
(50% , 80% +.
Na+ 1,8 100 mg/dl
).
.. ...

__

137

__

1. , 2 4-8 lt/min
(, , C).
2. GCS (D)
(E).
3. .,
- , SpO2, ,
, /, (
) . (+)
. ADA
2-3 amp KCl
+ 4-5 mmol/L.
4. :
6-10 Lt .
1 (1000 cc NaCl 0,9%) 30-60 min
> 90 mmHg. N/S 0,5-1 L/h
a+ .
30-80%
12-15 .
,
.
Na+ > 155 mEq/L
NaCl 0,45%,
150-300 ml/h. 1-3 amp. KCl .
5. :
. () 0,1 IU/kg Actrapid
iv-bolus ( 10 IU ).

.
50 IU Actrapid 500 ml NaCl 0,9%,
60 , 15-20 .
6. 250-280 mg/dl
500 ml D5W
NaCl 0,9% - Actrapid.
7. (NaHCO3) ,
pH < 7,1 , ,
.
1-2 amp. NaHCO3 4% 100 ml D5W N/S 30
pH 7,1.
8.
,
, , , .

.. ...

__

138

__

: ()
. ( 65 )
2,
. ,
, 1. , 20-40%
! 20-40%.
: , ,
,

.

/ shock ( ),
, ,
( ) ,
.
.
, Kussmaul
(.. shock).
:
( ), ,
( gram (-) ),
(, , , bblockers), , ,
, , , ...
,
/ . ,

.
, :
(Glu > 600 mg/dl 1500 mg/dl).
> 320 mOsm/L.
pH > 7,30 HCO3- > 15 mEq/L.
(,
).
( ).
.
(?) .
[ ,

(MUD PILES)].

.. ...

__

139

__

1. , 2
4-8 lt/min SpO2 > 90% (, , C).
2. GCS (D)
(E).
3. .,
- , SpO2, , ,
/, , ...
4. : 100-200 ml
Kg ,
8-12 . 8 ,
24.

,
, .
, 1-3 lt NaCl 0,9%

, .
NaCl 0,45%

.
1-2 amp KCl

/ .
.
5. : ,
(
). 25%
!
() 0,1 IU/kg Actrapid iv-bolus (

10 IU ).
.
50 IU Actrapid 500 ml NaCl 0,9%
1-3
50-70 mg/dl .
250-300 mg/dl 500 ml D5 W
N/S Actrapid
150-250 ml/.

.
6.
/ - ,
, .

.

.. ...

__

140

__

-
- .
,
, , ..

. , , ,
, ,
, ,
.
.

1. R/L
.
2. 2-3 Alcaine Tetracaine,
.
3.

.

.
4. , 1-2 Tobrex Tobradex.
5.
,
. Navitae (
A ). Corneregel Recugel
(1-2 3-5 ) , 5-7 .
6. 1-2 5%.
2-4 .
7. 5 - 7
1-2 Tobrex Tobradex 8 7-10 .
1-2
Tobrafen (/) .
8. ,

48.



.

.. ...

__

141

__

&

; , , ;

, ,
, ( ) .
(). H
,
.
.
pH .
; ,
, , , , ..
; ;

.
, ,

24-48 .
.

.

1. R/L
. 8-10
lt pH (pH: 7,0).
2. 2-3 Tetracaine Alcaine
.
3. 5-10 pH stick
. pH
, .
4.
. 1-2 10 cc N/S.
,
, , .
5. 2 Tobrex, 3 , 7-10 .
6. , Zovirax 3%,
5-6 .
7. ,
. coll. Ciloxan 0,3%, 2 drops /3h x 14d.
8. , .. coll. Atropine sulf. 1%
coll. Cyclogyl 1%, (1 3 2-3 ).
9. , 6
.
10. 2 - 4 ,

.
11. .
12. , , 24-48 .
.. ...

__

142

__

40-70 mmHg (.: 14-22 mmHg),
.
:
1. , .
2. ,
3. ,
4. , (
).
5. ( )
.

, .
.
,
/, .

:
().
().
(-,
(Iopidine) 1%, (Brimontal) 0,2%).
.

1. :
2 drops coll. Dispercarpine Isopto-carpine 2%
2 drops coll. Xalatan 50 mcg/ml coll. Travatan 40 mcg/ml.
5 30 6.
2. , ,
60-90 : tbs. Diamox 250 mg, 1x4.
3. per os,
+ + , :
1-2 drops coll. Cosopt (2+0,5)%

1-2 drops coll. Combigan (0,2+0,5)%

4. stress , 5-10 mg Stedon (im)
,
/ ,

(Laser
, , ,
, ...).
.. ...

__

143

__

.
,
.
, (),
, . ,
.
(
) .

. , < 5 mm
90%,
, . ,
(
) .
75%
. .
,
, , (
, , , , , ,
, ...).
: ( , ,
- , , , ..,
Sjgren, .). /: 4/1.
, 25%
,
.
: ( Giordano ?).
? WBC > 15000/mm ? .

(Proteus sp., Klebsiella sp., Pseudomonas sp.) . E. coli
.
Stick ( pH, , ).
: , ,
, , , , /
, , , .

1. (, , SpO 2).

.
2. (1 amp. Voltaren 75 mg Xefo 8 mg),
1 amp. Spasmoapotel 1-2 amp. Zantac 50 mg .
3. , (im), 1 amp. (.. Dynastat),
1 amp. Buscopan 1 amp. Apotel-plus.
.. ...

__

144

__

, 45-60 , :
.

250-500 ml N/S 1-2 amp. Buscopan 20 mg (iv) 30-45

500 ml N/S 45-60
.
,
1 amp. 75 mg (Zideron/Romidon) (im)
100 ml N/S - 1 amp. (im) 3-4 .
, , (1 amp. Tramal, im).
:
,
,
.
.

.
.
.... 3-5 , ..
Tab. Xefo rapid 8 mg, 1x2 2 1x1 3 ,
Tab. Mesulid 100 mg, 1x2 2 1x1 3 .
, ..
Tabs. Spasmo-apotel Buscopan-plus, 1x3 1x2 3-5 .
(, , ...),
(1x2) (1x1), 5-7 .
, per os
,
/ (. . / ) .
H - [Tamsoulosin, Silodosin (Silodyx)]
,
,
1- .
,
, .
, .
.
, .

,
, .
( ),
2 , .

, .
2 .

, .
, / U/S .
U/S 4065%.
.. ...

__

145

__

, .
.
1500 ml.
,
, ...
.
( )
.
,
(,
, ).
; ( , , ,
, Parkinson, , , ).

75% !

(, , , ,
, ) ,

Stamey-Mears.

1. , , Foley 14-16 fr
300-500 ml .
( )
300-500 ml 10 .
,
,
.
2. .
, .
3. ()

- (..
) 15-30 .
Tab. Omnic 0,4 mg, (p.o) 1x1,
Tab. Xatral OD 10 mg, (p.o) 1x1, .
PSA < 3 ng/ml,
1000 ml
-.
4. ( - caps. Ciproxin 500 mg, 1x2) 3 .
5. 5-7 ( ),
.. tbs. Septrin 480 mg / 24h. 3
( ).
6. ,
: caps. Ciprofloxacin 500 mg, 1x2, 4-6 .
7. .
.. ...

__

146

__

: () ,
.
.
: Gram (-): E. coli, Proteus sp., Gram (+): Staphylococcus
saprophyticus Enterococci.

, ,
.
: ( , -
, , ). .
: ( ,
). . .
: , , ,
, , ,
, , .

( ):

(E. coli) , .
> 20% .

( ).
1. -:
tab. Furolin 100 mg, 1x3 (p.o), 7 ,
tab. Augmentin 1gr, 1x2 (p.o), 7 ,
2. , :
tab. Septrin 960 mg, 1x2 (p.o), 3-5 .
3. , (p.o) :
: tab. Ciproxin 500 mg, 1x2 3 ,
: tab. Norocin 400 mg, 1x2, 3 ,
: tab. Tavanic 250 mg, 1x1 3 .
24-48 ,
.
.
,
.
, , .
, , , , .
.
.
.
(cranberries, blueberries).
E. coli
.
.. ...

__

147

__

(
> 100.000 CFU/ml ) ,
,
.
. coli (80%).
:
.
.
.
Gram (_) [,
, ...] Gram (+). 1-2%
Gram (-) .
: :
(
).
, ( Giordano).
(> 38 C) .
(, , ).
(, )
.
:
.
( / ).
CRP.
.
(80-95% > 105 / ml).
.
/ ... .
U/S ... , ,
.
: , , , .

,
, .

per os, 24.
10 .
1. (, , , SpO2)

( , .. - ,
, , , , , ...).

.. ...

__

148

__

2. -,
(.: , ).

48-72 .
tab. Augmentin 1 gr, 1x2 (p.o), 10-14
tab. Zinadol 250 - 500 mg, 1x2 (p.o), 10-14
tab. Ceftoral 400 mg, 1x1 (p.o), 10-14 .
3. -,
.
: tab. Ciproxin 500 mg, 1x2 10 ,
: tab. Tavanic 250 mg, 1x1 10
4.
, .
amp. Briklin 500 mg, 1x2 2x1, (im) 10 .
5. ( Foley, )
,
- (
) .
6. - - , .
7. .
.
8. .
9. (> 95% )
. :

-- ( ),
,
,
.

A : 14 .
: tab. Ciproxin 500 mg, 1x2
N: tab. Norocin 400 mg x 1x2
6-12 .
: 6 .
12 .

.. ...

__

149

__

: ()
, 12 Treitz.
(25%),
100-200 ml
, (15%) .
(, )

, .

: ;
; , , ;
,
. , , , ,
, (), , , , ...

: ;
(, ),
, ,
.

80% - 90%
. 70% - 80%
24, 10%.
: > 60 , shock ( > 100/
< 100 mmHg) .

(, , , SpO2, Hct/Hb).
Hct/Hb
. ( b-blockers,
).

,
Mallory Weiss.

: (20%),
12 (25%), (15%), Mallory - Weiss
(5%), , (15%), , ..

1. , .
2. 2 4-8 lt/min ( Venturi)
2 (SpO2) .
3. ... .. .
4. , .
5. (#16-18G) 3way 1 lt NaCl 0,9%
1 lt R/L. ( < 80-90 mmHg)
,
500-1000 ml Voluven 6% ( Haemacel).
.. ...

