Origami is the fascinating art of folding various shapes from paper. And in this master class we will tell you how to make paper cars using the origami technique, and also show you how to fold a three-dimensional 3D model of a car according to a diagram. This activity is sure to please children and will bring a lot of pleasure to adults as well. Therefore, stock up on sheets of colored paper and cardboard and, together with your kids, create a whole fleet of paper cars with your own hands.

Paper cars using origami technique

Required Tools

In order to fold the cars you will need:

• square sheet of colored paper;
• scissors.

Instructions – Option 1

Let's take a closer look at how to make a paper machine:

1. Fold a square sheet of paper into four parts, marking auxiliary lines, and unfold it back.

2. Fold the bottom of the sheet in half again. Then bend the corners down, creating the wheels of the future car.

3. Fold the top of the sheet toward you along the center line.

4. Now bend the workpiece as shown in the figure.

5. Bend one of the corners of the top of the sheet diagonally, connecting the red dots indicated in the figure.

6. Turn the workpiece over. A simple car model is ready! (photo_6)

7. Instructions – Option 2
8. Now let's look at how to make a three-dimensional paper machine using the origami technique.
9. To begin, choose a piece of paper of your favorite color, fold it in half and unfold it back.

10. Now we visually divide each of the resulting halves of the sheet into three equal parts and bend one third from the top and one third from the bottom to the inside of the workpiece.
11. Bend the corners on four sides as shown in the picture.

12. Fold the small corners of the triangles' tops inward to give a more rounded shape to the wheels of our paper car craft.
13. Bend the workpiece in half and place it in front of you, with the wheels facing down.

14. Bend one of the corners of the workpiece inward, along the dotted line shown in the figure.

15. Lightly cut the second corner and also bend it inward. This is how we got the windshield and hood of our car model.

16. The paper machine is ready! All that remains is to draw glass, doors, headlights and other details on it as desired.

3D paper car

Necessary materials

In order to make a volumetric paper machine you will need:

• Printer;
• a sheet of office paper;
• scissors;
• cardboard;
• glue;
• colored pencils, markers or paints.

Instructions

Let's look at how to fold a paper machine step by step:

Schemes of paper cars can also be colored. In this case, there is no need to paint anything. And to get a realistic miniature model of a car, you just need to print the diagram in good resolution on a color printer and fold it according to the instructions. But if the diagram of your machine is black and white or you don’t have a color printer at hand, then the model can be colored with pencils, felt-tip pens or paints. Here you can give free rein to your imagination and add an interesting pattern or make a car in an unusual color.

Today's master class will be devoted to creating a paper car. The technique for creating such a craft is quite simple; even a child can make this machine. To get started, prepare the following tools and materials:

• thick colored paper of medium or high density in red and white;
• durable cardboard in black and white;
• ruler;
• pencil;
• glue;
• scissors.

First we must create the base of the machine, that is, the body. From thick colored paper, any shade you like (in this case we will use dark red paper), cut out a rectangle.

Then we draw the outline of a circle on a sheet of white paper, and then cut it out.

You also need to cut out two pieces like this.

Now this blank must be glued to the base (red rectangle). Try to glue the part closer to the edge.

We make a hole like this in the center of the leaf. You can do it with scissors or a stationery knife.

Then we glue the remaining two parts on the other side of the workpiece.

Then we cut out these blanks. Also create four white circles, but of a smaller diameter.

Glue the white circles into the center of the black ones.

Now you can connect the ends of the machine base. This is what will happen in the end.

Then we glue the wheels to the side parts of the car body.

Then, also from black cardboard, we cut out the seat and glue it, but to the back of the car.

And there was the final touch - cut out any number from cardboard of a suitable shade and stick it on the hood of the car (in the center of the white circle).

Now the paper machine is ready!

In the future, if desired, the child will be able to paint the car or cut out some additional parts for it.

Improving the organization and maintenance of workplaces in health care institutions should be aimed at creating optimal conditions that ensure a high level of performance of medical personnel and a more complete use of the working time of doctors and nurses for basic types of work.

One of the important sections of scientific labor organization (SLO), aimed at creating favorable conditions for effective and high-quality work, is the rational organization of the workplace and working conditions for medical personnel in outpatient clinics. However, to date, this issue has not yet received due attention in the country's clinics. Office desks used in the practice of doctors and nurses are of little use for putting things in order in the workplace due to their limited coverage area and lack of facilities for placing medical documentation, instruments and office equipment. Often at a doctor’s workplace you can find a mountain of medical records, different forms, directions, glasses with spatulas and thermometers, which creates crowding and chaos. Poor workplace organization leads to wasted working time. It has been established that during a three-hour outpatient appointment, a local general practitioner has to search for a lost medical document, form, or medical record on average four times. The time spent searching for each document ranges from 10 seconds to 3.5 minutes. In addition to the loss of working time, this circumstance causes additional psycho-emotional stress in the work of the doctor and nurse, creates an unfavorable atmosphere at the reception, and negatively affects the state of the diagnostic and treatment process.

Specially conducted studies have shown that many elements of a doctor’s work during an outpatient appointment are performed in forced, non-physiological positions, which leads to a rapid increase in fatigue of various parts of the musculoskeletal system, the development of functional insufficiency and discomfort in them, and also negatively affects the quality of diagnostic work, especially at the stage of physical examination of the patient. To a large extent, the forced working postures of medical workers at outpatient appointments is associated with the irrational organization of workplaces: imperfect equipment, incorrect selection and placement of furniture, its inconsistency with the specifics of work, anthropometric data and physiological capabilities of workers.

Improving the organization and maintenance of workplaces in health care institutions should be aimed at creating optimal conditions that ensure a high level of performance of medical personnel and a more complete use of the working time of doctors and nurses for basic types of work.

