Foreign body in the breath. Principles of immediate assistance

Anyone can choke on food or water. That is why you should know the main principles of helping the victim. You can often hear the phrase: “Water went down the wrong throat.” What does this mean, and if this happened, how to deal with it?

Causes and symptoms

Why is this possible? The fact is that people carelessly and sometimes irresponsibly take the advice of experts: drink and eat slowly, do not talk at this time, chew food thoroughly. Such neglect simple rules can cost your health, and in some cases lead to a tragic outcome: food ends up “in the wrong place” and moves down a different path intended for air.

Elderly people who, due to their anatomical capabilities (lack of teeth or incorrectly selected dentures), cannot chew food well.
Children under 6 years old.
Patients with injuries or anatomical pathologies that may affect the swallowing process (for example, cleft lip).

A person who chokes on saliva or a sip of water will definitely start coughing. This great way clear the airways of any liquid that has entered there. Most often, such people do not need outside help. But if something hard gets into the wrong throat foreign body(seed, apple or berry seeds, bread crumbs), breathing is blocked partially or completely, the person begins to choke. The face changes color to pale or, conversely, burgundy.

It is important that the choking person does not panic, since in this case attempts to inhale air become more frequent, which can lead to pushing an unnecessary object deeper into the trachea or lungs. Also, you should not “help” the patient by randomly tapping on the back, especially if the person is in vertical position, because in this case what is stuck in the throat can move lower.

What to do?

It is most difficult to cope with a problem when there is no one near the victim. To save his life, he will have to help himself get rid of the foreign body in the larynx. Food that gets into the windpipe will not go away on its own. She needs to cough it up. A cough can be provoked by bending forward and down, while inhaling slowly and sharply pushing the air out of the lungs. The process of expectoration is possible only if the larynx is not completely blocked.

If the person who is choking cannot cope on his own, the person is suffocating, it is imperative to call ambulance. In the meantime, it is necessary to provide first aid medical care: tilt the victim forward and lightly tap between the shoulder blades several times (5 times is usually enough). Water or food debris should come out of your throat. If the method does not bring results, you need to use the Heimlich method:

Stand behind the patient.
Wrap your arms around him so that your hands meet in the area between the chest and the navel.
Make a fist with your other hand around it.
Press your fist at the indicated point, while squeezing your elbows and raising your fist up to your chest. Carry out the manipulation until the patient can breathe on his own.

Doctors advise combining tapping on the back in the interscapular area and the Heimlich method, performing them in turn. Please note that in the case of pregnant women, this method is also acceptable, but you need to press not on the stomach, but at the base chest(to avoid damage to the fetus). It is also worth acting when saving a person with overweight.

A food product stuck in the esophagus can not only cause a feeling of discomfort. It may well damage the walls of this section of the gastrointestinal tract. Such consequences cannot be treated independently; it is recommended mandatory consult a doctor.

Loss of consciousness during asphyxia due to the failure of air to pass into the lungs due to the larynx being blocked by food particles is not uncommon. It is recommended to place the patient on his back (the victim's head should not turn). Feel free to sit on top, then place your fist between the navel and the inframammary area and apply pressure several times, performing the same movements as if you were standing behind the person and using the Heimlich method.

How to help a child?

If something gets in your throat small child, in no case should you try to remove the object with your fingers: crumbs from the larynx can get into the respiratory tract. In addition, the pharynx and mucous tissues in children are too delicate and can be easily damaged - this will lead to serious complications and long-term rehabilitation. The first thing to do is call an ambulance team.

When you are waiting for doctors, you cannot sit idly by. Make sure your child's nose is clear of mucus. If the baby chokes, turn him over on his tummy, lift him by the legs so that his head is lower than his body, and lightly tap him on the back. But use this method only if you have the skill of saving a person in a similar situation. If you are not confident in your abilities, it is better not to take risks: a careless blow with a little more force than required can not only block breathing even more, but also lead to rupture of the lungs.

