ICD 10. CLASS XX. EXTERNAL CAUSES OF SICKNESS AND MORTALITY (W01-W99)

This class, which was complementary in previous revisions of the ICD, makes it possible to classify incidents, conditions and circumstances as the cause of injury, poisoning and other adverse effects When a code from this class is used, it is implied that it should be used as an addition to a code from another class indicating the nature of the condition Most often, the nature of the condition will be classified by a code from class XIX "Injuries, poisoning and some other consequences of exposure to external causes" ( S00-T98) The development of causes of death is recommended in accordance with headings of classes XIX and XX, but if only one code is included in the development, preference should be given to headings of class XX Other conditions that may be indicated as associated with exposure to external causes are classified in classes I- XVIII For these conditions, the class codes XX should be used to provide additional information only when conducting statistical analysis for multiple reasons.
Headings for designating the consequences of exposure to external causes are indicated in the block Y85-Y89.

This class contains the following blocks:
W01-X59 Other external causes of injury in accidents
W00-W19 Fall
W20-W49 Impact of inanimate mechanical forces
W50-W64 Exposure to living mechanical forces
W65-W74 Accidental drowning or submersion in water
W75-W84 Other accidents with threatened breathing
W85-W99 Accidents caused by electric current, radiation and extremes of ambient temperature and pressure levels

OTHER EXTERNAL CAUSES OF INJURY IN ACCIDENT (W00-W99)

FALLS (W00-W19)

[Cm

Excluded: attack ( Y01-Y02)
the fall:
from an animal ( V80. -)
inside or out of a burning building ( X00. -)
into the fire ( X00-X04, X08-X09)
into water (with immersion in water or drowning) ( W65-W74)
to the engine room (working) ( W28-W31)
inside or from a vehicle ( V01-V99)
X80-X81)

W00 Fall on a level surface covered with ice or snow

Excludes: crash mentioning:
skating and skiing ( W02. -)
stairs and steps ( W10. -)

W01 Fall on a level surface due to slipping, false step or stumbling

Excludes: falling on ice or snow ( W00. -)

W02 Fall while skating, skiing, rollerblading or skateboarding

W03 Another fall on the same level as a result of a collision with another person or a push

Included: falling when a pedestrian (vehicle) collides with another pedestrian (vehicle)
Excludes: crushing or trampling by a running crowd ( W52. -)
falling on ice or snow ( W00. -)

W04 Fall of face when carried or supported by another person

Included: face accidentally dropped while being carried

W05 Wheelchair-related fall

W06 Bed-related fall

W07 Fall associated with stool

W08 Fall associated with other furnishings

W09 Fall associated with sports ground equipment

Excludes: falls associated with equipment designed for
for fun ( W31. -)

W10 Falling on stairs and steps or from stairs and steps

Included: drop (on):
escalator
ramp
associated with ice and snow on steps and stairs
ramps

W11 Falling on and off a ladder

W12 Falls on and off scaffolding

W13 Fall from (from) a building or structure

Included: falling from (from) (through) such devices or structures as:
balcony
bridge
building
flagpole
floor
railings
roof
tower
tower
viaduct
wall
window
Excluded: collapse of a building or structure ( W20. -)
falling or jumping from a burning building ( X00. -)

W14 Fall from tree

W15 Fall from a cliff (steep cliff)

W16 Diving or jumping into water resulting in injury other than drowning or submersion in water

Included: blow about:
bottom when jumping or diving in shallow water
swimming pool wall or side
water surface
Excludes: accidental immersion in water or drowning ( W65-W74)
diving with insufficient air supply ( W81. -)
the effect of air pressure during diving ( W94. -)

W17 Another fall from one level to another

Included: falling out of (in) formations or devices such as:
cave
doc
a stack of hay
pit
indentation (pothole)
career
mine
tank
well

W18 Other falls on the same level

Included: drop:
on collision with an object
from (to) the toilet
on the surface of one level NOS

W19 Fall, unspecified

Enabled: accidental drop NOS

EXPOSURE TO NONLIVING MECHANICAL FORCES (W20-W49)

[See above subheadings of scene codes]

Excluded: attack ( X85-Y09)
contact or collision with animals or people ( W50-W64)
deliberate self-harm ( X60-X84)

W20 Hit by a thrown, crumbling or falling object

Includes: Impact of a collapsed rock that did not cause a condition
asphyxiation or strangulation
impact when the building collapses, except for collapse when
fire
hit by falling (s):
rock
stone
tree
Excludes: collapse of a burning building ( X00. -)
hit by a falling object when:
natural disaster ( X34-X39)
mechanical accident ( W24. — , W28-W31)
transport accident ( V01-V99)
hit by an object set in motion:
explosion ( W35-W40)
firearms ( W32-W34)
hit by sports equipment ( W21. -)

W21 Impact on sports equipment or sports equipment

Included: blow:
knocked or thrown ball
hockey stick or puck

W22 Impact on another object or object

Included: hitting the wall

W23 Snagging, crushing, squeezing or pinching in or between objects

Includes: snagging, pinching, crushing or squeezing:
between) (folding
moving) (object pushing objects) (door, door
motionless) such, (opening, packing
and moving) as (cage, wringer
objects) (washing device
in the object) (machines
Excludes: injuries caused by:
cutting or piercing tools ( W25-W27)
mechanisms for lifting and transmission ( W24. -)
mechanisms ( W28-W31)
non-power hand tools ( W27. -)
vehicle ( V01-V99)
hit by a thrown, crumbling or falling object ( W20. -)

W24 Contact with lifting and transmission devices, not elsewhere classified

Included: contact with:
chain hoist
transmission belt
pulley
cable
transmission belt or cable
winch
dragging
Excludes: transport accidents ( V01-V99)

W25 Contact with sharp glass edge

Excludes: falls affecting glass ( W00-W19)
scattered glass fragments due to an explosion or
shooting from firearms ( W32-W40)

W26 Contact with knife, sword or dagger

W27 Contact with hand tools without power motor

Included: contact with:
ax
can opener NOS
chisel
hand saw
pitchfork
hoe
ice ax bayonet
needle
paper cutter
rake
scissors
screwdriver
sewing machine manual
shovel

W28 Contact with power lawnmower

W86. -)

W29 Contact with other power hand tools and household machines

Included: contact with:
mixer
power (oh):
can opener
chain saw
DIY tool
garden tool
secateurs
with a knife
sewing machine
drying unit
washing machine
Excluded: W86. -)

W30 Contact with agricultural machinery

Included: contact with:
horse-drawn agricultural machines (or
cravings for other animals)
combine harvester
derrick hay crane
agricultural machine NOS
mowing machine or hay mower
thresher
Excluded: contact with self-propelled or towed agricultural vehicles ( V01-V99)
damage electric shock (W86. -)

W31 Contact with other and unspecified machinery

Included: contact with:
machine NOS
entertainment equipment
Excluded: contact with self-propelled or towed vehicles ( V01-V99)
electric shock ( W86. -)

W32 Handgun shot

Included: shot from:
guns
pistol
revolver
Excluded: shot from a rocket launcher ( W34. -)

W33 Shot from a rifle, shotgun and large caliber firearms

Included: shot from:
army rifle
hunting rifle
machine gun
Excludes: shot from airgun ( W34. -)

W34 Shot from other and unspecified firearm

Included: shot from:
air gun
weapons explosive
rocket launchers
gunshot wound NOS
shot NOS

W35 Explosion, rupture of a steam boiler

W36 Explosion, rupture of gas cylinder

Included: explosion, rupture:
aerosol container
air cylinder
compressed gas tanks

W37 Rupture of pressurized car tire, pipe or hose

W38 Explosion, rupture of another specified device under pressure

W39 Fireworks volley

W40 Explosion of other substances

Included: explosives
explosive gas
explosion (on) (in):
NOS
landfill
factory
granary
military warehouse

W41 Exposure to a jet of pressure

Included: hydraulic jet
pneumatic jet

W42 Exposure to noise

Included: sound waves
supersonic waves

W43 Exposure to vibration

Included: infrasonic waves

W44 Entry of a foreign body into or through the eye or natural opening

Excludes: ingress of corrosive liquids ( X49. -)
inhalation or ingestion of a foreign body with blockage respiratory tract (W78-W80)

W45 Penetration of a foreign body through the skin

Included: penetration:
edges of stiff paper
nail
broken can lid
splinters
Excluded: contact with:
hand tools (non-power) (power) ( W27-W29)
knife, saber or dagger ( W26. -)
sharp glass ( W25. -)
hit with an object ( W20-W22)

