Preparation of solutions for the provision of medical care. Preparation of disinfectant solutions

First aid supplies

First aid Is a complex of simple, expedient measures carried out at the place of extinguishing a fire or emergency in the manner of self and mutual assistance, as well as by participants in extinguishing a fire and rescue operations using service and improvised means and aimed at restoring or preserving the life and health of the victim.

The person providing assistance must know and correctly use the standard, and, if necessary, improvised means when providing assistance.

From the above, it is assumed that first aid equipment is divided into official and helpers.

By means of personnel first aid is a dressing material (bandages, medical dressing bags, large and small sterile dressings and napkins, cotton wool), a hemostatic tourniquet (tape and tubular), and for immobilization - special tires (plywood, ladder, mesh).

The main dressings are: gauze, cotton wool white and gray, non-woven blank-stitching threadless fabric. These materials are hygroscopic, absorb the secreted contents from the wound well, dry quickly, and are easy to sterilize.

Bandages, napkins, tampons, turundas, balls are made of gauze. The industry produces serviceable dressings: bandages of various sizes - sterile and non-sterile tubular; non-sterile knitted bandages; medical sterile dressing bags; large and small sterile wipes; large and small sterile dressings; cotton wool in the package is white, sterile and non-domestic; gray non-sterile cotton wool in the package; non-sterile medical scarves.

Bandages have different widths:

• up to 5 cm - narrow, used for bandages on fingers, brush;
• up to 7-10 cm - medium, with the help of which it is convenient to apply bandages on the neck, head, forearm, shoulder, lower leg;
• up to 20 cm - wide, for bandages on the chest, abdomen, thigh.

Medical dressing bags are produced in 4 types: individual, ordinary, first aid with 1 pad and first aid with 2 pads. The pads are packed in a parchment inner and a foil outer shell.

Sterile wipes- these are rectangular pieces of gauze folded in several layers, hermetically packed in parchment paper (20 pieces per pack). The sizes of large napkins are 70x68 cm, small ones - 68x35 cm.

Small sterile dressing includes a bandage 14 cm wide, 7 m long and 1 cotton-gauze pad measuring 56x29 cm, which is sewn to the end of the bandage.

Large sterile dressing includes a cotton-gauze pad measuring 65x45 cm, to which 6 fixing bandage straps are sewn in the corners and in the middle. Small and large sterile dressings are used for extensive burns and wounds.

Medical kerchief it is produced in the size of 135x100x100 cm, and the rolled-up one, which is inserted into the styling or the first-aid kit, is 5x3x3 cm. The kerchiefs are used to apply protective and immobilizing dressings. When using non-sterile headscarves, the wound is closed with a sterile napkin (bandage), if necessary, with a layer of cotton wool, which are then fixed with a headscarf.

Individual dressing package consists of 2 cotton-gauze pads measuring 32x17.5 cm, a bandage 10 cm wide and 7 m long. The package is used for applying an occlusive dressing for open pneumothorax, dressing wounds and burns.

One pad is fixed at the end of the bandage, the other moves freely along the bandage. The pads and bandage are sterile, wrapped in parchment paper and placed in a hermetically sealed rubberized fabric cover. There is a pin in the bag. The cover contains the rules for using the package. If these rules are observed, the sterility of the package is not violated, and it can be stored for 5 years.

Knitted tubular bandage available in 7 sizes to suit the circumference of different body parts. It is a tube made of mesh jersey, has good elasticity, fits tightly to any part of the body, does not squeeze blood vessels and does not disturb the mobility of joints. The elasticity of the bandage remains after washing and sterilization, so it can be reused.

Tubular mesh bandages used to secure bandages applied to various areas of the body. In this case, it is necessary to select the appropriate size of the bandage.

From non-woven canvas stitched fabric, you can quickly cut out bandages of any contour. When using it, there is no need to apply a layer of cotton wool. This material is widely used when applying dressings in extreme conditions in the presence of a large number of affected individuals.

Cleol and adhesive bandages apply to small wounds. The wound is closed with sterile material, securing it with strips of adhesive plaster or a napkin (piece of gauze), the edges of which are glued to the skin, lubricated with glue.

Small wounds, abrasions and scratches can be applied bactericidal patch or apply a thin layer glue "BF-2", "BF-6", which forms an elastic film that lasts 2-3 days.

As improvised means first aid can be used when applying bandages, a clean sheet, shirt, cotton fabrics (preferably non-colored). The Mashtafarov dressings are especially convenient and economical. In this case, pieces of fabric of various sizes are used, the ends of which are cut in the form of ribbons. A sterile napkin or bandage is applied to the wound, and, if necessary, cotton wool, and then the bandage is fixed with a piece of cloth, and ribbons are tied.

To stop bleeding, instead of a tourniquet, you can use a trouser belt or a belt, a twist made of fabric.

In case of fractures, instead of tires - strips of hard cardboard or plywood, boards, sticks, etc.

Equipment for rescue and fire brigades first aid equipment

Usually in fire and rescue and emergency rescue units, vehicles are equipped with first aid pads.

The use of a medical kit (packing) for a fire truck helps EMERCOM employees and firefighters to maintain the life of the injured person, prevent severe injuries, complications from burns, the spread of viral infections, as well as critical blood loss. The use of a well-equipped first-aid kit significantly reduces the risk of various kinds of injuries for victims of fires and emergencies.

Any damage to the human body resulting from a fire causes a shock and pain syndrome, which has a fairly strong effect, whether it is a burn of the skin, respiratory tract, mucous membrane, dislocations, fractures and bruises of varying severity. Therefore, the medical kit (packing) used in cars for extinguishing fires necessarily presupposes the presence of sedatives and anti-shock agents, devices for immobilization and local cooling. Also, a reliable and easy-to-use device for manual mechanical ventilation (IVL) in conditions of respiratory failure.

The ventilator kit allows for the aspiration of the secretions of the upper respiratory tract. Includes a PEEP valve (for adjusting and maintaining pressure in the airways at a certain level), masks for adults, children, newborns. The assembly is a self-expanding silicone breathing bag with an inlet valve and a patient valve, on the port of which a face mask is attached. Lightweight and durable packing allows storage and use of the device in the most difficult conditions.

This set looks like a backpack or a bag, where there are numerous compartments and pockets of different capacities for infusion systems, various kinds of injections and antiseptic liquids, hemostatic and anti-burn drugs, dressings and portable resuscitation equipment.

Such a kit should have the following qualities:

• compactness;
• convenient configuration of the inner space of a bag or backpack;
• the ability to quickly access content;
• functionality;
• moisture resistance (to ensure the waterproofness of the styling).

In equipping a fire and rescue vehicle, first aid equipment can be divided into two types of styling:

• First aid kit with standard equipment (fig. 1);
• Laying for artificial ventilation of the lungs (Fig. 2.).

Fig. 1 and Fig. 2

Another type of first aid is a car first aid kit, which must be present on every car (Fig. 3).

Rice. 3

Lists of first aid equipment (first aid kits, kits, packing, etc.) are developed on the basis of the volume of first aid determined by the procedures for providing first aid to victims of fires and emergency situations.

First aid kits, kits and first aid boxes are completed in accordance with the approved lists. The head (chief, commander) of the subunit is responsible for maintaining the packing in working order and replenishing it. Control over the correct use of medical supplies is entrusted to the doctor (paramedic) of the unit, if any, or medical departments (groups) of the Main Directorates of the EMERCOM of Russia, Regional Centers of the EMERCOM of Russia.

Taking into account the developed algorithms for providing first aid, the following composition of packing for the emergency and firefighting and rescue teams of the EMERCOM of Russia is expedient.

