When exposed to the temperature organ over 55 ° or a poisonous chemical compound A lesion of tissues called a burn is formed. The extensive effect of the aggressive medium leads to global changes in the body and negatively reflects on the integrity of the skin, the work of the heart, vessels, immunite.

The degrees of burns legs

1. In case of damage to the first degree foot, only small in the area of \u200b\u200bits zone suffers. Symptoms are associated with a slight change in skin color and edema. The victim does not necessarily apply for medical help. It is necessary to anesthetically in case of need and to displaced the scene.
2. At the injury of the foot of the second degree in humans, a pronounced pain syndrome is observed. Leather on the leg is red covered by blisters different size with translucent liquid. The victim should apply to the trauma, since the risk of infection is high. In addition, the patient has no necessary conditions for the provision of adequate first aid.

The pain is eliminated by medication. The violation of the integrity of the swelling bubbles will not help, but will only increase the risk of entering the infection.

1. When damaged the foot of the third degree makes itself felt the partial necrosis with the preservation of sprout areas of the skin. In a difficult situation, the entire bottom of the leg is amazed. Man will only help urgent hospitalization after first aid.
2. The most severe degree characterized by the complete necrosis of the upper cover, as well as damage and the charging of the inner tissues (muscles, bones). With such injury, death is possible. Treatment is associated with surgical intervention and is carried out only in the hospital.

Thermal burns in the ICD

The international classification of diseases is designed to simplify the storage and analysis of the names of diseases. Used not only in the scientific world, but also in ordinary hospital cards.

Each disease and injury is assigned code. The classification composition is revised every decade.

For burns of the foot and tibia, the numbering is determined by the degree and nature of damage. Distinguish burns:

• thermal;
• chemical.

For thermal burn, the Code of the ICD 10 begins with 25.1 and ends 25.3.

25.0 - the burn of the foot of an uncomputed degree.

Similarly, a classification for chemical injuries is presented: from 25.4 to 25.7.

T24 are thermal and chemical burns The hip joint and the lower limb, excluding the ankle joint and foot, unsuccessful degree.

Risk factors and groups

Injuries of this kind in the field of ankle joint and heels are extremely rare: the lower part of the leg is most often protected by a dense material of the shoe.

But sometimes doctors assign the T25 code on the ICD (sub-clause is determined by the degree), highlighting the following types:

• Thermal burns of the foot area. The damage occurs as a result of non-accurate treatment with any sources of thermal energy: hot items (heaters, batteries, fascinated metals as a result of foreign exposure), boiling water, steam, open flame.
• Chemical burn. Characteristic to hit the skin of various poisonous substances, rapidly or gradually disturbing the integrity of the upper covers. The most dangerous cases include acid and alkali.
• Radiation. Happens when irradiated. Get it in laboratories, at the site of disposal (especially unauthorized) waste of this kind, in the zones of increased radiation.
• Electric. It turns out as a result of the stroke of the foot.

Diagnostics

In case of damage to the ankle joint and the foot of an uncomplicated degree, experts seek to determine the nature of the injury.

To select the correct treatment strategy, the doctor draws attention to:

• depth;
• the area of \u200b\u200bthe affected area.

For this applies:

• "Palm rule";
• "Rule of nine."

In the first case, the area is calculated, based on the principle: proportionally palm takes 1% of the total surface of the skin.

In the second - 1 shin and stop at global injury are defined as 9% of the whole body.

Since children have other proportional dependencies, the Land and Brower table apply for them.

In the hospital to help specialists come film meters with an applied grid.

Treatment

From the quality of the first aid to the victim in the burns of the ankle and (or), the feet depends on further treatment, the availability of complications and the general forecast.

Everyone is useful to familiarize themselves with the simple order of action, performed during burns:

1. From the affected area remove all the clothes. Since the synthetic is used to stick to the skin, it is gently cut off with scissors.
2. Impose a sterile bandage.

It is impossible to use any creams, ointments, powders, compresses. The doctor prescribes medication treatment.

1. The victim helps to take the most convenient position with a fixed injured limb.
2. The only medicine that is given to a person is an anesthetic.

Alone to treat a 1st degree burn is allowed. In other cases, the intervention of a specialist is required.

Further events held in the Medical Institution are related to:

• warning and elimination of inflammation;
• healing.