W49 Exposure to other and unspecified inanimate mechanical forces

Included: abnormal gravitational forces [G]

EXPOSURE TO LIVING MECHANICAL FORCES (W50-W64)

[See above subheadings of scene codes]

Excluded: poisonous bites ( X20-X29)
sting (poisonous) ( X20-X29)

W50 Hitting, pushing, kicking, twisting, biting or scratching by another person

Excluded: attack ( X85-Y09)
hit with an object ( W20-W22)

W51 Strike or collision with another person

Excludes: falling as a result of collision of a pedestrian (vehicle) with another pedestrian (vehicle) ( W03. -)

W52 Crushing, pushing or trampling by crowd or in stampede

W53 Rat bite

W54 Dog bite or blow

W55 Bite or blow from other mammals

Excludes: contact with marine animals ( W56. -)

W56 Contact with marine animals

A bite or blow from a marine animal

W57 Bite or sting by non-venomous insects and other non-venomous arthropods

W58 Crocodile bite or blow

W59 Bite or crushing by other reptiles

Included: lizard
non-venomous snake

W60 Contact with plant thorns and prickles or sharp-edged leaves

W64 Exposure to other and unspecified living mechanical forces

Accidental drowning and immersion in water (W65-W74)

[See above subheadings of scene codes]

Excludes: immersion in water and drowning when:
the influence of the forces of nature ( X34-X39)
transport accidents ( V01-V99)
accidents on water vehicles ( V90. — , V92. -)

W65 Drowning and immersion in water while taking a bath

W66 Drowning and immersion in water by falling into a bathtub

W67 Drowning and immersion in water while in a swimming pool

W68 Drowning and immersion in water by falling into a swimming pool

W69 Drowning and immersion in water while in a natural body of water

Included: lake
the open sea
river
Creek

W70 Drowning and immersion in water by falling into a natural body of water

W73 Other specified cases of drowning and immersion in water

Included: fire fighting water tank
storage tank

W74 Unspecified drowning and immersion in water

Included: drowning NOS
falling into water NOS

OTHER HAZARDOUS RESPIRATORY ACCIDENTS (W75-W84)

[See above subheadings of scene codes]

W75 Accidental suffocation and strangulation in bed

Includes: airway closure and suffocation:
bed linen
maternal body
pillow

W76 Other accidental hanging and strangulation

W77 Threat to breathing from falling asleep in bulk solids, collapsed earth and other rocks

Included: falling asleep with breed NOS
Excludes: falling asleep with a breed in case of natural disasters ( X34-X39)
falling asleep with a breed without asphyxiation or suffocation ( W20. -)

W78 Inhalation of stomach contents

Included: asphyxiation)
blockage of respiratory) vomit
ways) [regurgitated food]
strangulation)
aspiration (inhalation) vomiting NOS
compression of the trachea)
interruption of breathing) vomit in
closing of the respiratory) esophagus
paths)
Excludes: damage other than asphyxiation or blockage
respiratory tract caused by vomit ( W44. -)
obstruction of the esophagus with vomit without mention
about asphyxia or blockage of the airways ( W44. -)

W79 Inhalation and swallowing of food resulting in airway obstruction

Included: asphyxiation)
respiratory blockage) food (including bone or
paths) fruit pits)
strangulation)
food aspiration (any) NOS
compression of the trachea)
interruption of breathing)
closing of the airways) with food in the esophagus
paths)
blockage of the pharynx with food (lump)
Excluded: inhalation of vomit ( W78. -)
damage other than asphyxiation or blockage
respiratory tract caused by food ( W44. -)
obstruction of the esophagus with food without mention of asphyxia
or blockage of the airways ( W44. -)

W80 Inhalation and ingestion of another foreign body resulting in airway obstruction

Includes: Asphyxiation caused by any object, excluding respiratory obstruction due to food or vomit
paths) of masses penetrated through the nose
suffocation) or mouth
aspiration (into the respiratory tract) of a foreign body, for
excluding food or vomit NOS
compression of the trachea)
interruption of breathing) foreign body v
airway closure) esophagus
foreign body in the nose
foreign body blockage of the pharynx
Excludes: aspiration of vomit or food ( W78-W79)
damage other than asphyxiation and blockage
respiratory tract caused by a foreign body ( W44. -)
obstruction of the esophagus by a foreign body without mention of
asphyxiation or blockage of the airways ( W44. -)

W81 Accidental or deliberate entry into an oxygen-poor environment

Included: accidental fall into the refrigerator compartment or other
hermetically sealed room
undersupply damage
air diving
Excludes: suffocation with plastic bag ( W83. -)

W83 Other cases of specified respiratory threat

Included: suffocation with a plastic bag

W84 Unspecified breathing threat

Included: asphyxiation NOS
aspiration NOS
strangulation NOS

ACCIDENTS CAUSED BY ELECTRIC CURRENT
RADIATION AND EXTREME AMBIENT TEMPERATURE LEVELS
OR ATMOSPHERIC PRESSURE (W85-W99)

[See above subheadings of scene codes]

Excluded: impact:
natural (oh):
cold ( X31. -)
heat ( X30. -)
radiation NOS ( X39. -)
sunlight ( X32. -)
lightning strike victim ( X33. -)

W85 Power line accident

W86 Accident related to electrical current source specified

current NOS
electroshock NOS

W87 Unspecified electric shock accident

Includes: burn or other electrical injury
current NOS
electroshock NOS
death by electric shock NOS

W88 Exposure to ionizing radiation

Includes: exposure to radioactive isotopes
exposure to x-rays

W89 Exposure to artificial visible and ultraviolet rays

Included: exposure to rays during electric welding (arc)

W90 Exposure to other non-ionizing radiation

Included: impact:
infrared)
laser) radiation
radio frequency)

W91 Exposure to radiation, type unspecified

W92 Exposure to excessive heat from an artificial source

W93 Exposure to excessive cold from an artificial source

Included: contact with dry ice
inhalation of vapors:
liquid:
air
hydrogen
nitrogen
long stay in the refrigerator

W94 Exposure to high and low atmospheric pressure and changes in atmospheric pressure

Included: influence:
high pressure when quickly immersed in water
pressure drop when climbing to the surface after
(from):
deep diving
dungeons
accommodation or long-term stay at a large
height as a reason:
anoxia
barodontalgia
barootitis
hypoxia
altitude sickness
sudden change in atmospheric pressure in air
vehicle during takeoff or landing

Bee allergies are common. It can develop not only by stinging, but also by touching an insect, it can form even when the air is inhaled, which contains the waste products of the insect.

Sometimes the consequences are very serious, there is a risk of death, so you need to clearly know how to act.

Code allergic reaction for a bee sting according to MKB-10 - W57. The diagnosis is made by a doctor based on symptoms and diagnostic results.

Digging to the root of the problem

Bee venom is a strong allergen; it contains elements such as histamine, peptides, melitin, norepinephrine, phosphoric acid, hydrochloric acid, amino acids and others. During the lesion, the sting penetrates the skin, toxic poison is released.

Usually the immune system eliminates poison in 10-15 minutes, after which only pain and puffiness.

If the immune system is weak, then the reaction can be unpredictable and cause serious complications, up to and including death.

More often, an allergy to a bee sting is manifested in patients diabetes mellitus, with viral and infectious diseases, with hormonal disorders, with autoimmune pathologies, as well as in women, children and the elderly.

An allergic reaction is not hereditary pathology, however, the risk of its development increases significantly in cases where it is present in at least one of the parents.

Normal reaction to attack

After being bitten by one bee, the consequences are less than with multiple attacks. In any case, there is swelling and noticeable hyperemia, an opening from the sting is observed in the center, and it often remains. The victim suffers from severe pain, often the temperature rises. If a patient has a tendency to an allergic reaction to a sting, bee venom, then a number of more serious symptoms arise.

The usual consequences of a bite in the photo:

Recognizing dangerous symptoms

The reaction to it can occur immediately or after some time. When it comes to bees, the first signs are pain, swelling, redness. If a sting remains, it must be removed immediately, otherwise the symptoms may become more pronounced. After a few days, the symptoms disappear. If the place itches a lot, this can also be a symptom of an allergy.

Local painting

Local symptoms of even one bee can appear immediately or after a certain time (from five minutes to five hours), disappear after 1-7 days. The most serious are bites to the head, face, neck, tongue, eyes: the consequences of such attacks by bees can become dire.