__

150

__

6. , Levin (
), .
Levin
,
.
7. 5 amp. (Losec/Nexium/Controloc) .
, p
.
8. 2
100 ml N/S 1 amp. (Stilamin 0,25 mg/amp)
1-3 . 1000 ml NaCl
0,9% 1 amp. Stilamin ( 3 mg/amp) 8.
,
, ,
, .
9. (
) , 4 amp. Transamin
250 mg 500 ml N/S 40-60 . (
.
, .
, ).
10. Foley 14-16 fr, .
11. ,
5-10 mg .
12. ( monitoring
)
.

.
13.
Glasgow - Blatchford (0),
:
13 g/dL ()

12 g/dL ()

< 39 mg/dL.
.

> 109 mm Hg.

< 100 / .
.

, .

,
30%. 30% !
,
Levin,
Sengstaken - Blakemore.
Sengstaken Blakemore 2 .
1 125 ml .
2 40 ml (
).
.. ...

__

151

__

Treitz, , ,
3 .

.
,
25% .

. .
Ht > 20%, 100/,
< 110 mmHg, (2) ,
4 , ,

, .
1/5

20-30 100.000 .
,
5%,
.
1/3
, , ..


, 15-35% .
,
,
. , ,
.
, ,
, ,
.
(0,5%),
.
5-10% ,
, .
, ,

.
Meckel ,
2-4 5-12 .

: , Crohn,
(Salmonella, E.coli 157:7, Shigella, Campylobacter, Cl. difficile,
CMV), , . , ,
. ,
, .
.. ...

__

152

__

.
, .
, 15-30
() , .
, .
.

. ( : , , ,
, , , ,
, , , ...).

.
, (20-40 ),
30-90 .

- - -
. ( ,
9:00 . 4:00 ..).
(, , ). .
,
, , , ,
( Bornholm), ,
, ,
, , , ...
, ,
,
Hartman. (),

, .
Murphy, ,
, 30%
.

.. ...

__

153

__

1. (, , , SpO2).
2. 3-way
500-1000 ml R/L
.
3. 1 amp. (Primperan) 1-2 amp.
(Zantac) .
4. . 1 amp. Xefo 4 mg (
1 amp. Dynastat 40 mg), 1 amp. Buscopan 1 amp. Apotel 1gr
100 ml N/S, 20-30 .
[, ,
1 amp. Voltaren 1 amp. Buscopan-plus ( Spasmo-Apotel), ].
5. ,
15-20 .
6. , 30-45 , 1 amp.
* (im) 1 amp. (Romidon / Zideron 75 mg) (im).
7. U/S .
8. , Murphy,
(>38 C) , / ,
, ,
( Charcot: , ,
Reynolds: Charcot
shock ).
1-4 Levin,
per os .
:
1. .... ( ),
4-5 , : tabs. Voltaren 50 mg Xefo-rapid 8 mg, 1x2.
2. () , 4-5 :
tabs. Buscopan-plus ( Spasmo-Apotel) 1x3.
3. : tabs. Zantac 150 mg, 1x2, 5-7 .
4. (5-10 ) :
. : ,
, , , , ,
, , , , , , ,
, , , .
: , ,
, , .
5. , /
3.
6. , UDCA (Ursofalk): 250 mg,
1x3 6-9 U/S .
* ,
Oddi 12.
.. ...

__

154

__

> 200 gr.
.

24.

(, , , ).
; (.. , ).

. . /
[ ; -
, , (/)
].
; .
, .

: 15 ,
.
: 15 .

: 3-4
.
: 72
.
E (..
, ,
)
per os (
).

1. , 50 gr 3-5 tabs. Ultracarbon

per os. .
2. 6-8
,
1 lt N/S R/L, .
3. , 1 amp. Primperan (iv) / 1 amp.
Vomex-A (im) 15 .
4. 1000 cc NaCl 1-2 amp.
KCl, .
5. 1 sir Ercefuryl p.o 2 caps. Ercefuryl p.o .
6. (Lactobacillus)
, caps. Ultra-Levure 50 mg, 1x3x5d 2x3x5d.
7.
, ,

/
.
.. ...

__

155

__

:
1. (Ercefuryl)
(Imodium)
:
Sir Ercefuryl: 1 / 8, caps. Ercefuryl 200 mg, 1x3 1x4.
Tabs. Imodium 2 mg. 2x1 1x1 .
2.
, per os Flagyl 500 mg, 1x3 10-14
. (Voncon)
125 mg 1x4, per os 10-14 .
, caps. Ultra-Levure 50 mg, 2x3 x 5d.
3. E :
,

,
,
,
< 50 ,
,
.
E , :
Septrin 960 mg, 1x2 p.o. 10 ( )
Ciproxin 500 mg, 1x2 p.o. 10
Tabrin 200 mg, 1x2 p.o. 10
Peflacin 400 mg, 1x2 p.o. 10 .
E. coli 157:7 ,
- ,
, .
4.
(S. aureus, B. cereus)
(Norwalk, Rotavirus)
.
5. , :
Sachs. Racecadotril (Hidrasec) 10 mg/sach, 1x3 2x3.
6. :
a) ().
b) cola, sprite .
c) (3 15 .
d) ( ).
e) , .
f) Almora, 3-5 , 3-4 .
, , ,
.
:
2-4 , .
1 , .
1 , .
1 (100-200 ml) .
100 - 200 ml .
.. ...

__

156

__

. , .
. , , .

.
> 60 ,
.

:
60 .
/, .
.
.
( 5
1 ).
( , CRP).
.
3 :
1. ( ).
2.
.
3. , ,
.

: (), ,
...., , ,
.., Ca , ,
, , , ...

(> 3
) 4 5 ,
(ASAS):
1. < 40 .
2. - .
3. .
4. .
5. .

. ,
.
PSA/f-PSA, Bence-Jones,
, CRP, Wright / Brucella, ...
,
.

,
( )
.
.. ...

__

157

__

1. /
.
1 amp. Apotel-plus (im) 1 amp. Dynastat Voltaren [ Movatec Xefo
] (im), 1 amp. Musco-Ril Norflex, .
2. > 65
.: 1-2 amp. (Zantac / Lumaren) (im).
( Voltaren + Musco-Ril, )!

:
1. 5-10 , ,
tabs. Mesulid 100 mg 1x2 2-3 1x1 3-4 .
2. /, ,
tabs. Norgesic 1x4 2 1x3 4-6 .
3. PPI .
4. ,
(, )
: tbs. Lonarid-N Lonalgal 1x1 1x2 , 7-14
tbs. Zaldiar (325+37,5) mg, 1x2 5-10 .
5. (.. ) , .
6.
, .
7. , .
8. , /
(
SSRIs) ,
. , :
tbs. Cymbalta 30 mg, 1x1 , 6 .
9. , ,
.

,
.

.. ...

__

158

__

:
1/3
,
.
.
.
, (95-98%),
.
,
.

:
.
.
, ,
.
, .
, (
).
. .
: ,
,
,

.
.
,
,
.

.. ...

__

159

__

1. / (F/P ) .
.
24 ,
.
2. ,
.
: 1 amp. Voltaren ( Dynastat efo) + 1-2 amp. Musco-Ril ( Norflex) +
1 amp. Apotel-plus, (im) 15-20 .
3. , ,
.
4. (
) Kocher
( ).
.
.
.

5. ( 15-28 )


, ,
, .
,
,
. 2 50 60 . [
< 20 ,
66%, 20-40 40%.
<30 80%!].
6. 4-7 , :
tbs. Voltaren 75 mg, 1x1, tbs. Norgesic (450/35) mg, 1x3.
7. ,

(rotator cuff)
.
8.
.
.
9. ,
, .
.. ...

__

160

__

KATA
. , , .

; ;

(.. , , , ...)
(, , , ...).
,

,
!
, :
:
.
.
:

, ,
.
: ,
(,
, ...).
:
():
.
, .
(..
-) .
:
. ,
.

, .
:
(..
).
:
.
:
.
:
(, ).
(.. Colles, Burton ..)
.
3 , .

.. ...

__

161

__

()


,
.
, , ,
(
) .
.

.
( 1/2 1/3).
15-20%

.
.

.

1. . ,
.
2. 1 amp. Voltaren ( Dynastat Xefo) + 1 amp. Musco-Ril ( Norflex) (im).
1 amp. Apotel-plus (im).
3.
.
.
, .
.
4. U
. ,
.
.
5. , air
splint ( ).
6. () :
(inj. Tetagam-P 250 iu )
, ,
, ,
(, ).
7.
. .
,
, .
.. ...

__

162

__

( / )
5%
.

.

.
, 50 ,
.
()
.
0,5 .
,
,
, .

. ,
.
.
, ,

.

1. . ,
.
.

,
.
2.
air splint .
3. 1 amp. Voltaren ( Dynastat Xefo) + 1 amp. Musco-Ril ( Norflex) (im).
4. 1 amp. Apotel-plus (im).
5. () :
(inj. Tetagam-P 250 iu, )
,
,
(, ).
6.
. .
()
.
.
8. , ,
2-3
. 0,5 .
.. ...

__

163

__

,
,
, .
,

,
.
9. -
( ,
).
, ,

(Colles)
(Smith) (Barton).
Colles
40 .
.
( ), .
2 .
.



() .
H Colles , ,
()
.
()

()

.
Smith Colles
.
,
.
.. ...

__

164

__

1.
.

.
2. 1 amp. Voltaren ( Dynastat Xefo) + 1 amp. Musco-Ril ( Norflex) (im).
1 amp. Apotel-plus (im).
,
5-10 ml
.
3. () :
(inj. Tetagam-P 250 iu, )
,
,
(, ).
4.
4 ,
5 Colles 6
Smith.
5.
air splint . , ,
250 ml N/S 1 amp. Tramadol , .
Colles,
,

.
.
5
, 7-10
3 ,
.

.. ...

__

165

__

&

.
.
.
.
(
).

.

60

,


,

.

,

,

.

.

.

,
.
, , ,

. .

1. (
). Doppler.

.
2. 1000 ml NaCl 0,9%.
3. / , 1 amp. Apotel 1g (iv) 100 ml N/S,
1 amp. Xefo 4 mg Dynastat 40 mg (iv) 1-2 amp. Norflex (im).
4. 1 amp. 1 amp. Zideron.
5. : 1 amp. Tetagam-P 250 iu (im).
6. ( ) .
.. ...

__

166

__

() .
85% ' 15%.
.
, ,
.
,
,
. ,
, .
,
.

,
. .
,
.
,
,
.
,
45 .

1. .
-
.
.
2. ,
, .