General requirements for workplace organization

The workplace should be understood as the area of ​​labor activities of an employee or group of employees, equipped and equipped with everything necessary to perform their official duties. When organizing workplaces for medical workers, the type of institution and the profile of the specialist are first taken into account, that is, the workplace must be specialized.

The rational organization of any workplace in a medical institution must include equipment, rational layout, organization of workplace maintenance, compliance with ergonomic, aesthetic and sanitary-hygienic requirements.

Equipping workplaces is one of the main conditions for the rational use of the labor of medical workers and involves providing each workplace with a set of furniture, special instruments and equipment, office equipment, standard forms, etc. When equipping, it is necessary to take into account the nature of the workers’ work activities.

The rational placement of medical furniture and equipment in the doctor’s office is important in organizing the workplace. In accordance with ergonomic requirements (see below), as well as based on observations of the actions of the doctor and nurse, it is recommended that the furniture and equipment of the doctor’s office be placed in accordance with the following rules:

The doctor's and nurse's desk should be in the most illuminated part of the office;

There must be space around the table to allow free movement of the doctor and nurse from the table to any object in the office;

The couch for examining the patient should be positioned so that the right half of the patient’s body is on the doctor’s side; the couch must be fenced off from the front door with a screen and a chair for the patient must be placed close to it;

The location of each item must be thought out in order to minimize the cost of movement and ensure compliance with aesthetic requirements in the design of the office;

The office door must be visible so that the doctor can see the patient entering.

Ergonomic requirements for the organization of workplaces determine the compliance of the design data and dimensions of work furniture and organizational equipment with the anthropometric, biomechanical and psychophysiological capabilities of the human body. Compliance with them makes it possible to provide a medical worker with a physiologically rational posture during work that meets the criteria of functional comfort.

Hygienic requirements for the organization of workplaces in medical offices provide for compliance with basic sanitary and hygienic standards: sufficient area, cubic capacity, footage per worker, microclimate parameters, lighting, noise, etc.

Aesthetic requirements for the organization of workplaces provide for the implementation of a set of recommendations for the artistic design of work premises, office interiors, and the institution as a whole.

Ergonomic, hygienic and aesthetic requirements for the organization of workplaces are set out in the relevant regulatory and methodological materials.

Maintenance of workplaces includes organizing document flow, providing medications, standard forms and instruments, organizing sick calls, preparing workplaces and cleaning premises.

In the rational organization of workplace services, an important place should be given to the use of standard forms for referrals for research and treatment. As observations have shown, the frequency of referrals, for example, in the office of a local general practitioner is on average 23 times by a doctor and 46 times by a nurse per 100 visits, and in an ENT office - 21 and 31, respectively. An average of 1.4 m is spent on issuing one referral. Taking into account the fact that the patient needs to be explained where and in which office he needs to appear, how to prepare for the study, the unproductive expenditure of working time increases significantly. Therefore, the rationalization of this element of the work of medical personnel has a significant benefit in the work of clinic specialists. Standard referral forms are recommended for use for certain types of research. The front side of each referral form consists of two sections. In the first section, the nurse enters the patient's last name, initials, medical card number and address, as well as the doctor's last name and date of appointment. The second part is intended to fill out the results of the study of auxiliary diagnostic services. The reverse side of the form has a memo for the patient, including information about the rules of preparation for the study, the place and time of its conduct. The presence of such forms completely frees the doctor from writing directions and saves the nurse’s working time. Referral forms must be placed in the table's blank file, only in this case they are convenient to use.

The use of pre-prepared prescriptions significantly saves the doctor’s working time. It has been established that the frequency of their discharge is, for example, an average of 100-150 per 100 visits for an otolaryngologist, and 200-250 for a local general practitioner, respectively. Specially conducted studies have shown that an otolaryngologist operates in his work with approximately 100, and a local doctor with 140-160 prescriptions, most of which are used repeatedly during the working day and week. Taking into account the above, the optimal volume of the prescription library should be designed for 40-60 prescriptions.

With a rational organization of the workplace, the issues of reducing the time spent on maintaining a medical record of an outpatient patient, which occupy at least 25-30% of the working time at the reception in the work of doctors of main specialties, require solutions. For this purpose, it is currently recommended in clinics to use printed inserts in the medical record, which allow, by emphasizing the signs listed in them and entering the missing ones in specially designated lines, to significantly reduce (by 15-20%) the costs of doctors for filling out the medical record. Inserts can be printed. typographically or by making a rubber cliché. In the latter case, they are printed as needed directly in the doctor's office.

Maintaining functional connections between doctors at outpatient appointments is ensured by equipping workplaces with means of communication with all the main departments and services of the clinic: the registry, the offices of specialist doctors, the head of the department, and auxiliary treatment and diagnostic rooms.

To call a patient to the doctor's office, it is advisable to use a light or sound alarm. When using a light alarm, a light sign is installed at the door of the office with the inscription “Do not enter”, which is illuminated while receiving a patient, and “Enter” when the doctor has received the patient and is calling the next one. In this case, the doctor’s workplace is equipped with a light signal switch. In the second option, any intercom communication device operating in loud-speaking mode is used.

Thus, thoughtful organization and maintenance of the workplace, its equipment and equipment taking into account the requirements of ergonomics and aesthetics, rational layout of the office should be aimed at creating conditions for effective and high-quality work of a doctor and nurse conducting outpatient visits.

Source: magazine "Chief Doctor" 2013/03

Other related articles

• Labor motivation in the quality management system
• Making and monitoring management decisions in healthcare
• Expert assessment in healthcare management

Organization of the nurse anesthetist's workplace.