Systemic manifestations

A mild degree of systemic manifestation is expressed in the form of signs of a non-allergic nature:

• pain;
• rhinitis;
• swelling;
• hyperemia;
• hives;
• tearing;
• general weakness;
• soreness and aches in the joints.

The photo shows the symptoms of a person's allergy to the stings of attacking bees:

Moderate systemic manifestations:

• nausea, vomiting;
• , puffiness on the body;
• convulsions, delusional state;
• paroxysmal abdominal pain;
• dizziness, loss of consciousness, general weakness;
• the amount of mucus in the nasopharynx increases, sneezing;
• disruption of work gastrointestinal tract with severe pain;
• violations of blood pressure, heart rate;
• high fever, fever, often accompanied by headache.

In some situations, urinary and fecal incontinence is manifested, this is due to intoxication of the body.

Heavy clinic

If serious clinical manifestations observed immediately after the sting, it is more difficult to cope with them, but if this is not done, then the consequences can be dire.

In more severe cases, edema and hyperemia form, which occupy a large area of ​​the skin, patients complain of itching, pain, general weakness. The following symptoms appear:

• pressure decreases;
• fainting;
• severe nausea, vomiting;
• impaired respiratory function, a feeling of suffocation;
• swelling of the face and limbs (Quincke's edema) after being bitten by attacking bees.

After 7-10 minutes, anaphylactic shock may develop, manifested by the following symptoms:

• deterioration in speech;
• the occurrence of seizures;
• a sharp drop in pressure;
• disorders of nervous activity;
• dizziness, loss of consciousness;
• pronounced rash, itching is possible;
• uncontrolled urination, diarrhea;
• swelling of the respiratory system, the occurrence of spasm.

This phenomenon is most dangerous for pregnant women, since the uterus begins to contract strongly - this can cause premature birth or termination of pregnancy.

Multiple stings are considered the most dangerous, this applies even to those people who do not suffer from allergies.

Many are interested in how to find out if there is an allergy to attacks by bees and wasps in the form of stings. For diagnostics, the level of specific antibodies is measured, and a sample of the skin is taken.

How to proceed

It must be remembered what to do if there is an allergy to any bee sting, and a defeat has occurred. It is urgent to provide first aid and call a team of doctors. The following activities should be carried out:

1. Remove the sting from the skin to stop the additional intake of poison in the body. It is best to do this with tweezers or tweezers, while taking care not to transfer the cavity with the poison.
2. Treat the area with an antiseptic... For this it is permissible to use iodine, alcohol solution, hydrogen peroxide, brilliant green solution.
3. Apply a cold compress to the affected area, change as it warms up, keep for 3-5 hours. This will make it possible to block the spread of toxins.
4. If the bite occurred in the leg or arm, then a tourniquet must be applied above this place, and held for no more than two hours.
5. Provide antihistamine intake in tablets to relieve the reaction from the bite (Suprastin, Tavegil).

Sometimes allergists perform immunotherapy, in which a dose of the allergen is injected several times. Such manipulations contribute to the reduction or complete disappearance of the manifestations of an allergic reaction.

What to do in case of a threat to life

For people prone to bee allergies, one sting is enough for a reaction in the body. If there are signs of allergies such as malfunctioning of the heart, swelling of the mucous membranes, the development of anaphylaxis for a bee sting, then not just treatment is necessary, but urgent first aid.

In any case, contact with insects is best avoided, but if a bite has occurred, then you should not wait for signs of allergy, you must immediately inject an adrenaline injection.

It is important not to panic, as stress hormones are produced, which causes the heart to contract faster and breathing speeds up - this provokes the rapid spread of toxins through the blood.

If the sting was in the area of ​​the face, neck, eyes, oral cavity, then you urgently need to inject a drug with one of these names: Prednisolone, Dexamethasone or Adrenaline 0.1%. Eufillin eliminates bronchial spasms. Carrying out such manipulations makes it possible to block the spread of poison toxins.

Treatment activities

Treatment of allergy to bee stings in a hospital is based on the use of certain medications and the following measures:

• the introduction of Novocaine;
• injection of calcium chloride or gluconate;
• intramuscular injection of an antihistamine substance;
• medicines to keep the heart working.

If anaphylactic shock occurs, then urgent qualified assistance is needed, otherwise the person may die. Treatment of any bee venom allergy must always be prompt and skilled. Especially it concerns child's body when the immune system is not fully formed.

It is acceptable to use folk remedies from bites, allergies in contact with bees, but after consulting a doctor.

Allergy sufferers want to know how to get rid of an allergy to poison, stings of such dangerous bees, is there an antidote. Excellent results are obtained by specific immunotherapy, when a person is injected with an allergen from bees and their venom prepared in a special way. With regard to the antidote, you need to understand that they are quickly and correctly selected drugs.

Timely protection

It is important to understand not only how to treat dangerous bee venom allergy, but also how to prevent it. Preventive measures:

• avoid contact with insects;
• you cannot make sudden movements to drive away the insect, as this attracts its attention;
• carry antihistamines with you;
• install mosquito nets on the windows in the house, they prevent the penetration of insects into the home;
• close the windows in the car during the trip;
• do not use perfumes with sweet aromas, since such smells attract insects, especially when the honey plants are in bloom;
• for work in the garden and vegetable garden, be sure to use gloves;
• when resting in nature, you cannot wear shorts and short-sleeved T-shirts, they must be changed to long trousers and a long sleeve;
• do not walk barefoot on the grass, there are also bees;
• wear a hat, since bites to the head are considered the most dangerous;
• do not wear bright clothes, as they attract stinging insects;
• take food carefully in the fresh air, since a bite in the oral cavity is very dangerous, in addition to this, an insect can accidentally enter the digestive tract;
• Do not crush the bee in any way, as it gives off a smell that warns other bees of the danger, so this behavior can only aggravate the situation.

All these rules must be taught to children, this will make it possible to avoid a bite, since children's allergies are even more dangerous.

If a person is diagnosed with allergies, then he needs to carry with him a special first-aid kit, which contains the necessary antihistamines, adrenaline injections, drugs of the corticosteroid group, a tourniquet, disposable syringes, and disinfection wipes. In this case, it is necessary to ensure that all drugs are suitable for the expiration date.

After the defeat, toxic substances enter the bloodstream and quickly spread throughout the body, therefore, the reaction often occurs rather quickly. It is important to know the rules of conduct, first aid and treatment of a bee sting. Any delay can cost a person his life.

Allergies to mosquito, bee and other insect bites are of varying severity, and in severe cases, they pose a threat to life. The body's hypersensitivity reaction does not depend on the frequency and number of bites.

Symptoms

To assert about the development of allergies, you need to know how the hypersensitivity of the body of an immediate or delayed type differs from a normal reaction to insect bites.

At the site of penetration of the poison, redness and slight swelling appear. The skin itches, itches, there is a seal (infiltration). The bite is accompanied by soreness due to irritation of the nerve endings toxic substances insect.

Important! A normal reaction is considered if the flushing of the skin does not spread to other parts of the body, the symptoms persist from several hours to 2-3 days.

According to ICD-10 (international classification of diseases), insect bites have the following codes:

W57 ─ sting or sting of non-venomous insects;

X21 ─ contact with poisonous spiders;

X23 ─ contact with bees, wasps, hornets;

X24 ─ contact with tropical insects.

Signs of a local allergic reaction

Allergy to insect bites is manifested by extensive localization inflammatory process... The sensitization reaction manifests itself both at the site of the sting and spread over the entire part of the body (arm, leg, face). At the same time, signs of allergy do not affect the entire skin. More often, hyperemia and swelling is located between two joints, if the bite was in the area of ​​the upper or lower limb.

The place of penetration of the poison is hot to the touch, red, swollen. The more stings, the larger the affected area. In some cases, the body temperature rises to subfebrile values ​​(37-37.5 ° C), general weakness, nausea appears, and the functionality of the limb is temporarily limited. Symptoms appear the first day after the bite and progress over the next 12-24 hours. Then they gradually subside. Skin marks disappear in 5-15 days.

Systemic inflammatory response of the body

Systemic allergic reactions are rare, 1-10% of all cases. Signs of a pathological process are not associated with the site of the bite.

The victim has the following general symptoms:

redness of various areas of the skin and mucous membranes (mouth, nasal passages, conjunctiva);

edema of the subcutaneous tissue of the lips, face, eyelids, larynx, tongue, upper and lower extremities (angioedema);

hives ─ skin rashes in the form of blisters that form against a background of high permeability blood vessels, are characterized by severe itching.

