<<

Ministry of Health of Ukraine Ukrainian Medical stomatological Academy

It is ratified On meeting department Of accident aid and military medicine «___»______20 __y. Protocol №_____ Manager of department DMSc ., assistant professor ______К.Shepitko

METHODICAL INSTRUCTION FOR INDEPENDENT WORK OF STUDENTS DURING PREPARATIONS FOR THE PRACTICAL LESSON Educational discipline «Emergency and Combat First Aid» Module № 1 Emergency and Combat First Aid Topic 7 Means of Mass Destruction. First Aid.

Weapons of mass destructions. Lesson 10 chemical accidents .First Aid

Сourse ІІ Foreing students training dentistry Faculty

Training of specialists of the (master) level of higher of education (название уровня высшего образования) Areas of knowledge ______22 «Health protection»______(шифр и название области знаний) Specialty ______222 «Medicine», 221 «Stomatology»______(код и наименование специальности)

Poltava 2019

The relevance of the topic: Military action in modern warfare will be carried out with high activity and limit tension. They cause great losses in the army and among the population, the destruction of potentially dangerous objects, centers, waterworks, the formation of large zones of destruction, fires and floods. The main form of countering in the war, is armed struggle - the organized use of armed forces and weapons to achieve specific political and military objectives, a combination of military actions of varying scales. To conventional weapons, the application of which may cause losses among the population are missiles and aerial munitions, including precision munitions volumetric detonation of cluster and incendiary. Have the greatest efficiency high precision conventional weapons, which provide automatic detection and reliable destruction of targets and enemy targets with a single shot (trigger). The main types of precision-guided munitions are missiles of various classes and planned aerial bombs, which have a probable deviation from the intended target not more than 10 m.

Specific objectives: To be able to provide pre-medical help with the defeat of poisonous substances and damage; use of means of medical protection for chemical and radiation injuries.

Basic knowledge, skills needed to study the topic (interdisciplinary integration): Name of previous disciplines Acquired skills 1. human anatomy Anatomy of the head and neck, anatomy of the chest, abdomen, pelvis and limbs. Anatomy of the vascular system. 2. Normal physiology Physiological basis of the functioning of the respiratory system.

Tasks for independent work in preparation for the lesson and in the lesson: Students should know: - clinical manifestations of potent toxic substances; - Signs of radiation sickness; - principles of use of radioprotectors.

The list of basic terms, parameters, characteristics that a student must learn in preparation for the lesson: Term Definition 1. Chemically hazardous facility. the facility where they are 2

manufactured, used as raw materials, stored or transported potent toxic substances; in an accident and the destruction of which massive damage to people, animals and plants can occur.

violation of the technological process 2. Accidents at chemically of production, which leads to the release hazardous facilities. of toxic substances into the environment, which can cause damage to people, animals, plants.

it should be considered a chemical 3. Toxic substance (toxin) compound of inorganic or organic origin, as it acts (unity of quantity and quality) under certain conditions causes with its specific symptom complex.

it is a liquid with a faint odor of 4. Poisonous substances of skin- mustard, steady (from one to several resorptive action. weeks), penetrate into the human body in any way.

liquid without color, with a smell of 5. Poisoning substances rotten hay or rotten apples, under asphyxiating action. normal conditions, turn into a vapor state. Resistance on the ground 15-30 . Vapor is heavier than air 3.5 times. Affects the respiratory system.

crystalline substance without color. 6. Poisonous irritating Cause irritation of the mucous substances. membranes at a concentration of 0.005 mg / L.

called the release of radioactive substances outside the 7. Radiation accident reactor, which can be created the increased radiation hazard that poses a threat to life and health of people.

this thread α, β, γ, and radiation.

3

8. Penetrating radiation (ionizing α and β-particles have a small length of radiation). the path and do not affect the ionization.

9. X-ray. the dose of in 1 cm3 dry air at a temperature of 0 ° C and a pressure of 760 mm Hg.St. forms of 2.08 billion pairs of ions.

this absorbed radiation dose, equal to 10. . energy of one absorbed by one of biological . 1 gray = 100 .

11. Acute radiation sickness. polisindromnoe acute , develops after a single, repeated or prolonged over several or days external exposure, internal exposure of the whole organism, in case of combined irradiation of deeply penetrating ionizing radiation in a dose of 1 Gy.

Theoretical questions for the lesson: 1. Accidents at chemically hazardous facilities. 2. Classification is a characteristic of potent toxic substances. 3. Medical care in case of defeat by potent toxic substances. 4. The damaging factors of accidents at radiation hazardous facilities. 5. Radiation lesions. 6. Radiation sickness, signs. 7. Radioprotectors. 8.Domedtsinskaya help in combat and non-combat conditions.

Practical work (tasks) that are performed in class: -conducting emergency "iodine prophylaxis"; -use of personal protective equipment

The contents of the topic: Accidents on chemically hazardous objects. Chemically dangerous object - the object where made, are used as raw materials, retain or transporterowych highly toxic substances; the damage and destruction which can occur mass destruction of people, animals and plants. By chemically hazardous facilities include:

4

- enterprises of chemical, oil refining, oil pumping industry; - plants that use refrigerants; - the pulp and paper industry; - the food industry; - water supply and water treatment plants that use chlorine (water utilities); - the railway station Park for heavy trains with toxic chemicals, ports; - warehouses and bases where they keep the used in agriculture; - warehouses and bases with the substances for disinfection, disinsection, disinfestation; - the warehouses of the Ministry of defense of Ukraine with rocket fuel, missile parts with mines; - warehouses for the storage of highly toxic substances, toxic substances, pesticides; - laboratory, scientific research institutes, which use highly toxic substances.

Causes of accidents on chemically hazardous objects: a) the failure of the assemblies, mechanisms, components, pipes, damaged containers; b) violation of integrity of welded joints and connecting flanges; C) failure to follow safety procedures, organizational errors, human error; g) violation of safety rules of transportation of chemicals; d) terrorist acts, acts of fraud, sabotage or sabotage; e) external exposure to forces of nature and man-made systems on the equipment.

Accidents on chemically hazardous objects, the violation of technological process of production, which leads to the release into the environment of toxic substances that can cause destruction of people, animals, plants. Depending on territory, population, living on it, its density and the presence of dangerous objects, chemical objects are divided into four levels of chemical risks .

Classification of chemically hazardous objects. Depending on the type of highly milking toxic substances, chemically hazardous objects are divided by: 1) the amount of chlorine - I - 250 tons or more; - II degree - 250 - 50 tons; - III degree - 50 - 08 tons; - IV degree - less than 0.8 tons 2) the amount of ammonia - I degree - 2500 tons or more; - II degree -2500-500 t; - III degree - 500-10 tons; - IV degree - less than 10 tons. 3) the equivalence coefficient of the existing toxic substance to 1 ton of chlorine:

5

- ammonia - 10 tons; - hydrogen sulfide - 10 tons; - nitric oxide - 6 tons; - hydrocyanic acid - 2 t; - phosgene - 0.75 t; - carbon disulfide - 125 kg.

Classification of accidents at chemically hazardous facilities. І. By the nature of the destruction: - without destruction of tanks, workshops, production; - with the destruction of tanks, workshops, production. II. By the number of affected people (animals) are divided: - without defeating people (animals); - single (the number of injured 1-2 people); - small (the number of victims 3-10 people); - medium (the number of victims is 11-50 people); - large (the number of victims 51-100 people); - gigantic (the number of victims is more than 1000 people).