Equipping search and rescue and fire and rescue teams with service medical equipment

№ p / p	Name of medical products destination	Form release (the size)	Quantity (things), not less
1	Medical products for temporary stopping of outdoor bleeding and wound dressings
1.1	Hemostatic rubber tourniquet corrugated with a fastener in the form of a loop "Alpha"	-	3 pcs.
1.2		5m x 10cm	10 pieces.
1.3	Medical sterile gauze bandage	7m x 14cm	10 pieces.
1.4	Individual sterile dressing bag with a sealed sheath with two pads	-	10 pieces.
1.5	Bactericidal adhesive plaster	2.5 x 7.2 cm	20pcs
1.6	Rolled adhesive plaster	2 cm x 5 m	3 pcs.
1.7	Sterile medical gauze wipes	16cm x 14cm	10 pieces.
1.8	Antiseptic wipes made of paper textile-like material sterile alcohol	At least 12.5 x 11.0 cm	10 pieces.
1.9	Hemostatic dressing "Hemostop" sterile	-	5 pieces.
1.10	Hydrogel dressing, anti-burn, sterile version "LYOXAZIN-SP" (hydrogel dressing, anti-burn, sterile with immobilized drugs "Lioxazin-SP" in the package)	Napkin 24.0 x 24.0 cm	5 pieces.
1.11	Cotton wool	-	1 pack.
1.12	Contour dressings	-	10 pieces.
1.13	Elastic bandage	-	3 pcs.
2	Medical devices for cardiopulmonary resuscitation
2.1	Respiratory bag for artificial respiration (single use)	-	1 PC.
2.2	Oropharyngeal airway	-	3 pcs.
2.3	Respiratory protection devices for resuscitators	-	3 pcs.
2.4	Face mask		2 pcs.
3	Other medical products
3.1	Lister dressing scissors or knife	-	2 pcs.
3.2	Medical non-sterile gloves, examination	-	15 pairs
3.3	Medical non-sterile mask	-	3 pcs.
3.4	Glasses or eye protection	-	1 PC.
3.5	Isothermal rescue blanket	Not less than 150 x 200 cm	1 PC.
3.6	Hypothermic package	-	3 pcs.
3.7	Sterile napkin	Not less than 40 x 60 cm	1 PC.
3.8	Sterile napkin or sheet	Not less than 70 x 140 cm	1 PC.
3.9	Collar-splint for adults	-	1 PC.
3.10	Collar-neck splint for children	-	1 PC.
3.11	Set of blanks for immobilization tires	Length not less than 60, 90, 120 cm	1 kit
3.12	Mechanical sphygmomanometer (blood pressure meter) with aneroid manometer and stethoscope	-	1 PC.
3.13	Medical thermometer	-	1 PC.
3.14	Medical stretcher, soft, frameless	Not less than 180 x 70 cm	1 PC.
3.15	Medical kerchief	-	3 pcs.
3.16	Unloading bandage for the upper limb	-	3 pcs.
3.17	Transport shield	-	1 PC.
3.18	Vacuum stretcher	-	1 PC.
3.19	Corset - tow truck	-	1 PC.
4	Other funds
4.1	Block of paper forms	At least 30 sheets	1 PC.
4.2	Pen	-	1 PC.
4.3	Recommendations for the use of medical devices packing for first aid in rural settlements by persons trained	-	1 PC.
4.4	Plastic bag with a clip	Not less than 20 x 25 cm	2 pcs.
4.5	Plastic case-container	-	2 pcs.
4.6	Plastic bag or suitcase	-	1 PC.
4.7	Emergency victim registration card	-	-
4.8	Chemical heating pad	-	-
4.9	Safety pin	-	-
5	Special purpose equipment *
5.1	KIMGZ (set of individual medical civil protection)	-	2 pcs.
5.2	Activated carbon	0.5 x 10 pcs	10 pack.
5.3	Magnesium sulfate	pack. 30.0	3 pack.
5.4	Means for preparing a salt-alkaline mixture (table salt and baking soda) or "Regidron"	-	3 pack.
5.5	Antihypoxant, antidote for CO poisoning - "Acizol" *	Syringe-tube (w / t) 6% - 1ml	5 amp.
5.6	Antidotes Anticyan Pelixim * Ficillin	20% solution 1 ml in w / t; 1 ml in w / t	-
5.7	Potassium iodide *	125 mg	1 tab.
5.8	Antiemetic - "Ondansetron" (Latran 0.004, 10 tablets) *	-	2 tab.
5.9	Preventive radioprotective agent - drug B-190 or cystamine *	150 mg, 10 tablets. packaged	-
5.10	Individual anti-chemical package IPP-11	-	2 pcs.
5.11	Ketorolac 10 mg tablets *	-	1up.

* Included in the set of individual medical civil protection, accepted for supply to the EMERCOM of Russia in 2006 (at present it is completed by order of the EMERCOM of Russia dated January 23, 2014 No. 23 "On amendments to the order of the EMERCOM of Russia dated November 01, 2006 No. No. 633 and invalidation of the order of the Ministry of Emergency Situations of Russia dated May 25, 2007, No. 289 ".

• The packing is located in a waterproof case;
• Stowage is used in the emergency zone by all personnel of the guard (shift);
• Packing replenishment (as property is spent) is carried out at the end of the work shift;
• When entering on combat duty of the next guard (shift), the composition of the packing must comply with the approved standards;
• To replenish expendable assets in each unit, it is necessary to have a stock of material resources that ensures the work of shifts (guards), as well as practical exercises to develop practical skills in first aid.

In case of disasters, accompanied by the contamination of the territory with radioactive, poisonous and highly active toxic substances, additional equipment is required, taking into account the nature of the contamination of the territory and the destruction of the population. In cases where firefighters and rescuers are in such areas and carry out fire extinguishing and rescue operations there, personal protective equipment will be required.

Individual first aid kit (AI-2) is intended (Fig. 4) :

• for the prevention of traumatic shock;
• personal prevention of radiation injuries and for the treatment of primary radiation reactions;
• protection against infections and prevention of infectious complications;
• protection against toxic substances.

The first-aid kit contains a set of medical supplies (anesthetic, antiemetic, antibacterial, radioprotective agents, antidotes), distributed over the slots in a plastic box, and contains instructions for use.

Box size - 90X100X20 mm, weight - 130 g; the size and shape of the box allows you to carry it in your pocket and always have it with you.

The first aid kit contains the following slots:

• nest number 1- backup (intended for anesthetic);
• socket number 2- in a red pencil case, will contain antidote tablets against organophosphorus 0V (FOV). Used as a means of personal prevention of damage before entering the outbreak (1 tablet per dose);
• socket number 3- in a large white pencil case antibacterial agent No. 2. It is taken after radiation exposure for gastrointestinal disorders - 7 tablets per dose on the first day and 4 tablets daily for the 2nd and 3rd days. Used for the prevention of infectious diseases and in connection with the weakening of the protective functions of the irradiated organism;
• socket number 4- in 2 pink pencil cases, radioprotective agent No. 1. It is taken for personal prophylaxis in the event of a threat of radioactive contamination 30-60 minutes before the start of irradiation (6 tablets per dose). Re-taking the same dose of tablets is allowed only after 5-6 hours;
• socket number 5- in 2 white pencil cases a broad-spectrum antibiotic - antibacterial agent No. 1. It is taken for injuries, burns and for emergency prophylaxis when working in foci of infectious diseases (5 tablets per dose with an interval between the first and second doses of 6 hours);
• socket number 6- in a white pencil case, a radioprotective agent No. 2. It is taken in cases where a person is permanently or temporarily in a territory contaminated with radioactive substances (1 tablet daily for 10 days). This agent prevents the deposition of radioactive iodine in the thyroid gland;
• nest 7- in a blue pencil case, an antiemetic. Take 1 tablet for head bruises, concussions and contusions, with primary radiation reaction in order to prevent vomiting.

Individual anti-chemical package (Fig. 5 and 6) - intended for partial sanitization for the purpose of degassing exposed areas of the body and adjacent clothing. IPP - 8 consists of a bottle of liquid and gauze tampons, IPP - 10 is available in an aerosol package. The package contains instructions for its use.

If the skin is damaged by droplet mustard gas or lewisite, or if these 0V get on the clothes, they immediately carry out a partial sanitization with the help of an individual anti-chemical package.

Areas of the skin infected with lewisite are smeared with a solution of iodine tincture after treatment. In addition, the decomposition of mustard gas and lewisite on the skin and clothing is carried out by treatment with solutions of ammonia, hydrogen peroxide, alkalis, and various oxidants.

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Introduction

1. Injection forms, their characteristics

1.1 Advantages and disadvantages of injection

1.2 Requirements for injectable dosage forms

1.3 Classification of injection solutions

2. Technology of injection solutions in a pharmacy

2.1 Preparation of injection solutions without stabilizers

2.2 Preparation of injection solutions with a stabilizer

2.3 Preparation of physiological solutions in pharmacy conditions

Conclusion

Bibliography

Introduction

In modern conditions, an industrial pharmacy is a rational and cost-effective link in the organization of the treatment process. Its main task is the most complete, affordable and timely satisfaction of the needs of inpatients in medicines, disinfection solutions, dressings, etc.