A systemic allergic reaction is an acute process that develops rapidly within 15-30 minutes, sometimes later. The more time has passed from the bite to the first signs, the less dangerous the allergic consequences and complications will be.

If life-threatening symptoms develop rapidly, the victim should be hospitalized immediately. With repeated bites, the risk of developing an immediate response increases. Anaphylaxis often develops on stings of hymenoptera (bees, wasps). The risk group includes children with a history of bronchial asthma, people with food allergies.

How anaphylaxis (shock) manifests itself:

tightness in the throat, pressure, heaviness in the chest;

shortness of breath, shortness of breath;

dizziness, impaired coordination of movement;

pain, abdominal cramps, nausea, vomiting, loose stools;

heart palpitations, decreased blood pressure, threadlike pulse;

clouding of consciousness, collapse.

Allergy to stings of various types of insects

An allergic reaction to insect bites is a seasonal phenomenon. The peak of reported cases occurs during the summer months and early fall (September). Allergens are poison, insect saliva, chitinous hairs. Stinging representatives cause severe hypersensitivity. Allergy to midge bites, mosquitoes is diagnosed less often.

Hymenoptera venom allergy

The composition of bee venom includes compounds such as melitin, hyaluronidase, apamine, histamine, phospholipase. These protein substances act on neurons, causing pain, destroy red blood cells, and affect blood clotting. Once in the systemic circulation, they quickly spread throughout the body, dilate blood vessels, and provoke inflammatory reactions.

After a bee sting, swelling immediately occurs, then redness appears. The place where the insect stung (by the presence of a protruding sting) is clearly visible. Immediately there is a local sharp pain, severe burning sensation. Edema and hyperemia quickly spreads over a wider area, sometimes the whole body is covered with a small rash. If the victim's body is hypersensitive, general symptoms appear ─ fever, chills, malaise, and skeletal cramps in children.

Wasp venom contains kinin, a substance that dilates small-sized blood vessels and relaxes their walls. This slows down the venous blood flow in the tissues, and extensive persistent hyperemia is formed.

Against the background of edema and irritation, small vesicles filled with liquid (plasma released from blood vessels against a background of high permeability and inflammation) may appear. With a severe form of allergy, a runny nose appears. A transparent exudate of medium viscosity is released from the nose. Lacrimation intensifies.

Hornet venom has a stronger effect on the body. It affects the functioning of the vital organs ─ heart, lungs, bronchi. Lowers blood pressure, accelerates heart contractions, causes spasm of the bronchial tree and asthma attacks, increases the production of respiratory secretions.

After a hornet bite, a person with high sensitivity develops (swelling of the subcutaneous tissue) on different parts of the body. The skin is covered with spots. Extremities get cold, pulse quickens, dizziness develops. Due to a strong pain symptom, children may lose consciousness.

Hypersensitivity reaction to blood-sucking bites

With mosquito bites, allergies are provoked by specific enzymes contained in the insect's saliva. The reaction manifests itself locally. After the bite, a characteristic swelling (white blister) appears, around the reddened skin. This place itches, itches. Mosquitoes do not crawl under clothes, rugs, blankets. Therefore, the sites of localization of blisters are open areas of the body. Multiple bite marks are often found.

A sign of an allergic reaction to mosquitoes is redness spreading throughout the body. Irregularly shaped elements appear that can merge. The nature of the rash changes over time, the swelling decreases or increases in size. The degree of redness is individual for each organism. Pink papules (seals, nodules) appear. This is a form of urticaria. Due to constant scratching, scabs (dried blood crusts) form on the elements of the rash. In people prone to any manifestations of allergies, a bubble up to 3-4 cm in diameter, filled with liquid (blood plasma), can form at the site of a mosquito bite.

Severe forms of pathology with disruption of work internal organs and systems are extremely rare.

Reaction to

Midges love heat and moisture. Therefore, allergy bites are most common in the middle of summer. People who are near water bodies in the morning and afternoon give in to the attack of insects.

Multiple bites are found on the skin in the form of red itchy dots, mainly on the arms and legs. Then there is an extensive hyperemia of the epidermis, against which there are punctate wounds. Swelling develops.

The bites of midges are more painful, accompanied by irritation, burning. Depending on the reaction of the body, a rash appears on the body, from infiltrates to bubbles with liquid (as in the photo). A black scab remains in the areas of scratching.

In a child, a midges attack can cause general symptoms:

temperature rise to 37.5-39 ° C;

cardiopalmus;

increase in regional lymph nodes(ear, cervical, axillary, inguinal).

High sensitivity to ant bites

After an ant bite, redness immediately appears, which is accompanied by burning pain, irritation. If symptoms persist for more than a day, this indicates an allergy.

Ants bite several times on a limited area of ​​the skin. More often it is lower limbs... With a massive attack (accidental destruction of the anthill), the skin swells, after 2-3 hours blisters appear. Itchy wounds force a person to constantly comb them. This leads to infection and suppuration.

The severity of signs depends on the reaction to ant poison. Rashes are in the form of small, bright red multiple dots or swellings with uneven edges. Children under 6 years of age develop urticaria, less often anaphylaxis.

The most dangerous are exotic species of insects ─ red fire ants, nomadic, bullet ant.

Treatment

Allergy with local characteristics on the skin is treated on an outpatient basis.

No specific therapy is required. Prescribe remedies to relieve symptoms. The complex effect is provided by tablets, capsules of antihistamine action. They block the production of inflammatory mediators, relieve soft tissue edema, itching, and irritation of the epidermis.

Important! Antihistamines should not be given to children without first consulting a doctor!

Allergy medications for adults (solid form):

Claritin ─ is prescribed for the manifestation of urticaria, 1 tab. once a day. There are no contraindications, except for individual intolerance. Price: 30 pcs. RUB 550 (manufacturer Germany).

Lorahexal ─ is indicated for insect bites, itchy dermatoses, angioedema. Treatment regimen: 1 tab. per day. Contraindications ─ pregnancy, severe functional disorders of the liver. Price: 10 pcs. RUB 55 (manufacturer Switzerland).

Erius ─ eliminates urticaria, itching, swelling of the skin and mucous membranes. Assign 1 tab. in a day. Contraindications ─ high sensitivity to components. Cost: 10 pcs. RUB 580 (manufacturer Belgium).

Tsetrilev ─ eliminates urticaria. Not prescribed for chronic functional disorders severe kidney, with glucose intolerance, lactose. Take once a day, at night. Cost: 30 pcs. 440 RUB (manufacturer India / UK).

L-Cet is effective for severe irritation of mucous membranes and skin. Take 1 tab. once a day with a little water. Contraindications ─ individual intolerance, renal failure... Price: 30 pcs. 420 RUB (manufacturer India).

Tavegil ─ is prescribed when severe itching, allergic dermatoses, including insect bites, urticaria. Take 1 tab. 2 times a day, morning and evening. Contraindications ─ sensitivity to components, porphyria (severe genetic liver disease, in which the process of hemoglobin formation is disrupted). Cost: 20 pcs. RUB 215 (made in Italy).

Suprastin ─ is used for allergies to bites of all types of insects, urticaria, dermatoses. Treatment regimen for adults: 3-4 tab. per day, divided into several receptions. Contraindications ─ bronchial asthma, stomach ulcers, glaucoma, arrhythmias, myocardial infarction, renal dysfunction. Cost: 20 pcs. RUB 125 (producer Hungary).

Children are treated similar drugs, which are available in the form of syrups and drops for oral administration. Often appointed in pediatric practice─ Alerzin (14 pcs. 355 rubles), Aleron (10 pcs. 226 rubles.), Telfast 30 mg (10 pcs. 128 rubles.), Cetrin (30 pcs. 243 rubles.).

Important! Before determining if the reaction is allergic and what to do, it is necessary to carry out differential diagnosis... Its purpose is to eliminate serum sickness or toxic reactions.

Elimination of local allergic manifestations

To relieve itching of the skin, eliminate rashes, reduce swelling, use funds local action... These are ointments, gels, creams of natural or chemical origin.

For treatment different types allergic dermatitis recommend such drugs:

antihistamine ointments and creams ─ Elidel, Psilo-balm, Fenistil;

hormonal agents ─ Celestoderm-B, Prednisolone, Hydrocortisone, Lorinden S, Beloderm, Mesoderm, Flucinar, Advantan;

gels and ointments based on natural ingredients ─ Nezulin, Irikar, La Cree.