To provide anesthesiological care to patients during surgery, a space has been allocated in the operating room for the placement of anesthesia and respiratory equipment, monitoring equipment, and an anesthetist's table. The placement of equipment is carried out taking into account compliance with sterility zones. The operation of medical equipment must be in accordance with safety and labor protection rules. In the operating room, work is carried out during the day and at night. The following activities are carried out in the operating room:

1. preparation and administration of anesthesia during surgery

2. when carrying out special and diagnostic treatment procedures

3. patient care in the immediate postoperative period

4. implementation of a set of measures for resuscitation and intensive care for persons with dysfunction of vital organs until their activity stabilizes.

For the proper organization of the work of the medical anesthetist, an anesthesia room must be organized, which is intended for introducing the patient into anesthesia and for adequate restoration of the vital functions of the patient’s body after surgery, until it is brought into a state of transportability.

The size of the anesthesia room largely depends on the nature, number and volume of surgical interventions, however, in all options, communication unity with the operating room and the area of ​​the anesthesia room, which should provide for the possibility of a free roundabout of the patient lying on a special gurney, the possibility of freely transporting him to operating room and back with a connected anesthesia-respiratory apparatus and a system for intravenous infusion, as well as optimal access to the gurney when carrying out the necessary therapeutic and diagnostic procedures, during postoperative rehabilitation activities.

There is a designated area in the anesthesia room for disinfection. The disinfection area contains furniture for storing containers for disinfection and storage of detergents, cleaners and disinfectants.

Proper organization of the workplace of the medical anesthetist will allow rational use of working time, competently and clearly carry out the manipulations and prescriptions of the anesthesiologist, carry out high-quality sanitary and anti-epidemiological measures and thereby ensure a higher level of diagnostic and treatment process in the operating room.

Equipment for the anesthetist's workplace.

No.	Name	Quantity (pcs.)
	1. Furniture
	Chair
	Mirror
	Hook
	2. Medical equipment.
	Manipulation table
	Anesthetist's table
	Anesthesia-respiratory apparatus
	Surgical suction device (aspirator)
	Defibrillator
	Tonometer
	Pulse oximeter
	IV infusion stand
	Ambu bag
	Wall-mounted bactericidal irradiator
	Centralized oxygen
	3. Electrical equipment
	Fridge
	Telephone
	Wall clock
	4. Medical supplies.
	Scissors
	Syringes 5.0; 10.0 Vazocan Systems for intravenous infusion Sterile gloves Catheter for CPV	3 pcs. 2 pairs of 2 pcs.
	Test tube
	Kidney-shaped tray
	Intubation tray
	Container for receiving medicines from the senior m/s
	Test tube rack
	Perforated tray
	Sterilization box KSK – 12
	Container E DPO
	Containers for receiving packages from CSO
	Vein compression bandage (tourniquet)
	Gastric tube
	Suction catheter
	Oilcloth armrest
	5. Styling.
	For blood transfusion, determination of blood group and Rh factor: a set of standard sera for determining blood groups a ceramic marked plate for determining the blood group pipettes eye glass rods container for 0.9% NaCl solution gelatin solution 10 ml test tubes cone-shaped rubber stoppers Pasteur pipettes water thermometer water bath container for defrosting plasma
	For tracheal intubation: endotracheal tubes of various sizes; conductor - stylet; air duct; tongue holder; mouth dilator; anesthesia mask; syringe; forceps; knitting for fixing endotracheal tubes; laryngoscope with blades	1 piece each
	For epidural anesthesia: perforated tray sheet diaper syringe 10.0 clamp tweezers Tuohy needle, subcutaneous, intramuscular needle, needle for a set of medicines napkins 20×20 balls 10×10	1 piece each
	Intracardiac set: perforated tray diaper sheet syringe 10.0 tweezers clamp intracardiac needle
	For duty tools: perforated tray sheet diaper tweezers clip scissors container for duty tools
	Anesthesia table for anesthesia: sterilization box, diaper, napkins 20×20, balls 10×10
	For sterile rags: sheet rags
	6. Medication provision
	Sterile solutions: 0.9% sodium chloride Ringer's solution 0.25% novocaine solution 4% soda solution 7.5% potassium chloride solution 5% aminocaproic acid solution	10 bottles each 2 bottles
	Antihypertensive drugs.
	Dibazol 5% - 5.0	1 package
	Papaverine 2% - 2.0	1 package
	Eufillin 2.4% - 10.0	1 package
	No-shpa 2.0	1 package
	Hemostatic drugs.
	Calcium chloride 10% - 10.0	1 package
	Etamsylate 12.5% ​​- 2.0	1 package
	Dicynon 2.0	1 package
	Aminocaproic acid 5% - 100.0	2 bottles
	Heartfelt.
	Cordiamine 20% - 2.0	1 package
	Dopamine 0.5% - 5.0	1 package
	Strophanthin 0.025% - 1.0	1 package
	Adrenaline 0.1% - 1.0	1 package
	Nitroglycerin 0.0005 No. 50	1 package
	Hormones
	Dexomethasone 4 mg	1 package
	Prednisolone 30 mg	1 package
	Antihistamines.
	Diphenhydramine 1% - 1.0	1 package
	Suprastin 2.0	1 package
	Potent drugs.
	Atropine 0.1% - 1.0	1 package
	Others.
	Lidocaine 2% - 2.0	1 package
	Analgin 50% - 2.0	1 package
	7. Dressing material.
	Bandage
	Band-Aid
	8. Containers for disinfection.
	For rags
	For syringes, systems and needles
	For endotracheal tubes
	For blood waste
	For anesthesia-breathing circuit
	For walls
	For disinfecting gloves
	9. Storage containers.
	Clean rags
	Detergents
	Cleaning products
	Disinfectants
	baking soda
	Talc
	Clean gloves
	Tools used
	Distilled water and hydrogen peroxide	1 piece each
	10. Soft equipment.
	Towel
	11. Special clothing
	Surgical gown
	12. Measuring containers (graduated)
	Capacity 1 liter
	Capacity 500 ml
	Capacity 5 g.
	Disinfectants, SMS, cleaning products (per day)
	Virkon	4 packages
	Hydrogen peroxide 6%	10 l
	Septodor forte 0.4%	80 ml
	Baking soda	1 pack
	SMS "Lotus"	100 gr.
	Toilet soap	1 piece
	Cleaning products: Pemolux soda ash	40 gr. 1 pack 1 pack
	Diapers	16 pcs.
	13. Stationery.
	Scissors
	Ruler
	Glue
	Eraser
	Paper clips	1 package
	Pencil
	Calendar for the current year	1 package
	Note paper
	Scotch
	14. Plumbing equipment.
	wash basin