Classification and characterization of potent toxic substances. A toxic substance (toxin) should be considered a chemical compound of inorganic or organic origin, as it acts (unity of quantity and quality) under certain conditions it causes poisoning with its specific symptom complex. Explaining this definition, it should be noted that the effect of toxic substances on the body is due to their physicochemical properties. Among the physical factors, the aggregate state (liquid, steam, gas, finely dispersed forms, solid state), solubility in water and fats, hydrolysis rate, vapor density relative to air, volatility, boiling and freezing temperatures, heat capacity, heat of evaporation, which determine the paths, are significant their entry into the body. In the form of steam, gas, for water- soluble substances, the leading route is the inhalation route, for fat-soluble substances it is also percutaneous. The degree and timing of the occurrence of damage by inhalation depends on the penetration rate of the toxic substance. The latter depends on the amount of pulmonary ventilation, the concentration of toxin released in the air, the toxin distribution coefficient between the alveolar air and blood, and also on the size of the volume of blood circulation. settle on the conjunctiva and accessible mucous membranes. Suction will be fast enough. Despite the small area of the conjunctiva and mucous membranes, a clinic of poisoning will occur when highly toxic toxic substances get on them. When aerosol is deposited on the skin, the penetration of toxic substances into the body will depend on the location of the affected area (epidermis thickness, the density of sweat and sebaceous glands), and the degree of poisoning will depend on the area of the lesion and the saturation of the aerosol. Water- soluble substances will enter through the sweat glands, and fat-soluble substances also through the sebaceous glands and epidermis by simple diffusion. Aerosol can

6

settle on food and drinking water sources. Under such conditions, the toxin can enter the body through the digestive system (oral route). In the form of a liquid and in the solid state, toxins most often enter, percutaneously and through the wound surface. In any way, three types of action are distinguished: reflex, local and general resorption. Among the chemical factors, the leading ones are the ability to react with biological molecules of enzymes, structural proteins, lipids, disrupting or inactivating them, and also creating more toxic substances due to transformation and synthesis in the body that characterize the specificity of the lesion. By the presence of certain biological structures in the organs with which certain toxins react, target organs are determined. Chemical properties also determine the methods for indicating toxic substances, their degassing in the environment and in antidote therapy and detoxification.

Classification of ADDS and OWL. There are a significant number of classifications of toxic substances. This is due to the fact that the authors laid different principles on their basis. There are classifications by chemical structure, purpose, by pathogenetic mechanisms, selective toxicity, characteristics of a chemical lesion focus, etc. For clinical practice and the formation of a diagnosis, it seems most convenient to classify ADHD with their effect on the body and clinical manifestations:

I. Substances predominantly asphyxiating: a) with a significant cauterizing effect (chlorine, phosphorus trichloride, etc.); b) with a weak cauterizing effect (phosgene, chloropicrin, sulfur chloride, etc.); II. Substances with predominantly general toxic effects (carbon monoxide, hydrocyanic acid, dinitrophenol, ethylene chloride, etc.). III. Substances with suffocating and general toxic effects: a) with a significant cauterizing effect (acrylonitrile, etc.); b) with a weak cauterizing effect (hydrogen sulfide, nitric oxide, sulfur dioxide, etc.); IV. Neurotropic (organophosphorus compounds, etc.). V. Substances with asphyxiating and neurotropic effects (ammonia). VI. Substances that disrupt the metabolism and structure of cells (dioxin). VII. Metabolic poisons (ethylene oxide, methyl chloride, dimethyl sulfate, etc.). According to a similar principle classified BOV. BOV of nerve-paralytic action: sarin, soman, Vi-gases; BOV of general toxic effect: hydrocyanic acid, chlorocyan; BOV of suffocating action: phosgene, diphosgene; BOV of a skin-boiling effect mustard gas, nitrogen mustard, lewisite; Irritating BOV (diphenylchloroarsin, adamsite, C es, Ci ar and lacrimation action of chloroacetophenone, bromobenzyl cyanide, chloropicrin.

7

Psychotomimetic agents. The speed of action on the human body chemical warfare agents are divided into: - toxic substances imminent lethal; - toxic substances obscheyadovitym action; - toxic substances delayed lethal action. For each toxic substance there are three generally accepted concepts of concentration and dose: - threshold level of concentration is the smallest concentration of toxic substances in the environment, in which there are functional disorders beyond homeostasis and having a reverse development; - is the concentration that causes death of 50% of the affected; - absolutely lethal dose, when a 100% amazed. Chemical warfare agents, together with their means of delivery (artillery shells, mines, bullets, aircraft tundish, gas, aerosol and smoke machines, etc.) are chemical weapons.

Pre-medical help with the defeat of poisonous substances. Poisonous substances fast deadly action. Poisonous substances nervously-paralytic action and obscheyadovitym action form the of chemical contamination imminent lethal. A feature of these cells is that they are sanitary losses formed within 5-15 minutes, that is, at the same time there are massive sanitary potri. Of decisive importance is the provision of self - help. In addition, there is a need to simultaneously evacuate a large number of affected. Nerve agents (sarin, soman, V-x). This group also presented a significant number of insecticides: typos, metafos mercaptophos, Malathion, trichlorfon, methylmercapto, - liquids (gases) without color, odor and taste, stable on the ground (from several hours to several weeks in the summer, and from one day to several months in winter depending on toxic substances and environmental temperature). Penetrate the human body by any means - through the organs of respiration, through the skin and mucous membranes, through the . The pathogenesis of action of FOS on the human body is the inhibition of the enzyme cholinesterase that breaks down acetylcholine after the synaptic membrane, resulting in the synaptic cleft builds up an excess of acetylcholine, there is overstimulation of the cholinergic nervous system structures. Signs of damage: salivation, constriction of the pupils (cramps), increased sweating, , shortness of breath, , , loss of consciousness, convulsions appear через1-15 minutes after the lesion (depending on the way of penetration of toxic substances and of the dose). In case of contact with FOS, timely and correct application of first aid measures possible to prevent (reduce) the development of the lesion. To do this, you should first immediately stop further flow of venom into the body. When you contact the FOS on the skin must quickly (in the first minute after ) to treat infected areas of skin with liquid of individual chemical package (IPP) or 10-15% solution

8

of ammonia; simultaneously ingest a preventive antidote. In case of contact with eyes drops FOS recommended rinsing with water or a 2% solution of sodium bicarbonate, after which atropine shall be used in the form of eye drops and administered the antidote. If you suspect a poisoning, contaminated water or food necessary to conduct a tubeless gastric lavage with water and enter the adsorbent (activated carbon). At the first sign of defeat: - dressing mask; - the introduction of an antidote (Taren) - if necessary, carry out artificial respiration (outside the area of contamination); - if unconscious fixation of the tongue; - evacuation from the battlefield and the chemical hearth in the first place.

Poisonous substances obscheyadovitym action. Hydrocyanic acid is a volatile liquid, colourless, with a smell of bitter almonds CYANOGEN chloride - a volatile liquid, colourless, with a pungent irritating odor, is unstable on the ground (toxicity persists up to 30 minutes). Enter the body only through the lungs. Substances in this group cause tissue due to blockade of tissue respiration. Hydrocyanic acid and cyanides inhibit cytochrome a, A3 (cytochrome), which activate oxygen to connect with the protons. As a result, the arterialization of venous blood. The more severe the poisoning, the smaller arteriovenous difference in blood oxygen saturation. Signs of damage: smell of bitter almond, metallic taste in mouth, compression in the chest, weakness, , nausea, vomiting, shortness of breath, heart pain, agitation, fear of death. Characteristically, mucous membranes and face have a pink color. In severe cases there are cramps and often death occurs. Pre-medical help: - to wear a mask; to evacuate from the contaminated atmosphere; - if necessary - artificial ventilation of the lungs (outside the area of contamination).