An integral element of the completeness and accessibility of drug care is the availability in pharmacies, in addition to finished drugs, extemporal dosage forms. These are mainly drugs that are not produced by pharmaceutical companies.

The share of infusion solutions accounts for 65% of all extemporaneously prepared forms: solutions of glucose, sodium chloride, potassium chloride of various concentrations, aminocaproic acid, sodium bicarbonate, etc.

The proportion of injectable solutions in the extremporal formulation of self-supporting pharmacies is about 15%, and in pharmacies of medical institutions it reaches 40-50%.

Injection solutions are drugs injected into the body with a syringe with a violation of the integrity of the skin and mucous membranes; they are a relatively new dosage form.

The idea of ​​introducing medicinal substances through the damaged skin arose in 1785, when the doctor Furcroix, using special blades (scarifiers), made incisions on the skin and rubbed medicinal substances into the resulting wounds.

For the first time, subcutaneous injection of drugs was carried out at the beginning of 1851 by a Russian doctor at the Vladikavkaz military hospital, Lazarev. In 1852 a syringe of modern design was proposed by Pravats. Since that time, injections have become a generally accepted dosage form.

1. Injection forms, their characteristics

1.1 Advantages and disadvantages of injection

It should be noted the following advantages of esttemporal production of injectable dosage forms in comparison with the use of finished dosage forms:

Providing a quick therapeutic effect;

The ability to manufacture a medicine for a specific patient, taking into account weight, age, height, etc. according to individual prescriptions;

The ability to accurately dose the drug;

The administered medicinal substances enter the bloodstream, bypassing such protective barriers of the body as the gastrointestinal tract and liver, which can change and sometimes destroy medicinal substances;

The ability to administer medicinal substances to an unconscious patient;

The shortness of time between preparation and use of the medicinal product;

The ability to create large stocks of sterile solutions, which makes it easier and faster to dispense from pharmacies;

No need to correct the taste, smell, color of the dosage form;

Lower cost compared to industrial drugs.

But the injection of drugs, in addition to the advantages, also has negative sides:

When fluids are introduced through the damaged skin cover, pathogenic microorganisms can easily enter the blood;

Together with the solution for injection, air can be introduced into the body, causing vascular embolism or cardiac dysfunction;

Even small amounts of foreign matter can have a harmful effect on the patient's body;

The psycho-emotional aspect associated with the painfulness of the injection route of administration;

Medication injections can only be performed by qualified professionals.

1.2 Requirements for injectable dosage forms

The following requirements are imposed on dosage forms for injections: sterility, absence of mechanical impurities, stability, pyrogen-freeness, for individual injectable solutions - isotonicity, which is indicated in the relevant articles or recipes.

Parenteral use of drugs involves a violation of the skin, which is associated with possible infection with pathogenic microorganisms and the introduction of mechanical impurities.

Sterility injection solutions prepared in a pharmacy are provided as a result of strict adherence to the rules of asepsis, as well as sterilization of these solutions. Sterilization, or depletion, is the complete destruction of viable microflora in a particular object.

Aseptic conditions for the production of medicinal products are a complex of technological and hygienic measures that ensure the protection of the product from the ingress of microorganisms into it at all stages of the technological process.

Aseptic conditions are necessary in the manufacture of thermolabile drugs, as well as unstable systems - emulsions, suspensions, colloidal solutions, that is, drugs that are not subject to sterilization.

Also, compliance with the rules of asepsis in the preparation of medicines that can withstand thermal sterilization plays an equally important role, since this method of sterilization does not free the product from dead microorganisms and their toxins, which can lead to a pyrogenic reaction when such a preparation is injected.

Lack of mechanical impurities... All injection solutions should not contain any mechanical impurities and should be completely transparent. The injection solution may contain dust particles, fibers of the materials used for filtration, any other solid particles that can get into the solution from the dishes in which it is prepared. The main danger of the presence of solid particles in the injection solution is the possibility of blockage of blood vessels, which can be fatal if the vessels supplying the heart or medulla oblongata are clogged.

Sources of mechanical impurities can be poor-quality filtration, technological equipment, especially its rubbing parts, ambient air, personnel, poorly prepared ampoules.

Microorganisms, particles of metal, rust, glass, wood rubber, coal, ash, starch, talc, fibers, asbestos can get into the product from these sources.

Pyrogenicity... Apyrogenicity is the absence in injection solutions of metabolic products of microorganisms - the so-called pyrogenic substances, or pyrogens. Pyrogens (from Lat. Rug - heat, fire) got their name for their ability to cause an increase in temperature when ingested, sometimes a drop in blood pressure, chills, vomiting, diarrhea.

In the production of injection drugs, they are freed from pyrogens by various physicochemical methods - by passing the solution through columns with activated carbon, cellulose, membrane ultrafilters.

In accordance with the requirements of the GFC, injection solutions should not contain pyrogenic substances. To meet this requirement, injection solutions are prepared in pyrogen-free water for injection (or oils) using medicines and other excipients that do not contain pyrogens.

1.3 Classification of injection solutions

Medicines for parenteral use are classified as follows:

Injectable medicines;

Intravenous infusion medicines;

Concentrates for injection or intravenous infusion medicines;

Powders for injection or intravenous infusion medicines;

Implants.

Injectable medicinal products are sterile solutions, emulsions or suspensions. Injection solutions should be clear and substantially free of particles. Emulsions for injection should show no signs of delamination. Suspension for injection, when shaken, must be stable enough to provide the required dose upon administration.

Intravenous infusion drugs are sterile aqueous solutions or emulsions with water as a dispersion medium; should be free of pyrogens and usually isotonic with blood. They are intended for use in high doses, therefore they should not contain any antimicrobial preservatives.

Concentrates for injection or intravenous infusion drugs are sterile solutions intended for injection or infusion. The concentrates are diluted to the specified volume and after dilution, the resulting solution must meet the requirements for injectable drugs.

Powders for injection medicinal products are sterile solid substances placed in a container. When shaken with the indicated volume of the appropriate sterile liquid, they rapidly form either a clear, particle-free solution or a homogeneous suspension. Once dissolved, they must meet the requirements for injectable medicinal products.

Implants are sterile solid medicaments that are suitable for parenteral implantation in size and shape and that release the active ingredients over a long period of time. They must be packed in individual sterile containers.

2. Technology of injection solutions in a pharmacy

In accordance with the instructions of the GFC, water for injection, peach and almond oils are used as solvents for the preparation of injection solutions. Water for injection must meet the requirements of Article 74 GFH. Peach and almond oils must be sterile, and their acid number must not exceed 2.5.

Injection solutions must be clear. The check is carried out when viewed in the light of a reflector lamp and the vessel with the solution must be shaken.

Injection solutions are prepared in a mass-volumetric manner: the drug is taken by weight (weight), the solvent is taken to the required volume.

The quantitative determination of medicinal substances in solutions is carried out according to the instructions in the relevant articles. The permissible deviation of the content of the medicinal substance in the solution should not exceed ± 5% of that indicated on the label, unless otherwise indicated in the corresponding article.

The original medicinal products must meet the requirements of the GFC. Calcium chloride, caffeine-sodium benzoate, hexamethylenetetramine, sodium citrate, as well as magnesium sulfate, glucose, calcium gluconate and some others should be used in the form of a grade "for injection" with an increased degree of purity.

To avoid contamination with dust, and with it the microflora, preparations used for the preparation of injection solutions and aseptic medicines are stored in a separate cabinet in small jars closed with ground glass stoppers, protected from dust by glass caps. When filling these vessels with new portions of preparations, the jar, stopper, cap must be thoroughly washed and sterilized each time.

Due to the very responsible method of application and the great danger of mistakes that can be made during work, the preparation of injection solutions requires strict regulation and strict adherence to technology.

Simultaneous preparation of several injectable drugs containing different ingredients or the same ingredients, but in different concentrations, as well as the simultaneous preparation of injectable and any other medicine is not allowed.