. ,
, .
.
3. 500 - 1000 ml NaCl 0,9%.
7. - : 1 amp. Voltaren + 1 amp. Musco-Ril (im)
1 amp. Apotel (iv) , 1 amp Xefo Dynastat
(iv) bolus. , 1 amp. Zideron Tramadol.
4. ,
,
. , airsplint ( ).
5. 1 2-3
. 2
4-6 3
,
6-8 .
.. ...

__

167

__

.
, :
1.
3.
2.
4. .
.
,
( ), , (
), , , ...
,
,
.
20 40
, 40 60
.
/ 9/1.
30%
, ,
.
80-90%
1 ,
. :
, , , , ,
.
.
, , .
30%
38 C. ,
12-24
7-10 .


,
, .
1. : .
1 amp. inj. sol. Indocid 3 mg (im), 6
1 tab. Fortathrin 75 mg (per os).
:
1 amp. Dynastat 40 mg (im) (iv) 100 ml N/S.
, :
tab. Brufen 600 mg (per os) 1x3 x3d & 1x2 x5d.
, :
tab. Naprosyn 250 mg (p.o) 1x3 x3d & 1x2 x5d.
1 amp. Xefo 4 mg (im) tab. Xefo Rapid 8 mg (p.o) 1x2 x3d & 1x1 x5d.
.. ...

__

168

__

2. : 6 mg 24 .
, 1 mg ,

. :
1 tab. Colchicine 1 mg, 1x4 1-2 .
1 tab. Colchicine 1 mg, 1x2 3-5 .
3. ,
( 2 ),
.
4. :
(
).
, ,
(30-60
mg/ , 2 )
10-15 mg 3 .
5. ACTH:
.
, .
CTH
(): 1 amp. Cortrosyn / Synacthen 0,25 mg/ml (max 2-3 ).

:
1. : tab. Zyloric / Zylapour 100 mg/ (
< 30 ml/min) 600 mg/ ( ),
300 mg/ (per os).



. ,
.
, .
2. ,
(Adenuric). , , Adenuric 80 mg
, . > 6 mg/dl
2-4 , Adenuric 120 mg
.

. > 65
.
3. : , (),
, , , , , , ,
, , , ,
.
, .

< 6 mg/dl < 5 mg/dl
.
4. .
.. ...

__

169

__

?!

.
, .
12-18 .
,
.

:
.
.

.
Octenisept Betadine.
: ,
!
2%.

.
.

Nylon 2/0, 3/0. 10-15 .

Nylon 4/0, 5/0. 4-7 .

Nylon 6/0, 7/0, 8/0. 4-7 .

(silk) 2/0, 3/0. 5-7 .

Safil quick Vicryl rapid 3/0

( ).

(silk)
.


.

Dexon Vicryl 3/0,
.
, , 2 , 2
.
(clips).
clips 7-21
, ().
.. ...

__

170

__

(inj. Tetagam-P 250 iu) ,

.
.
(. 500 iu)

24
.
(3
& 10 ), .

,


.
,
, (
).
.
, , ,
/
( , , , ..).
.. : Ceclor 500 mg, 1x3 4 ,
Ceclor MR 750 mg, 1x2 4 ,
: Procef 500 mg 1x2 4 .
, , , :
Ospen,
Augmentin,
Procef,
Amoxil,
Ceclor,
Dalacin.
(.. , ,
..) , , ,
( ),
,

.

.. ...

__

171

__

:
.
,
. ,
, , ,
,

. 5% .

,
, .

(), Staphylococcus aureus.
()
. ,

( ).
Staphylococcus aureus ,

Gram (-) (Candida).
Staphylococcus aureus,
.
Staph. aureus .
Pseudomonas aeruginosa
.
.

.
.

.
.

.
, , ,
, ,
.

, Staphylococcus aureus ,

(, Eikenella corrodens,
Bacteroides Prevotella) Pseudomonas sp.
:
(.., , , HIV
- , -IVDU).
.
;
,
.
.. ...

__

172

__

.
.
1. Betadine.
.
2.
-. ,
.
3.
.

.
4. 3-5 20 60 ml
Betadine / 22 (10/10 30/30 ml ).
NaCl 0,9%
.
5. 1-2 amp. Netromycin 300 mg, (
).
6. (
48),
10 :
/ (tbs. Augmentin 1gr, 1x3)
(tbs. Flagyl 500 mg, 1x3).
7. (IVDU)

Staph. aureus ( 15-20 ). ,
:
(tab. Dalacin-C 300 mg, 1x3)
/ (tab. Begalin 375 mg, 2x2)

(Zivoxid 600 mg / 12 iv p.o.),

(Voncon 0,5-2 gr, 1x3),
(Flagyl 500 mg, 1x3).
8. ( )
( 1, 2, 3, 5, 8, 13).
9. gel Likacin oint. Fucidin, 2-3 , 3-5
. .
10. , 24
, .
11.
( , , , )
.


.
.. ...

__

173

__

- -
,
, .


.


.

.

: , / ,
. ,
.
, ,
.
. () .
1 45 ,
80% !
, ,
, ,
,
. ,
,
, (damage control strategy),
.
. ,
,
,
.
,
:
1. (> 6 )
2. .
3. .
4. (> 20 ).
5. ( > 8 km/h).
6. ( > 32 km/h).
7. .
,
,
.

.
.
.. ...

__

174

__

- ,
,
.


.


,
, / .

(Triage).


.
, .

, .

:
1. ,
.
2. .
3.
4.
. .
5.
6. .
1-4
(ATLS) ,
: ( - ), (), C () D
( , - ), (
, , .
, ).

,
MARCH :
M
A
R
C
H

Massive hemorrhage control

Airway with cervical spine control
Respiration (Breathing)
Circulation
Head, spinal cord & other injuries (Disability & Exposure)

.. ...

__

175

__

.
.

AIS (Abbreviated Injury Scale)
ISS (Injury Severity Score).
.
.
AIS ,
: 1) -, 2) , 3) , 4) , 5)
, 6) .
1 ( ) 5 (
). AIS
.
ISS AIS. ISS
,
.
(
).
ISS AIS
.

RTS (Revised Trauma Score)
, (). RTS
,
12 ( )
0 ( ).

()
S.B.P.
Points

R.R.
Points

G.C.S.

Points

15-13

> 89

10-29

12-9

76-89

>29

8-6

50-75

6-9

5-4

1-49

1-5

RTS

.
RTS < 11 .
RTS ,
.
.. ...

__

176

__

(%)

R.T.S. (Revised Trauma Score)

12
10
8
6
4
2
0

<1
12
33
37
66
70
100

,

.
Athens Trauma Score (ATS)

(.
shock).
.

SCORE

(mm Hg)

< 89

70-89

50-69

1-49

H.R. / min

< 100

101-119

120-139

> 140

R.R. / min

10-24

25-35

> 36

1-9

SpO2 (%)

> 90

< 90

G.C.S.

13-15

9-12

6-8

4-5

<4

SCORE ATS

14 - 17

Ringers solution (R/S) Ringers lactated (R/L)

9 - 13

Ringers solution (R/S) Ringers lactated (R/L)

6% (Voluven)

0-8

Ringers solution (R/S) Ringers lactated (R/L)

+ 6% (Voluven)

,
(
- triage). ,
:
1.
2. .

.. ...

__

177

__

. .... (Airway)
.

. (GCS < 8),
, , , (, ,
), ,
, .

, ,

, ,
.

Guedel
GCS < 10 , (, ).
GCS > 8 ,
.

.

,
.

.. ...

__

178

__

, -,
(GCS: 8-12), ,
, , . ,
,
( = )
(, , ..).
( 80-90%
),
. ,
.

, :
:
, .
.
, ( , ,
..).

shock.
GCS < 8 / (, , ..).
.. ...

__

179

__

:
( , , ,
/ shock, .).
,



,
, ,
.
:
( )
(, , /, , )
( - , [Bull Neck],
, )
(, )
,
. , Sellick
:

.
Sellick ,
, .
(
, ), 2% (Xylocaine gel 2%),
2-4 cm , ,
. , 3-5
2% (Xylocaine 2% spray), .

,
. 70-100 Kg, :
(Diprivan) Inj. emu: 1% x 20 ml (10 mg/ml) x 5 amp.
1% x 50 ml (10 mg/ml) x 1 amp.
: 2 3 mg/kg 150 300 mg 15 30 ml 1% (iv bolus)
7 15 ml 2%.
: 20 25 mg (2-3 ml) iv-bolus 1-2 ml/min.

(Dormicum)

Inj. sol. 15 mg / 3 ml-amp. x 5 amp. 3ml.

Inj. sol. 50 mg / 10 ml-amp. x 5 amp. 10 ml.

: 5 - 10 mg (iv-bolus) 1 - 3 ml (iv-bolus).
: 10 - 15 mg (2-3 ml), (Fentanyl).
,
. !

.
.. ...

__

180

__

,

:
(Esmeron)
inj. sol. 10 mg/ml
: 0,6 mg/kg >>>>>>> 40 60 mg >>>>>>> 4 6 ml.
: 0,15 mg/kg >>>>>> 10 15 mg >>>>>> 1 2 ml
(Nimbex)

inj. sol. 2 mg/ml

:
0,15 mg/kg >>>>>> 10 15 mg >>>>> 5 8 ml.
: 0,02 mg/kg >>>> 1,4 2 mg >>>>> 0,7 1 ml.
, ,
,
.
, (LMA) i-gel
cobra, Combitube, ...
,
, ,
.
,
.
(Laryngeal Mask Airway - LMA), ,
. LMA,
, ,
, ,
,
, .

(cuff)
LMA, :
ml cuff = ( x 10) 10..
,
. 50 kg
4 5. ,
.
.
.. ...

__

181

__

Cobra-PLA
. 5 .
, , .
,
.
70%.

.

,
.
. ,
,
,
, ,
, .
, ()
Philadelphia.
.
, !
,
, ,
, , straps, .

.. ...

__

182

__

. (Breathing)

, ,
,
. ,
.

.
, ,
, ,
.

CO2 ,
!
( 2) .
SpO2: 93-99% SpO2: 97-100% FiO2: 0,21.
, , .
( ),
( ), ,
( ).

, ,
,
. ,
, , ,
, ,
.
,
.
,
, ,
.
.

(. ): , 2, 3
( Monaldi) , 5,
6 ( Bullau).

.. ...

__

183

__

, ,
, Monaldi, 2, 3
.
, Monaldi.
(G14, G16).
,
Luer-Lock
. , ,
.
( , ,
, , ),
.