Poisonous substances delayed lethal action. Toxic substances skin-resorptive action (like mustard gas) is a liquid with a faint odor of mustard, steady (from one day to several weeks), penetrate into the human body in any way. The first signs of lesions appear a few hours after the application of toxic substances (from 2-3 to 10-12 hours). On the site of the lesions appear , with no pain, but often with intense itching. After 12-24 hours around the erythema appear filled with fluid, which gradually merge and after 2-3 days in their place come the ulcers. Healing gradual (from 1-2 weeks to 1-2 months). Pre-medical help: partial sanitary treatment;

9

- wear PPE (mask, UGC) - after leaving the infected area repeated partial sanitization; - evacuation from the battlefield (with the inflammation) in the second turn. To prevent lesions applied integrirovannoi uniforms.

Toxic substances suffocating action (phosgene, diphosgene) - liquid without color, with a smell of rotten hay or rotten apples, under normal conditions, turn into a vapor state. Resistance on the ground 15-30 minutes. Vapor is heavier than air 3.5 times. Affects the respiratory system. The first signs of defeat: cough, shortness of breath, nausea, vomiting, fear of death disappear as soon as it stops the action of poisonous substances. The stage of hidden phenomena, which can last from 1-2 to 12-24 hours. During this period, signs of damage, but the body develops pulmonary edema. Pre-medical help: - to wear a mask; is to provide complete physical rest and warming the affected; - to make (take) affected by man-made hearth in the stage of medical evacuation regardless of its state. Poisonous substance psychotomimetic action (type BZ) - resistant substances, without color. They penetrate the human body by any means. The first signs of damage: dilated pupils, decreased vision at short distances (accommodation spasm), dry mouth, loss of orientation in time and space, impaired consciousness, visual, auditory and tactile hallucinations, fear. If untreated, this condition can last from 1 to 5 days, and then, for 1-2 weeks, the state of asthenia remains. After suffering psychosis, the victims do not remember what happened during psychosis. Domestic care: - take away weapons; - wear a gas mask; - bind and evacuate.

Irritating toxic substances (such as CS, CR) are crystalline substances without color. Causes mucosal irritation at a concentration of 0.005 mg / L. The first signs of damage are heartburn and pain in the eyes, nasopharynx, behind the sternum, lacrimation, sneezing, coughing, salivation, shortness of breath, nausea, vomiting and sometimes , nosebleeds. Symptoms of irritation continue to grow after putting on a gas mask (leaving the infected area) for 10-15 minutes. Signs of damage persist from 1-3 hours to two days. Domestic care: - wear a gas mask; - exit (withdraw) from the infected area; - evacuation only in individual cases.

Unknown gas poisoning.

10

Diagnostic Criteria: • when exposed to irritating gases (chlorine, ammonia solution, formaldehyde, phosgene), ―sore‖ in the throat, cough, of the skin and mucous membranes are noted; • when exposed to suffocating gases (argon, neon, helium, hydrogen, nitrogen, methane, ethane, acetylene, butane, propane, natural gas and carbon dioxide), rapid breathing, coughing are noted; • when exposed to toxic gases (hydrogen sulfide, methyl bromide, organophosphorus compounds, carbon dioxide, hydrocyanic acid), , headache, weakness, dizziness, nausea, vomiting, blurred vision, rapid pulse, shortness of breath, coma are noted. Domestic care is provided in the form of mutual assistance: - stop the action of poisonous gas: put on a gas mask, remove the injured person to fresh air; - put the victim (on a stretcher) in a side position; - ensure airway patency - apply artificial ventilation of the lungs by mouth-to- mouth method; - inform the doctor (paramedic), refer to a higher level of medical support. Transportation: in the absence of impaired vital functions, continue the measures described above and immediately send to the hospital. lying down. Poisoning by an unknown substance. Diagnostic Criteria: - nausea, vomiting - salivation or dryness of the mucous membranes - mental disorders, possibly psychomotor agitation; - cramps - impaired consciousness; - discoloration of the skin and mucous membranes. Domestic care is provided in the form of mutual assistance: - put the patient (on a stretcher) in a side position; ensure airway patency, provide access to fresh air; - if necessary, apply mechanical ventilation by the method of "mouth-to-mouth"; - check for a pulse - artificially induce vomiting; - inform the doctor (paramedic), refer to a higher level of medical support. Transportation: in the absence of impaired vital functions, continue the measures described above and immediately send to the hospital. Transport lying down.

The carbon monoxide poisoning. Poisoning can occur when operating gasoline engines, the combustion of natural gas, fires. The main of carbon monoxide poisoning - headache, nausea, shortness of breath, confusion, muscle weakness, red face. Prolonged exposure to carbon monoxide can lead to death. Pre-medical aid in cases of poisoning with carbon monoxide: - the victim should immediately move to fresh air; - release of the tight clothing that interferes with breathing, loosen collar and belt;

11

- on the head and chest of the victim should put cold compress; drink hot tea, coffee; - when you stop respiration and circulation - cardio-pulmonary resuscitation; - bring to the nostril a piece of cotton wool moistened with liquid ammonia.

The concept of accidents at radiation hazardous objects (ROO). A nuclear power plant and other economic entities, in case of accidents or damage which may occur mass radiation poisoning of people, animals and plants, referred to as radiation-hazardous objects (ROO). Radiation accident is the release of radioactive substances outside the nuclear power reactor, which can be created the increased radiation hazard that poses a threat to life and health of people. Causes of accident on NPP personnel errors in the operation, malfunction and inadequate design of, the emergency situation of natural character and the like. Signs of the accident at the nuclear power plant: a rapid increase in the concentration of radioactive gases, isotopes, in the premises of the plant, release of radioactive substances into the atmosphere, increasing the concentration of radionuclides on the ground, in the water of the reactor, in the water cooler.

Damage factors of accidents at a radiation hazardous facility.

Shock wave It is generated due to the huge energy released in the reaction zone, where there is an exceptionally high temperature and pressure, which reaches billions of atmospheres. In the center of nuclear damage, 4 zones of destruction caused by the wave are distinguished. The nature and extent of the lesion depends on the power of the explosion, the distance from the epicenter, weather conditions, as well as on the location of the person (in the house, in the open area and body position (lying, sitting, standing). Extremely severe concussions and injuries in people occur with excessive pressure - - 1 kg / cm. Moderate severity - at 0.4-0.6 kg / cm. degrees of damage - at 0.2-0.4 kg / cm. Light emission. By its nature, the light radiation of a nuclear explosion is a combination of visible light and the and rays close to it in the spectrum at a temperature of 8000-10000 ° C. The duration of light radiation depends on the power of a nuclear explosion: during an ammunition explosion, 20 kt (kilotons) -3 s , 1 Mt (megatons) -10 s. As a result of the action of light radiation, fires occur in buildings, the nature of which depends on the destruction zones. The effect of light radiation on people leads to burns of open parts of the body, retina, temporary blindness. Penetrating radiation (ionizing radiation) - a stream of α, β, γ, and . α and β-particles have a small length of the path and do not affect the ionization. Ionizing radiation is characterized by the dose, neutron flux and flux density. The intensity of the penetrating radiation is measured in , milliroentgen, microrentgen related to exposure doses (table 2 see Appendix).