M/s memo on labeling of medical products.

In medical institutions, it is necessary to label medical products in order to comply with the technology for preparing disinfectants, the correct use of patient care items and maintaining order in the workplace. The following items are subject to marking: walls, furniture, containers.

Labeling requirements:

1. Each m/s workplace must have stencils and oil paint for timely updating of markings.

2. Marking is applied with oil paint, transfer font or stencil with self-adhesive film.

3. The color of the marking is selected to match the tone of the main containers and the color scheme of the room. The size of the marking font should be from 0.5 to 1.5 cm. The distance between letters should not exceed 0.5 cm.

Marking of the anesthetist's workplace.

Scroll	Marking name
Anesthetist's table	"A "Venena" Sterile solutions
Wall oxygen tap vacuum tap nitrous oxide tap	O 2 – blue paint V – red paint N 2 O – gray paint
Tray	For intubation
Tray	Honey. waste
Disinfection containers	Disinfection No. 1 Disinfection No. 2 Disinfection No. 1 endotracheal tubes Disinfection No. 2 endotracheal tubes Washing solution Distilled water Blood waste
Storage containers	Clean rags Alcohol 95 0 AN Plevasept AN
Containers for storing detergents, cleaning agents and disinfectants	SMS Baking soda Disinfectant Cleaner
Containers for bulk materials	Talc

Note: Alcohol containers must be graded and graded.

Operational stress.

A surgical operation for the body is not only pain, but also aggression to which the patient’s body is subjected, causing a complex of compensatory and adaptive reactions. During surgery, the patient experiences so-called “operational” stress, so modern pain management benefits not only eliminate pain, but also control the basic functions of the body during surgery.

The main components of “operational” stress:

· psycho-emotional arousal

· sick

non-pain reflexes

· blood loss

· disturbance of water-electrolyte metabolism

damage to internal organs

The objectives of anesthesia care are to prevent and treat the harmful effects of “operational” stress

Anesthetic benefits include:

ü preoperative (pre-anesthesia) preparation

ü anesthesia during surgery

ü bringing the patient out of anesthesia

ü early (post-anesthesia) postoperative period

The components of modern pain management are:

1. Anesthesia (numbness, numbness) - switching off consciousness, reducing the neurovegetative reaction, pain sensitivity. It is carried out using inhalational or non-inhalational anesthetics.

2. Analgesia - pain relief. It is achieved by using general or local analgesics, narcotic and non-narcotic.

3. Neurovegetative blockade. It partially develops during anesthesia and analgesia. To deepen it, drugs are used: anticholinergics and sympatholytics, neuroleptanalgesia (NLA).

4. Myoplegia (muscle relaxation) – weakening of muscles. It is achieved by the introduction of muscle relaxants (depolarizing and non-depolarizing, that is, short and long-acting). They allow surgical interventions and mechanical ventilation.

5. Maintaining adequate breathing. It is provided in modern anesthesia through the use of IVL and IVL, increasing the oxygen content in the inhaled mixture.

6. Support adequate blood circulation. It is carried out by the rational use of anesthetics, analgesics, relaxants, replenishment of surgical blood loss, treatment (correction) of cardiovascular disorders.

7. Regulation of metabolic processes. It is carried out using the previous components of anesthesia and additional methods:

§ Controlled hypotension

§ Controlled hypothermia

§ Artificial circulation (CPB)

Preparation for anesthesia.

Preparation for anesthesia begins from the moment the patient enters the hospital.

Preoperative preparation is the time from the moment the patient is identified for surgery until he is taken to the operating table. The time of the preoperative period is determined by the type of surgical intervention. There are: planned operations, urgent (no more than 6 hours), emergency, in which the patient receives resuscitation measures on the operating table, intensive care and the surgical aid itself.

Preparation for anesthesia begins with getting to know the patient, examining him, followed by the appointment of appropriate additional examinations and drug therapy.

The anesthesiological team bears equal responsibility with the surgeon, therefore it determines the indications and contraindications for anesthesia, selects the method of anesthesia and, depending on the type of surgical intervention (i.e. planned, urgent, emergency), preparation for anesthesia can last from several minutes to many days.

From the patient's medical history it is important to know:

Previous diseases, operations, anesthesia and its complications

About the use of medications (corticosteroids, insulin, antihypertensives, tranquilizers, antidepressants, anticoagulants, barbiturates, diuretics, contraceptives)

Allergic reactions to medications

Accompanying illnesses:

o respiratory system – chronic pneumonia, bronchitis, asthma, frequency of acute respiratory infections.

o CVS – coronary insufficiency, arrhythmias, hypertension, edema, shortness of breath, how long the patient can walk. This requires individual selection of anesthetic.

o about kidney and liver diseases, since all drugs used in anesthesia are destroyed by the liver and excreted by the kidneys.