At the workplace during the manufacture of injectable drugs, there should be no barbells with drugs that are not related to the drug being prepared.

In pharmacy conditions, the cleanliness of the utensils for the preparation of injectable drugs is of particular importance. For washing dishes, mustard powder diluted in water in the form of a suspension of 1:20 is used, as well as a freshly prepared solution of hydrogen peroxide 0.5-1% with the addition of 0.5-1% detergents ("News", "Progress", "Sulfanol" and other synthetic detergents) or a mixture of 0.8-1% solution of the Sulfanol detergent and trisodium phosphate in a 1: 9 ratio.

The dishes are first soaked in a washing solution heated to 50-60 ° C for 20-30 minutes, and heavily soiled - up to 2 hours or more, after which they are thoroughly washed and rinsed first several (4-5) times with tap water, and then 2-3 times with distilled water. After that, the dishes are sterilized in accordance with the instructions of the GFC.

Poisonous substances necessary for the preparation of injectable drugs are weighed by the recipe controller in the presence of an assistant and are immediately used by the latter to prepare the medicine. Receiving a poisonous substance, the assistant is obliged to make sure that the name of the barbell corresponds to the purpose in the recipe, as well as the correctness of the set of weights and weighing.

For all, without exception, injectable drugs prepared by an assistant, the latter must immediately draw up a control passport (coupon) with an exact indication of the names of the drug ingredients taken, their quantities and a personal signature.

Before sterilization, all injectable drugs must undergo chemical control for authenticity, and if there is an analytical chemist in the pharmacy, quantitative analysis. Solutions of novocaine, atropine sulfate, calcium chloride, glucose and isotonic sodium chloride solution are subject to qualitative (identification) and quantitative analysis under any circumstances.

In all cases, injectable drugs should be prepared under conditions of the most limited microflora contamination of the drug (aseptic conditions). Compliance with this condition is mandatory for all injectable drugs, including those undergoing final sterilization.

The correct organization of work on the preparation of injectable drugs presupposes providing the assistants in advance with a sufficient set of sterilized dishes, auxiliary materials, solvents, ointment bases, etc.

2.1 Preparation of injection solutions without stabilizers

The preparation of injection solutions without stabilizers consists of the following sequential operations:

Calculation of the amount of water and dry medicinal substances;

Measuring the required amount of water for injection and weighing out medicinal substances;

Dissolution;

Preparation of vial and closures;

Filtration;

Evaluation of the quality of the injection solution;

Sterilization;

Registration for vacation;

Quality control.

Rp .: Solutionis25% 30ml

Da. Signa: 1 ml intramuscularly 3 times a day

A solution of a substance readily soluble in water has been prescribed for parenteral use.

Calculations.

Analgina 7.5

Water for injection

30 - (7.5x0.68) = 34.56ml

0.68 - coefficient of increase in the volume of analgin

Technology.

The creation of aseptic conditions is achieved by preparing injectable drugs from sterile drugs, in sterile containers and in a specially equipped room. However, asepsis cannot guarantee the complete sterility of solutions, so they are further sterilized.

When calculating the amount of water for injection, it is necessary to take into account that the concentration of analgin exceeds 3% and therefore the volume increase factor must be taken into account.

In an aseptic unit, 7.5 g of analgin is dissolved in 34.65 ml of freshly distilled water for injection in a sterile stand. The prepared solution is filtered through a double sterile benzene filter with a lump of long-fiber cotton wool. You can use glass filter # 4 for filtration. the solution is filtered into a sterile 50 ml vial made of neutral glass.

Seal the bottle with a sterile rubber stopper and roll in a metal cap. Check the solution for transparency, absence of mechanical impurities, color. Then the solution is sterilized in an autoclave at 120 ° C for 8 minutes. After sterilization and cooling, the solution is transferred for control again.

The bottle of transparent glass is sealed with a hermetically sealed rubber stopper "under the run-in", the recipe number and labels are pasted: "For injection", "Sterile", "Store in a cool and dark place", "Keep out of the reach of children."

Prescription date and number

Injectionibus 43.65

Sterilized

Prepared

Checked

2.2 Preparation of injection solutions with a stabilizer

In the manufacture of injection solutions, it is necessary to take measures to ensure the safety of medicinal substances.

Stability is the invariability of the properties of medicinal substances contained in solutions - it is achieved by selecting the optimal sterilization conditions, using preservatives, using stabilizers that correspond to the nature of medicinal substances. Despite the variety and complexity of the decomposition of medicinal substances, hydrolysis and oxidation are the most common.

Medicinal substances requiring the stabilization of their aqueous solutions can be divided into three groups:

1) salts formed with strong acids and weak bases;

2) salts formed by strong bases and weak acids;

3) easily oxidizing substances.

Stabilization of solutions salts of strong acids and weak bases (salts of alkaloids and nitrogenous bases) is carried out by the addition of acid. Aqueous solutions of such salts, due to hydrolysis, have a weakly acidic reaction. During heat sterilization and storage of such solutions, the pH rises due to increased hydrolysis, accompanied by a decrease in the concentration of hydrogen ions. A shift in the pH of the solution leads to the hydrolysis of alkaloid salts with the formation of poorly soluble bases, which can precipitate.

The addition of strong acids and weak bases of the free acid to the solutions of salts inhibits hydrolysis and thus ensures the stability of the injection solution. The amount of acid required to stabilize salt solutions depends on the properties of the substance, as well as the optimal pH range of the solution (usually pH 3.0-4.0). 0.1 N hydrochloric acid solution is used to stabilize solutions of dibazol, novocaine, antispasmodic, sovcaine, atropine sulfate, etc.

Rp .: Solutionis Dibazoli 1% 50ml

Da. Signa: 2 ml once a day subcutaneously

A liquid dosage form for injection use has been prescribed, which is a true solution, which includes a substance of group B.

Calculations.

Dibazola 0.5

Acid solution

hydrochloric 0.1 and

Water for injection up to 50 ml

Technology

The recipe contains a solution for subcutaneous administration, which contains a substance that is hardly soluble in water. Dibazol injection solutions need stabilization with 0.1 N hydrochloric acid.

Under aseptic conditions, in a sterile volumetric flask with a capacity of 50 ml, 0.5 g of dibazol is dissolved in a portion of water for injection, 0.5 g of 0.1 N hydrochloric acid solution is added and the mixture is brought to the mark with water. the prepared solution is filtered into a bottle for dispensing with a capacity of 50 ml of neutral glass through a double sterile ashless filter with a lump of long-fiber cotton wool.

The bottle is sealed and the solution is checked for the absence of mechanical impurities, for which the bottle is turned upside down and viewed in transmitted light on a black and white background. If mechanical particles are found during viewing, the filtration operation is repeated. Then the neck of the bottle with a cork is tied with sterile and still damp parchment paper with an elongated end of 3x6cm, on which the assistant must make a note with a graphite pencil about the incoming ingredients and their quantity, and put a personal signature.

A bottle of MS with the prepared solution is placed in a bix and sterilized at 120 ° C for 8 minutes. After cooling, the solution is transferred to control.

Date Recipe No.

Aquaeproinjectionibus

Solutionis acidi

Hidrychloridi 0.1 No. 50ml

Volume 50ml

Sterilized

Prepared

Checked

Salt stabilization strong bases and weak kitties lot carried out by adding alkali or sodium bicarbonate. Solutions of salts formed by strong bases and acids dissociate with the formation of a weakly dissociating acid, which leads to a decrease in free hydrogen ions, and, as a consequence, to an increase in the pH of the solution. To suppress the hydrolysis of such salt solutions, it is necessary to add alkali. The salts stabilized with caustic sodium or sodium bicarbonate include: nicotinic acid, caffeine sodium benzoate, sodium thiosulfate, sodium nitrite.

Stabilization of solutions of flammable substances ... Easily oxidizing medicinal substances include ascorbic acid, sodium salicylate, sodium sulfacyl, soluble streptocide, chlorpromazine, etc.

To stabilize this group of drugs, antioxidants are used - substances with a greater redox potential than stabilized drugs. This group of stabilizers includes: sodium sulfite and metabisulfite, rongalite, ascorbic acid, etc. Another group of antioxidants is capable of binding heavy metal ions that catalyze oxidative processes. These include ethylenediaminetetraacetic acid, Trilon B, etc.