Often, doctors prescribe a course of antibiotics to prevent the development of infection.

Additional events:

• tetanus vaccination;
• analgesics.

Experts are closely monitored so that the suppurations are not formed.

In special cases, an operation is assigned:

• plastic;
• skin transplantation.

Thermal and chemical burns of easy degree - frequent household injury. Heavy cases are associated with accidents or negligence in production. Sterile materials are used and with suspected degree higher than the first to see a doctor.

Burns are a fairly frequent view of human skin injuries, so a whole section is dedicated to them in the document. international Classification Diseases 10 revision. Consequently, on the ICD 10 thermal burn has a code that matches the scale and location of the area of \u200b\u200baffected skin.

Classification

Thermal damage to the surface of the body of updated localization have a cipher in the T20-T25 range. Characteristic damages in multiple form and unspecified localization are encoded as T29-T30, depending on the prevalence of the lesion. The T31-T32 code is usually used as an addition to the T20-T29 rubrics in determining the scale of skin lesion on the human body in the percentage ratio. For example, a thermal burn of 70-79% of the surface of the entire body has a cipher T31.7, which can additionally characterize any code from the T20-T29 rubric.

In burn centers, such data of world nosology provide colossal assistance in determining the degree of diagnostic, medical events, as well as forecasts.

For many years, highly qualified specialists have been successfully used in practice Local Protocols for first aid and conduct patients with a burn damage to the skin of the body of any localization and the lesion stage.

Definition of pathology

In ICD 10, thermal burn is formed due to the impact on the skin of hot liquids, steam, flame or strong flux of hot air. Chemical burn is obtained by hitting aggressive solutions chemical composition, for example, acids and alkali. They are capable of provoking necrosis of tissues even deep layers of skin in a short period of time.

The burn surface is distinguished and qualified according to the degree of propagation and damage to the skin and subcutaneous tissues as follows:

• redness and sealing of the skin area (1 degree);
• blister formation (2 degree);
• necrosis of the upper layers of the skin (3 degree);
• complete death of the epidermis and dermis (4 degree);
• the lesions at which all layers of skin die are dying and involved in the necrotic process of subcutaneous tissues (5 degree).

The thermal burn code of the foot, hands, abdomen or back depends on the scale of the process's prevalence, according to the recommendations of the local protocols in the ICD 10.

The area of \u200b\u200bthe lesion is determined using the "Rules of Nine", that is, each part of the body corresponds to a certain percentage of the entire surface.

So the head and hand are 9%, the front (belly and chest), the rear surface of the body (spin) and the foot of 18%, 1% is assigned to the crotch and genitals. More experts can use palm, the area of \u200b\u200bwhich is conditionally equal to about 1% of the area of \u200b\u200bthe entire body of a person.

For example, thermal burn brushes, facial or foot will be 2% of the burn surface. When establishing the prevalence of the process, the doctors take into account the conditions under which tissue injury occurred. Important aspects It is considered: determining the nature of the agent, the time of its impact, ambient temperature and the presence of aggressive factors in the form of clothing.

Thermal burn (code on the ICD-10) is skin damagewhich differ in the international classification of diseases. This system has been operating since 1998 to this day. The article will analyze the degree of thermal burns and ways to provide first aid.

The burning of the epithelium or deeper layers of the skin arising from open fire, the heated objects are called thermal. The impact emanating from solid, liquid and gaseous substances having a high temperature is taken into account.

Damaged damage is dangerous, and may cause death. Among the thermal burns, the code on the ICD-10 T20-30 is the bolery, impact strikes, radiation, friction, electric strokes and heating appliances. This classification does not include diseases caused by ultraviolet radiation, Erythema.

Causes of lesions:

• the fire;
• boiling water or steam;
• touching hot objects.

Depending on the depth of the lesion and the type of damage, the severity of the patient's condition is diagnosed. At the launched stages of this kind of injury are the causes of death.

The treatment is complex, long, because the skin overheating is accompanied by the destruction of proteins involved in the tissue update and cellular construction.

Features of burns at different parts of the body on the ICD

Differ in the area of \u200b\u200bdefeat on the human body:

1. Head and neck.
2. Torso.
3. Shoulder belt and upper limbs.
4. Brushes, wrists.
5. Hip zone, leg, legs.
6. The ankle joints and feet.