C. (Circulation)

(
).
.
(, ),
,
.
,
.
,
(). ,

. ,

, "damage control surgery",
,
.
,
.


,
, , ,
. ,
.
, 2-3
.
, .


.
(shock)
: , , ,
.. ...

__

184

__

, , ,
, , (<0,5 ml/Kg/h <1ml/Kg/h
). , ,

, .
, , ,
() :
: : ~ 60-70 mmHg, : : ~70-80 mmHg,
: : > 80 mmHg.
shock

.
, ,
( ) ,
. ,
,
,
.

.

(ml)

< 15%
< 750 ml

15-30%
750-1500 ml

30-40%
1500-2000 ml

> 40%
> 2000 ml

< 100

100-120

120-140

> 140 < 60

..

< 90

< 70

< 1 sec

1-2 sec

> 2 sec

( )

< 20

20-30

30-35

> 35 < 9

> 30-50

20-30

5-20

0-5

(mmHg)

(ml / )

& 3/1

(< 1500 ml).
2 lt R/L R/S
3/1 ( 1500-2000 ml).
V
2-3 lt, (Voluven, Haemacel)
(0 -)
.
.. ...

__

185

__

50 mL/kg
(. 3-5 ),

.
, .
,

(shock). , ,
, 30%
. , ,
shock,
. ,

, .

,
.
()
,
.
( )
:
.
80 mL/kg.
- - ,
, 20 mL/kg .
20 mL/kg,
, 25%
.
, 20
mL/kg, 60 mL/kg,
25%, 3/1 (
) ,
. 20 mL/kg
(, , , ...)
,
.
.
,
,
,
.
,
, !

.. ...

__

186

__

D. (Deficits - Disabilities)

,
,
.
,
. (GCS)
...,

, A, V, P, U. :

(Alert):
.

V (Vocal stimuli responds): .

P (Painful stimuli responds):
U (Unresponsive): .

,
,

(.
, , ...).
( )
.

.. ...

__

187

__

GCS 8,
5 ,
( ), .
, ,
,
,
.
,

.
- (
),
GCS.
, ,
, , , , , ...
:


, ;


, .
shock

.
shock
, .

. shock

,
. ,
,
, shock.
,
(
) ( )
.
shock :
1) ,
2) ,
3) ( ),
4) .
,
,
.

.. ...

__

188

__

()
(), .
(C),
.
,
,

. :
3-10 g/kg/min iv (4 amp. Giludop 50 mg / 5 ml 250 ml D5 W
10-20 , ).

,
.

6 ,
(Solu-Medrol / Lyo-Drol) 30 mg/kg ..
15 . , :
65 kg, :
4 amp. Solu-Medrol 500 mg, 250 ml NaCl 0,9%.
100 kg, :
6 amp. Solu-Medrol 500 mg, 250 ml NaCl 0,9%.

45 , 5,4 mg/kg/h 23 .

E. -
(Evaluation - Exposure)
.
.
(
) , ,
.
,
(log roll).

,
.
, .

,
.
. ,

, ,
, ,
, .
.. ...

__

189

__

, .
,
!

.

. ( )

( 10
).


,
.
( log-roll) E Exposure ,
.., .
,
.
Battle's. ,
, ,
Raccoon Eyes, .
....
.
,
.
.

.
, ,

( ).

.
.
.
,
,

.
(Levin),
shock
, . ,
,
.
.. ...

__

190

__

, , , -
.
(
), .
: , ,
.
.

,
.
,
( . )
(Foley) .
.
Foley
,
, , .

, (
) , .
.
: , , , ,
.
(
).
.
:

.
.

.

.
(, ,
).
,
AMPLE (Allergies, Medications, Previous illnesses,
Last meal, Events associated with injury),
.

.. ...

__

191

__

E
,
,
,


ABCDE.
,
.


, .
'' ''. ,
, - -
,
.

, ,
.
,
, ,
,
,
, .

.. ...

__

192

__

, , , () .
, , ,
.
:
: 80%
.
. .
, ,
, , .
, , ,
, , ,
, ,
, .

. ,
.
: 4-6% .

,
(flash).
(, ...) ,
, ,
,
, .
, ,
,
,
, .

,
.
: 5-7% .

.
.
.
,
. , ,
.
pH ,
, ,
, .

.
.
.
.. ...

__

193

__

(%)
9 (
14 ) :
,
( ) 1% .

, ,
.
. .
(/, , , ..).
; ;

(.. , , , ).

: 1
.
(.. ). ,
48-72 . ,
. 7-21 , .
1. , , .
2. , .
3. (Depon, Lonarid-N, Zaldiar).
4. , , ,
.
5. Fucidin Jelonet Jalplast
2-3 .
Burnshield
Orthoban .
6. , 2-3 .
7. :
, ,
Likacin 5% 2-3
, ..: Alkaderma Histoplastin Red Sylfio Jalplast-plus 2-3
, 6-9 .
.
8. , : inj. Tetagam-P (im, ).
: ,
.


. 2
. .
,
.
.
,
.. ...

__

194

__

. ,
.
I. NaCl 0,9%, Betadine.
II. .
III. .
IV. (5) :
Fucidin Jelonet Jalplast-plus.
( Likacin, Sylfio, Betadine).
3-4 .
(3-5 ) (Orthoban).
- .
2, 4, 7, 10 15 .

.
,

. , .

.
:

,
. 3
.
.
, , , ,
. .
.
.
1. . GCS.
2. 3way ,
(#16-18G . )
Ringers lactate. Parkland
, : 4 m l / kg / BS A%.
, Parkland,
8 .
3. 1 amp. (iv ), .
4. 1 amp. PPI (Losec/Nexium) 2 amp. (Zantac), ,
stress ( Curling).
5. Foley 14-16 fr
. 0,5-1 ml /kg/h
1ml /kg/h 30 kg.
6. .
7. (inj. Tetagam-P 250 iu). ,
2-3 amp. Tetagam.
8. Fucidin Jalplast.
Burnshield
Orthoban .
9. , , .
.. ...

__

195

__

. ,
.
.
:
1. .
(Voltage) .
2. (, ).
3. .
4.
(, , , ...).
5. (
).
:
, ,
.
( < 380 Volt),
. .

. .
.
(,
). 25 mA 75 mA .
30 sec, ,
. 75 mA 5A
1 sec.
: Ampere , Volt
, :
: ( , ),

ST-T, , , .
: , , , , ,
, , , ,
, , , , .
: ( ),
, , .
: , stress (Curling), .
/: , () , ,
, , .
: , , ,
.., .
: , .
: , , ,
, , .
: , , , .
.. ...

__

196

__

1. .
(, HR, RR, SpO2, ) GCS.
2. ..
.
Philadelphia ....
3. 2 8-12 lt/min, Venturi.
4. ,
ALS ACLS.
.
5. 3way
( #18 Gauge ) Ringers
lactate / R/S N/S.
20-40 ml/kg ..
( 1500 - 3000 ml , .: 70-95 kg).
6. PPI (1 amp. Losec/Nexium) (2 amp. Zantac/Lumaren),
, stress ( Curling).
7. Foley 14-16 fr
.
100-125 ml/h .
CPK > 400 U/L,
( pH > 6,5)
(100 ml NaHCO3 30-40 , iv).
8. (inj. Tetagam-P 250 iu) , ,
.
9.
(1 amp. Stedon 10 mg 100 cc N/S).
10. (, ,
) .
,
.
11. ,
. ,
(. ).
12. (
) 24
.

.. ...

__

197

__

, .
,
. ,
,
.

, ,
, .

. : Staphylococcus spp, Streptococcus spp
Eikinella corrodens, Prevotella, Actinomyces Bacteroides.
,
.
, ,
, , .
, 80-90%
. 5% > 50 ,

24 , .
.
: Capnocytophaga canimorsus, Pasteurella multocida,
Staphylococcus aureus, Streptococcus spp Actinomyces sp., Bacteroides sp.
, 5-20% .
50-80%. Pasteurella multocida
( 24 ) .
,
.
, gram (-) , , .
Bartonella Henselae.
.
, . T
, ,
, .
.
.
, ,
, , , ,
(. Hodgkin) ...
,
, 39-39,5C, , , ,
, .
.
.
15-20% ,
, , , , ,
, , .
.. ...

__

198

__

1.
.
.
10 .
2. ! (
) 1-3 .
- steril-strip
, .
3. .
.

2012.
3-5
20 60 ml .
4. ,
(22) Betadine 1-2 amp. Netromycine 150 300 mg. ,
3-5 .
5. : [inj. sol. Tetagam-P, (im)], .
6.
.
( ) (Berirab-P, inj. 750 iu / amp
5 ml),
() / , ..
. : 20 iu/kg ..,
2 Berirab-P, 70-80 kg.

0, 3, 7, 14, 28.
7. , :
Amoxi/Clav (Augmentin) 1 gr, 1x2 1x3 p.o., 7-10 ,
Doxycycline (Vibramycin) 100 mg, 1x2 p.o., 7-10 ,
Ciprofloxacin (Ciproxin) 500 mg, 1x2 p.o., 5-7 .
(Dalacin 300 mg, 1x3 Flagyl 500 mg, 1x3).
( : Pasteurella multocida, Staphylococcus
aureus, Streptococcus spp., Gram (+) , Fusobacterium spp.,
Gram (-) ).
8. , , (1, 2, 4, 7, 10 ).
9. .
10.
, .
11. (CSD), .
, :
tbs. Azithromycin (Zinfect) 600 mg, 1x1, 5 ,
tbs. Ciprofloxacin (Ciproxin) 500 mg, 1x2, 10-14 ,
tbs. Rifampicin (Rifadin) 600 mg, 1x1, 14 .
.. ...

__

199

__

(Hymenoptera) .
: Vespids
[ (Vespula vulgaris), ] Rapids [ (Apis
mellifera) (Bombus agrorum)].


.
.
,
, , , 2, .

, , .

.
.
1-3%.
35-60%.

.
.
IgE .
, ,
, . (,
) .
, , ,
.
, , , , ,
. , 1-2
, , ,
.

1.
.
, .
2. , ,
, spray
.
3. , :
1 amp. (Fenistil) 100 ml N/S (iv), 15-20 .
4. , , 1 amp. Solu-Medrol (40,
125, 500 mg) 1 amp. Solu-Cortef (250, 500 mg), im iv-bolus.
5. 2 amp. Zantac (iv bolus) 2 .
6. 1-2 amp. Calcium Gluconate 10%, 250 ml D5 W N/S.
7.
(: - shock)
24h.
.. ...