Solutions of a number of substances cannot acquire the necessary stability when using any one form of protection. In this case, resort to combined forms of protection. Combined protection is used for solutions of sodium sulfacil, epinephrine hydrochloride, glucose, ascorbic acid and some other substances.

2.3 Preparation of physiological solutions in pharmacy conditions

Physiological solutions are those that, in terms of the composition of solutes, are capable of supporting the vital activity of cells, surviving organs and tissues, without causing significant shifts in physiological equilibrium in biological systems. In terms of their physicochemical properties, such solutions and adjacent blood-substituting fluids are very close to human blood plasma. Physiological solutions must be isotonic, contain chlorides of potassium, sodium, calcium and magnesium in proportions and quantities characteristic of blood serum. Their ability to maintain a constant concentration of hydrogen ions at a level close to blood pH (~ 7.4) is very important, which is achieved by introducing buffers into their composition.

Most saline solutions and blood-substituting fluids usually contain glucose, as well as some high-molecular compounds to provide better nutrition of cells and create the necessary redox potential.

The most common saline solutions are Petrov's liquid, Tyrode's solution, Ringer-Locke's solution and a number of others. Sometimes a 0.85% sodium chloride solution is conventionally called physiological, which is used in the form of injections under the skin, into a vein, in enemas for blood loss, intoxication, shock, etc., as well as for dissolving a number of medicines during injection.

Rp .: Natrii chloride 8.0

Kalii chloride 0.2

Calcii chloride 0.2

Natrii hydrpcarbonatis 0.2

M. Sterilisetur!

A liquid dosage form has been prescribed for intravenous administration, as well as for administration in enemas with large losses of fluid in the body and with intoxication. The dosage form is a true solution, which does not include list A and B substances.

Calculations

Sodium chloride 8.0

Calcium chloride 0.2

Sodium bicarbonate 0.2

Glucose 1.0

Water for injection 1000ml

Technology

The recipe contains substances that dissolve well in the prescribed amount of water. Ringer-Locke's solution is prepared by sequentially dissolving salts and glucose in 1000 ml of water (the amount of dry ingredients is less than 3%). In this case, it is necessary to avoid strong shaking in order to prevent the loss of carbon dioxide when adding sodium bicarbonate. After dissolving the substances, the solution is filtered, poured into vials for blood substitutes.

Sterilization is carried out in steam sterilizers at 120 ° C for 12-14 minutes. During the manufacture and sterilization of this solution, the joint presence of sodium bicarbonate and calcium chloride is permissible, since the total content of calcium ions is very insignificant (does not exceed 0.005%) and cannot cause cloudiness of the solution. It is allowed to open the vials only after 2 hours after sterilization. The shelf life of the solution prepared in the pharmacy is 1 month.

Prescription date and number

Aquae pro injectionibus 1000ml

Natrii chloride 8.0

Kalii chloride 0.2

Calcii chloride 0.2

Volume 1000ml

Sterilized!

Lost

Checked

Conclusion

Currently, a lot of work is being done to improve the manufacture of injection solutions.

1. New methods and devices are being developed for obtaining high quality water for injection.

2. Possibilities are being sought to ensure the necessary aseptic manufacturing conditions to meet the requirements of the GMR standard.

3. The range of detergents, disinfectants and detergents is expanding.

4. The technological process is being improved, modern production modules are being used, new modern devices and devices are being developed (measuring tanks-mixers, filtering installations, laminar air flow installations, sterilizing devices, devices for monitoring the absence of mechanical impurities, etc.).

5. The quality of the starting substances and solvents is being improved, the range of stabilizers for various purposes is expanding.

6. The possibilities of intra-pharmaceutical preparation of solutions are expanding.

7. Methods for assessing the quality and safety of injection solutions are being improved.

8. New auxiliary materials, packaging and closures are being introduced.

Bibliography

1. Belousov Yu.B., Leonova M.V. Fundamentals of Clinical Pharmacology and Rational Pharmacotherapy. - M .: Bionika, 2002 .-- 357 p.

2. Besedina I.V., Griboyedova A.V., Korchevskaya V.K. Improving the conditions for the preparation of injection solutions in a pharmacy in order to ensure their apyrogenicity // Pharmacy.- 1988.- No. 2.- p. 71-72.

3. Besedina I.V., Karchevskaya V.V. Evaluation of the purity of injection solutions of pharmaceutical manufacture in the process of use // Pharmacy.- 1988.- No. 6.- p. 57-58.

4. Gubin M.M. Problems of making injection solutions in industrial pharmacies // Pharmacy. - 2006. - No. 1.

5. Moldover B.L. Aseptically manufactured dosage forms St. Petersburg, 1993.

6. Preliminary and sterilizing filtration of injection solutions, parenteral drugs of large volume. http://www.septech.ru/items/70

7. Sboev G.A., Krasnyuk I.I. Problems of harmonization of pharmacy practice with the international system of pharmaceutical care. // Remedium. July 30, 2007

8. Modern aspects of technology and quality control of sterile solutions in pharmacies / Ed. M.A.Alyushina. - M .: Vsesoyuz. Center for Scientific Pharmaceuticals. inform. VO Soyuzfarmatsiya, 1991. - 134s.

9. Directory Vidal. Medicines in Russia. - M .: AstraFarm-Service, 1997 .-- 1166 p.

10. Ushkalova E.A. Pharmacokinetic drug interactions // New pharmacy. - 2001. - No. 10. - P.17-23.

Page 16 of 19

1. Get acquainted with the conditions for the preparation of drugs for injection.
2. Prepare utensils and supplies.
3. Prepare a solution for injection with a concentration of the drug over 5%.
4. Prepare an injection solution from a salt of a weak base and a strong acid.
5. Prepare a solution for injection from a salt of a weak acid and a strong base.
6. Prepare an injection solution from a readily oxidizing substance.
7. Prepare glucose solution.
8. Prepare a solution for injection from a thermolabile substance.
9. Prepare saline solution.

10. Calculate isotonic concentrations.
Medicines for injection include aqueous and oily solutions, suspensions, emulsions, as well as sterile powders and tablets, which are dissolved in sterile water for injection immediately before administration (see the article of the State Pharmaceutical Institute "Dosage forms for injection", page 309).
The following basic requirements are imposed on injectable solutions: 1) sterility; 2) pyrogen-free;

1. transparency and absence of mechanical impurities;
2. stability; 5) for some solutions isotonicity, which is indicated in the corresponding articles of the State Pharmacopoeia or in the recipes.

Water for injection (GFH, p. 108), peach and almond oils are used as solvents. Water for injection must meet all the requirements for distilled water and, in addition, be free of pyrogenic substances.
Testing of water and solutions for injection for the absence of pyrogenic substances is carried out according to the method specified in the article of the State Pharmacopoeia ("Determination of pyrogenicity", p. 953).
Pyrogen-free water is obtained under aseptic conditions in distillation apparatuses with special devices for releasing water vapor from water droplets (see "Temporary instructions for obtaining pyrogen-free distilled water for injection in pharmacies", Appendix No. 3 to the order of the USSR Ministry of Health No. 573 of 30 November 1962).

CONDITIONS FOR PREPARATION OF MEDICINES FOR INJECTION

The preparation of injectable dosage forms should be carried out under conditions that maximally limit the possibility of microorganisms entering the drug (aseptic conditions).
Asepsis is a specific mode of operation, a set of measures that minimize the possibility of drug contamination by microflora.
The creation of aseptic conditions is achieved by the preparation of drugs for injection in a specially equipped room, from sterile materials, in sterile containers (for the provisions on the aseptic room-box, see the Handbook of Basic Guiding Materials on Pharmacy, 1964).
Get acquainted with the device, equipment and organization of work in the aseptic room.
Disassemble and sketch in the diary the diagrams of the device for obtaining pyrogen-free water, installation for vacuum filtration, autoclave and table box.
Study the instructions for use, safety precautions and autoclave care.
For the conditions of preparation, quality control and storage of drugs for injections, see the order of the USSR Ministry of Health No. 768 dated October 29, 1968 (Appendix 11).