Damage to the head and neck includes a violation of the integrity of the cover of the ears, eyes, the hair. Separately, wounds, limited to the eye area, mouth and pharynx are considered separately. Danger is proximity to the nasal mucosa, eyes.

If the side or straight walls of the abdomen are damaged, back, rib cage, groin, genitals, then they are classified according to the ICD 10 T21. Exceptions are the wounds of the scaling area and the axillary zones discussed in T22.

When the wound is distributed between zones or it is impossible to determine the severity of the lesion, it is referred to in unspecified localization.

Thermal effect on the shoulders, the forearms of the brush and hands are classified to T22.

Burning the skin of wrists, brushes, including nails, palms - a separate item. T24 over MKB-10 includes thermal burns of hip, limb injuries. Damage to the foot and ankle - in paragraph T25.

The degree of thermal burns and their consequences

Under the influence of high-temperature modes, human skin is injured. If the flame was affected, with the initial processing of the wound, it is difficult to remove the remains of burnt clothing. In the future, the flats will cause infection.

The hot liquid that fell on the epidermis leads to the formation of the wound. When burning a shallow, but often amazes airways. When touched with hot objects, the wound is clearly defined, deep, but when removing the focus of exposure, an additional detachment occurs. There are several degrees of thermal exposure on the ICD-10:

• soreness of the epithelium;
• formation of bubbles;
• burning fiber;
• fabric death, charging of muscle and bone joints.

At the first degree, the tour is damaged, they appear red, swelling. Two or three days later, the location suffered the thermal creation is healing. At the end of the lunch of the dermis, the tracks from the outside disappear. The thermal burn of the foot or fingers on the ICD-10 in the second stage is less dangerous than damage to the face and chest. When burning to a spike layer, bubbles filled with gray are formed. Regeneration of the consequences lasts a month or more.

The epithelium, dermis suffer to the third degree. Wound - Strip of black, brown, painful sensitivity below. In the absence of infectious complications and secondary recesses, the cover is independently restored for six months. When destroying bone tissues, the fourth degree is diagnosed.

Urgent help

Oil ointments and fat do not apply. It only aggravates the state, and subsequently you will have to remove the film from the oil, which will hurt the victim. Incorrect bandage imposition will worsen the patient's condition, lead to edema and the occurrence of suppuration.

The striking factor should be eliminated, and the burned zone is cooled under running water half an hour, if the integrity of the epidermis is not violated.

The use of a harness without need will result in loss of limb. The most correct solution when receiving the burn is the appeal to medical institutionwhere pain relief and processing.

The burn is a local violation of the integrity of the body tissues as a result of the effects of high temperature or chemical reagents. Depending on the etiology of the external factor, they are divided into thermal (temperature factor), chemical (alkali, acid), radiation (solar strike), electric (lightning strike). According to WHO, the thermal injuries account for about 6% of all injuries.

The burning of the ICD 10 is classified according to a variety of criteria (the nature of damage, the severity of injury, localization, by lesion area) to immediately determine the method of treatment, projection of the outcome.

Clinical manifestations of thermal damage are based on the depth of skin lesion. With the 1st degree, the burn has the appearance of a hyperemic and edema. The pain remains for three days. Complete regeneration of the skin without visible defects occurs.

Characteristic is the presence of blisters. Occurred middle defeat Skin and swelling of the packer layer of the dermis. In the damage zone there is severe pain, limited redness, burning, swelling up to the demarcation line.

Bubbles are easily infected during the wound process. If you do not comply with the rules of aseptic, the development of a purulent-inflammatory focus is possible.

It is characterized by a sharp pain, and a black stamp is formed on the body. Regeneration occurs slowly, with the formation of a scar.

With the 4th degree of damage, the formation of blisters, as well as a dark red stamp.

Views

Thermal burns On the ICD-10 (international classification of the 10th review of the 10th revision) have a range of T20 to T-32. Each species has its own code on the ICD 10, which is then indicated in the diagnosis in the history of the disease.

T20 - T25 Thermal and chemical burns of external parts of the body, with a certain localization. The list indicates the stage of damage. Thermal burns on the ICD-10:

• T20. Heads and necks.
• T21. Middle body.
• T22. The upper free limb, excluding the wrist and phalange of the fingers.
• T23. Wrists and brushes.
• T24. Lower limb, except the ankle and the plantar part of the foot.
• T25. Areas of the ankle and foot.
• T26. Limited periorbital zone.
• T27. .
• T28. All.
• T29. Multiple bodies.
• T30. Indefinite localization.

