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IN UKRAINE

Today it is a powerful service, taking the 4-th place by the number of physicians in Ukraine among other medical specialities (after therapeutists, surgeons, obstetricians-gynecologists).

Structural subsections of anesthesiologic service are regulated by the order of the Ministry of Public Health of Ukraine No. 303 dated from October 8, 1997. They are available in every medical institution, having a surgical department, as well as where there is a need to carry out an intensive care in patients with the disorder of vitally important functions or with a threat of such disorder (cardiologic, infectious, toxicologic et al.). Medical staff of anesthesiologic service is established depending on the number of hospital beds of surgical type in the given medical institution. So, 1 position of a doctor-anesthesiologist is established per 25 beds of cardiac surgery, thoracic surgery and tuberculous lung surgery departments, per 50 beds of burns unit, per 75 beds of neurosurgery, neurotraumatology, oncosurgery departments, per 100

beds of orthopedic traumatology, obstetric gynecology and other departments of surgical type, per 200 beds of ENT and ophthalmology departments, per 40 beds of surgical unit for children and per 50 beds of departments of surgical type of other names for children. In order to provide an urgent, round-the-clock work the additional positions of doctors-anesthesiologists are introduced. Positions of medical nurses-anesthetists are established at 1.5 per each position of a doctor-anesthesiologist in the departments with hospital beds for intensive care and 2 positions in the departments with-out any beds. In the intensive care wards 1 doctor-anesthesiologist is provided for 6 beds and 1 medical nurse-anesthetist — for 3 beds.

In medical institutions where, according to the medical staff, no more than 3 doctors-anesthesiologists are due with the corresponding number of medical nurses-anesthetists, an anesthesiologic group is organized, but if 4 and more doctors — anesthesiologic dapartment. In treatment departments with high surgical activities and significant number of grave patients anesthesiologic departments with beds for intensive care are organized, and where there is a great deal of such patients being concentrated departments of intensive care of general type are created. Within the departments, having beds for intensive care, express-laboratories are organized not forming a part of clinico-diagnostic laboratories of the hospitals.

Starting from the group, all structural subsections of anesthesiologic service are subordinate directly to the head doctor and his substitute on medical work, as long as except carrying out anesthesia and management of the immediate postoperative period in surgical patients, the task of this service includes performing resuscitation and intensive care in patients with the disturbance of vitally important functions in the therapeutic, infectious and other departments.

Proceeding from the expediency of anesthesiologist's participation in the treatment of extremely grave (critical) states, narrow-profile departments of intensive care (toxicologic, intensive care of sepsis, cardiologic and etc.) are organized in the hospitals, where such patients are concentrated.

Tasks of anesthesiologic department:

1. Preparation of patients for carrying out a general anesthesia (narcosis) and regional anesthesia.

2. A conducting of general anesthesia (narcosis) and regional anesthesia in the course of operations, in deliveries, treatment and diagnostic procedures, postoperative monitoring in the immediate postanesthetic period.

3. A carrying out of intensive care for patients with disturbed functions of vitally important organs and systems up to the stabilization of these functions condition at the safety level.

4. A training of the personnel of the department and medical institution to carry out the techniques of primary cardiopulmonary and cerebral

resuscitation. 5. A handling of record and reporting documentation. Indications for patients' hospitalization to the IC wards (the order of the Ministry of Public Health of Ukraine No.303 dated from 8.10.1997):

1. Acute respiratory failure (ARF):

— dispnea with auxiliary musculature participation;

— persistent cyanosis;

— pathologic type of breathing;

— acute disturbances of patency of the upper respiratory tracts;

— pneumothorax, hemothorax, hydrothorax;

— staphylococcal destruction of the lungs;

— pneumonia and progressing respiratory failure;

— stenosing laryngotracheitis;

— status asthmaticus.

2. Acute circulatory disorders:

— acute cardiovascular insufficiency with arrhythmia and venous hypertension;

— thromboses of great vessels;

— acute hypovolemia not associated with uncontrollable bleeding;

— shock of any etiology;

— a state following a clinical death.

3. Disorders of functions of gastrointestinal tract (GIT):

— acute diarrhea syndrome with uncompensated hypovolemia;

— pyloric stenosis with the absence of passage from the stomach;

— chemical and thermic injuries of the stomatopharynx and esophagus.

4. Acute hepatic failure.

5. Acute renal failure.

6. Comatous conditions of any etiology.

7. Convulsive syndrome of any etiology.

8. Acute meningoencephalitis, meningitis with disturbance of functions.

9. Botulism, tetanus.

10. Polymyeloradiculitis (ascending or descending).

11. Grave craniocerebral injury before and after surgical intervention.

12. Surgical pathology:

— trauma and multiple trauma after surgical operations;

— postoperative period that needs a dynamic correction of disturbances of physiologic functions;

— newborns with surgical pathology before and after surgical treatment;

— complete and partial parenteral feeding.

13. According to special indications:

— for carrying out hemodialysis, plasmapheresis, plasma-, lympho- and
hemo-sorption;

____ replacement blood transfusion;

— poisoning of any etiology;

— electrical injury, lightning injury;

— drowning;

— strangulation asphyxia.

14. Acute disorders of thermoregulation:

— hyperthermia persistent to antipyretic agents;

— malignant hyperthermia, heat stroke, overheating;

— supercooling.

15. Acute endocrine insufficiency accompanied by disorders of vitally
important functions: respiration, blood circulation and metabolism.

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