PREPARATION OF DISHES AND AUXILIARY MATERIALS FOR THE MANUFACTURE OF INJECTION MEDICINES

A bottle with a ground glass stopper is thoroughly washed with a brush, mustard powder or synthetic non-alkaline powder until the glass surface is well degreased. The water used to rinse the bottle should drain off its walls in an even layer, without leaving drops.
The flasks together with the stoppers are placed in a special metal container and sterilized in an autoclave or hot air, according to the instructions of the State Pharmacopoeia of Chemistry (article "Sterilization", p. 991).
The sterile vials are kept in a closed box until they are used. They also sterilize volumetric dishes, beakers, coasters and funnels.
Folded filters, folded from thick high-quality filtered paper with a spatula and, if possible, without touching the hands, are individually wrapped in parchment capsules. The packaged filters are sterilized in an autoclave at the same time with a funnel and a cotton swab. The sterile filter wrappers are opened immediately before use.

PREPARATION OF SOLUTIONS FOR INJECTION
WITH A CONCENTRATION OF PREPARATIONS OVER 5%

Solutions for injection should be prepared at a concentration by weight. This requirement becomes especially important in the manufacture of solutions, the concentration of which is more than 5%, when there is a significant difference between the volumetric weight and weight concentration.
Take: Sodium salicylate solution 20% -100.0 Give. Designate. For injection.
The solution can be prepared as follows. 1. In a measuring container - sodium salicylate (20 g) is placed in a sterile volumetric flask, dissolved in a portion of water for injection, and then the solvent is added to 100 ml.

1. In the absence of volumetric dishes, determine the required amount of water, taking into account the density of the solution.

The density of a 20% sodium salicylate solution is 1.083.
100 ml of solution weighs: 100X1.083 = 108.3 g.
Water for injection must be taken: 108.3-20.0 = = 88.3 ml. In a sterile stand, 20 g of sodium salicylate is placed and dissolved in 88.3 ml of water for injection.

1. To prepare the same solution, the amount of solvent can be calculated using the so-called expansion factor (see page 60).

The coefficient of increase in the volume of sodium salicylate is 0.59. Therefore, 20 g of sodium salicylate, when dissolved in water, increases the volume of the solution by 11.8 ml (20X0.59).
Water must be taken: 100-11.8 = 88.2 ml.
The resulting sodium salicylate solution is filtered into a sterile bottle through a sterile glass filter No. 3 or 4. Wash water should never enter the bottle for dispensing. If necessary, the filtration is repeated several times through the same filter until a solution is obtained free of any mechanical impurities.
The bottle is closed with a ground stopper, tied with moistened parchment and sterilized with flowing steam at 100 ° for 30 minutes.

PREPARATION OF SOLUTIONS FOR INJECTION FROM SALTS OF WEAK BASES AND STRONG ACIDS

Solutions of salts of alkaloids and synthetic nitrogenous bases - morphine hydrochloride, strychnine nitrate, novocaine, etc. - are stabilized by adding 0.1 N. a solution of hydrochloric acid, which neutralizes the alkali released by the glass, suppresses the reactions of hydrolysis, oxidation of phenolic groups and the reaction of saponification of ester bonds.
Take: Strychnine nitrate solution 0.1% - 50.0 Sterilize!
Give. Designate. For injection
Check the correct dosage of strychnine nitrate (list A).
When manufacturing, it should be taken into account that according to the State Pharmacopoeia of Chemistry (p. 653), the strychnine nitrate solution is stabilized with 0.1 hydrochloric acid solution at the rate of 10 ml per 1 liter.

In a sterile volumetric flask, place 0.05 g of strychnine nitrate, dissolve in water for injection, add 0.5 ml of sterile 0.1 N. a solution of hydrochloric acid (measured with a microburette or dosed in drops) and add the solvent to 50 ml. The solution is filtered and sterilized at 100 ° for 30 minutes.
Solutions of salts of stronger or more readily soluble bases - codeine phosphate, pachicarpine hydroiodide, ephedrine hydrochloride, etc. - do not need acidification.

PREPARATION OF SOLUTIONS FOR INJECTION FROM SALTS OF STRONG BASES AND WEAK ACIDS

The salts of strong bases and weak acids include sodium nitrite, which decomposes in an acidic environment with the release of nitrogen oxides. To obtain stable solutions of sodium nitrite for injection, it is necessary to add sodium hydroxide solution.
In an alkaline medium, solutions of sodium thiosulfate, caffeine-sodium benzoate, and theophylline are also more stable.

Take: Sodium nitrite solution 1% -100.0 Sterilize!
Give. Designate. For injection
A sodium nitrite solution is prepared with the addition of 2 ml of 0.1 N. solution of caustic soda per 1 liter of solution (GF1H, p. 473).
Place 1 g of sodium nitrite in a sterile volumetric flask, dissolve in water for injection, add 0.2 ml of sterile 0.1 N. sodium hydroxide solution and add solvent to 100 ml. The solution is filtered and sterilized at 100 ° for 30 minutes.

PREPARATION OF SOLUTIONS FOR INJECTION FROM PRE-OXIDIZING SUBSTANCES

To stabilize easily oxidized substances (ascorbic acid, chlorpromazine, diprazine, ergotal, novocainamide, vicasol, etc.), antioxidants, which are strong reducing agents, are added to their solutions.
Take a solution of ascorbic acid -100.0 Sterilize
Give. Indicate Injection
But GPC (p. 44) a solution of ascorbic acid is prepared in ascorbic acid (50 g per J l) and sodium bicarbonate (23.85 g per 1 l). The need to add sodium bicarbonate to the ascorbic acid solution is explained by the fact that it has a sharply acidic reaction of the medium. To stabilize the resulting sodium ascorbinate add anhydrous sodium sulfite in the amount of 2 g or sodium metabisulfite in the amount of 1 g per 1 liter of solution.
In a sterile volumetric flask, 5 g of ascorbic acid, 2.3 g of sodium bicarbonate and 0.2 g of anhydrous sodium sulfite (or 0.1 g of sodium metabisulfite) are placed, dissolved in water for injection and the volume is adjusted to 100 ml. The solution is poured into a sterile support, saturated with carbon dioxide (for at least 5 minutes) and filtered into a tempering bottle. Sterilize the solution at 100 ° for 15 minutes.

PREPARATION OF GLUCOSE SOLUTIONS

When sterilized (especially in alkaline glass), glucose is easily oxidized and polymerized.
Take: Glucose solution 40% -100.0 Sterilize!
Give. Designate. 20 ml for intravenous administration
GPC solutions of glucose (p. 335) are stabilized by adding 0.26 g of sodium chloride per 1 liter of solution and 0.1 N. solution of hydrochloric acid to pH 3.0-4.0. The indicated pH value of the solution (3.0-4.0) corresponds to the addition of 5 ml of 0.1 N. hydrochloric acid solution per 1 liter of glucose solution (see GF1H, p. 462).
For the convenience of work, a sterile solution of the stabilizer is prepared in advance according to the prescription:
Sodium chloride 5.2 g
Diluted hydrochloric acid 4.4 ml Water for injection up to 1 liter
The specified stabilizer is added in an amount of 5% to the glucose solution, regardless of its concentration.
When preparing a glucose solution, it is necessary to take into account that its concentration is expressed in weight-volume percentages of anhydrous glucose. A standard glucose preparation contains one molecule of water of crystallization, therefore, when making a glucose solution, the drug is taken in a larger amount than indicated in the prescription, taking into account the percentage of water.
The solution is filtered and sterilized at 100 ° for 60 minutes. Glucose solutions are tested for pyrogenicity.

PREPARATION OF INJECTION SOLUTIONS WITH THERMAL SUBSTANCES

Solutions of thermolabile substances are prepared without heat sterilization. This group includes solutions of akrikhin, barbamil, barbital sodium, hexamethylenetetramine lactate ethacridine, salicylate physostigmia, apomorphine hydrochloride.
Take: Barbital sodium solution 5% -50.0 Sterilize!
Give. Designate. For injection
2.5 g of barbital sodium are weighed aseptically, placed in a sterile volumetric flask, dissolved in sterile chilled water for injection, and the volume is adjusted to 50 ml. The solution is filtered into a tempering flask under a glass cover. Dispense the solution with the label: "Prepared aseptically."
Solutions for injection from thermolabile substances can be prepared according to the instructions of the State Pharmacopoeia of Chemistry (p. 992). 0.5% phenol or 0.3% tricresol is added to the solutions, after which the flask is immersed in water, heated to 80 ° and kept at this temperature for at least 30 minutes.