About bad habits

Obstetric and gynecological anamnesis. It allows you to judge the Rh conflict (number of pregnancies, number of children born), a critical day, since 3 days before this the rheology of the blood changes (its fluidity) and 3 days after.

Mental illnesses, conditions

Blood transfusions in the past and how complications survived

Hereditary diseases (myasthenia gravis, porphyrinuria)

Data on the patient’s age, body weight, and build make it possible to select the type of anesthesia, dosage of drugs, and promptly prepare for respiratory disorders during surgery, in the postoperative period, in particular in obese patients.

§ Physiological age (as far as it looks)

§ Contact with the patient (ears)

§ Eyes (and whether they exist), pupil (size, reaction to light, friendly movement of eyeballs, ciliary reflex)

§ Nose. Nasal breathing (especially in children).

§ Mouth. Does it open? Condition of teeth (shakyness, caries, false teeth, bite, palate, oral cavity, distance from the front teeth to the larynx).

§ Jaw (shape).

§ Neck. Does she exist? Its length is four fingers from the chin to the thyroid cartilage - this is the normal length of the neck.

§ Rib cage. Configuration, emphysema, shortness of breath at rest, type of breathing.

§ Arms (veins).

§ Legs (veins, varicose veins).

§ Bladder and bowels (emptying).

It must be remembered that any anesthetic affects the function of the brain, heart, blood vessels, lungs, liver and kidneys. Moreover, the degree of impact depends, among other things, on the initial state of the organs. Minimum set of studies: anamnesis, examination, auscultation, palpation, OAK ( platelets), OAM, blood biochemistry (blood sugar), ECG.

The nurse anesthetist is directly involved in preparing the patient. On the eve it is necessary to weigh the patient, since many anesthetics are administered per kg of weight.

Cleansing the gastrointestinal tract is a strict rule. Anesthesia is administered only on an empty stomach. An exception is infants and patients with diabetes - a light breakfast three hours before anesthesia. During emergency surgery, a tube is inserted, but the stomach is not washed. A cleansing enema is given as planned the evening before, after the enema, a bath, preferably a shower, with a complete change of linen. Last meal at 18:00. in the morning before being taken to the operating room, empty your bladder. They lay you on a gurney, holding a medical history in your hands.

Psycho-emotional preparation of the patient for manipulation and anesthesia.

Nursing process	Rationale
When communicating with a patient in a procedure room or operating room, the nurse anesthetist must distract him from the thought of the operation. Instill in him cheerfulness and faith in a favorable outcome of the intervention. It is necessary to take into account the individual characteristics of the patient and his current condition. By her behavior, the nurse anesthetist must inspire respect for her and create confidence in the patient in her competence. Actions of the nurse: greet the patient, get to know him, distract him with questions.	Creating psychological comfort for the patient, convincing the patient of a favorable outcome of the operation.
Explain to the patient the purpose of the upcoming anesthetic procedure and manipulation. This is about the instruments used, medications, the purpose of their use, the time for the effect to appear, possible complications and side effects.	Ensuring the patient's rights to information, conscious participation in the manipulation (Article 46 of the Constitution of the Russian Federation).
Inform the patient in a timely manner about the upcoming injection.	Conditions for high-quality preparation for manipulation.
Ask questions about preparation algorithms.	Make sure you understand the information correctly.
It is mandatory to accompany the patient after manipulation or anesthesia to the ward or intensive care unit.	Psychological support.
Monitor the patient's condition.	Psychological support.
Document what has been done.	Ensuring continuity and forming a data bank.

The nurse anesthetist not only warns the patient about the possible negative side effects of drugs, but also promptly and correctly assesses the clinical manifestations of drug intoxication. The most insignificant changes in the patient’s condition should not escape her, about which she must report to the anesthesiologist.

All examination and treatment data in accordance with the stages of surgical intervention are entered into a medical document - the anesthesia (anesthesiology) observation card of the patient. Currently, punched cards are used; they make it possible not only to record data, but also to analyze it.

The anesthesia record is kept by a nurse anesthetist, but it must be signed by the doctor and the head of the department. This is a legal document. It is unacceptable to fill out the anesthesia card from memory after completion of anesthesia, in this case it is not reliable. The nurse anesthetist begins to fill out the card before anesthesia:

Passport details (according to words)

Ages required for drug calculations

Body weight, height

Ventilator parameters

The diagnosis is copied from the medical history

Biochemical and laboratory parameters are rewritten. If the patient has diabetes, call the laboratory - there is a risk of hypoglycemic coma.

Degree of operational risk. On the eve of the operation, the nurse finds out from the doctor what type of anesthesia will be used and receives medications before the patient is admitted to the operating room (in the anesthesia card he notes the time of admission to the operating room).

Measures blood pressure, pulse, respiratory rate

Marks the time of venipuncture

The anesthesia card notes the composition of the drug mixture, concentration, gas flow, anesthetics, muscle relaxants (the frequency of their administration strictly according to time), analgesics, transfusion of solutions, blood.

All measurements are taken after 5 minutes, according to the Harvard monitoring standard. It is necessary to record the time of intubation, extubation, stages of the operation in the anesthesia card and that it all coincides in time.

At the end of the benefit, the nurse must summarize the doses of administered medications in the anesthesia card and note them in the anesthesia card. All data on the anesthesia card are absolutely identical to the records in the medical history.

Medication preparation is carried out the day before at 22:00. are appointed:

§ 1st group: long-acting sleeping pills ( luminal(action in 40 minutes) , nitrozepam, radedorm, midozalam) and drink it with WARM water.