__

200

__

,
, Centuroides sp., Tityus
trinitatis ( ), Bothriurus sp., Androctonus sp ( ,
, ), Hemiscorpius lepturus ( ).
(Androctonus)
.
.
.

.
, 5--.
,
(./.., .. ...).
(, , , ) (,
, , ,
, , , , , ,
, , )
,
.
2-48
.

,
.. ,
.
1. , .
2. () 5-10
(3-5 ml Xylocaine).
3. , ,
(1 amp Movatec, Xefo ) (1 amp Musco-Ril).
.
4. ( )
, 15-30 , 1 amp. (Catapresan) 100 ml
NaCl 0,9%.

:
5.
6.
7.
8.

2 4-6 lit/min, .
1 amp. Stedon 250 ml N/S, .
1-2 amp. Calcium Gluconate 10%, 250 ml D5W N/S.
( ) .

.. ...

__

201

__

;
, ,

.
.

;
(viperidae - )
, (colubridae)
,
(, , ).
, , 2
7 mm. ,

"U". (Vipera ammodytes)
, (Vipera aspis), (Vipera lebetina), , .

(.., .. ...).

20-30
.
,
( ).

30-120
, , , , , ,
, , , , .

.
2 .
!

.
.

,
, ,
(
, ),
.

.. ...

__

202

__

1. !

.
2. , ()
.

, .
,
.
3. . ( , , ,
, -, ,
). .
4. , ,
Betadine .
5. , , ,
, .
,
!
6. 3-way (#16-18G) 500 ml D/W 5% 1000 ml N/S.
(20-40 ml/kg)
, (Voluven, Haemaccel). ,
: 3-10 g/kg/min (iv) (.: 4 amp. Giludop 50 mg/5ml
250 ml D5W 10-20 ~ ).
7. , Solu-Medrol Solu-Cortef ( .).
8. 1 amp. Fenistil (iv) 250 ml NaCl 0,9%, 20-30 .
9. (UFH) 1 ml (5000 iu) (sc).
(Clexane) 1 mg/kgr . (sc).
- -
1 amp. Fondaparinux (Arixtra) 2,5 mg.
10. , : inj. Tetagam-P (im).
11. 1-2 amp. Zantac 1 amp. (Nexium) .
12. (.. amp. Xefo / amp. Apotel)
( , .).
13.
2-5 amp. 10 ml 500-1000 ml N/S (
),

( , , ONA, shock, ..).
14. , monitoring (, , SpO2).
15. ( )
, 5-7 ,
Amoxi/Clav: (Augmentin) 1 gr, 1x2 1x3 (p.o),
Doxycycline: (Vibramycin) 100 mg, 1x2 (p.o),
Metronidazole: (Flagyl) 500 mg, 1x3 (p.o),
Amikacin: (Briklin) 500 mg, 2x1 (im).
.. ...

__

251

__

SHOCK

. .

IgE
IgE- . IgE- ""
, .
,
, ,
.
:
(, , ) .
(, , , ,
, latex, ...).
: , , , ,
, , , .
,

shock.
shock :
, , , .
, .
, , , , .
, , , , , arrest.
, , , , arrest.
, , , , , Flushing.
, , , .

1. .
,

!
2. , 1 amp. (Fenistil) 100-250 ml N/S (iv),
15-20 1 amp. (Titanox) .
3. 2 amp. Zantac (iv bolus) 2 .
4. , , 1 amp. Solu-Medrol (40, 125, 500 mg)
1 amp. Solu-Cortef (250, 500 mg), bolus .
,
20-30% , , 2
1-8 !
.. ...

__

204

__

5. 2 4-6 lt/min,
(Aerolin / Pulmicort).
6.
, , :
1 amp. Aminophylline 250 mg Uniphillin 240 mg, 500 ml N/S, 30-45 .

shock, :
7. Trendelenburg.
8. .
9. 2 6-10 lt/min, Venturi (31-40%).
10. 0,3 - 0,5 ml 1:1000* im/sc (
> 12 ). 10-15 min, shock .
( )
,
shock.
, shock.
: - ( -)
, ,
1-2 mg (iv) 5-10 .

(Glucagen) .
11. , 1000 ml NaCl 0,9% (iv).
1-2 Lt ,
. . 1 amp. = 1 ml 1:1000
100 ml N/S 15-30 ,
monitoring .
12.
[ (Fenistil)], / [ (Titanox)].
13. , .
14.
, 5-7 .

- (Epipen).
0,3 mg 0,15 mg.

.
:
.
.
.
.
.
.
, 1 mg/ml
1:1000.

.. ...

__

205

__

,
.
,
,
, 24
.


/ ( 24 ).
, .

, .
(NaCl <0,5% NaCl >3% ),

, ,
shunt. O
.
,

, ARDS .

(
).
.
. , ,
, , ,
, - .
(surfactant) ,
, ,
.
:
.
.
.
, .
.
.
.
/ . / .
, ,
, Parkinson .
, ,
/ .
/
(surfing, water-skiing, jet-skiing).
.. ...

__

206

__

.
4 :
I. .
II. (,
), , , , .
. , ,
. (
). , .
III. (arrest). , (55%),
(30%), (15%).
IV. . .
.

1. , .
,
. (GCS <8)
(LMA).
2. ,
.
3. (2) 100% .
100% , ,
(CPAP) .
,
(PEEP).
4. (18G) 3way ,
1000 ml N/S R/L-R/S, .
5. , monitor, .,
(RR), (HR) SpO2 .
6.
1-2 amp. Berovent 1 amp. Pulmicort, 2 () 5-8 lt/min.
7. 1 amp. (Solu-Cortef) 250 500 mg, (iv-bolus).
8. ,
, (1-3 amp. Furosemide/Lasix),
.
9. 100 ml NaHCO3 4% (iv), 30-45 ,
( pH < 7,1).
10. Foley 14-16 fr .
11. (Levin)
.
12. .
, ,
( ).
30C.
13. ,
,
.
.. ...

__

207

__

.
,
, (, , , LSD,
, angel dust), , ,
..
(Heat illness)
.
, :
a) (Heat Edema),
b) (Heat Cramps),
c) (Heat Tetany),
d) (Heat Syncope),
e) "" (Heat Exhaustion)
f) (Heat Stroke) .

"" ,
:
I. ( ""),
, ,

II. ,

.

: , ,
, , , ,
, , ,
.
:
(41- 43 C), .
. .
, , ,
, , (
) .


, ,
(D.I.C.) .
, ( ) ,
, :

ARDS
OEM /

/

Status epilepticus

.. ...

__

208

__

1. ,
GCS AVPU.
monitoring (, , ,
, SpO2) .
2. ,
38,5 C.
20 25 C


(14-16 C).

(),
,
.
3.
, , ,
. ,
.
4. ,
1-3 ,
Levin ( ) 10-20 .
5. 2 4-6 lt/min, .
6. 3way (1000 ml N/S
R/L) , .
7. Foley 14-16 fr, .
8. ( < 80-90 mmHg)
(4 amp. Giludop 50 mg, 250 ml N/S, R/L D5W) .
9. , 20 - 50 mg [. 1
amp. Zuledin 25 mg/5 ml, (im)] .
10. , : 1 amp. Stedon 10 mg,
100 ml 250 ml N/S, 30-40 .
11. , monitoring, .

,
,

,

,
.

.. ...

__

209

__

,
98% ( : 140 meq/l,
: 4 meq/l). H ( 35:1)
Na-K ,
Na+, + .
-.
(2%) +
(+ >8 meq/l).
+ ,
pH, , ,
.
> 5,5 mEq/L.
. + > 6,0 mEq/L
.
:
1. (,
, , , , ,
, , ).
2. . 30 mEq.
3. (/, ,
, , ,
, ...).
:
.
: ,
, , , , ,
.

( + >6,5 mEq/L) ,
PR, QRS .
+ > 8,5 mEq/L ,
.
.. ...

__

210

__

1. monitoring
(, , , SpO2, ) .
2.
. 1 amp. 10% 2 amp.
10% 100 cc N/S 5-10 .

+
3 amp. 10% 500 cc N/S 45-60 .
, 10 ml CaCl2 10%, 3
Ca 10 ml 10%. CaCl2

.
(:
).
3.
. 3 amp. 10 ml D/W 35% 250 ml D/W 5%
7-10 IU (Actrapid).
20-30 .
Gluco-stick .
10 Actrapid 500 ml D/W 10% 60-90 .
4. ,
.
2-4 amp. (Lasix) 2-4 amp. (Burinex) iv-bolus .
5. 2-,

. 1-2 amp. (Aerolin)
2-3 ml N/S, 5-10 2-5 .
10-20 90
. .
6. .
1-2 amp. 100 ml D5W N/S
20-30 .
7.
(Kayexalate). 15-20 gr Kayexalate
20% (
) 6-12 .
20-50 gr Kayexalate 200 ml D/W 20%
15-30 .
30-60 .
Foley 12-14 fr . H 4-6
( ).
[ ,
.
].
8. ( monitoring)
,
.
.. ...

__

211

__

,
, , ,
, , CO2 CO , ..

, ,
. ,
,
.
,
,
,
,
.
(.., ,
, SpO2, ), (GCS), ,
(.. ).

,
.
: K
.
, ,
.


, :
(1-3 amp. D/W 35% 10 ml), .
(1-5 amp. Narcan) 2 mg (iv bolus)
(1000 ml D5 W, 1-2 amp. Soluvit).
1. ,
8-12 lt/min, .
2. 3way 16-18G.
3. .

,
. :

(Anexate)
- (Parvolex / Flumil)
(Narcan)

. .
. /

.. ...

__

(Sintrom)

212

__

. . /

2 100%
. .
. Fullers earth.
. . .
.
. 12. .

(Kapavit / Konakion)

(Anexate)
,
.
4. monitoring , , .
5. .
6. .
N/S 0,9% R/L
.
()
.
.
.
,

.
,
,
, 30-60
, 30%
.

. :
.
.
.
.
.
.
6 .
( ).
,
60-90
.
/ . Levin
(36-40 F 22-24 F ),
.
.. ...

__

213

__

.
(fl. Toxicarb 250 ml)
60-90 .
0,5-1 g/kg (. 25-100 gr) , 25-50 gr
1-12 10-25 gr .
,
, ,
, , , ,
(..: , , ,
, ..).
( 0,5 g/kg 2-6
24-48 ) ,

, , , ,
.
.
.
7. :

.
(500-1000 ml/h)
NaCl 0,9% D5W ( ).
(D/W 10%) 20%
(200 ml) .
pH (
) .