12

X - ray- such a dose of ionizing radiation in 1 cm3 dry air at 0 ° C and a pressure of 760 mm Hg.St. forms of 2.08 billion pairs of ions. Derived units of Milli- roentgen is roentgen (1мР = 103Р or one thousandth of a roentgen), µr / h (1 µr = 106Р, or one millionth of a roentgen). in SI system is measured in g (grams), non-systemic - in rads (rad - radiation absorbed dose) is the quantity of ionizing radiation of any kind, the effect of which is irradiated kilogram mass will get the amount of energy, equal to 0, 01 Joule (j). Gray is the absorbed dose, equal to energy of one Joule absorbed by one kilogram of biological matter. 1 gray = 100 rad. Ber (biological equivalent of a rad). 1 REM is the dose of ionizing radiation, which creates in a living body has the same biological effect as a dose of 1 rad of x-or γ radiation. is the absorbed dose in the irradiation gives the same biological effect as 1 gray of absorbed dose of x-or γ radiation. 1 REM = 0.01 Sievert; 1 SV = 100 Baram; 1 gray = 1 Sievert. When exposed to radiation, energy is absorbed by the biomolecules that are ionized and excited damaged and turn into active radicals (radiotoxins). They (radiotoxins) out of the irradiated tissue and into the lymph, the blood and transferred to the undamaged tissue, penetrate into cells and exhibit its radiometric effect. The main action of ionizing radiation is damage to the nuclear structures (DNA). DNA operates in a complex set of , the nuclear membrane, which is very sensitive to ionization. When the membrane is changed, it leads to disruption of enzyme systems. Radiotoxic act on the nucleus, chromosomes, chromatin, DNA, and formation of cells with micronuclei, degenerative mitosis, the silencing of chromatin. Come morphological changes in the cells of the tissues. Ionizing rays act on polysaccharides - hyaluronic acid, which breaks down and damages the membrane and connective tissue. Effect on proteins is manifested by rupture of hydrogen bonds, sulfhydryl bridges leads to disruption of the immune system. When exposed to the lipids of the biomembrane are violated depend on the kernel function, mitochondria, lysosomes. Radioactive contamination caused by the fallout of radioactive substances from the cloud of a nuclear explosion. This non-reacted part of the nuclear fuel (uranium, ), fission products of the substances that are part of nuclear fuel (up to 400 radioactive isotopes of 36 chemical elements: cesium - 134 and 137, plutonium - 238, 239, tellurium-132, with a half-life of desetak years caesium - 135 - a thousand years, and others), as well as particles of radioactive soil, as a result of exposure to neutron flux of a nuclear explosion (sodium, silicon, iodine, etc.). The half-life of the chemical elements given radiation ranges from several hours to several days. So, iodine-131 is the most dangerous in the time of the explosion. Alpha particles can not penetrate through any clothes or skin epithelium. Therefore, if the radiation source alpha particles is outside the body (external radiation), they do not represent any serious danger to human health. However

13

when getting this source into the body, for example, with food or air, alpha particles are dangerous for human (internal radiation). Beta particles are shielded by clothes and external irradiation exposed areas of the human body depending on the value of the energy of radiation they can linger in the epithelium of the skin, causing the pigmentation ( "nuclear tan"), skin burns or ulcers forming on the body.Special health hazards are sources of beta radiation for internal exposure. Gamma radiation has high penetrating ability through the substances, including through the tissues of the body. High penetrating ability of gamma radiation makes it equally dangerous as in the internal and external irradiation. Neutron radiation occurs only in artificial . are neutral, so the flow has a high penetrating power, depending on the density of irradiated material and the energy of the neutrons. It is dangerous for external and for internal irradiation. The most important characteristic of any radioactive substance is its half-life period. The time during which a radioactive substance loses half of its activity is called the half-life (T 1/2). Every radioactive substance is unchanged, which is characteristic only to him, a half-life of (табл. 3). Период полураспада обратно пропорционален активности.

In areas of radioactive contamination of the area during accidents at nuclear power plants, there are two main factors of radiation hazard: a) external radiation - a type of contained in the air at the time of passage of a radioactive cloud, mainly from radioactive fallout that has fallen to the ground; in this case, there is a general irradiation of the entire human body, which decreases over time; b) internal exposure - as a result of inhalation of radionuclides from an ejection cloud that has fallen from precipitation on the ground into the air and has entered the human body with water and food contaminated with OM. This leads to irradiation of individual organs and tissues of the body and produces less impact than the total g-radiation. An important feature of the emergency release of radioactive substances is that they are finely dispersed particles that have the property of tight adhesion to the surfaces of objects, especially metal, as well as the ability to be sorbed by clothes and skin, penetrate into the ducts of sweat and sebaceous glands. This reduces the effectiveness of decontamination (removal of radioactive substances) and sanitation (measures to eliminate of the surface of the human body). The share of activity of radioactive substances ejected from the reactor during the accident amounted to: • iodine-131 - 20% • cesium-137 - 13% • cesium-134 - 10% • barium-140-5.6% 14

• strontium-89 - 4% • strontium-90 - 4% In the first months (especially days and weeks), iodine-131, which enters the body with inhaled air, as well as with contaminated products and water, is a significant hazard. This radioactive isotope of iodine, getting from the blood into a small thyroid gland in volume and mass (25-30 g), accumulates in it. With the decay of iodine-131 beta particles are released, which directly affect the tissue of the gland. Given the short half-life of iodine-131 (8 days), there is a danger of intensive exposure to this endocrine gland, which is quite sensitive to radiation. Radioactive strontium accumulates in the bones, and cesium in the muscle tissue. The half-life of these radioactive substances is about 30 years, which makes it possible for them to enter the body with water and food products grown in contaminated areas. Electromagnetic pulse. Explosions produce electromagnetic fields that create pulsed electric currents and radio emissions in overhead and cable lines, in the antennas of radio stations, which even at large distances cause damage to electronic and radio equipment, and damage people. . Radiation injuries can make up a significant part of sanitary losses. They will occur both at the time of a nuclear explosion, and on the trail of a radioactive cloud. Depending on the dose and nature of the radiation, as well as a number of other radiation conditions (short-term or long-term, uniform or uneven, single or repeated, external, internal or mixed, etc.), the clinical course of the lesions, methods for their diagnosis, prevention and treatment are determined by certain features, take into account the biophysical characteristics of ionizing radiation and the pathogenesis of radiation . According to the radiation conditions, the development of the following main clinical forms of radiation injuries of a person is possible: - acute radiation sickness (ARS) - chronic radiation sickness (CLL) - local radiation damage (radiation burns) - combined radiation damage (ARS + radiation ) - combined radiation damage (ARS + injury + burn, etc.). The medical consequences of exposure in humans can be different, with changes occurring both in the irradiated individual and in his descendants. Distinguish somatic (non- stochastic) - that is, the direct effects of , they can be early or late. Immediate consequences: acute radiation sickness, chronic radiation sickness, destruction of the thyroid gland, cataract, radiation injuries of the skin, psycho- emotional disorders). Stochastic (probabilistic) - that is, the long-term effects of radiation exposure, are somatic (premature aging of the body, shortening life expectancy, growth in general somatic pathology, , thyroid , breast cancer, lung cancer and other types of tumors, pathology of and childbirth, development of