§ 2nd group: sedatives ( seduxen 0.005; elenium 0.005; meprotane 0.2; amizil 0.001; trioxosine 0.3). The purpose of the prescription is to calm down, the patient becomes largely indifferent. Has a pronounced antiemetic and sedative effect etaperazine 0.004; but it “will not allow you to wake up” after anesthesia, that is, after using this drug, awakening is prolonged. To get a better effect, these drugs can be prescribed several days in advance.

§ 3rd group: antihistamines. Most often used diphenhydramine 0.05, diprazine 0.025; suprastin 0.025. The prescription of antihistamines is especially indicated if there is a history of urticaria, asthma, hay fever, etc., since the prescription of antihistamines prevents allergies and is a means of combating vomiting.

Purpose of medication preparation:

1. slow down, cause drowsiness

2. calm down, cause indifference

3. prevent allergies and vomiting

Medication preparation the day before is not carried out for children under 14 years of age and mental patients.

Premedication is pre-anesthesia preparation before surgery. The route of administration of drugs depends on the type of operation (planned, urgent, emergency) and it can be:

A. IV administration (emergency surgery)

b. intramuscular injection (30 minutes before surgery)

Premedication:

1. group – narcotic analgesics. These drugs belong to group A and are subject to strict accounting (order No. 3132) and storage. They are administered under medical supervision. Promedol 1 and 2% - 1.0; omnopon; dipidolor(pyridramil).

2. group – antihistamines. Diphenhydramine 1% - 1.0; diprazine 2%; suprastin 2%.

3. in 100% of cases they are administered, that is, not a single anesthesia is prescribed without Anticholinergics - atropine 0,1% - 1,0. Metacin 0.1%, it is used if atropine is contraindicated - when IOP cannot be increased in small children, since they have severe tachycardia. They reduce mucus secretion and prevent the irritating effect of the vagus nerve on the heart. Relieve bronchospasm, dry the mucous membrane of the oral cavity, trachea, and bronchi.

Purpose of premedication:

1) remove unwanted reflexes from the larynx and pharynx; extinguish the gag reflex.

2) Remove the influence of the vagus nerve (vagus). Vagus – parasympathetic nervous system (“kingdom of the night”). Tachycardia, dry skin, the patient speaks poorly because he has a dry mouth, pulse – tachycardia. If the pulse is less than 100 V', then the patient is not taken for surgery.

3) Dry the mucous membrane of the oral cavity, trachea, bronchi; reduce the secretion of gastric glands

4) Induce drowsiness and calm the patient.

Currently, other drugs are administered as premedication - cimitidine. It is especially indicated for urgent and emergency operations, as it reduces the secretion of glands and the acidity of gastric juice. Prednisolone, especially in pediatric practice, since children are mostly allergic and have thymus syndrome (children with lymphatics). Immunosuppression – the stimulus does not match the response. In adults, if there is a history of severe allergic reactions.

Degrees of operational risk.

Potential and obvious dangers of anesthesia, surgery and related circumstances are defined as operational risks of varying degrees. According to Ryabov:

I degree: Somatically healthy people undergoing minor planned surgical intervention (hernia repair, minor gynecological operations, dental procedures, opening of abscesses, diagnostic procedures, except for measuring pressure in the cavities of the heart)

II A degree: Somatically healthy patients undergoing more complex surgical intervention (cholecystectomy, for a benign tumor, that is, not associated with severe surgical trauma and large blood loss.

II B degree: Patients with diseases of internal organs undergoing minor planned surgical intervention.

III A degree: Patients with diseases of internal organs, fully compensated without special treatment, undergoing complex surgical intervention (gastric resection, surgery on the intestine, rectum) or intervention associated with large blood loss (breast extraction, adenomectomy).

III B degree: Patients with uncompensated diseases of internal organs undergoing minor surgical interventions.

IV degree: Patients with a combination of severe general somatic disorders undergoing extensive surgical interventions.

Grade V: Individual patients who may die regardless of whether surgery is performed or not. According to vital indications (cardiac injury, AMI, PE or AMI + thrombus in the vessels of the brain).

For emergency procedures, the risk of anesthesia increases by one degree.

The nurse anesthetist enters the degree of operational risk into the anesthesia or anesthesiology record.

Before the patient enters the operating room, the nurse anesthetist should check:

ü Anesthesia machine, respirator, prepare instruments, medications, systems.

ü The presence of oxygen and its quantity, nitrous oxide and its quantity, fill the evaporator with an anesthetic, and the adsorber with a chemical absorber. Check the operation of the valves and the tightness of the “device-patient” system.

ü Availability of masks of different sizes (mask from the bridge of the nose to the corner of the jaw), sterile endotracheal tubes of different sizes, endotracheal tubes (consists of: connector, body, cuff and coupling). The length of the endotracheal tube is 25-27 cm, for separate intubation - 33 cm. slice = 45 0. there is an oval window. The diameter of the tube corresponds to the size of the tube. There are endotracheal tubes for children - they are without a cuff and they are selected according to the formula: length = age / 2 + 12; diameter = 3-3.5 mm, diameter can be selected according to the little finger. For adults, the length is selected by calculation. Take the distance from the earlobe to the wing of the nose and multiply by two. Any endotracheal tube must have a conductor - a stylet. Endotracheal tubes are disposable, reusable, or made of special rubber. Tubes are not stored in solutions; the connector is removed during storage. Before use, inflate each of the tubes and check the integrity of the cuff (hernia) and coupling. In pediatric practice, Cole endotracheal tubes are used.

