Thanks to a large number of studies on community-acquired pneumonia (CAP) by scientists around the world, new data are emerging on various aspects of the problem. Therefore, it is necessary to regularly update knowledge on this issue. Despite the tendency to decrease in recent years, the incidence of CAP is 5-10 cases per 1 thousand of the population. In the structure of the general morbidity of respiratory diseases, CAP ranks 2nd in the adult population and 1st in children. Mortality from CAP ranges from 5% to 25-50% depending on the severity, mechanisms of development and personality of the patient (age, nutritional status, concomitant diseases, immune system, etc.), increasing with the growth of diseases of the upper respiratory tract caused by pneumotropic viruses. The clinical lecture presents current data on the features of etiology, previously little known mechanisms of the pathogenesis of CAP, the clinic of typical bacterial, viral, fungal, mycoplasmic and parasitic CAP, as well as the features of the disease in patients with severe immune disorders (AIDS, other diseases/pathological conditions) and aspiration pneumonia. In short form there are discussed the main recommendations for the treatment of CAP in various clinical groups: outpatients, persons with mild CAP, patients with severe CAP with suspected infection with Pseudomonas aeruginosa and aspiration.
Any professional medical activity carries the danger of complications. According to the ICD-10, any pathological process which resulted from a medical action is iatrogenesis. Now, when the aggression of therapy surpasses the severity of the disease, the problem of iatrogenesis is of particular importance. The complications caused by catheterization of a subclavian vein make 2.7-11.2% cases of iatrogenesis, serious complications – 1.2%. The hemothorax is an infrequent complication of this manipulation, its frequency doesn't exceed 0.4-0.6%. The hemothorax with a lethal outcome is a medical casuistry. This work is devoted to one case of traumatic iatrogenesis, i.e. to a complication of a puncture of a subclavian vein by hemothorax with the volume not less than 4.5 liters, with development of an acute respiratory failure and a lethal outcome.
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