If the area of ​​the affected skin is extensive, physiotherapy procedures are prescribed. With edema and local hyperthermia, ice is applied to the site of inflammation. Well relieve the itching of the bath from the broth medicinal herbs─ chamomile, thyme, coltsfoot, steelhead, veronica.

With severe pain, nonsteroidal anti-inflammatory drugs are prescribed inside and ointments containing an anesthetic (lidocaine, novocaine, benzocaine).

Treatment of systemic manifestations of allergies

If a person develops anaphylaxis, he is hospitalized and treated under medical supervision.

Principles of emergency care:

injections of adrenergic drugs ─ Epinephrine;

bronchodilators to relax the smooth muscles of the airways;

intravenous administration of blood pressure stabilizers;

systemic use of hormones;

oxygen supply through the mask;

according to indications tracheal intubation.

In order to prevent further recurrence of allergies, it is necessary to avoid staying in places where dangerous insects live. Equip the living space with mosquito nets. Clothing should be cotton and cover arms and legs. A home first-aid kit should contain antihistamines, anti-allergic drops for rhinitis and conjunctivitis, soothing skin ointments. If the hypersensitivity reaction recurs periodically, it is recommended to undergo a course of immunotherapy.

Frequency... Dog bites are reported at 12: 1,000 of the population. Cat bites - 16:10,000.

Code for the international classification of diseases ICD-10:

Causes

Risk factors... Dogs bite more often in the afternoon, especially in warm or hot weather, they do not like half-naked people. Cats bite more often in the morning. Drinking alcohol: Dogs do not like the smell of alcohol.

Symptoms (signs)

Clinical picture- bitten wounds are represented by abrasions, scratches, the edges of the wound are usually torn, crushed.

Diagnostics

Research methods... 75% of bitten wounds are infected - it is possible to sow a culture of microorganisms. X-ray examination of the affected area to exclude bone damage and follow-up in dynamics when osteomyelitis is suspected.

Treatment

TREATMENT

Surgery. Primary surgical treatment of a wound with the removal of non-viable tissue. Suturing the wound is possible if the bite occurred no more than 12 hours ago, a full-fledged primary surgical treatment was carried out, as well as if the surgeon is confident that infection in the wound cannot develop. The imposition of primary - delayed sutures 3-5 days after the bite is optimal for knowingly infected wounds and the impossibility of preventing the development of infection only by primary surgical treatment. For fractures of the bones of the hand, a splint is required.

Drug therapy

Administration of rabies serum for rabies prophylaxis.

Administration of tetanus toxoid (to immunized patients, if more than 5 years have passed since the last vaccination) - see Tetanus.

Human tetanus immunoglobulin with incomplete primary immunization(see Tetanus).

Preventive therapy in the first 12 hours after the bite .. Phenoxymethylpenicillin 500 mg orally 4 r / day (children 50 mg / kg / day orally 2 r / day) for 3 days .. Other drugs - amoxicillin 500 mg orally 3 r / day for adults and 40 mg / kg / day 3 r / day for children, or amoxicillin + clavulanic acid, 250-500 mg orally 3 r / day for adults and 20-40 mg / kg / day 3 r / day for children.

When the first signs of infection appear, amoxicillin + clavulanic acid (until the results of bacteriological studies are obtained).

Alternative therapy (prophylactic or empiric) in patients allergic to penicillin .. Doxycycline. Contraindicated in children under 8 years of age, pregnant and breastfeeding women .. Ceftriaxone or erythromycin. Cephalexin should not be used due to the resistance of P. multocida strains. Approximately 10% of patients allergic to penicillin develop cross-allergy to cephalosporins.

Complications... Septic arthritis. Osteomyelitis. Extensive damage to soft tissues with scarring and subsequent deformation, sometimes with loss of function. Sepsis. Bleeding. Gas gangrene. Rabies. Tetanus. Cat scratch disease.

Forecast... In the absence of complications, the wounds heal by secondary intention after 7-10 days.

ICD-10 . W54 A bite or blow from a dog. W55 A bite or blow from other mammals

International classification diseases ICD -10. Electronic version. Our projects: MKB-10 · MKB-S-3 (dentistry).

International Classification of Diseases ICD-10 Online ICD Codes -10 N20-N23 Urolithiasis disease (11).

You are in the section: International Classification of Diseases, By code, Enter at least three characters of the name or signs of the nosology code.

Artifakia. List of diseases for determining disability

Artifakia code for ICB Ophthalmologists code for microx 10 pseudophakia Case history iridocyclitis of the right eye Case history.

ICD 10. International classification of diseases. Diagnosis codes, names. You can download for free electronic version reference book.

I can not understand if this is again a typo or what, about the ICD code 10 - H53.51. There is an option: Quote: H53.5 Color vision anomalies.

Artifakia. (ICD N25-N28). The degree of impairment of the body's functions, Clinical and functional characteristics of the impairment, The degree of restriction.

ICD-10 codes

Afakia and pseudophakia. Afakia is the absence of a lens. An eye without a lens is called aphakic. Congenital aphakia is rare.

Artifakia Mkb Code

Artifakia. pseudophakia - the lens carried out earlier. pseudophakia with other diseases of both or better seeing eye. ICD code 10. International classification of diseases of the 10th revision (ICD-10, By code, Enter at least three characters of the name or signs of the nosology code.

Class III - Diseases of the blood, blood-forming organs and certain disorders involving the immune mechanism (164)>. Class XV - Pregnancy, childbirth and postpartum period(423)>. Class XVI - Certain Conditions Arising in the Perinatal Period (335)>.

Artifakia of the right eye. Initial cataract Russian Artifakia MKB 10 Artifakia of the eye MKB English Artifakia of the eye MKB code.

ICD 10 code: H26 Other cataracts. If it is necessary to identify the cause, an additional external cause code (class XX) is used. ICD code - 10.H 52.4. Signs and diagnostic criteria: Presbyopia - senile hyperopia. It develops as a result of progressive loss. Artifakia. (ICD N25-N28). The degree of impairment of the body's functions, Clinical and functional characteristics of the impairments, The degree of restriction.

Class XVII - Congenital malformations [malformations], deformities and chromosomal abnormalities (624)>. Class XVIII - Clinical and laboratory symptoms, signs and abnormalities, not elsewhere classified (330)>.

Class XIX - Injuries, poisoning and some other consequences of exposure to external causes (1278)>. Class XX - External causes morbidity and mortality (1357)>.

All about the tick bite according to ICD 10

If a person is bitten by a tick, doctors use a classification under the code ICD 10 to diagnose him. After that, each insect is assigned a code. The classification includes blood-sucking ticks, the length of which is 3 mm. They can be found quite often not only in local forests and parks, but also in many countries on different continents. Experienced medical and scientific specialists distribute all ticks into several types.

Of these, those that feed only on organic matter and are safe for humans and animals are distinguished, as well as those that drink blood and carry infections that are harmful to health: borreliosis, fever, encephalitis. Based on the data collected, only a few people subsequently develop diseases from a tick bite. If this happens, you need to apply for medical care to the emergency room.

International Classifier of Diseases

There are many social spheres, each of which has its own standards. In medicine, they are designated by the code ICD 10 (International Classification of Diseases). It is used by all doctors around the world. Doctors review it every 10 years. The international classification under the code ICD 10 consists of 3 volumes. Each of them is accompanied by separate instructions.

The main purpose of creating ICD 10 is to collect and analyze information from different parts the world about all diseases, some of which even lead to death. Due to the fact that there are quite a large number of them, a code was assigned to each disease. This code consists of several numbers and letters. Due to the presence of codes in the international classification of ICD 10 for each disease, it is much faster and easier to find the information you need about them.

In this section of ICD 10, there are also other codes for diseases from a tick bite according to ICD 10:

Tick ​​bite site

Removing the tick with a thread

When spring comes and the weather becomes very warm, ticks begin to crawl out on the leaves of plants and trees and look for a new victim to profit from. They can be replaced at this time of the year, since in winter they hide from the cold deep in the ground. Therefore, it is not surprising that being somewhere in nature, you may notice a tick bite on your body.

After a tick bite, redness forms around the damaged skin. Noticing this, you need to go to the hospital as soon as possible. It is better not to try to remove the tick on your own and still seek help from a doctor. In some cases, when this is still possible, you can pull out the tick yourself, but you need to be very careful and careful to remove not only its body, but also the proboscis. If you do this immediately after being bitten, the risk of contracting an infection is greatly reduced.