ü A laryngoscope with a set of blades (straight and curved in a plane) is prepared. The laryngoscope consists of: a switch, a tube that ends with a lock, and the lock is inserted into the blade; at the end of the blade there is a light bulb (it can be battery-powered or fiber-optic). Blades: children's, teenage, medium and long. The laryngoscope is fed into the left hand, and the tube into the right with the blade or cut toward you.

ü The serviceability of the aspirator is checked.

ü Prepare a gastric tube, urethral catheter, mouth dilators, tongue holder, fur mask.

ü We check the availability of IV infusion systems and stands.

ü Assembling the intubation tray:

§ Three endotracheal tubes

§ Syringe for cuff inflation

§ Stiletto or conductor

§ Napkins

§ Laryngoscope

ü We cover the anesthetist’s table. We cover before starting work and for each patient.

§ Treat with disinfectant

§ We take out a sterile diaper from the bag (4 layers, and when we close it there will be 8 layers)

§ Syringes:

· 20.0 for barbiturates

· 5.0-10.0 (or insulin syringe) only for muscle relaxants

· 1.0-2.0 for atropine

§ Needles (at least 9 pcs.): air, for systems, for barbiturates, + 2 more syringes

§ Kits, but the CPV kit should always be at hand

§ Beaker

§ Container for alcohol

§ Balls and napkins

§ Bottle 200.0 or 400.0 with isotonic solution

§ There must be a tonometer (on the respirator) and a fur mask.

Manipulations preceding anesthesia.

After premedication, the patient in a drowsy state is brought from the department to the operating room, always with a medical history, and if necessary, a test tube. Transportation is carried out by two people, not one.

The patient is transferred to the operating table as follows: the head end of the gurney is placed to the foot end of the operating table, the patient is carried by three people, placing the hands under the shoulders and head, the chest with the pelvis, under the legs. The patient is placed on a warm operating table, usually on his back. Patients who cannot tolerate this position (CHF, pregnancy) are given a comfortable position that is longer necessary for surgery.

Standard set of medicines

Solutions for transfusion

Indications for CPV:

1. IV administration of solutions over 3 days

2. The need to measure CVP

3. Extracorporeal diagnostic methods

4. Measurement of pressure in the cavities of the heart

5. Constant blood tests

6. Prolonged stay on mechanical ventilation.

Contraindications to CPV:

1. Profound changes in the skin and subcutaneous tissue

2. Severe skin hyperesthesia

3. Severe nervous or psycho-emotional arousal

Principles observed during CPV:

A. respect for the vein

b. strict adherence to asepsis and antiseptics

V. psycho-emotional preparation of the patient

Set for CPV.

1. Set the table according to the action algorithm

2. Three syringes, needles (i.c., subc., special needle 10-12 cm long, cut 45 0, diameter must correspond to the guidewire and catheter that will be placed)

3. Catheter with guidewire and two plugs

4. Rack system

5. Novocaine 0.25%. Show the doctor the date on the bottle and open it in front of him, following the rules, drain it, fill a special container or syringes

6. Balls, napkins

7. Alcohol or dibitane, chlorhexedine

8. Perforated tray with suture material

9. Band-Aid, scissors

11. Bixes with sterile material

12. Sterile jar with a capacity of at least 30 ml

Patient position during CPV:

o Lay on your back with your arms brought to your body

o The head is turned in the direction opposite to the puncture to stretch the posterior scalene muscle, which promotes swelling of the vein

o It is advisable to raise the foot of the bed by 15-25 0 to increase venous inflow and reduce the risk of air embolism.

Advantages of puncture catheterization of the main veins:

1. the possibility of long-term (up to several months with proper care) use of the only access to the venous bed

2. possibility of massive infusions

3. unlimited mobility of the patient in bed

4. convenience in patient care

A nurse anesthetist assisting a doctor in performing CPV must clearly know the kit’s contents and the CPV technique performed by the doctor, possible complications and their prevention.

CPV technique (performed by a doctor):

Local anesthesia with 0.25% novocaine, puncture site - until lemon peel. Changing 2 needles: i/c and sub/c means changing syringes too.

Using a puncture needle 10-12 cm long with an internal lumen of 1.5-2 mm and a bevel, connected to a syringe filled with novocaine solution, the skin is pierced 1 cm downward from the lower edge of the clavicle at the border of the inner and middle third. The needle is installed at an angle of 45 0 to the collarbone and 30 0 to the surface of the chest. Slowly moving the needle, inject novocaine into the space between the collarbone and the rib. Advancement of the needle into the depths of the soft tissues stops from the moment blood appears in the syringe. The syringe plunger should not move (if it pulsates, then we are in the artery).

The syringe is disconnected and a conductor is inserted through the lumen of the needle - this is a polyethylene fishing line with a diameter of 0.8-1 mm and a length of 40 cm. The fishing line is inserted to a depth of 8-12 cm with rotational movements.

The needle is carefully removed with a rotational movement, and the catheter is advanced into the vein to a depth of 8-12 cm with rotational movements. The guidewire is removed, and the catheter is closed with a special plug or the system is connected, or a heparin plug is made (1 ml of isotonic solution + 0.1 ml of heparin). A heparin plug is placed each time the system or injection is disconnected.

The catheter is fixed with a silk suture or adhesive tape. The catheter is processed as necessary, as it becomes dirty, but at least 2 times a day. The catheter should be changed weekly, the plug should be plugged after five punctures. The skin around the catheter can be treated with alcohol-containing antiseptics (iodopirol, brilliant green, chlorhexedine). If skin changes or redness occur, the nurse should immediately notify the doctor.

Algorithm for working with a catheter. Whenever using a catheter, the first movement of the nurse is “piston towards itself”, when blood appears - administering the medicine. We have no right to remove the plug. We turn off the system when performing an injection through an elastic band while wearing gloves.