Code codes from T30 to T32 are composed, depending on the affected surface of the adult body. Burn code determines the class of diseases.

Degree

The classification of the depth of tissue damage allows determining the level of development of the pathological process and predict further actions.

Degree of lesion:

First degree. It occurs due to insignificant and short-term contact with a hot surface, liquid or steam. The defeat affects only the layer of the epidermis.

Second. There is damage to the layer of epithelial cells. Over the skin, spherical shapes are formed, containing a blood plasma, rich leukocytes - bubble.

Third. Typical skin necrosis. Allocate two stages:

• IIII - necrosis at the level of epithelial cells and the surface layer of the dermis;
• IIIB - necrosis at the level of the dermis to the mesh layer inclusive, with destruction hair follicles; Skin glands, with partial transition to the hypoderma.

Depending on the aggregate state of the agent, which has anticipated with the skin, highlight wet burns and dry. It occurs with a long, massive effect on the surface of the epithelium of the thermal factor.

Fourth. The most large-scale degree. May result in death. All 3 layers of skin, underlying fabrics are subject to necrotic changes.

Diagnosis and degree of degree

For reliable diagnostics, there is a special algorithm for collecting information.

1. Conduct analysis of anamnesis at the same time as necessary research.

In the history of the disease should be indicated:

• receiving time;
• place of receipt (open / closed room);
• how was obtained;
• what was obtained.

At this stage, the doctor finds out the quality of the first emergency care, conducts a collection of general anamnesis. It is necessary to compile a subsequent treatment scheme.

In general, the history list:

• chronic pathology;
• operational operations;
• the presence of allergies;
• hereditary pathologies.

1. Based on the information received, the doctor conducts a general inspection:

• Evaluate the lesion area depending on the proportions of the body;
• Degree of lesion (1-4);
• The area of \u200b\u200bintact body sections is determined;
• It turns out the localization of thermal injury (on lower limbs In general, diffuse on foot and foot);

The surgeon defines the testimony for hospitalization, conducts the necessary medical measures.

15-10-2012, 06:52

Description

Synonyms

Chemical, thermal, radiation eye damage.

Code of the ICD-10

T26.0.. Thermal burn of the eyelid and the near-eyed area.

T26.1.. Thermal burner burn and conjunctival bag.

T26.2. Thermal burn leading to the rupture and destruction of the eyeball.

T26.3. Thermal burn of other parts of the eye and its apparatus.

T26.4.. Thermal burn eye and its apparatus of unspecified localization.

T26.5.. Chemical burns of the century and the near-eyed area.

T26.6. Chemical burns of the cornea and conjunctival bag.

T26.7. Chemical burn leading to the rupture and destruction of the eyeball.

T26.8. Chemical burns of other parts of the eye and its apparatus.

T26.9. Chemical burn eye and its apparatus of unspecified localization.

T90.4.The consequence of the injury of the eye of the near-eyed area.

CLASSIFICATION

• I degree- hyperemia of various departments of the conjunctiva and the zone of limb, surface erosion of the cornea, as well as hyperemia of the skin of the eyelid and their swelling, lightweight.
• II Stepnb - Ischemia and superficial necrosis conjunctivations with the formation of easily removable protein stuffing, roinsing the cornea due to damage to the epithelium and surface layers of stroma, the formation of bubbles on the skin of the eyelids.
• III degree - Necrosis conjunctiva and cornea to deep layers, but not more than half the area of \u200b\u200bthe surface of the eyeball. The color of the cornea is "matte" or "porcelain". Notes changes in the ophthalmotonus in the form of a short-term increase in WFD or hypotension. The development of toxic cataracts and iridocyclitis is possible.
• IV degree - Deep defeat, necrosis of all the layers of the age (up to charred). Defeat and necrosis conjunctivations and sclera with ischemia vessels on the surface of over half of the eyeball. The cornea "porcelain" is possible a fabric defect. Over 1/3 of the surface area, in some cases it is possible to run. Secondary glaucoma and heavy vascular disorders - front and rear uveitis.

ETIOLOGY

Conditionally allocate chemicals (Fig. 37-18-21), thermal (Fig. 37-22), thermochemical and raughter burns.