Aerosol for ticks

The peculiarities of the vital activity of these insects include the fact that they can feel the victim, being at a distant distance. At the same time, they see absolutely nothing. It is believed that the most dangerous tick bite: the ICD 10 code can be obtained from a forest or taiga blood-sucking insect. At the time of the bite, an infection enters the blood of a person or animal. Recently, the number of people who have contracted borreliosis exceeds those who have contracted encephalitis.

Due to the fact that these types of ticks are very common, the incidence of bites of these ticks according to the ICD 10 of the International Classification of Diseases is gradually increasing. To determine whether a person is infected with an infection from an insect bite, doctors conduct a study and diagnose ICD 10. The results of a tick bite diagnosis according to ICD 10 can be obtained immediately or the next day after contacting a medical institution.

According to statistics, every year in Russia there are about 500 thousand people who have suffered from a tick bite according to the ICD 10 of the International Classification of Diseases. They deliberately attack both children and adults only if they feel hungry.

Therefore, when going to nature, you need to wear clothes that cover the body as much as possible. Thus, you can protect yourself and your children from the bite of harmful insects. You can also prevent tick bites by using creams and sprays against them. Surrounded by vegetation and greenery, where mites are usually found, the smell of these products will resist them from settling on the skin and taking a bite.

ICD 10 - International Classification of Diseases

In any industry, no matter what you take, there are uniform standards and classification systems. Of course, a similar system should exist in the healthcare sector, and it does exist. International Statistical Classification of Diseases and Related Health Problems(abbreviated as ICD - International Classification of Diseases) is a basic normative document used by physicians around the world. This document is revised every 10 years. The publication consists of three volumes, which include instructions, the classification itself and an alphabetical index.

The purpose ICD-10 is the creation of optimal conditions for the processing and analysis of statistical data on morbidity and mortality obtained from different regions and countries. Verbal diagnoses thanks to ICD-10 converted to an alphanumeric code. This makes it much easier to analyze, store and retrieve data. In addition, the International Classification of Diseases provides common methodological approaches and international comparability of information data.

The ICD structure divides diseases into 21 classes, each of which is designated by Roman numerals. The diagnosis codes themselves consist of a Latin letter and numbers. For example "Influenza Complicated by Pneumonia" denoted as J11.0... a "Pathological intoxication (acute)" - F10.0. Obesity - E66... Above is a list of disease groups and their reserved Latin letters and numbers. From it we can conclude that influenza refers to diseases of the respiratory system, as indicated by the letter J (at the beginning of the code), intoxication - to mental disorders and behavioral disorders (letter F), and obesity - to disease endocrine system, eating disorders and metabolic disorders.

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? ??????? ??????????? ?????????, ?????????? ?????????? ? ??????? ??? ??????? ??????, ????? ?????????? ???????????? ????????, ?????????? ???????????.

? ???????????? ???????? ????? ?????????? ??????? ?????????????? ?????? ? ??????????? ??? ????? ? ?????????? ????????? (3 ??? ???-10). ? ????????? ?????? ???? ????? ??????? ? ????? ????????????????. ?????? ??????? ???????, ??? ? ???????? ??????? ???????? ? ????????? ??????????? ???????? ????????? ??????????? ????????? ? ????? ??????????????? ??? ?????????.

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

?????????? ??????????? ????????? ?? ?????? ????????????? ???????? ("??." ? "??. ?????"), ?????????? ? ?????????.

1 ???? ???-10 ? ??????, ??? ??????????? ??? ? ????????? ? ???? ?? ????? ?????????? ????? ????????, ??? ? ???? 1 ????? ????? ??????????????? ?????????? ? ????????? ??????. ?????????? ????????? ????? ?????? ? ??????? ?????????????? ?????? ???? ? ????????? ?? ??????????, ? ???? ??? ????????????, ?? ?????? ???? ??????? ? ???? 1.

1-? ??? ???-10, ?????????? ????????????????? ????? ??????????? ??? ???????????? ?????????, ???????? ??? ????????? ????? ??? ??? ????????? ??????, ????? ??? ???????.

????? ?? ?????? ??? ??????? ??????????? ????????? ????????? (??????? ???????? ?? ???????? "†" ? "*"). ????? ?? ??????? "*" ? ??????????? ?????????? ?? ???????????? ? ??????????? ?????? ??? ??????????? ?????.

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

???????? ??????????? ?????????, ???????????? ? ?????????? ?????????????? ?? ????????????

???????????? ????, ??? ?????????? ???????????? ?? ?????? ??????, ??? ?????? ???????? ??????????? ??????, ??????, ?????? ?????, ??????? «????????» ????????? ??? ???????????, ? ??? ?? ???????? ????????????? ???????????.

????????? ??????????? ??????????? ???????????? ?????????? ??? ???????????? ??????????? ?????? ???????? ? ???????? ????? ?? ?????? ?????????? ?????????????????? ? ???? ?????????????? ?????????? ? ?????????????? ? ?????? ?????????, ????????? ? ????????? ??????????? ??????.

?????? «??????????????» ??????????????? ???????????? ?????? ???? ?? ??????????? ????? ?????????????, ????? ???????????????? ????????? ??????????????? ???????? ???.

???? ? ????? ??????? ??????????? ?????? ?????? ??????? ?? ??? ??????????, ?? ??????? ?????????????? ?? ??????????, ??????? ? ?????????? ??????? ????????? ????????? ???????? ?????????? ? ?????? ????????????? ? ?????????, ?? ?????? ???????? ??????????? ??????? ??? ????????????.

«????????» ????????? ? «??????» ?????????, ??????????? ? ??????? ??????? ??????????? ??????, ?????? ????????? ??????? ????, ? ??????????? ? ????? ??????? ?? ???????????? ??????????, ????????? ??? ??????????? ? ????????? ?????? ??????? ????? ???????????? «????????» ?????????.

???? ? ?????-?????????? ??? ???????????? ?????????? ????????? ????????? ??? ???????? ?????? ? ??????????? ?????? «?????????» ?????????, ?? ???? ??????? ??????????? ???????? ? ???? ????????????? ??? ??????????? ?????????? «????????» ??????????, ??? ??????? ?????????? ????? ??? ?????????.

2 ???-10.

?????? ?????? ???? ???????? «??????» ?????????, ??????????? ? ??????? ??????????? ??????, ? ?????????? ? «?????????» ????????? ???? ? ?????? ??????? ?????????????? ?? ????????? ???????, ??? ??? ??? ?????????? ????? ??????? ?????? ??? ?????? ??????????? ???? ??? ??? «?????????» ?????????.

???????? ??????????? ?????? ??????

?????????? ?????? ?????? ???????? ?? ????????? "?????????????? ??????? ?????? ", ??????? ???? ???????? ?? ????????????? ??????????? ?? ??????? ?????????? ? ?????? ? 1948 ????.

?????????????? ??????? ?????? - ???:

??????? ??? ??????, ????????? ???? ???????, ??????????-

????? ????????? ? ??????;

?????????????? ??????????? ?????? ??? ???? ???????, ??????? ??????? ??????????? ??????.

??? ??????????? ???????????? ???, ???, ???????? ???? ???????, ????????? ? ??????, ????? ? ???? ??????? ???????? ?? ???, ? ????? ?????????????? ??????.

? ?????? ?????? ?????? ??? ?????????? ??????????? ??????????? ????????????? ? ?????? (????? - ?????????????). ?????????? ????????????? ???????????? ?? ???????????? ????????.

19 ??????? "??????? ?????? " ????????????? ?????? ???? ???????? ?? ????????? ????????? ??????????? ???????????? - "??????????? ???????? ",? ?????????????? ????? ???????? ?????? ???? ????? ??????? ?????????????? ???????: ???????? ???????????, ??? ????????????????????? ??????? ? ????????????, ???????, ????????????? ? ????????????? ???????????.

?????? ?????? ?????? ???????????? ? ??????? ???????????? ? ?????????????? ???????????? (?????? ??????????????????? ?? ?? 19.01.09 ?. ?14-6/10/2-178):

I ??????????? ?????? ???? ??????? ??????, ??? ???? ????? ???? ????????? ?????? ????????? ?), ?????? ?????????? ?)? ?) ??? ?????? ?????????? ?),?)? ?). ?????? ????????? ?) ??????????? ??????, ???? ???????? ?????? ???????? ?????? ? ??????????;

I ?????? 19 ???????????? ????????????? ???????????? ? ???????? ?????????????????? ? ????????? ??????????? ? ????????????: ???????????? ????????? ??????????? ?????????, ??? ???????, ?? ?????? ????????? ?). ????? ?????????? 1-2 ??????????, ?? ??????? ?????????? "?????????? ??????????????????" ? ?????????? ?? ?? ??????? ?????????? ?)? ?). ??? ???? ?????????, ?????????? ??????? ????, ?????? ???????? ???????? ????????????? ?????????, ??????????? ??????? ????. ??????????? ??????????? ????? ?????? ?????? ??? ???????????? ????????????? ? ? ?????? ???????, ??????? ? ???????????????? ???????;

I ?????? 19 ????? ???? ???????? ?????? ???? ?????????????? ???????, ???? ??? ?? ????????? ???????????? ????????? ???-ten.