PREPARATION OF PHYSIOLOGICAL (PLASMA SUBSTITUTING AND ANTI-SHOCK) SOLUTIONS

Physiological solutions are called solutions that can support the vital activity of the cells of the body without causing serious changes in the physiological balance. Examples of saline solutions are Ringer's, Ringer-Locke's solutions, saline infusions of various compositions, Petrov's liquid, etc.
Take: Ringer's solution - Locke 1000.0 Sterilize!
Give. Designate. For intravenous administration
Ringer-Locke's solution is prepared according to the following recipe:
Sodium chloride 8.0 Sodium bicarbonate 0.2 Potassium chloride 0.2 Calcium chloride 0.2 Glucose 1.0
Water for injection up to 1000.0
The peculiarity in the manufacture of the Ringer-Locke solution is that a sterile solution of sodium bicarbonate and a sterile solution of the remaining ingredients are prepared separately. The solutions are decanted before administration to the patient. Separate preparation of solutions eliminates the possibility of calcium carbonate precipitation.
Chlorides of sodium, potassium, calcium and glucose are dissolved in water for injection, the solution is filtered and sterilized at 100 ° for 30 minutes. In another part of the water, sodium bicarbonate is dissolved, the solution is filtered, if possible, saturated with carbon dioxide, tightly sealed and sterilized at 100 ° for 30 minutes. The sodium bicarbonate solution is opened after complete cooling.
When making a small volume of Ringer-Locke's solution (100 ml), you can use sterile concentrated salt solutions, dispensing them with drops: sodium bicarbonate solution 5%, potassium chloride solution 10%. calcium chloride solution 10%.

CALCULATIONS OF ISOTONIC CONCENTRATIONS

To determine isotonic concentrations, three main calculation methods are usually used: 1) calculation based on Van't Hoff's law; 2) calculation based on Raoult's law; 3) calculation using isotonic equivalents for sodium chloride.

Of the various disinfectants, chlorine-containing compounds are most often used, the antimicrobial properties of which are associated with the action of hypochlorous acid released when chlorine and its compounds are dissolved in water.

A solution of bleach is prepared according to certain rules. 1 kg of dry bleach is stirred in 10 liters of water, getting the so-called bleach milk, and left in a tightly closed glass sun-protection container for 24 hours until enlightenment. In the future, for wet cleaning, usually a 0.5% clarified solution of bleach is used, for which 9.5 liters of water and 0.5 liters of a 10% solution of bleach are taken for 10 liters of solution. To prepare a 3% bleach solution, take 3 liters of 10% clarified bleach solution with the addition of 7 liters of water.

The chloramine solution is most often used in the form of a 0.2-3% solution, while the required amount of chloramine is first added to a small amount of water, stirred, and then the remaining volume of water is added to obtain the desired concentration of the chloramine solution.

To prepare a 1% solution of chloramine, take 100 g of chloramine per 10 liters of water (10 g per 1 liter of water);

2% chloramine solution - 200 g of chloramine per 10 liters of water (20 g per 1 liter).

Solutions for general and current processing

Soap-soda solution - dilute 50 g of soap in 10 liters of hot water, add 10 g of soda and 50 g of ammonia.

Chlorine-soap-soda solution: add 50 g of soap and 10 g of soda ash to 10 liters of 1% (0.5%) chloramine solution.

Currently, disinfectants "Samarovka", "Klindamizin", "Amiksan" are widely used for general and routine treatment.

It should be remembered that when processing vertical surfaces and ceilings from a hydraulic control unit, a 0.5% chloramine solution should be used.

The device of the reception and diagnostic department

The admission and diagnostic department consists of a waiting room, reception and examination rooms, a sanitary checkpoint, and a room for storing clothes of admitted patients. In large multidisciplinary hospitals, the admission and diagnostic department has a doctor's office, a diagnostic room, a treatment room, an emergency laboratory, a room for medical personnel, and sanitary rooms. It is possible to separate the therapeutic and surgical reception and diagnostic department.

The main functions of the reception and diagnostic department:

■ organization of admission and hospitalization of patients, while a preliminary clinical diagnosis is established, the validity of hospitalization is assessed;

■ consultations of patients in the direction of local doctors and who appeared "by gravity";

■ provision of emergency medical care if necessary;

■ prevention of infection in the hospital - isolation of an infectious patient and the organization of specialized medical care for him;

■ patient sanitization;

■ transportation of the patient to the department;

■ reference and information service;

■ registration of the movement of patients in the hospital.

Documentation of the reception and diagnostic department:

● register of admitted patients and refusals in hospitalization (form No. 001 / y);

● alphabetical journal of admitted patients;

● journal of consultations;

● journal of examinations for head lice;

● register of vacant places in the hospital;

● medical card of an inpatient (form No. 003 / y).

Large medical institutions have a special staff of medical workers. In small medical institutions, the reception of patients is carried out by the duty personnel. Reception of patients is carried out in a strict sequence: registration, medical examination, necessary medical assistance, sanitary and hygienic treatment, transportation of the patient to the appropriate department.

Functional duties of the nurse of the admission and diagnostic department:

♦ fills in the title page of the inpatient's medical record (medical history): passport part, date and time of admission, diagnosis of the sending institution;

♦ fills out the register of patients admitted and the alphabet book for the information service;

♦ performs thermometry of the patient;

♦ conducts anthropometric measurements;

♦ examines the patient's skin and throat to exclude an infectious disease;

♦ examines the patient for head lice and scabies;

♦ fills in a statistical coupon for an admitted patient;

♦ conducts sanitization of the hospitalized patient and transports him / her to the medical department.

First aid equipment can be divided into service and helpers. In turn, the time-based ones are divided into individual and collective.

There is a separate group that includes sets of medical equipment. Their content represents a significant portion of the property of both classes. Medical property is divided into consumable and inventory property according to registration characteristics and the order of use. Consumable medical equipment includes disposable items that are consumed instantly and irrevocably.

Inventory medical property includes items that are quickly depreciated (heating pads, ice bubbles, breathing tubes, etc.) and durable items (apparatus, instruments, surgical instruments, etc.). Further replenishment of the inventory property of parts and medical institutions is carried out only as the wear and tear of this property is carried out (they are written off according to an act of technical condition or an inspector's certificate).

For inventory medical property, the terms of operation are established. According to the quality condition (the degree of depreciation and the suitability for use), the inventory property is divided into 5 categories. The state of inventory medical property is taken into account according to the degree of suitability for use and the need for repair and is divided into suitable, requiring repair, and unusable - items, the repair of which is economically inexpedient. All other material assets are counted as good and bad.

By design, medical property is divided into:

1. special-purpose property (a reduced nomenclature of the most necessary and effective items (medicines, antibiotics, vitamins, blood substitutes, dressings and sutures, etc.));
2. general property (includes a wide range of consumable and inventory items of medical equipment that are designed to meet the daily needs of the medical service).

The division of medical equipment into special and general-purpose property is to some extent arbitrary and aims to single out extremely necessary equipment that requires constant attention when planning and organizing medical supplies during military operations.

The procedure for using the packing of a medical rescuer, an individual first-aid kit, a sanitary stretcher, an individual dressing package, an individual anti-chemical package

The procedure for using the packing of a medical rescuer, a sanitary stretcher

Collective protection medical equipment includes: a military first-aid kit, a military medical bag (SMV), a nurse's bag, a field paramedic kit, a set of B-2 tires, an immobilizing vacuum stretcher.

A military first-aid kit is a flat metal case containing iodine solution in ampoules, ammonia solution in ampoules, scarves for immobilizing dressings, sterile bandages, small medical dressing, tourniquet and safety pins. The military first-aid kit is fixed on the wall of the body or cabin of the car in a conspicuous place.

The military medical bag contains: part of the medicines included in the AI, bandages, a sticky plaster, absorbent cotton wool, kerchiefs, hemostatic tourniquets, pneumatic medical tires, automatic syringes, an automatic reusable syringe (SHAM), a breathing tube TD-I and some other items, facilitating the provision of medical care to the wounded and sick.

Using the medical means of SMV, it is possible to make: banding and correction of previously applied primary bandages; stop external bleeding; immobilization in case of bone fractures, joint injuries and extensive damage to soft tissues, intramuscular injection of a therapeutic antidote to the affected OPA or an analgesic agent; artificial ventilation of the lungs by the "mouth-to-mouth" method, etc.