Clinical picture

General signs of burn burns:

• the progressive nature of the burning process after stopping the impact of the damaging agent (due to the impairment of metabolism in the tissues of the eye, the formation of toxic products and the occurrence of the immunological conflict due to autoinoxication and autosensibilization to the post-commencement period);
• next to recurrence inflammatory process in the vascular shell at different times after receiving the burn;
• trend towards the formation of synechs, adhesions, the development of massive pathological vascularization of the cornea and conjunctiva.

Stage of the burn process:

• Stage I Stage (up to 2 days) - rapid development of necrobiosis of affected tissues, excessive hydration, swelling of the connective tissue elements of the cornea, dissociation of protein-polysaccharide complexes, redistribution of acidic polysaccharides;
• Stage II (2-18 days) - manifestation of severe trophic disorders due to fibrinoid swelling:
• III stage (up to 2-3 months) - trophic disorders and vascularization of the horn shell due to tissue hypoxia;
• The IV stage (from several months to several years) is the period of scarring, increasing the number of collagen proteins due to the increase in their synthesis of cornea cells.

DIAGNOSTICS

The diagnosis is based on the anamnesis and clinical picture.

TREATMENT

Basic principles of eye burns treatment:

• emergency assistance aimed at reducing the damaging effect of the burn agent on the tissue;
• subsequent conservative and (if necessary) surgical treatment.

When rendering emergency care, the victim is necessarily intensively washing a conjunctive cavity with water for 10-15 minutes with a mandatory twist of the eyelids and washing the tears, thorough removal of foreign particles.

Washing is not conducted with a thermochemical burn if a penetrating wound is detected!

Operational interventions on centuries and eye apple In early dates are carried out only with the aim of preserving the body. Conduct vitrectomy of burned fabrics, early primary (in the first hours and days) or a delayed (after 2-3 weeks) blepharoplasty with a free skin flap or skin flap on a vascular leg with a single-metoslamist transplant to the inner surface of the eyelids, archs and on the scler.

Planned surgical interventions on centuries and eyeballs with the consequences of thermal burns are recommended after 12-24 months after the burn injury, because on the background of autosensibilization of the body arises allevousinization to the tissues of the transplant.

With heavy burns, it is necessary to introduce subcutaneously 1500-3000 ME anticipable serum.

Treatment of I Stage Burns Eye

Long irrigation of the conjunctival cavity (for 15-30 minutes).

Chemical neutralizers are used in the first hours after the burn. Subsequently, the use of these drugs is inappropriate and can provide a damaging effect on buried fabrics. For chemical neutralization, the following means apply:

• pitch - 2% solution boric acid, or 5% citric acid solution, or 0.1% solution of lactic acid, or 0.01% acetic acid:
• acid - 2% sodium hydrocarbonate solution.

With pronounced symptoms of intoxication, intravenously drip 1 time per day Belvidon to 200-400 ml per night drip (up to 8 days after injury), or a 5% dextrose solution with ascorbic acid 2.0 g in volume 200-400 ml, or 4- 10% Dextran solution [cf. Like. Weight 30 000-40 000], 400 ml intravenously drip.

NSAID

H1 receptor blockers: chloropiramine (inside 25 mg 3 times a day after eating for 7-10 days), or Loratadine (inside 10 mg 1 time per day after eating for 7-10 days), or fexofenenadine (inside 120-180 mg 1 time per day after eating for 7-10 days).

Antioxidants: methyl ethylpyridinol (1% solution of 1 ml intramuscularly or 0.5 ml of parabulbarno 1 time per day, per course 10-15 injections).

Analgesic: Sodium metamizole (50%, 1-2 ml intramuscularly with pain) or ketorolac (1 ml with intramuscular pain).

Preparations for instillations in the conjunctival cavity

For heavy conditions And in early postoperative period The multiplicity of instillation can reach 6 times a day. As the inflammatory process decreases, the duration between the instillations increases.

Antibacterial agents: Ciprofloxacin ( eye drops 0.3% 1-2 drops 3-6 times a day), or offloxacin (eye drops 0.3% 1-2 drops 3-6 times a day), or Tobramycin 0.3% (eye drops, 1 -2 drops 3-6 times a day).

Antiseptics: Plexoxidin 0.05% 1 drop 2-6 times a day.