15

sclerotic processes), genetic effects (dominant mutations, genetic defects, chromosomal disorders), teratogenic (mental retardation, congenital malformations of children), psycho somatic disorders. An important medical and social problem of the consequences of the is negative changes in mental health, which manifest themselves in the form of psychosomatic, neuropsychic and somatoneurotic disorders. Injuries from ionizing radiation. During the accident at the Chernobyl nuclear power plant (1986), the same damaging factors acted on the human body as with weapons of mass destruction. This is light radiation and flame, which cause thermal and radiation burns. Under the influence of light radiation, burns occur. Initial burns appear due to the action of infrared radiation through the 1.1 to 2.5 s since the explosion of a nuclear bomb. This affects exposed areas of the body, is turned in the direction of the explosion. Such burns called profile. Secondary burns - it burns caused by ignition of clothing and cover the body with flame. They are called contact. The armament of modern armies is of incendiary (Napalm, phosphorus and others), the combustion of which there is a high temperature, from 800 to 2200 ° C causes thermal burns. During the combustion of Napalm produce large quantities of carbon monoxide (carbon monoxide). When the use of Napalm sanitary losses arising from burns, account for 14-16% of the total number affected. Medical personnel must be able to organize and provide assistance to a large number of victims. Radiation burns result from direct action of ionizing radiation neutron, gamma and beta rays, when the total dose uniform single fractional irradiation is 1G and more. Damaging effects of alpha particles is not expressed. Getting on the skin, they linger its stratum corneum. Radiation burns are especially common, sharply worsen the course of ARS, and often (with an area of skin lesions over 30% body surface) leads to death. In the pathogenesis of radiation burns, there are five periods: 1st - primary erythema - redness appears a few hours after exposure, but sometimes may not appear. Erythema can stay from several hours to 2-6 days; 2nd - hidden - during this period, symptoms of skin lesions are not visible. Depending on the absorbed dose and the latent period lasts from several hours to 15-20 a day; 3rd - acute inflammation (the height of the local changes) on the affected skin occurs secondary erythema, edema, blisters, erosions, ulcers, there is a sharp pain. The period lasts from 2-3 weeks to several months; 4th - the recovery (process is completed) - this period is characterized by a gradual decrease in erythema, edema. Comes epithelialization and wound healing. Deep ulcers not healing years; 5th - remote consequences - in this period there are of subcutaneous tissue, dryness and pigmentation disorders of the skin and the formation of late radiation ulcers, cicatricial contractures, etc. Aid to victims with trauma, burns is that you should apply multi-layered sterile dressing that 60% will restrain the activity of radioactive substances. The surface

16

of burn wounds to be rinsed with 0.9% physiological solution of sodium chloride or a solution of soap or other antiseptic solution (furatsilina rivanola). The ambulance to be put on IV and administered intravenously 5% glucose 500ml with a 5% solution of ascorbic acid 1 ml; in addition, enter for 0.05% strofantina 0.5-1 ml of 20% glucose solution 20 ml intravenously. Carried out a partial sanitary treatment of the body for the purpose of removing radioactive dust from skin (or full - body wash with soap and water or special gear "Protection-7", infusion No. 11, No. 11b). The victim of the individual kits to give cystamine 0,2 3 tablets 4 times a day. For prevention of vomiting - etaperazin 0,004 2 tablets 4 times a day; intramuscularly 3% solution of phenazepam 1 ml (2.5% solution of chlorpromazine and 1 ml intramuscularly). In the collapse to apply a 10% solution of caffeine benzoate 1 ml intramuscularly; 1% solution mezatona 1 ml intramuscularly; intravenously impose poliglyukin 500 ml of 0.2% norepinephrine tartrate. To limit the accumulation of radioactive iodine in the thyroid gland should be appointed potassium Iodate 0,2 to 1 tablet a day for 10 days. In the diagnosis of radiation injuries of challenges. To determine the severity of only on the 3rd to 15th day after irradiation. Treatment of radiation burns should begin as early as possible.In the period of initial erythema should be applied local . To carry out infiltration of the affected tissues with 0.25% solution of novocaine. Spend novocaine blockade on Wisniewski or administered intravenously 20-30 ml of 0.5% solution of novocaine. To prevent cracking of the skin grease with sterile oil. If you experience bubbles to impose bandages soaked in a solution (1: 5000) furatsilina. Stratified epidermis to cut. Burns I-II degree, treated by conservative method. With burns III-IV degree apply surgical methods of treatment.

Acute radiation sickness due to external uniform radiation. (ARS) acute polisindromnoe disease, develops after a single, repeated or prolonged course of several hours or days external exposure, internal exposure of the whole organism, in case of combined irradiation of deeply penetrating ionizing radiation in a dose of 1 Gy. Clinical form of ARS and its degree of severity depends on radiation dose (table. 4, see Appendix). In the clinic of acute radiation sickness are distinguished the following syndromes: (hemo poetic, pancytopenia); - hemorrhagic; infectious complications; - gastrointestinal (intestinal); syndrome lesions of the nervous system (cerebral); - the General intoxication; - oropharyngeal; - sensitization; - trophic disorders; - asthenic; - radiation pneumonitis.

17

A characteristic feature of the flow of a typical bone marrow form of ARS is its power phase. Distinguish 4 periods in the course of the disease: 1) the initial period (the period of primary reactions to radiation); 2) hidden, latent period (the period of imaginary well-being); 3) period of swing (the period of the expressed clinical manifestations); 4) recovery period. The period of primary reactions to radiation starts or immediately after irradiation (in severe cases), or 2-3 hours when I level, 1-2 hours at the II degree, 40-60 min at III degree, 10-30 min with IV degree of exposure. Signs of a primary reaction depends on the total dose of irradiation, redistribution of it in the organs and tissues irradiated. Dyspeptic syndrome is often caused mainly by irradiation of the chest and abdomen, headache and disturbance of consciousness - irradiation of head, etc. In the initial period common symptoms of ARS are nausea, vomiting, only in severe cases, diarrhea. General weakness, irritability, , vomiting are the symptoms as irradiation of the brain, and of intoxication. Important signs of radiation lesion is hyperemia of the mucous membranes and skin, particularly in high doses, increased heart rate, increase and then a decrease in blood pressure up to the collapse, neurological symptoms (in particular, loss of coordination, meningeal signs). The severity of symptoms depends on the dose of irradiation (table. 5, Annex). Among the indirect signs have diagnostic value, it should be noted the overall weakness mild at doses of 1-3 Gy to severe at doses above 4 Gy. Body temperature can rise to subfebrile dose of more than 2 G and exceed 38-39 ° C at a dose of 4 Gy. The duration of the initial manifestations of radiation reaction varies from a few hours in mild cases up to 2 days or more in severe forms of ARS. Within a few hours after irradiation in patients with marked . Note that the symptoms and severity of symptoms of the primary reaction is significantly influenced by therapeutic measures (as use of antiemetics), until their complete elimination. The hidden (latent) period is characterized by the relative well-being. Most of the symptoms of the initial period passes. However, may remain General weakness, loss of appetite, dyspepsia, sleep disturbance, reduced tolerance to stress. The most typical progressive drop in the level of leukocytes, , and reticulocytes in the peripheral blood (table. 6). The height of the ARS is characterized by (table. 7) severe clinical manifestations. General condition worsens, a headache, weakness, , fever stand. At the end of the latent period of the hair starts to fall. The reduction of blood granulocytes to critical numbers (below 1109 / l) leads to disruption of the flow of immune processes. In the presence of irradiation of the mucous membranes, skin, internal organs there are serious infectious complications such as stomatitis, enterocolitis, pneumonia. Thrombocytopenia in combination with symptoms of intoxication, increased vascular permeability leads to the development of hypogeomagnetic, which is manifested by skin hemorrhages, gastrointestinal . As a result of intoxication, infectious complications, and possible

18

degenerative changes of the cerebral symptoms, even to comatose state. At the end of the peak razvivaetsya due to the natural loss of red blood cells in the background of toxemia. The recovery period starts with the normalization of hematopoiesis. Recovery of granulocytes begins with 4-5 weeks. Out of agranulocytosis is carried out for 1-3 days, it for 1-2 days precedes the increase in count. With the restoration of bone marrow function, the normalization of body temperature, feel better, fade the signs of bleeding. Slowly returning to normal nervous system function, often persists asthenia. Stop bleeding and loss of hair (the areas that went bald again covered with hair) disappear . The duration of the recovery period at I extent of 1.5-2.5 months old. at the II degree up to 6 months. when III degree up to 1 year or more. Sometimes for many years appear to be asthenic-autonomic and other neurological syndromes, the development of cataracts, the occurrence of leukemia, neoplasms.