(NaHCO3). ,
,
(NH4Cl) .
8.
(, , , ,
- ..).
,
-
-
.

,
, ,
, .

( )

.
(: 210-77.93.777)

.. ...

__

214

__

: - GABA (
). .
.
.
.
:
(.. Trapanal)
(3 ):
( ).
(3-6 ): ( - Amytal).
( > 6 ): .. (Gardenal), (Mysoline).
10
. .
, . , ,
, , , , .
, shock,
, , ,
/ - .
, .
.


shock.
1. A-B-C-D (, ,
, ).
, .
2. 2 4-8 lt/min Venturi.
3. 3way (#16-18G).
4.
6-8 , Levin
NaCl 0,9%, .
5. , per os (Toxicarb
fl. 250 ml) / (3-5 sachets Molaxole 13,7 gr Fortrans 74 gr).
6. 30-45
.
7. (shock),
5%, 80-90 mmHg.
8. 2 , 500 ml NaCl 0,9% ,
. 4-8 amp. (200 - 400 mg) (Giludop)
500-1000 ml NaCl 0,9% 5-10 g/kg/min.
9. Foley (14-16 fr), ,
4-6 ml/kg/h.
10. .
100 ml NaHCO3 30-45 .
11. ,
( monitoring , SpO2) .
.. ...

__

215

__

: , , , , ,
, , , ..
: , ( )
.
,
.

, , ,
, , , , (
), (), , .
, ,
.

1. A-B-C . A
.
2. , 8-10 lt/min 2 Ambu
Venturi .
3. 4-6 ,
,
, .
(30 ml 15 ml ) 2-3 .
.
4. Levin
30-50 gr (Toxicarb) Levin.
5. , ,
/ ,
, .
iv-bolus, ( im sc) 0,4 2 mg (. 1-5 amp. Narcan).
1 mg 25 mg .
2-5 amp. Narcan 3-5
3 .
12 amp. Naloxone (Narcan 0,4 mg)
1000 ml N/S 12 (0,4 mg/h 1 amp/h).
(
)
.
.
.
6. , .

.. ...

__

216

__

.
.

.

(/Xanax, /Halcion, ).
;
.

: ,
, , , , , ,
.
.

.

, , .

1. GCS AVPU.
2. ,
6-10 lt/min Venturi.
3. 3way 1000 ml NaCl 0,9% R/L R/S.
4. (), (SpO2)
, (.. oC) (GCS).
5.
(GCS:14-15), .
, ,
30 ml 15 ml 2-3 .
6.
Levin / (1 fl. Toxicarb 250 ml .
1 gr/kg ..).
7. .
8. (Anexate) (2-4 amp. 1000 ml
0,5 mg/h), iv bolus 0,2 mg = 2 ml 15 sec,
60 sec 1 mg.

(
) .
: 5 mg ,
.
9.
.
.. ...

__

217

__

:
,
.
, , , .
35 mg/Kg.
> 50 mg/Kg.
, ( , QRS, ), /,
, .
;
.
;
,
, (
), , , , .
, , , , ,
, collapsus, .
. monitoring , ,
. .

1. [ (, HR, ..)
(RR, SpO2)], C GCS AVPU.
2. ,
6-10 lt/min Venturi.
3. 3-way 500-1000 ml N/S.
4.

.
(< 5 mg/Kg)
30 2 fl sir Ipecavom per os,
.
5. , Levin,
2-4 .
6. ,
. 1-2 .
7. (.. )
.
8. 1000 ml NaCl 0,9% 1-2 mg/kg
Lidocaine (iv-bolus, 3-8 ml )
, .
9. 100 ml [aHCO3] 4%, 30-40 ,
( QRS>100 msec,
).

pH: 7,50-7,55.
10. 1 amp. Stedon 100 ml N/S, (iv).
11. monitoring /.
.. ...

__

218

__

()
: , ,
Krebs, ,
,
.
. ;
; (oil of Wintergreen);
, 75-150 mg/kg
. 6
, .
;
( )
.
, : , ,
, , , ,
,
, , , ,
.

1. ( ) ,
.
, , (SpO2),
GCS.
2. 2 4-8 lt/min, , .
3. (Ipecavom 2 x 15 ml) ,
.
4. ( 4-6 )
(fl. 250 ml Toxicarb)
Levin, .
5. (Salospir)
1%.
6. Foley 14-16 fr .
7. (N/S R/S), 400 ml/m2
.
3 lt / m2/24h.
8. 100 ml [aHCO3] 4%, 30-40
1000 ml D5 W 3 amp. NaHCO3 4-6 (
).
9. 2-3 amp. Lasix,
20%
5 mg/kg .
10. ,
(1 amp. Konakion 10 mg) .
11.
,
/ FFP.

.. ...

__

219

__

()

. .
140
mg/kg .. 7,5 gr 24.
0,2 -1 g/kg ( 20 - 25 gr)
.
, ,
p450, --p- (NAPQI).
NAPQI (
),
.
:
, 24 , , , , ,
, , .
, 2-3 , ,
, .
, 3-5 , , ,
, , , , .
: , ,
, 24.

1. ABCD .
, 3-way .
2. monitoring (, HR,
RR, SpO2, oC) GCS AVPU.
3. 2-4 30 ml (2 fl.)
(Ipecavom) ,
.
4. (Toxicarb) Levin.
5. ( ) per os
Levin, 20-30 mg/kg , 8-12
Trebon-. (
,
).
6. , . N- (C):
, 250 ml D5 W 5 amp. 20% (Parvolex/ Flumil)
15 .
2 amp. , 500 ml D5 W, 4 .
, 3-4 amp. 1000 ml D5W, 16 .
300 mg/kg, . ~ 10 amp. 20 .
.. < 40 kgr
7. 100 ml NaHCO3 4% (iv), 30-45 ,
( pH < 7,1).
8. 10 mg (Konakion)
.
9. ,
.
.. ...

__

220

__

B - ( - BLOCKERS)

: c-AMP
.
b-blockers,
( ,
, , ), QRS,
QT, .
:
, , ,
( ) grand
mal, .
torsades de pointes.
,
.

1. ABCD . ,
(SpO2 > 90%) (#16-18G) 3way .
2. monitoring
(, SpO2) GCS AVPU.
3. per os 2000 mg ( 2 fl. 15 ml)

GCS > 13.
4. ( 4-8 )
(Toxicarb 250 ml)
Levin, .
5. 3way 1000 ml N/S 500 ml D5 W
.
6. 1-5 mg (1-5 amp. 1 ml) iv bolus 2-5 amp.
1000 ml N/S . 50 mg
24 .
(
(Glucagen) ).
7. 1-3 amp. iv bolus.
, 0,02 mg/kg, 0,15 mg
1 mg (1 amp.) .
8. ,
(5 amp. Isuprel 250 ml D/W 5%, 5-20 ).
9.
(1-3 amp.
10%, 250 ml N/S D5W, 15-30 .
10. ,
0,5 U/kg (iv-bolus) 0,5 U/kg/h .
1000 ml D5W D10W .
11. , monitoring / / SpO2,
24 .
/ .
.. ...

__

221

__

-
(, , Diazinon, Ethion)
() .

.

(Sarin, Soman, Tabun, VX).
2 mg 120 mg .
.
( ,
) 30-60 min (peak)
2-8 . ,
.
, :
: , , , , ,
, , , , , ,
, .

SLUDGE (Salivation, Lacrimation, Urination, Diarrhea, GI upset, Emesis)
DUMBELS (Diaphoresis/Diarrhea, Urination, Miosis, Bradycardia/Bronchospasm/
Bronchorrhea, Emesis, Lacrimation, Salivation).
: , ,
,
.
..: , ,
, , , , , , , .

1.
10 .
2. . 2 6-12 lt/min
.
3. 3way (#18G) 1000 ml N/S
> 80 mmHg > 0,5 ml/kg/h.
4.
2-5 mg (im iv) 0,05 mg/kg .
5, , 50 mg .
: .
5. ,
(2-PAM). 250 ml D/W 5% 5 amp. 200 mg
Contrathion , 5 .
, 30 min .
, 24 .
24,
.
6. - 1 amp. (Stedon), ,
.
7. .
.. ...

__

222

__

-
Paraquat, Diquat, Silvex,
Methoxon, Atrazine, Diuron, Molinate, Alachlor, TCA, Oxadiazon ..
Paraquat Hit and Run ,
.
,
. Paraquat
10 , (
), .
.
( , , ).

, , (),
, , , , .
Paraquat ,
, ' .

, ,
.


,
.
1. (

30 ).
2.
. Levin.
3. , ,
. (fullers earth)
1 15%.
, (Bentonite 70 g/vial)
1 7%, 2-4 2 .
,
50 gr 250 ml !
4. (3-5 sachets Molaxole Fortrans)
8 , .
5. (1000 ml N/S R/L),
2-5 amp. Lasix
.
6. , - 1 amp.
(im) 1 amp. Tramal (im) , 100-250 ml N/S (iv).
7. 2, PO2
, 2 Paraquat!
8. , , .
.. ...

__

223

__

.
: Amanita muscaria, Amanita phalloides, Volvaria speciosa Gyromitra
esculenta.
, -, -, - ,
, , ..
2-6
, , ,
, , , ,
, ,
, ,
, , .
,
, , , , , .

.

1. (amp. Apo-Go
10 mg, sc) 2 g ( 2 fl. 15 ml).
2. ()
NaCl 0,9%.
3. per os 50 gr (1 fl. Toxicarb 250 ml) 2-4
(3-5 sachets Molaxole 13,7 gr Fortrans 74 gr).
4. 3-way 1000 ml N/S 1000 ml D/W 5%.
5. Foley 14-16 fr, .
6. G, (Benzylpenicillin) 5 x 106 iu / 6 (
)

.
7. , , (
, ),
36 .
, 3-6 amp. Lasix 500-1000 ml N/S,
, 24.
8. 0,5-2 mg ( - 2 amp.)
(im iv) .
9. (Amanita phalloides)
(Legalon / Madaus) 4 fl. (: 20 mg/kg/24h) 2 ,
4 , 24.
10.
, 10 mg ( 1 - amp. Konakion).
11. , 1 amp. (Stedon) 10 mg,
100-250 ml N/S, .
12. , .
.. ...