Glucocorticoids: dexamethasone 0.1% (eye drops, 1-2 drops 3-6 times a day), or hydrocortisone ( eye ointment 0.5% for the lower eyelid 3-4 times a day), or prednisone (drops of eye 0.5% 1-2 drops 3-6 times a day).

NSAID: Diclofenac (inward 50 mg 2-3 times a day before meals, course 7-10 days) or indomethacin (in-25 mg 2-3 times a day after meals, course 10-14 days).

Midryatiki: Cyclopentolate (eye drops 1% 1-2 drops 2-3 times a day) or tropiacal (eye drops 0.5-1% 1-2 drops 2-3 times a day) in combination with phenylephrine (eye drops 2 , 5% 2-3 times a day for 7-10 days).

Corneal Regeneration Stimulants:actovegin (gel of the eye of 20% for the lower eyelid one drop 1-3 times a day), or solicoryl (gel of the eye of 20% for the lower eyelid one drop 1-3 times a day), or decapantenol (gel eye 5% for the lower eyelid 1 drop 2-3 times a day).

Surgery: Sectoral conjunctivotomy, paracentesis, necratetomy conjunctivations and cornea, genonoplasty, corneal bioproopy, plastic age, layered keratoplasty.

Treatment of II Stage Burns Eye

PDP groups, stimulating immune processes that improve the utilization of oxygen and reduce tissue hypoxia are added to the treatment.

Fibrinolysis inhibitors:aprotinin in 10 ml intravenously, for a course of 25 injections; Installing the solution in the eye 3-4 times a day.

Immunomodulators: Levamizol 150 mg 1 time per day for 3 days (2-3 courses with a break of 7 days).

Enzyme preparations: Systemic enzymes of 5 tablets 3 times a day 30 minutes before meals, drinking 150-200 ml of water, the course of treatment is 2-3 weeks.

Antioxidants: methyl ethylpyridinol (1% solution of 0.5 ml of parabulbarno 1 time per day, per course 10-15 injections) or vitamin E (5% oily solution, inward 100 mg, 20-40 days).

Surgery: layered or through keratoplasty.

Treatment III The stages of burn burns

The following is added to the treatment described above.

Midships of short-term action: Cyclopentolate (eye drops 1% 1-2 drops 2-3 times a day) or tropicamid (eye drops 0.5-1%, 1-2 drops 2-3 times a day).

Hypotensive drugs: Betaxolol (0.5% eye drops, 2 times a day), or thymolol (0.5% eye drops, 2 times a day), or dorzolamide (2% eye drops, 2 times a day).

Surgery: Ceratoplasty for emergency testimony, anti-cloudomatous operations.

Treatment of IV stages of burn burns

The following is added to the treatment.

Glucocorticoids:dexamethasone (parabulbarno or under conjunctiva, 2-4 mg, per course 7-10 injections) or betamythazone (2 mg of Betamethazone phosphate dynatory + 5 mg of betamethazone dipropionate) parabulbarno or under conjunctival 1 time per week 3-4 injections. Triamcinolone 20 mg 1 time per week 3-4 injections.

Enzyme preparations in the form of injections:

• fibrinolysin [person] (400 units Parabulbarno):
• collagenase 100 or 500 KE (the contents of the vial dissolve in a 0.5% solution solution, 0.9% solution of sodium chloride or water for injections). Impact subconjunctivally (directly in the lesion center: Spike, scar, art, etc. with the help of electrophoresis, phonophoresis, and also apply from you. Before use, they check the patient's sensitivity, for which 1 ke is introduced under the conjuncture of the patient and observe 48 hours. Absence allergic reaction Conduct treatment for 10 days.

Non-media treatment

Physiotherapy, eyelid massage.

Approximate disability

Depending on the severity of the lesion, 14-28 days are. Invalidation is possible in case of complications, loss of vision.

Further maintenance

Observation of the ophthalmologist at the place of residence for several months (up to 1 year). Control of ophthalmotonus, state status, retina. With a raising increase in WFD and the absence of compensation on drug regimens, an anti-cloudsomatous operation is possible. Under development traumatic cataract The removal of a turbid lens is shown.

FORECAST

It depends on the severity of the burn, the chemical nature of the damaging substance, the timing of the arrival of the victim in the hospital, the correctness of the appointment of drug therapy.

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