Acute radiation sickness with uneven exposure. Given the conservation of the low-irradiated part of the bone marrow during irregular irradiation, the periodization during ARS is smoothed out, a decrease in the number of granulocytes and platelets may be less pronounced. At the same time, lesions of individual organs and systems come to the fore. When irradiating half of the body or its smaller part, survival is possible at doses exceeding 6-8 Gy. When irradiating the head and neck, there is an increase in the manifestations of the primary reaction (vomiting, headache, facial flushing, etc.). When irradiated in a dose of more than 5 Gy. develops oropharyngeal syndrome - radiation damage to the oral mucosa and upper respiratory tract. It is characterized by swelling of the mucosa in the first time after irradiation, its subsequent weakening and repeated growth after 3-4 days. The mucous membrane becomes inflamed, erosion appears. The course, as a rule, is undulating, lasting from 2 weeks to 1.5 months in the background of salivation. At a dose of more than 10 grams. ulcerative necrotic form of stomatitis develops. When breast irradiation, the initial reaction is poorly expressed, but pain in the heart, rhythm disturbances, ECG changes are possible. Signs of inhibition of hematopoiesis are characteristic according to sternal punctate with a slightly changed picture of peripheral blood. In the conditions of radiation accidents and catastrophes, products (NAPs) may get inside. The most dangerous is the inhalation route of radionuclide intake. The nature of the lesion depends on the composition of the isotopes: cesium and rubidium are evenly distributed in the body; in the thyroid gland - iodine, in the bones - strontium, calcium, zirconium, barium. The absorption of radionuclides occurs in the first 12-23 hours, which dictates the need for therapeutic measures in the early stages. With inhalation infection, conjunctivitis, bronchitis, bronchopneumonia are found, with enteric intake, gastrointestinal disorders. Depending on the maximum accumulation of radionuclides, pain may appear in the bones (strontium), in the region of the kidneys (uranium, ),

19

and the thyroid gland (iodine). Pure internal irradiation often leads to a chronic course of radiation sickness. Incorporation in catastrophic conditions is usually combined with external exposure, worsening the condition and modifying the picture of ARS.

Chronic radiation sickness (CLS) is a common chronic disease that develops as a result of prolonged, repeated repetition of the action of ionizing radiation in relatively small single doses, significantly exceeding the norm, however, to the maximum permissible. The disease usually manifests itself in 2-3-5 years from the onset of radiation exposure. Symptoms of the disease manifest and progress gradually. Depending on the severity of clinical manifestations, mild, moderate and severe degrees of chronic radiation sickness are distinguished. The disease is characterized by a progressive course and often ends in death as a result of infectious and hemorrhagic complications. Possible incomplete clinical and hematological remission.

Radioprotectors. Radioprotectors (radio resources) is a chemical medications are synthetic or of biological origin, the introduction of which into the organism before radiation leads to a lower lose to ionizing radiation of radiosensitive tissues and accelerate their recovery, reduces the severity of radiation injury. The use of radioprotectors after irradiation of the practical effect does not. Radioprotectors belonging to different classes of chemical compounds. Practical importance are the following two groups: a) Radioprotectors short-term: 1) reducing agents, which include sulfur-containing compounds (cysteamine, cysteine, mercaptoethylamine, gammafax, etc.), antioxidants (ascorbic acid, vitamin E, Tocopherols, etc.) 2) drugs that cause hypoxia of cells and tissues (metgemoglobina the adjustable, cyanides, nitrites, etc.) b) Radioprotectors prolonged action: 1) preparations of the anabolic (estrogen) 2) polymers, polyanionic nature (heparin, polysaccharides, nucleic acids, polynucleotides, some vaccines, synthetic polymers). Service is the radioprotector cysteamine. Pre-medical help in combat and non-combat conditions with radiation injuries. In combat action first aid is aimed at eliminating or weakening of the early signs of radiation damage. They are executed in the order of self - or mutual aid, orderlies and aninstructor mouth in the lesion or at the stages of medical evacuation. The sequence of events is presented according to their priority: - immediately after a nuclear explosion CRA for exposure of military personnel to make individual kits (AI) anti-emetic - Demeter (0.2 g) or etaperazin;

20

- immediate evacuation of the victim from the zone of radioactive contamination, the direction in specialized medical institution in its transportable condition (to comply with the rules of transportation affected) - at the risk of further exposure (stay in the territory contaminated by radioactive substances) to take radioprotective tool - cystamine 6 tablets at once (1.2 g) inside (with AI); - use individual and collective protection means (, gas masks, etc.); - if you suspect ingestion of radionuclides - tubeless gastric lavage, adequate drinking; - in combined radiation injury (ARS + trauma + burn, etc.) - measures for the termination on the affected by mechanical or thermal factors, to stop bleeding: applying an impromptu (or standard) tourniquet above the site of bleeding; pressing the artery above the vein below the wound with gauze (if possible sterile) swab directly in the wound; - elimination of obstacles for free breathing: remove from the mouth any foreign objects and substances (to open the mouth of the victim; turning his head to the side; finger, wrapped with a material, clean the cavity of the mouth); - antishock measures: pain relief; - when penetrating chest injuries - occlusive dressing to stop the flow of air inside; - decontamination of wounds (burn), contaminated with radioactive substances by abundant washing with water, creating venous hyperemia (venous tourniquet above the wound, the artery is not pressed), with the aim of enhancing venous bleeding from the wound; - immobilization of limbs fractures, damage to joints, burns; bandaging, cooling; - in case of contamination with radioactive iodine to prevent thyroid lesions give drugs of stable iodine (tablets of 0,125 inside or a 5% solution of iodine -5 drops in a glass of water) or apply a 5% solution of iodine on the skin; partial sanitary treatment (CHSO) exposed areas of the skin, the mucous membranes of the mouth, eyes, throat, running cool (30 ° C) water when the probable contamination of their more acceptable level, by shaking out clothes outside of the affected area. In the hearth and in the contaminated area group hard affected being evacuated first. First aid in peacetime provide a self - or mutual assistance, as well as by the forces of the State service of disaster medicine. Measures of first aid: 1. Protection of respiratory organs, eyes and skin from direct exposure to damaging factors in accidents at radiation hazardous objects, through the use of personal protection (wearing mask, , cotton-gauze bandage). 2. As soon as possible the withdrawal (removal) of the victim from the lesion. 3. Carrying out a partial sanitizing exposed areas of the body under running water with soap and water; decontamination of clothing, shoes, etc. 4. The use of individual kits (AI-2) inside: a) preparations: radioprotective remedy # 1 (slot 4) - cystamine 0,2 - consumed with the threat of exposure for 30-40min at the same time 6 tablets with water and

21

under irradiation that lasts for 4-5 hours, 6 tablets. Medium efficiency - about 50%. Radioprotective remedy # 2 (slot 6) -potassium iodide 0,125 - take 1 tablet daily for 10 days after 30 to 60 minutes after the radioactive fallout and the dangers of radioactive iodine in the body.Protective properties last 5-6 hours; b) the use of antiemetics (nest 7) for nausea and vomiting - etaperazine 0.006 g, 1 tablet 2-3 times a day, or dimetcarb. The drug is used for manifestations of the primary reaction to radiation to prevent vomiting, as well as for traumatic brain injuries. 5. In case of radiation burns, a multilayer aseptic dressing is applied to the injured, the burn surface of the wound is washed with an isotonic sodium chloride or rivanol solution, and sent to a specialized institution. 6. Evacuation to the first aid unit or medical institution. Emergency "iodine prophylaxis". To prevent the radiation effects of iodine radioisotopes, stable iodine preparations are used that effectively prevent the accumulation of radioisotopes in the thyroid gland and facilitate their excretion from the body. For iodine prophylaxis, potassium iodide in tablets or an aqueous-alcoholic solution of iodine are used. For adults and children over two years of age, it is recommended to take potassium iodide in tablets in doses of 125 mg, for children under 2 years of age - 40 mg after a meal.