__

224

__

[CO]
,

, .
CO

. CO !
,
HbCO ().
,
HbCO .
.

, , , , , , , ,
, , ,
( Babinski ) Parkinson .
, (

/ ), ,
, , , ,
, .

, , ,
CO.

1. ,
.
2. .. .
, (, ..).
3. .
4. , 2 100%, , 4 .
5. 3way 1000 ml N/S 500 ml D5 W 1-3 amp.
Lasix,
( ).
6. 1 amp. Dexaton 8 mg (
). , 200 ml 20%.
7. , 1 amp. Stedon 10 mg, 100 ml N/S (iv).
8.
( 95% 2 5% CO2 ),
, .
.. ...

__

225

__

()

: , ,
(qua forte) .

.
.
,
, , .
, , , , .
.
,
/ .
.
..,
collapsus .

.

, .

1. .
2. .
3. ( ) (
).
4. .
5. 50 - 120 ml
60 - 250 ml .
(2-4 ) (3-4 ).
6. , Levin
, ,
10 .
7. (#18G) 3way ,
, 1000 ml NaCl 0,9 % / 1000 ml Ringers.
8. 1 amp. .
9. , 1 amp. Stedon 10 mg, 100 ml N/S (iv).
10. 2 8-10 lt/min SpO2 > 90%.
11. , 10-20
.
12. , F
(Ca++), ,
(2 amp. Calcium Gluconate, 500 ml NaCl 0,9%, ).
13. , monitoring .., SpO2.

.. ...

__

226

__

()

( )
.
,
, .
, ,
.
,
, , collapsus.
.
.
,
, ,
.

1. .
2. .
3. - - (
), , , .
4. ,
2 .
5. ,
50 - 120 ml 60 - 250 ml .

24 .
6. 3way (#18G) 1000 ml N/S R/L
>100 mmHg.
7. (1 amp. 500-1000 ml ).
8. 1 amp. Stedon 10 mg, 100 ml N/S (iv).
9. 2 8-10 lt/min SpO2 > 90-92%.
10. .
4-6 ,
.
.
1 amp. (Dexaton) 8 mg (iv)
1 amp. (Solu-Medrol) 500 mg-1 gr (iv) .
11. - - , monitoring
.., SpO2.

.. ...

__

227

__

...
M
.
,
.. .
K :
1.
2.
3.
4.

, ,


.

O
, ,
, , , ,
.


, BCG Sabin . '

.
,
.
,
, .

, ,
.

1 ,
2015.

2 CDC
2015, (.. )
(.. , , , ...).

3 CDC
2015 (
), .
.. ...

__

228

__

.. ...

__

229

__

.. ...

__

230

__

.. ...

__

231

__

Hep-B (Engerix): .
1 HepB ( 12 )
(HBsAg),
. 1 HepB
.
1 ,
4 3 ( 2 1
3 2 ). 1 2
2 3 4 .
(3) (4) 8-16
24 (6 ).
- 3
HepB , 9-18 HbsAg anti-HBs.
Hep-B ,

(anti-HBs 10 mlU / ml).
!
, 6
. ,
, 6 1 .
1 ,
(HBsAg) 12 ,
0,5 ml (HBIG).
( ) .

(HBsAg)
(-HBs) 9 15 .

(HBsAg) ,
2
HbsAg, 1 .
,
3 ( 6-8
6-18 2 8-16
6 ).
, 1998 .
,
12 .
,
.

1.
2.
3.
4.

5.
6.
7.
8.

.. ...

__

232

__

Hep-A: .
(Havrix), :
2 18
, >18 .
1 2 ,
6 , .
:
1. .
2. .
3. , ,
, ...
4. (
).
5. ( ,
, ...).
6. , , .
7. C, , .
,
< 4%. , , ,
, 1-5% .
(
10) > 95% .

DT aP (Infanrix): , ,
( )
. pertussis ( ,
)
(acellular pertussis aP) .
E: , 2
6 .
TdaP: , , ,
. IPV
18 . TdaP
11-12 ( 64 )
. 5 DTaP
d ,
. TdaP ( IPV)
Td . 10 Td
.
Td (D.T.VAX):
1/5-1/10 DT
. 10 Tdap
. .
.. ...

__

233

__

IPV (Salk): .
T , 3 (1, 2, 3) .
.

.
18

( )
.
.

M.M.R (Priorix): , , .
12-15 .
2 4-6
2 1 .
2 2
.
2 .
HIV .
,
. .
MMR .
.
. ( > 39,5 C) 5-15% .
7-12 1-2 .
5 . 5%
.
. , , ,

.
, .
.

.
48-96
.
. 1

25.000 1 1 . .
, .
.
,
,
.
MMR , GuillainBarr,
Crohn, , ,
.
.. ...

__

234

__

Hib (Act-Hib, Hiberix): .

B Diphtheria CRMI97 .

H. influenzae B, 2 5 .
T H. influenzae B B.
<6 3 2 . >12-15 .
7-12 > 15 .
12 - 5 .

. Act-Hib Hiberix
( ) Hib-TITER ( ).
(
> 90%).
, (DTP, MMR,
Sabin, ), . ,
.
.
, ,
25% 12-24 ,
.

MCC (Meningitec): ,
C ().
N. meningitidis. 50 g
A C A, C, Y
W135 (MCV4).
E:
1.
A+C
2.
( )
3.
4. .
5. .
2 3 -
2 2 15-18
.
> 12 , 1 .
, C.
a. , Meningitec,
15 g CRM197
.
Meningitec, < 12 , 3
.
b. Neisvac-C,
>12 .
.
.. ...

__

235

__

PCV-13 ( Prevenar): , , ,
( 4, 6B, 9V, 14, 18C,
19F, 23F). 7-
,

.
o , .
2-24 .
2-6 : 3 1
>12.
6-12 : 2 1
>12.
12-24 : 2 2 .

(, ).
,
23 (PPV).

PPSV-23 ( Pneumo23): ,
(23) ().
K 0,5 ml 25 g
23 (1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F,
18C, 19A, 19F, 20, 22F, 23F, 33F) .
2
( ,
).

,
2-23 .
> 65 : 1 5.
PCV13
PPSV23, 8 .
PPSV23 5 .

2 > 60 .
( IgG2)
HIV.

( HIV) .
.
.
.
.
.
.

.
.. ...

__

236

__

INFL (Vaxigrip, Fluarix): (whole-virus)

, 1
6 .

(2 1 ).

. ,

.
(.. , )
.

.
8 , 2
(0,25 ml < 3 0,5 ml 3 ) 4 .
,
6 .
60
.

:


( )
( )
(.. Kawasaki)
Reye .






60
*
: :
1. ,
2.
,
3. (

).
*,, , 3
.
( ) ,
.
.
.. ...

__

237

__

Varicella - Zoster (Varilrix, Varivax, Zostavax): Z

- ( Oka)
(MRC-5) .
12-18 ( 15
), .
2 4-6
2 1 .
2 2
.
2 .
HIV-
.
:
1. ( ,

).
2. .
3.
, ) , ,
, , , ) )
.
Zostavax
.

60 .

HPV (Cervarix, Gardasil):

. ,
9-26 .
11-15
15-26 (
,
, 3-4 ).
. (Cervarix)
(Gardasil). 16 18.
(6 11),
().
3
14 . 0-1-6 ,
0-2-6 .
,
, . ,

.
.
,
.
, Pap-test, HPV DNA test,
.
.. ...

__

238

__

BCG (Bacillus Calmette-Guerin):

(. bovis).

,
, 6 .

(.. , ..).

.
Mantoux
12-15 4-6 ( BCG)
, 11-12 ( ).
,
,
.

ROTAVIRUS (Rotarix):
R1X4414 G1, G2, G3.
Rotarix
.
. ,
16
, , 24 .
13
( 27 ).
Rotarix
, .

EMBOIO TYOEIOY Typhoid Vaccine:

: ) A B
, )
Ty-21, )
Vi .

, , .
.
: A > 10 :
0,5 ml 4 .
6 - 10 : 0,25 ml , ,
4 . A 3 , .
> 2 : 0,5 ml . 2.
> 6 : M 1, 3, 5 7
(, ). H
.
.. ...

__

239

__

:
, , 2-8 C.
,
.
, ,
.
,
.
, ,
2-8 C 8 . ,
,
, .
.
: ,
, , .
, ,
.
.
,
, .
(< 2 )
,
. (> 2 ) ,
. ,
, ,

.
:
. ,
,
.
DTP,
,
. ,
,
.
, ( 12 )
23 2,6 cm. , 20
22 2,5-3,2 cm.
, 25
1,6 cm .
11-12
( , ),
.

, ( ).
.. ...

__

240

__

1.

(- ).

2. .
3. .
4.
G-6-PD.
5. &
.

.. ...

__

241

__

.. ...

__

242

__

.. ...

__

243

__

.. ...

__

244

__

-2
.: < 2,0 g/ml

h - TG ( )

, , ..., ,
Waldenstrm.
().

.: < 25-50 ng/ml.

.: < 0,1 g/lt.

Ca , Ca , ,
, , , .

.. ( )

..., , Ca .

T - Cal ( )

.: < 5 IU/L

.S.E. ( ).
.: < 12,5 ng/ml.

T.P.A. ( ).
.: < 0,9 IU/ml.

a-F.P. (- ).
.: < 8,5 ng/ml

C.E.A. ( ).
.: < 3-5 ng/ml.

CA : 72-4
.: < 4-7 U/ml.

CA : 50
.: < 15 U/ml.

CA : 125
.: < 35 U/ml.

, , , ,
, , Ca .
Ca , , , ,
, , .
Ca , , , ,
, , .
Ca , , , ,
, , , , .
Ca , ,
, , .
Ca , ( /)
, .
Ca , , , , ,
, .
Ca , .

CA : 242
.: < 20 U/L.

CA : 549

Ca , .

CA : 15-3

Ca , , ,
, Ca , .

.: < 25 U/ml

CA : 19-9
.: < 37 U/ml

Free - HCG
.: -

.: 20 - 150 & 450 g/L

S.C.C.
.: < 2 ng/ml

C ()

Ca , , , ,
, , .
Ca , , , , ,
, , , .
Ca , , ,
, Hodgkin.
Ca , Ca -
Ca , , , , , TB.
Ca , .

.. ...