II ?????? 19 ???????? ?????? ??????? ?????? - ??? ?? ?????? ?????? ???????????, ????????? (???????, ?????????????? ?????????????), ??????? ?? ???? ??????? ? ?????????????? ???????? ??????, ?? ?????????????? ??????????? ??????. ??? ???? ???????????? ????? ?????? ??? ?????????, ??????? ??????? ???? ??????? ?? ?????? ?????? (????????? ???????? ???????????? ???????? ??????). ? ?????? ????? ????? ????????? ???? ???????????? ????????, ????????????? ???????, ???????????? ? ?????? ??????????? ???????, ?????????? ?? ? ?????,? ????? ????????????? ???????? ??? ?????? ??????????? ????????????? (????????, ????), ???????, ?? ?????? ?????, ????? ????????? ? ??????. ?????????? ???????????? ????????? ?? ??????????.

??? ????????, ????? ??? ????????? ?????????????????? ???????????, ??????????? ??????? ??????, ???????????? ?????, ???????, ????????? ? ????????????? ????????,? ??. ????? ???????????? ??????, ???????, ???? ??? ???? ??? ????? ? ???????? (??), ?? ?????????? ???????? ? ????? II ?????? 19 ???????????? ?????????????.

?? ????????????? ???????? ? ????????????? ? ???????? ?????? ?????? ???????? ? ?????????, ?????????????? ???????? ??????, ????????, ?????, ??? ????????? ??? ??????????? ???????????????, ??????? ??????????? ? ???? ???????.

?????????????? ?????????? ?????? ????????????? ?? ?????? ?? ??????????????, ?? ? ?? ????????????? ???????? ??????. ??????? ? ????????????? ???????? ??? ?????????? ??????????? (?????????), ??????? ?????? II. ?? ??????????? ??????????? ??? ?????????? ?????????????????? ??????????????? ??????.

10 ???????????? ? ????? "??? ?? ???-10" ???????? ????????? ?????????????? ??????? ?????? ? ??????????????. ???? ?????? ?????? ?????? ???????????? ? ??? ?? ?????, ???????? ?????? ?????? ??? ?????????????.

? ????? "??????????????? ?????? ??????? ????? ??????? ??????????????? ???????? ? ???????" ???????? ?????? ?????????? ??????? ??????????? ?????? ??????? ? ???????, ?????, ????, ???????, ???????, ?????. ??? ???? ??????? ?????????, ??? ??????, ????????? ?? ?????? ????, ?? ????? ???? ?????? ???????, ?????????? ??????? ????. ?????? ???????? ?????????? ??? ????????? ?????????? ? ??????? ???????? ??????? ??? ????????? ???????????? (??????????).

19 ???????????? ????????????? ? ?????? ?????????? ????????? ??? ???? ?????????? ?????????? ? ????? ?????????????? ??????? ??????.

???? ????????????? ????????? ? ???????????? ? ?????????????? ???????????? ? ????????? ?????????? ??????????????????, ?? ? ???????????? ? "????? ????????? " ?????????????? ??????? ?????? ?????? ????? ?????????? ?? ????? ?????? ??????????? ?????? ??????? I.

2 ???-10.

??????????? ?????????? ??????????? ???????????? ? ??????????? ?????????

1999 ???? ?? ????????????? ?????????????? ????????????? ???????? ? ???????, ????????? ?? ?????????, 10 ?????????? ??????????? ???????? ????? ????????????? ????????????, ????????????? ?? ?????? ??????? ????.

? ????? ? ???? ???????? ????? ?????? ????????? ????????? ? ?????????? ????????? ??????????? ????????????, ?????????? ?????????? ???????? ? ??????????? ????????? ??????????? ? ?????????.

? ???????? ????? ??????? ????????? ??????????? ???????????? ??????????? ? ?????????? ?????????:

"??????????? ????? ????????????? ???????? " (?. 025 /? - 04);

"????? ????????????? ???????? " (?. 025-12 /? - 04);

"??????????? ????? ????????????? ???????? " (? .003 /?);

"?????????????? ????? ????????? ?? ?????????? " (?. 066 /? - 02);

"??????????? ????????????? ? ?????? " (?. 106 /? - 08).

???????? ???? ???????? ??????????? ????????????:

12 "???????? ? ????? ???????????, ?????????????????? ? ???????, ??????????? ? ?????? ???????????? ????????? ?????????? ";

fourteen "???????? ? ???????????? ?????????? ".

? ????????? ??????????? ???????????? ??????? ?????? ???? ??????? ?????????, ??? ??????????, ?????????? ????????.

??? ?????????????? ???????????? ???????? ??? ??????? ??????????????? . ?? ???? ??????? ?? ???????. ??????????????? ????????? ????????? ???????:

1. ???????? ???????????;

2. ?????????? ????????? ???????????, ??????? ?????????? ???????- ?????? ?? ??????? ???????;

3. ??????? ? ????????????? ???????;

4. ????????????? ???????????.

???????? ????????? ?? ??????????? (??????, ??????????), ??????? ???? ?? ???? ??? ????? ???? ?????????? ??????? ??????? ??? ????????? ?? ??????????? ???????, ????? ???????? ?????????????? ? (???) ??????. ??? ??????? ????? ?????? ???????????, «????????» ??????? ??, ?? ???? ???????? ???????? ?????????? ????? ?????????????? ??????????? ????????.

????????????? ?????????????? ????????????? ???????? ?? ???????? ???????? ??? ?????????????? ???????????? ????????, ? ?????? ?????? ??? ??? ????????????.

??????????? ? ???????? ???????? ????????? ???????? ???????, ?????? ? ????? ???????? («??????????? ??????? ??????», «?????????????????? ???????», «????? ????????????» ? ?.?.). ? ???????? «?????????» ??????????? ?????? ???????????? ?????? ???? ?????????? ?????????????? ???????. ??????????? ??????? ?????? ????????? ????????????? ????????? ??? ????????? ???????.

??????? ?????? ???? ??????????? ? ????????????? ???, ????? ??? ????? ???? ????????? ? ????????????? ?????????????? ???, ???????????? ? ?????????? ??? ?????????? ?????????????? ??????.

??????????? ??????????? ???????? ???????????? ???????? ?????. ????-????????? ??? ??????????? ????????? ???????? ?? ???????? ???????? ???????????, ?? ?????? ????????? ???????????? ??????????? ????????? ??????, ? ? ?????? ?????????????? - ????????? ???; ???? ? ??????????? ????????? ?????????? ????????? ??? ???-10, ??????? ????????? ?????????????? ???????? ?????? ???? ????????? ???????? ????? ??? ???????????.

IX "??????? ??????? ?????????????? " ????? ???????? ??????????? ? ?????? ? ?? ???????????? ???????????? ? ????? ???? ???????????.

?. ???????????-??????????????? ?????????? ? ?????????????.

1. «????? ????????????? ????????» - ???????? ??????? ???????? ???????????, ? ??????? ??? ??????????????? ????? ?????? ???? ????????? ????????????? ? ??????? ??????? ? ???????????? ??? ?????????, ????? ?????????? ?????????.

???? ??????? ????????? ?? ??????????? ???????, ????? ???????????,? ????????, ?? "????? ????????????? ???????? " (????? - ?????) ????????? ? ??????????? ????? ??????? ?? ????????? "????????? ???????? ". ??? ???? ???? ??????? ?????? ?? ?????, ?? ???????????? ??????? ? ??????????? ???? ??????????? ??? ???????? ????? ?12 ? ??????? ? ?????????. ???? ??????? ?? ????? ?? ??????, ?????????????? ??? ??????????? ??? ??????? ? ?????????.

????????? - ??? ??????? ???????? ? ?????? ??????????? - ???????????????? ?????????? (?????????????) ??? ?????????? (??? ??????????? ??????????????) ?? ?????? ?????? ? ??????????? ??????? ? "??????????? ????? ????????????? ???????? ", ?????????? ??????, ???????, ??????????? ??????, ???????? ? ???????????? ?? ?? ???-ten, ?????? ????????, ?????? ???????????? ? ????????????? ??????????, ??????????? ???????, ????????????.