Medical PPE is designed to: - use in radiation accidents; - use in chemical accidents and household poisoning by various toxic substances; - prevention of infectious diseases and the weakening of the damaging effect on the body of toxins; - ensure effective realization of a partial special processing to remove radioactive, chemical, bacteriological agents from the skin of the person. To MSIS include: Radioprotectors (radioprotective drugs), antidotes (remedies from the effects of S and OHV), antibacterial agents (, sulfonamides, vaccines, serums) and means special treatment. To service MZIS include: individual first aid kit (AI-2), individual anti-gas package (IPP-8, EMC-10, EMC-11), individual dressing package (PIP), antidotes self - help for ODDS in unit-dose syringes (atropine, affinity, budacsik). The composition of kits may vary depending on the availability of antidotes and purpose (military personnel during local or large-scale war; rescue workers in case of accidents in peacetime or wartime, etc.). First aid kit individual AI-2 is designed to prevent or reduce the impact of various damaging factors, and also to prevent the development of shock in traumatic injuries. The contents of the kit are a syringe, a tube and different shape and color of a pencil with the drug, placed in a plastic box and hold the inner walls of the housing. Each medicine are in a special place that allows you to quickly find the necessary means. In the cold season, the kit should be stored in a breast pocket to prevent freezing of liquid dosage forms.

22

Medications contained in the kit are used depending on the situation, as directed by a health professional (commander, leader) and independently in accordance with the enclosed in the kit instructions, with which the people and rescuers are introduced in the learning process. It is necessary to strictly maintain the dosage of medicines in order to avoid reducing their effectiveness or, on the contrary, manifestations of negative impact of overdose. In nest No. 1 first aid kit is a syringe-a tube of 2% solution promedola. Morphine - strong analgesic action. It is used to prevent shock in severe pain caused by fractures, extensive wounds, crushing of tissue and burns.

Execution skills: rules for the use of the syringe-tube: - pull out the EpiPen from the first aid kit; - one hand to hold the ribbed edge of the cannula, the other for the housing and turn it clockwise to puncture the membrane; - holding the syringe tube in the cannula, remove the cap protecting the needle; holding the syringe tube over the ribbed edge of the cannula and not clutching the case, insert the needle into the soft tissue of the thigh, buttocks or shoulder (can be through clothing) to the cannula; - squeeze out the contents of the tube by squeezing its body; - clenched fingers, pull out the needle. The syringe tube after injection of its contents the patient needs to attach to armband or clothing in a conspicuous place. In nest No. 2 is a round pencil case is red with a prophylactic antidote for POOR - Taren (6 table). One pill is accepted by the team. If signs of poisoning it is necessary to take another pill on your own. Re-the drug can be taken not earlier than 5-6 hours In the individual first aid kit AI-1 is a 15% solution budakia 1 ml, which is injected intramuscularly. Restores cholinesterase. Nest No. 3 is a long round pencil case without color with an antibacterial agent number 2. In the box is 15 tablets of sulfadimetoksin (sulfa drugs prolonged action). Taken in case of gastro-intestinal disorders after irradiation at wounds and burns to prevent infection. In the 1st day taken 7 pills, the next two days - 4 tablets a day. In nest No. 4 has two octagonal penala pink color, containing radioprotective remedy # 1 - cystamine (6 tablets each). and 30-60 min prior to entering a contaminated area should take 6 tablets. If necessary, re-admission is allowed after 4-5 hours. In nest No. 5 are two four-sided canister without color with an antibacterial agent No. 1 5 tablets each. As a means of emergency nonspecific prevention of infectious diseases is used chlortetracycline. The drug is taken when the threat of bacterial contamination, as well as in extensive wounds and burns for prevention of purulent complications. The first dose is 5 tablets, repeatedly (6 h) 5.Can be used Biseptol or septrin, as well as any modern (ampicillin, doxycycline, kefzol, cefobid, tsifran etc.).

23

In nest No. 6 is four-sided pencil case white color, containing radioprotective remedy # 2 - potassium iodide (10 tablets of 0.25 g). Adults and children aged two years and older is drug 0.125 g, that is, 1/2 tablet once a day for 7 days after radioactive fallout (children under two years of age are at 0.04 g a day) after meal with jelly, tea or water. Pregnant women taking potassium iodide (0.125 g) should be combined with the simultaneous intake of potassium perchlorate, and 0.75 g (3 tablets of 0.25 g). Nest No. 7 is a round pencil case is blue, which is one of antiemetics - Latran, dimetpramid or etaperazin (5 tablets). The drug is taken 1 tablet immediately after irradiation, and also in the appearance of nausea, vomiting after irradiation and after injury, with a concussion. Nausea that continues etaperazin, you should re- take 1 tablet 3-4 hours Children up to 8 years while taking all of the drugs with the AI-2 present at one time 1/4 of a tablet (except of potassium iodide), 8 to 15 years - 1/2 tablet. The exception is anti-bacterial remedy that in children older than 8 years are used in full dose, to two years - not used. In the individual first aid kit no tools obespokoilas actions and means that reduce the feeling of fear. In emergencies, as shown, these funds are needed. Therefore, it is possible to recommend to the population in addition to the content of AI-2 to use tranquilizers (Elenium, sibazon, fenozepam). First aid kit individual AI-1. The individual chemical package (IPP-8, STI-9, EMC-10, EMC-11) For first aid on the battlefield to defeat chemical and biological weapons, as well as ionizing radiation from nuclear explosions of ammunition, each soldier has an individual first aid kit (AI-1).Its content is embedded into the plastic box with slots inside. The AI is designed to prevent or reduce the damaging factors of modern weapons, and to provide first medical aid at occurrence of signs of damage. In the kit are medical tools that are used by the command (order) of the commander, or independently, depending on the presence of lesions and tailored to the specific circumstances. They contain: 1. Budacsik - 1-2 syringe-tube with red cap, 1 ml each. 2. Backup place. 3. Promedol - 1-2 syringe-tubes with white (colorless) cap 1 ml, 2% drug. Used in severe pain caused by fractures, large wounds, compression of tissue and burns. 4. Cystamine - radioprotective agent in the tablets of 0.2 grams contained in 2 octagonal canisters of pink (in 6 table. each). 5. Doxycycline hydrochloride - in 2 square canisters without color (in each case 2 capsules to 0.1 g of the drug). The broad-spectrum antibiotic. Apply the contents of one canister while hazards from bacterial agents, infectious diseases, and also in wounds and burns. Used 30 minutes prior to entering into a hotbed of bacterial contamination. Readmission (the second case) - in 12hours. 6. The drug "P-6" in pencil case yellow, 6 tablets. It's a preventative antidote ODDS. Use 2 tablets 30 minutes before the entrance of the centre of chemical infection. Re - admission- via-12hours.

24

7. Demeter - antiemetic in the pencil case with a blue cylindrical body 6 pills 0,42 g Drugs contained in a syringe-tubes, you can enter yourself (self-help) or with friend (mutual aid). For medication, you need to take EpiPen for the basis of the ampoule in one hand and the thumb and forefinger of the other hand - ribbed part of the cap, back cap clockwise, while pushing, to get him back on the cannula in the direction of the ampoule of the tube to the end. Because of this, mandrina the free end pierces the vial to the syringe tube. Then you need to remove the cap and insert the needle intramuscularly in the thigh area, buttocks, or other convenient place. After insertion of the needle, squeeze the contents of the ampoule and by loosing fingers to remove the needle.