__

245

__

ADRENALINE
ADRENALINE
ADRENALINE
AEROLIN RESPIR.
AEROLIN SYR.
AIMA
AIMA
ALDACTONE
ALOPERIDIN drops
AMINOPHYLLINE
AMINOPHYLLINE
AMOXICILLINE
AMPICILLINE
ASPIRINE
ATARAX SIR
ATROPINE
AUGMENTIN
BEGALIN
BENTONITE
BISOLVON
BRIKLIN

0,01 cc/kg (sc). 15 x 3 . : 0,05cc.

max = 0,5 cc. 3 , .
: 1-5 amp. . , .
< 5 : 0,5 cc. 5 : 1 cc.
0,2 mg / 24h 4 . Sir 2mg = 5cc.
X = H Hb . : 3BX.
13 cc/kg. 25 /1 . : 6BX. B=B kg.
2,25mg/kg/24h. 3.
2 mg/kg/24h. 4.
6 mg/kg/. A 6. . 50-100 cc . 30'.
Max 20mg/kg/24h.
50mg/kg/24h. 3.
50-100 mg/kg/24h. : 100. : 200. : 300. Max/24h = 9 gr.
13,2 mg/kg/24h. : 4.
6 -5 : 0,5 .. x 2. >5 : 1 .. x 3. (2 mg/kg/24h 4 )
0,05 mg/Kg . 1amp.=1cc=1mg. ax =2mg .
2-7 : 37,5mg/kg/24h 3 . 2 : 25mg/kg/24h 3 .
<30kg: 50mg/kg/24 2 . >=30Kg: .
250-500cc 7% Milk of magnesia 60cc 2 .
<2 : 10 x 3. 2-6 15 x 3. >5 15 .x 3.
15mg/kg/24h. 2 , .

CALCIUM GLUCON.
CECLOR
CELESTONE drops
CHOLEDYL SYR.
CLAFORAN
COMBANTRIN

100mg/kg/6h. 20'.
40mg/kg/24h. 3.
4./kg/24. 2.
5cc=62,5mg. 9,4 mg/kg. 6,2 mg/kg/6.
50-100mg/kg/24h. 4.
10mg/kg. 9 .

DECADRON
DEPON
DEXTROZE-35%.
DIGOXINE

1,5 mg/kg . ax = 30 mg. 0,5 mg/kg/24h 4 .

12,4 mg/kg/24h. 4. (5 cc = 120 mg.)
/0,35 cc . kg.
0,04 - 0,08 mg/kg/24h .

EPANUTIN AMP.
ERYTHROCIN

5 mg/kg . x3/24. Nacl-0.9%.

50 mg/kg/24h. 4

FENISTIL SIR
FER-IN-SOL drops.
FLAGYL

5 cc=0,5mg. <1 : 1/3-1 x 3/24h. 1-3: 1-1 1/2 x3. >3: 1 1/2-2 x3. >12: 2-4 x3.
5 mg/kg/24h. 0,6cc=15mg Fe.
20 mg/kg/24h. 3.

GLUCAGON
GULAMYL SYR.
GULAMYL SYR.

0,1 mg/kg/. 20' .

5cc=50mg. 2-5 3mg/kg/8. 5 4 mg/kg/8.
1 : 4 mg/kg/6.

.. ...

__

INDOMETHACINE
IPECAVOM
KALIO
KAPAVIT, KONAKION
KEMICETINE
KENTACEF
KLARICID SIR

246

__

3,5 mg/kg/24h.
9-12 10cc. 1-12 15cc. > 12 30cc. M 20' .
2mEg/kg/24 . 1amp.=10cc=13,5mEg.
5-10MG .
100mg/kg/24h. 4.
50mg/kg/24h .
5cc=125mg. 15/kg/24 2 . 6 .

LANITOP DROPS
LASIX
LOMOTIL
LUMIDROPS

0,04 mg/kg/24h 3 . Max /24h = 1,25mg.

1-2 mg/kg 2 /24. : 2mg/kg x 2.
0,4 mg/kg/24h.
5 mg/kg/24h. 2 . 13 . x 3. 40. x 3.

MANNITOL
MIOCAMEN
MOXACEF
MUKOMYST SIR.

2 gr/kg 30'. (K 4h).

1 cc = 50 mg/kg/24 2 12.
40 mg/kg/24h. 4.
0-2 0,5 .. x 2. 2-7 1.. x2. >7 1. x3.

NETROMYCIN
NITROFURADOIN

6 mg/kg/24h. 3.
1,5 mg/kg 1 24.

ORADEXON
ORBENIN
OSPEN SUSP.

1,5mg/kg . ax=30mg. 0,5mg/kg/24h 4 .

50-100mg/kg/24h. 4.
1cc=400.000 i.u. : 0-6 1.. x 3. 6 1.. x4. (0,25cc/kg/24h.).

PEDIAZOLE
PENICILLINE AMP.
PENICILLINE AMP.
PONSTAN
PREZOLON

5 cc = 200mg Erythromycin + 600mg Sulfisoxazole. Erythromycin 50 mg/kg/24h.

300.000/kg/24h 6 (/4). 100.000/kg.
150000 i.u./kg/24 4 .
25 mg/kg/24h. 3 . (5cc=50mg).
1 tabl = 5mg. 1 amp = 25mg = 1cc. :2-5mg/kg/24h.

QUIBRON R
RIVOTRIL
ROCHEPHIN

50 mg Theophylline=5cc. . Gulamyl, Choledyl.

1 0,5amp. . 1 1amp. . (0,01-0,03mg/kg/).
50 mg/kg/24 .

SEPTRIN
SEPTRIN
SOLU CORTEF
SOLU MEDROL
STEDON
STEDON

Trimethoprime: 6mg/kg/24. : 2mg/kg 24.

: : 40mg TM/5cc. Forte: 80mg TM/5cc.
10-20 mg/kg/24h. 4 .
1 mg/kg , 8.
0,5/kg , . 5 . : 0,4mg/kg, 20 .
Max : 5mg. 10mg.

ULTRACARBONE
UNIPHYLLIN
VERMOX
XYLOCAINE
ZADITEN SIR.
ZULEDIN

1gr./kg 30-120cc .
Sir 50mg/5cc: 5mg/kg/6. Supp-100mg: 100mg/10kg/24 3 .
1 tabl 5cc Sir 24. 9 .
1,5mg/kg/. Max 5mg/kg.
2 2,5cc x 2. A 2 5cc x 2.
0,5mg/kg/6h. Max= 800mg/24h.

.. ...

__

247

__

G-6-PD.
G-6-PD
,
, , .

. -
.
(),
(, ), , C,
, .

.

(ASA)

5-

(vitamin C)

(elastine)

Isobutyl nitrate

(vitamin K4)

bisulfite (vitamin K3)

(quinacrine)

(L-dopa)

.. ...

__

248

__

(vitamin K1)

(toluidine blue)

( ).

.
, , (

), , tonic water .
(cattle gallstone bezoar, honeysuckle, Chimonanthus

flower, pearl powder).

.. ...

__

249

__

& A

:
1. .
2.
,
.
3. ,
.
4. ,
.
5.
:
.
, .
, .
.
, , .
6.

7.

, ..
,
.
Sintrom
,
, .
70-140 mg/.

g / 100 gr.

()

850-1000
880
715
650
570
390
210
200
180
130

.. ...

__

250

__

, , ,
, ,
,

125
95
60-70
40-50

( )

12
C ( )

( )

.. ...

__

251

__

1. . . , 2002.
2. . . , 2005.
3. . . , 2002.
4. Current Emergency Medicine. Sixth Edition Lange. 2011.
5. Current Medical Diagnosis & Treatment. Lange CMDT 2015.
6. .
., ., . - 2010.
7. . . . 1999.
8. Manual . Carrey-Lee-Woeltje 29 .
9. . O.J. Ma, D.M. Cline. 6 2007.
.
10. . ....
. 2008.
11. . . - 2010.
/ - , .... .
12. &
... , 2003.
13. & ... 2012.
14. ICD-10 . ...
15. . . . 2002.
16. The ICU Book. Paul L. Marino. 3nd Edition - 2014.
17. Lockey D and Deakin CD. Pre-hospital trauma care: Systems and Delivery.
Contin Educ Anaesth Crit Care Pain. 2005; 5: 191-194
18. .
., ., .
. 2008.
19. . . - (5 - 2000).
20. 2 : .
. , . . 1999.
21. 6 : .
.. - . 2003.
22. 8 : .
.. - . 2005.
23. 9 : .
.. - . 2006.
24. 16 :
. .. 2013.
25. . .
8 - , 2007.
.. ...

__

252

__

26. 13 .
- , .. 2208,
.. 71003 , . http://www.greekphcguidelines.gr/
27. International Statistical Classification of Diseases and Related Health Problems - 10th
Revision. http://apps.who.int/classifications/icd10/browse/2010/en
28. .
. , . , . . - ...
http://www.eof.gr/c/document_library/get_file?p_l_id=14016&folderId=34049&name=D
LFE-1013.pdf
29. Guideline - The diagnosis and management of Anaphylaxis: an updated practice
parameter. J Allergy Clin Immunol. Mar 2005;115(3 Suppl 2):S483-523. [Medline].
30. , , . .
, 2000.
31. Immediate Life Support (ILS) Manual European Resuscitation Council (www.erc.edu)
ISBN 9-0769-3427-4.
32. Prehospital systems and medical oversight, 3rd edition A. E. Kuehl (editor), NAEMSP
Kendall / Hunt publishing company, Dubuque, Iowa. ISBN 0-7872-7071-7.
33. Atlas of Emergency Medicine M. I. Greenberg, M. Silverberg, R. Hendrickson Lippincott
Williams and Wilkins ISBN 0-7817-4586-1.
34. : www.solonas.gr
35. : www.ika.gr
36. : www.eopyy.gov.gr
37. : www.eof.gr
38. : www.gpnotebook.co.uk
39. : http://guidance.nice.org.uk/
40. : http://emedicine.medscape.com/
41. : http://neomed.gr ( )
42. : http://www.kefalalgia.gr
43. : http://respi-gam.net ( - )
44. : http://www.isathens.gr/nomika-themata/nomothesia.html ( - )
45. : http://www.ecg-quiz.com/

.. ...

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__

.. ...

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254

__

ISBN 9 7 8 - 9 6 0 - 6 8 2 7 - 1 4 - 3
MEDICAL GRAPHICS
10-12, ..:185 36 . .:210 4510874, fax:210 4528025
.. ...

__

255

__

ISBN 9 7 8 - 9 6 0 - 6 8 2 7 - 1 4 - 3
MEDICAL GRAPHICS
..

4528025
...

10-12,
..:185 36
. .:210
4510874,
fax:210