??? ?????????? "?????? ????????????? ???????? " ???? ????? ?????? ??????? ? ???? ??????? ??????????? ????????? ? ????????????? ???????????, ?????? ? ?????? ? ????????????? ?????. ??? ?????? ?????????? ??? ?????????? ???????? ????? ? 12.

1.1. ???? "?????? ????????????? ????????? " (I00-I02).

"?????? ????????????? ????????? " - ?????? ???????????, ?????????????????? ?? 3-? ???????. ??????: ????????????? ? ??????? ? ?????? ??????????? - ??????????? ????????????? ??????? ??????.

1.2. ???? "??????????? ??????? ?????? " (I20-I25).

- ??? ?????? ????? ??????????? ???????? ??????. ???? ??????? ???????? ??????????????? ? ???????? ?????? ??? ? ?????, ?? ?????????? ??? "?????? ??????? ???????? " (I21), ??? ??????????? ???????? ???????? ? ?????? ? ???? ?? ???????? ?????????? ??? "????????? ??????? ???????? ", ??? I22.-, ??????? ??????????.

10 ? ?????????? 4 ??????, ??? 28 ???? ?? ?????? ???????????.

??????? ???????? (?????? ??? ?????????), ???????????? ??? ???????? ?????????, ????????????????? ? ????? ??????? ???????? ??????????? ?????? (??????????? ??? ???????????) ?????? ?????????????? ??? ?????? ??????? ?????????? ??????????? (?? ?????? +).

2.1.1. ?? 3-? ??????? ?? ?????? ??????????? "?????? ????????????? ????????? " ?????????????? ?? ??????????????? ?????? ?????? 1000, 2000, 3000? 4000 ??? ??????? ?????????? ??????????? (? +).

2.1.2. ??? ??? "?????? ????????????? ????????? " ??????????? ????? ?? ?????, ?? ?? ??? ???????? ??????????????? (?????? ?????? ?? ?????? "???????????????? ?????"? "??.? .? ?????????, ????????????? ???????? ????? "?????? 1000, 2000, 3000 ? 4000 ?????? ???? ?????).

2.1.3. ????????????? ????? "?????? ????????????? ????????? " ???????? ? ??????? 3-? ??????? (?????? ????? "??????? ???????????? ???????????" ??? ??? 1000, 2000, 3000? 4000 ?????? ???? ????? ???????? 25% ?? ????? ???????? ?????????).

2.1.4. ? ?????? ?????????????, ???? ? ????? ?????? ?????, ?????????? ?????????? ??????????, ?? ??????? ???????????? ???? ?????? XXI “???????, ???????? ?? ????????? ???????? ????????? ? ????????? ? ?????????? ??????????????? " (Z54 ????????? ?????????????; Z86.7? ?????? ???????? ??????? ??????? ??????????????; Z91? ?????? ???????? ??????? ????? ??? ?????). ???????? ???????? ? ???????? 1100, 2100, 3100? 4100.

2.1.5. ???? ??????? "?????? ????????????? ????????? " ??????? ??????????? ????????????? ??????? ??????, ?? ??????????? ??????????? ????????????? ??????? ?????? ???????????? ?? ??????????? ??????, ??? ??????? ?????????? ??????????? (?????? ?????????????? ???????),? ? ?????????? ?????????????????? ? ????????????? ??????? (1 ??? ? ??? ? -) ? ??????? ????? ??????? ????????????? ??????????. ??? ???? ?? ?????? "?????? ????????????? ????????? " ???????? ??????? ? ?????.

2.1.6. ? ?????? ?????? ???????? ?? "?????? ????????????? ????????? " (???? ??????? ??????????? ??????????? ??? ??????? ?????? ????????? ??????????? ????????????), ???????? "??????????? ????????????? ? ?????? " (??????? ?????? 106 /? - 08, ???????????? ???????? ?????????? ????????? ?????? ?? 12/26/08?.? 782?).

2.2. ???? "??????????? ??????? ?????? " (I20-I25).

??????? "?????? ? ????????? ???????? ???????? " (I21-I22) - ? ???????????? ? ???-10 ??????????? ???????? ???????? (??????? ??? ??????????) ?????????????? ?? 28 ???? ?? ??? ???????????.

2.2.1. ? ???????? ??????? ???????? ??????????? ??????, ???? ??????? ?????????? ?? 28 ???? ?? ?????? ???????????, ?? ???????????? ?????? ??? ????????? ??????? ????????, ?????????? ?? ????????????????? ??????????????;

2.2.2. ???? ?????? ???????? ??????????? ?????? ??????? ??????? 28 ??? ?? ??? ?????? ???????????, ?? ???????????? ????????????? ????????????? (I25.8). ????,? ???????? 28 ???? ??????????? ?????? ?????????????? ? ???????? ??????, ?? ??? ?????? ?????????????? ?????????????? ?????????????? ????????????? (??? I25.8);

2.2.4. ??? ??? ?????? ??????????? ??????????????? ?? ????????, ?? ?????? ??????????????? ????? ?? ?????? "???????????????? ????? " ? "? ?.?. ? ?????????, ????????????? ??????? ? ????? " ?????? 3000? 4000 ???????? ????? ? 12 ?????? ???? ?????.

2.2.4. ?????? ? ????????? ???????? ???????? ???????? ????????????? ?????????? ? ??????? 28 ????,? ?????,? ??? ? ????? "??????? ??? ???????????? ??????????? " ?????? 3000? 4000 ?????? ???? ???????? ?????? ?? ???????? ????????, ??????? ???? ???????????????? ? ???? ?????? ??? ????? ? 12, ?.?. ? ??????? ?????? ????????? ????;

2.2.5. ? ?????? ?????? ?? ??????? ??? ?????????? ???????? ???????? ??????? ???????, ??? ?? ??? ?????? ????????? ???????? ?????????? I21-I22:

— ??? ????????? ??????? ??? ?????????? ???????? ???????? ?? ??????????????? ????????????????, ???????? ???????? ??? ???????????? ?????? ?????????????? ???????? ?????? ??????? ??? ???????????, ? ???????? ???????? - ?? ???????????? (???-10, ?. 2, ???. 75), ?????? ????????? ?????? ???? ????????? ???????? ? ?????????????? ?????????? ????????, ?????????? ??????? ??????????? - ?? ??????? 28 ???? ?? ?????? ????????????? ???????? ??? ? ???????? ??????? ???????? ??????????? ??????;

-? ????????? ??????? ?????????????? ???????? ?????? ??????? ??????? ?????? ??? ????????? ??????? ???????? (???? I21-I22)? ?????????? ??????? ?? 28 ???? ??? ? ???????? ??????? ???????? ??????????? ?????? (????, ???? ?????? ?????????? ????? 28 ????);

- ???? ??????? ???????? ???????? ??? ?????????? ????? 28 ???? ?? ??? ?????????????, ?????????????? ???????? ?????? ??????? ??????? ?????????????? ?????????????, ??? I25.8 (??? - 10,?. 1,?. 1, ???. 492);

- ??? I25.2? ???????? ?????????????? ??????? ?????? ?? ???????????, ?????? ????????? ?????????? ??????? ????????, ???????????? ? ??????? ? ????????????????? ?? ???,? ??????? ?????? - ?????????????. ??? ??????? ? ????????? ??????????? ???????????? ?????? ? ???????????? ? ??????? ???????? ???????? ??? ????????? ????????? ? ?????????? ????????? ?????? ???????????, ?????????????? ???????? ?????? ??????? ??????? ?????????????? ?????????????, ??? I25.8;

- ???? I23? I24.0? ???????? ?????????????? ??????? ?????? ????? ?? ???????????, ?????????? ???????????? ???? I21-I22 (??? - 10,?. 2, ???. 61);

— ??? ????????? ???????? ???????? (??????? ??? ??????????) ? ?????????, ?????????????????? ?????????? ???????? ?????????, ????????? ??? ?????? ?????????????? ??????? ?????? ?????? ???????? ???????? ???????? (???-10, ?. 2, ???. 59-61).

2.2.6. ? ?????? ?????? ???????? ?? "??????? ??? ?????????? ???????? ???????? " (?? ?????????????? ??? ???????????????? ??????? ??????) , ???????? "??????????? ????????????? ? ?????? " (??????? ?????? 106 /? - 08, ???????????? ???????? ?????????? ????????? ?????? ?? 12/26/08?.? 782?).