Individual anti-gas package (IPP-8) is designed for partial sanitary processing of open parts of the body affected drop and liquid toxic substances or bacterial agents. IPP-8 contains a generic crystallizer in a glass bottle with a capacity of 200 ml and gauze. The specified number of degasser provides processing about 1500-2000 cm2 exposed areas of the body (face, neck, hands). The contents of the package with instructions Packed in a plastic wrapper. The weight of the package - 330 g. Execution skills: rules for the use of individual anti-chemical pack IPP-8. The sudden use of enemy chemical weapons is necessary: wear a mask and cloak in capes, open the package, wet cotton-gauze tampon content of the bottle, hold my breath, close my eyes and, holding the left hand valve box, remove the face piece gas mask with chin and his right hand quickly to wipe the skin under the front part of the mask. Dry swab to remove excess formulation, since the skin around the eyes, wear a mask, make a sharp exhale, open your eyes; to moisten the recipe swab to wipe his neck, hands, collar, cuffs of sleeves, the outer surface of the front part of the mask; close the bottle and put it in the bag mask. Skin treatment recipe IPP-8 held not later than 5 min after spray S on the skin. When dressed a gas mask you need: opening the package, moisten the swab with recipe wipe neck skin, arms, again to moisten the swab and RUB the collar and cuffs of sleeves (capturing swab the outer and inner surface), the outer surface of the front part of the mask; a dry swab to remove excess formulation from the skin of the neck and hands; close the bottle and put it in the bag for the gas mask. In the processing of facial skin care must be taken to ensure that the fluid package is not hit in the eye. If this happens, rinse eyes with water or 0.25-0.5% solution of chlorine bleach. When using individual anti-gas packages, you should prevent the liquid degassing of solutions in the eye. These substances are flammable and poisonous. In the absence of individual anti-gas package partial special treatment can be done with 5% solution of ammonia, 1.0% solution of chloramine, chlorine, milk and other means.

Materials for self-control:

25

TESTS: 1. 2 hours after completion of the work to eliminate the consequences of the terrorist attack, the victim N. was taken to the emergency department. Complains of pain behind the sternum, shortness of breath during physical exertion, discharge from the nose and excessive salivation. The consciousness is clear, the lips are cyanotic, , the skin is moist, the pupils are narrowed. Giofibrillation in the region of the right forearm and the right shoulder. When leaving the contaminated area, the protective equipment was damaged. What types of OM were used? 1. * OS of nerve action. 2. OS of asphyxiating action. 3. OS of general toxic effect. 4. OV of skin-boiling action. 5. Severe carbon monoxide poisoning

2. A nuclear power plant is: 1. Industrial enterprise, which stores nuclear stocks for peaceful purposes. 2. An industrial enterprise that works to form a nuclear charge. 3. * An industrial enterprise that runs on nuclear fuel to generate electricity. 4. An industrial enterprise that uses any energy to produce nuclear elements. 5. An industrial enterprise that deactivates PP.

3. What level of absorbed dose in gray causes a cerebral clinical form of acute radiation sickness? 1.10-20 Gy. 2. 30-50 Gy. 3. 6-70 Gr. 4. 5-15 Gr. 5. *> 80 Gy.

4. In what units is the absorbed dose of nuclear radiation measured: 1. X-ray. 2. Pendant / kg 3 joule / kg 4. Sievert 5. * Gray, glad

5. At what level of absorbed dose in gray does the intestinal clinical form of acute radiation sickness occur? 1. * 10-20 Gy. 2. 80-100 Gy. 3. 5-10 Gr. 4.100-120 Gr. 5.1.6 g.

26

6. Which clinical forms of acute radiation sickness are distinguished: 1. marrow, transitional, hemorrhagic, cerebral; 2. marrow, transitional, intestinal, cerebral; 3. cerebral, bone, hemorrhagic, meningeal; 4. * bone marrow, intestinal, toxemic, cerebral; 5. bone, pulmonary, intestinal, cerebral.

7. Penetrating radiation is: 1. electromagnetic pulse; 2. infrared rays; 3. * the flux of gamma rays and neutrons that occurs during fission of an atomic nucleus; 4. an elementary particle that carries a negative charge; 5. an elementary particle that carries a positive charge.

8. At what level of absorbed dose in the grays does the bone marrow clinical form of acute radiation sickness occur? 1.7-10 Gy 2.10-15 Gr. 3.1.6 g. 4.15-20 Gr. 5. * 1-10 Gr.

9. The stochastic effects of radiation exposure can be: 1. radiation burns, malignant neoplasms, leukemia; 2. acute radiation sickness, radiation burns, radiation cataract; 3. * malignant neoplasms, leukemia, genetic changes, transmitted to descendants; 4. chronic radiation sickness, radiation burns, leukemia; 5. radiation sickness, hereditary diseases, thyrotoxicosis.

10. At a radiochemical production, a radioactive aerosol leak with a significant iodine content 131. What measures should be taken first of all for personnel who are in the radioactive contamination zone? 1. * taking iodine preparations; 2. taking cysts on; 3. reception of sorbents; 4. the use of workwear; 5. use of a respirator.

Литература: Основная литература: 1. Екстрена медична допомога : підручник / [М. І. Швед, А. А. Гудима, С. М. Геряк та ін.] ; за ред. М. І. Шведа. – Тернопіль : ТДМУ, 2015. – 420 с.

27

2. Медицина невідкладних станів: швидка і невідкладна медична допомога / І.С. Зозуля, А.В. Вершигора, В.І. Боброва та ін.; за ред. І. С. Зозулі.  К.: ВСВ ―Медицина‖, 2012.  728 с. 3. Стандарт підготовки Фахова підготовка санітарного інструктора роти (батареї). - К. : «МП Леся», 2015. – 366 с. 4. Тарасюк В.С., Матвійчук М.В., Паламар І.В., Корольова Н.Д., Кучанська Г.Б., Новицький Н.О. Медицина надзвичайних ситуацій. Організація надання першої медичної допомоги: Підручник. - К.: «Медицина», 2011. – 526 с. 5. Тарасюк В.С., Матвійчук М.В. Паламар М.В., Поляруш В.В., Корольова Н.Д., Подолян В.М. Малик С.Л., Кривецька Н.В. Перша медична (екстрена) допомога з елементами тактичної медицини на догоспітальному етапі в умовах надзвичайних ситуацій. – К.: Медицина, 2015. 6. Козачок М. М., Лиховський О. І., Скляр С. І., Красюк О. А., Коваль М. М., Желеховський О. А.. Військова терапія: підруч. для студ. вищ. мед. навч. закл. IV рівня акредит. / Українська військово-медична академія / М.М. Козачок (ред.) — К., 2007. — 449с. 7. Військова токсикологія, радіологія та медичний захист: Підручник / За ред. Ю.М. Скалецького, І.Р. Мисули. – Тернопіль: Укрмедкнига, 2003. – 360с. 8. Електронна версія Стандарт підготовки І-СТ-3: Підготовка військовослужбовця з тактичної медицини (видання 2) – http://www.medsanbat.info/standart-pidgotovki-i-st-3-vidannya-2-pidgotovka- viyskovosluzhbovtsya-z-taktichnoyi-meditsini/ (назва з екрану).

Дополнительная литература: - 30 невідкладних станів у терапії: Довідник // За ред. Проф. Ю.М. Мостового. – Вінниця, 2013. - Сучасні класифікації та стандарти лікування захворювань внутрішніх органів. Невідкладні стани в терапії: довідник-посібник / за ред. Ю. М. Мостового ; Вінницький національний медичний університет імені М. І. Пирогова. – 16-те вид. доповнене і перероблене. – К. : Центр державного земельного кадастру, 2014.– 79 с.

Guidelines prepared by PhD in medical sciences A. Levkov

28