The nurse's bag contains: solutions of iodine and ammonia in ampoules, bandages, dressing bags, a scarf, a tourniquet, a plaster, scissors for cutting dressings, safety pins. The orderly's bag with its contents weighs 3-3.5 kg. The bag is designed to bandage 15-20 wounded; it also contains some medicines to help the sick.

A field paramedic kit is assigned to all units that have a paramedic on the staff (battalions, separate companies). It contains the medicines necessary for the provision of outpatient care: caffeine, solution of iodine alcohol 5%, sodium bicarbonate, norsulfazole, ammonia solution, amidopyrine, alcohol, phthalazole, etc., various antidotes, as well as simple surgical instruments (scissors, tweezers, scalpel) and some medical items (baths, syringe, thermometer, tourniquet, etc.).

The kit provides outpatient care, as well as care for the wounded and sick in units where there is no doctor. The set fits in a box with slots. Weight approx. 12-13 kg.

To create immobility (immobilization) of a broken limb, use standard tires packed in a plywood box - set B-2:

- plywood 125 and 70 cm long, 8 cm wide;

- ladder metal with a length of 120 cm (weight 0.5 kg) and 80 cm (weight 0.4 kg). The width of the tire is 11 and 8 cm, respectively;

- transport for the lower limb (Dieterichs tire) made of wood, folded has a length of 115 cm, weight 1.6 kg. This tire belongs to the category of distraction, that is, acting on the principle of stretching;

- Collar slings (tires). The tire has two main parts: a rigid plastic sling and a cloth support cap, which are connected with elastic bands;

- pneumatic medical tire (SMP), is a removable device made of a transparent two-layer plastic polymer shell and consists of a chamber, a zipper, a valve device with a tube for injecting air into the chamber.

Vacuum immobilizing stretchers are designed for transport immobilization in case of fractures of the spine and pelvic bones, as well as for creating sparing conditions during the evacuation of victims with other injuries and burns.

The immobilizing vacuum stretcher is a rubber-fabric airtight casing filled with 2/3 of its volume with expanded polystyrene granules. (Fig. 3).

The inner part of the shell is covered with a removable bottom, on which elements for fixing the wounded are reinforced.

Rice. 3 Vacuum immobilizing stretcher (NIV)
a) with the victim in the supine position;
b) with the victim in a half-sitting position;

The stretcher is equipped with a vacuum pump NV-PM-10.

The dimensions of the vacuum stretcher are as follows: length - 1950 mm, width - 600 mm, thickness - 200 mm.

The principle of operation of the immobilizing vacuum stretcher is as follows: when creating a vacuum inside the rubber-fabric shell, the expanded polystyrene granules come closer, the adhesion between them sharply increases, and the stretcher becomes rigid.

First aid tools at hand.

To stop bleeding, in the absence of a standard tourniquet, you can use any thin rubber tube, rubber or gauze bandage, leather or cloth belt, towel, rope, etc. for making the so-called twist.

Underwear and bed linen, cotton fabric can be used as a dressing material.

For various fractures, for the implementation of improvised (primitive) transport immobilization, you can use wooden slats, blocks of sufficient length, thick or multilayer cardboard, bundles of brushwood.

Various household items or tools (sticks, skis, shovels, etc.) are less suitable for transport immobilization. Do not use weapons, metal objects or metal strips.

To carry the victims, you can use a homemade stretcher made on the spot from improvised material. They can be made of two poles connected together by two wooden planks and intertwined with a stretcher strap, rope or waist belts, a mattress pillowcase, etc. can also be used, or from one pole, sheet and strap.

You can use a raincoat, blanket, or sheet to carry the victim at close range.

A sanitary stretcher is a device for carrying the injured and sick by hand, transporting them on various types of sanitary or specially equipped general-purpose vehicles in a lying or semi-sitting position, as well as on nosocomial carts. They can also be used for temporary accommodation of the affected and sick in medical centers and medical institutions.

Two types of N.s are made: non-folding (with a rigid base for ambulances) and folding (folding longitudinally or transversely). Depending on N.'s design with. can be with fixed and retractable handles. The stretcher produced by the domestic industry has the following dimensions: length 2200 mm (1860 mm with handles retracted), width 560 mm, height 165 mm, length of the panel 1830 mm (Fig. 1). The stretcher bars are made from metal pipes with a diameter of 35 mm. N.'s cloths. can be made of artificial leather, linen or semi-linen canvas, as a rule, of khaki. The headrest is made of a raincoat or tent cloth impregnated with antiseptics. N.'s weight with. should not exceed 8.5 kg.

Various types of specialized stretchers have been developed: ship-type stretchers and folding, trench stretchers (Fig. 2), immobilizing vacuum stretchers with a relief panel, designed for transport immobilization of the wounded with injuries of the spine and pelvis, as well as for creating sparing conditions during the evacuation of seriously wounded and victims with extensive burns , stretcher chairs, etc.

An improvised stretcher can be made of two 2-2.5 m long poles connected by a 60-65 cm cross-section, a cape, a greatcoat and shoulder straps. For transportation

for the affected and sick in the mountains and hard-to-reach areas, pack stretchers are used, the design of which ensures their attachment to pack animals.

Store in dry, well-ventilated areas. For temporary storage of stretchers at the stages of medical evacuation, stretcher pyramids are used.

Stretcher "sanitary" (Russia)

Purpose: The stretcher is designed for carrying and transporting sick and wounded, and establishes general technical requirements and test methods for stretchers manufactured for the needs of the national economy and export in climatic versions: for the needs of the national economy.

The procedure for the use of individual medical devices

Personal protective equipment includes:

Individual first aid kit (AI-2);

Individual anti-chemical package (IPP-8);

Individual dressing package (PPI);

Pantocid as a means for individual disinfection of drinking water.

Individual first-aid kit (AI-2) is designed to provide self-help in case of injuries, burns (pain relief), prevention or weakening of the lesion of RV, BS and OS of nerve-paralytic action (Fig. 1)

Rice. 1 First aid kit, individual (AI-2)

The pain reliever is in the syringe tube (slot 1). It is used to prevent shock in an affected person or in shock. The agent used in case of poisoning or the threat of poisoning with OPF is placed in nest 2. It is taken: one pill in case of danger of chemical damage (at the same time put on a gas mask) and one more pill with an increase in signs of damage. Antibacterial agent No. 2 is placed in nest 3, it is taken after irradiation, in case of gastrointestinal disorders, 7 tablets at a time in the first day and 4 tablets in the next two days. Radioprotective agent No. 1 (nest 4) is taken at the threat of radiation, 6 tablets at a time; with a new threat of radiation, after 4-5 hours, another 6 tablets are taken.

Antibacterial agent No. 1 (nest 5) is used when using BS and in order to prevent infection in case of injuries and burns; first take 5 tablets, after 6 hours another 6 tablets.

The nest 6 contains the radiation protection device No. 2; it is taken after the fallout of radioactive fallout, one tablet daily for ten days.

The antiemetic agent (slot 7) is used one tablet per dose when there is an initial reaction to radiation, as well as when nausea occurs after a head injury.

The individual anti-chemical package (IPP-8) is designed to neutralize droplet-liquid agents that have fallen on exposed skin and clothing (sleeve cuffs, collars).

The IPP-8 set includes a flat glass bottle with a capacity of 125-135 ml with a degassing solution and four cotton-gauze swabs. The bottle and tampons are sealed in a hermetic polyethylene shell (Fig. 2). When using IPP-8, the tampons are moistened with a degassing solution from the bottle and wipe the infected areas of the skin and clothing with them. It should be remembered that the degassing liquid of the PPI is highly toxic and dangerous if it comes into contact with the mucous membranes of the eyes.

Rice. 2 Individual anti-chemical package (IPP-8)

Means for individual disinfection of drinking water are used in cases where the centralized water supply is interrupted, and the water sources encountered have not been examined or signs of poor quality water are found.

The means by which each serviceman or rescuer is provided is a chlorine-containing substance in tablets stored in glass test tubes. One tablet provides reliable neutralization of up to 1 liter of water, which can be used 30-40 minutes after the tablet is dissolved in it.