Complications.

I. Technique-related punctures: pneumothorax, arterial puncture, brachial plexus injury, air embolism.

II. Caused by catheter position: arrhythmias, perforation of the vein wall, perforation of the atrium, migration of the catheter into the cavity of the heart, paravasal administration of fluid, prolonged bleeding from the puncture hole (this is due to a blood clotting disorder, especially with disseminated intravascular coagulation syndrome).

III. Caused by prolonged presence of the catheter in the vein (or improper use): thrombophlebitis, phlebothrombosis, suppuration of the soft tissue around the catheter, septic endocarditis.

IV. Mechanical damage: do not pinch the catheter with a forceps and do not remove it according to the rules.

The main veins are punctured: subclavian I (using the upper approach and lower (more often) access according to Sideringer), jugular, femoral.

Peripheral veins are catheterized using a vasocan. See Appendix No. 1.

Occupational safety in the healthcare system of the Russian Federation is one of the priorities. Its organization directly affects the provision of medical care to the population of the country. Medical workers are influenced by the specifics and characteristics of their professional activities. The work of medical personnel is very difficult to compare with any other types of work. The work of a doctor requires extreme care, because every awkward step can result in the death of the patient. A doctor is the most responsible profession in the world.

They say that to become a doctor you need to have a heart of stone. Seeing the dedication of people in white coats, it is difficult to agree with this opinion. They pass all the experiences, all the tears and bitterness of the patients through themselves. The failures of patients in the fight against diseases are their failures.

During their career, doctors have to come into contact with a large number of patients with a variety of diagnoses. At the same time, they must maintain high performance and be able to withstand stress 24 hours a day. Their work is almost always associated with extreme situations. What kind of psyche and skill do you need to have in order to suddenly, sometimes, “gather a person bit by bit” and breathe a second life into him? Seeing the complexity, difficulty and costs of the profession, proper organization of working conditions at his workplace is necessary.

At a meeting of the Expert Council of the Federation Council Committee on Social Policy and Health on June 9, 2011, issues of working conditions and safety of medical personnel were discussed. The main reason that brought the meeting together was the increased level of occupational diseases among healthcare workers. This figure ranks fifth, ahead of workers in the chemical industry. The first place among pathologies is occupied by infectious diseases, the second by allergic diseases, the third by intoxication and diseases of the musculoskeletal system. Such a high level is caused, as it was concluded, by many factors, among which insufficient compliance with labor protection requirements stands out.

All medical institutions use microbiological diagnostics, which destroy viruses, infections, and bacteria contained in the air and on work surfaces. It would seem that this is precisely why the cause of infectious diseases should not exist at all. But working with the source of infections, patients, often involves the use of sharp, piercing and cutting instruments, which are direct carriers of infections through cuts, injections and other injuries. The meeting participants saw a solution to this problem in the use of developed production of safe medical devices. For example, the use of new safe hollow needles reduces accidental sticking of workers by 90%. Infections are often transmitted to medical personnel through airborne droplets. There are known cases where doctors at tuberculosis dispensaries become infected with tuberculosis through contact with patients. It’s unusual to hear about doctors getting sick. While caring about people's health, they often forget about their own. The first reason, of course, is non-compliance with safety conditions.

Medicine is in dire need of a labor protection system. Without deep and thorough checks, the safety of both health workers and patients is reduced. A form of periodic control is (AW, - ed.) - one of the effective subsystems of labor protection. AWP is carried out in accordance with. Certification is carried out for all jobs, from doctor, nurse, paramedic to technical staff. Let’s take a closer look at the certification of a doctor’s workplace.

The influence of external factors on this group of workers is quite large. Ultrasound rooms, radiology departments, operating rooms, physiotherapy departments, etc. associated with the influence of harmful and dangerous factors. Let us remember our own fear when we have to do fluorographic examinations every year. With every snapshot, it seems to us that our life expectancy is decreasing. But doctors reassure us, saying that the influence of the rays is established within reasonable limits. Ionizing radiation has a significant impact on the work of doctors. In accordance with sanitary regulations SP 2.6.1.758-99 The annual dose of medical radiation is set at 1 m3v/h. The standard can only be exceeded in extreme situations. This indicator must be kept under control, because radioactivity has a high penetrating ability. The consequences may include malignant neoplasms, radiation burns, and leukemia.

The severity and intensity of the work process also exceeds all indicators. Their working postures are “standing” and “sitting”. A specific example of the first pose is the work of surgeons, who tirelessly remain in a tense state for several hours while performing operations. The “sitting” working position is more common for dentists. They are forced to stay there for the entire work shift.

The doctor's workplace must be organized in accordance with sanitary requirements. Sanitary and epidemiological requirements for the design, placement of equipment, preventive and anti-epidemic measures, and working conditions for medical personnel in medical institutions are given in SanPiN 2.1.3.2630-10.

In addition to identifying production factors, doctors also determine the level of injury risk and the provision of collective protective equipment (PPE - ed.). As for the risk of injury, it is also present in medicine. It is characterized by work on complex medical equipment, with toxic drugs, as well as work with patients. There are many cases when emergency doctors, when visiting at the request of patients, are attacked by completely inadequate people, drug addicts.

The main PPE for doctors, and for all workers in medical institutions, is the white coat. White color symbolizes the color of purity and trust. True, today this color is gradually becoming a thing of the past. It is being replaced by more practical colors, such as violet, green, and blue. Regardless of the color, the doctor’s clothing should be antistatic, bactericidal and blood-repellent. Mandatory PPE also includes: rubber gloves, masks, caps, preventative shoes, shoe covers.

If harmful and dangerous working conditions are identified at the doctor’s workplace,