Children over 10 years old can free their breathing using the Heimlich method.

On the Internet on forums you can also find information that if a child chokes on water or milk, raise his hands up.

To avoid food or drink getting into the trachea or lungs, you must always remember the saying “When I eat, I am deaf and dumb!” As practice shows, food or water goes down the wrong throat of an adult at the moment when he wants to express his opinion.

Situations in which a foreign body can enter the respiratory tract often occur. Active communication and laughter during meals, hasty absorption of food with poor chewing, alcohol intoxication- the most common causes of such cases in adults.

But even more often, cases of foreign objects entering the respiratory tract occur in children (more than 90%). They love to put it in their mouth small items, while eating, they twirl, talk, laugh and play.

Sometimes it is enough for the victim to cough quickly to clear the airways. But if the coughing attacks continue, the person begins to grab his throat, cannot breathe, his face, initially red, begins to turn pale and then turn blue - emergency help is required. Delay threatens his life and health. It is necessary to immediately call an ambulance and take urgent measures to clear the airways.

Removal of a foreign body from the respiratory tract using the Heimlich maneuver

In children

Signs: The victim is suffocating, unable to speak, suddenly becomes cyanotic, and may lose consciousness. Children often inhale parts of toys, nuts, and candies.

In adults

In pregnant women or obese victims (it is impossible or impossible to give abdominal thrusts).

If the victim loses consciousness, call an ambulance and begin cardiopulmonary resuscitation. It is carried out only on a hard surface.

Continue resuscitation until arrival medical personnel or until spontaneous breathing is restored.

After breathing has been restored, place the victim in a stable lateral position. Ensure constant monitoring of breathing until emergency medical assistance arrives!

Everyone knows that it is better to prevent injuries or illnesses than to be treated later and suffer from their consequences. Avoiding foreign bodies entering the respiratory tract does not require much effort. It is enough to follow a few simple rules:

do not rush to eat and chew food thoroughly;
while eating, do not be distracted by conversations, arguments and showdowns - violent emotions, laughter and sudden movements with a full mouth can result in Heimlich maneuvers;
do not eat while lying down, while walking on the street, in transport, especially while driving;
wean children off and not put it in their mouth themselves foreign objects: pen caps, coins, buttons, batteries and the like.

One of the most critical pathologies that anyone can encounter - a foreign body in respiratory tract. Emergency assistance in these situations should be provided instantly - in the first seconds. Certain maneuvers that anyone can master can save the lives of adults and children if applied immediately.

This pathology develops many times more often in patients childhood. This is due to the behavioral characteristics of babies - while eating they tend to play, talk, laugh or cry, and cough. In addition, children very often put various small objects in their mouths, which they can then accidentally inhale. Anatomical features oral cavity and underdevelopment in children protective reflexes also contribute to an increase in cases of aspiration (inhalation) of foreign bodies (FB) in young patients.

Adults most often suffer from this pathology when greedily absorbing food without chewing it or when actively talking while eating. Another “aggravating circumstance” is alcohol intoxication, which reduces activity nerve centers responsible for protective reflexes.

Symptoms of a foreign body in the respiratory tract

The peculiarity of this pathology is that most often it occurs while eating. This - important information, allowing us to assume that a person loses consciousness precisely as a result of a foreign body, and not, for example, heart attack(although this is also possible).

Clinical picture a foreign body goes through three stages in its development:

initial stage, in which there is a sudden strong paroxysmal cough, lacrimation, facial redness;
development– the cough becomes stronger, there is practically no breathing, although breathing movements the patient does, cyanosis appears around the lips;
final stage, during which breathing stops, the person loses consciousness, after short time cardiac arrest is observed, followed by clinical death.

How to recognize a foreign body in the respiratory tract by external signs

The moment a foreign body enters the respiratory tract looks like this:

suddenly the person stops talking, laughing, screaming or crying, and grabs his throat with his hands;
a severe cough occurs, the victim stops answering questions;
when the victim tries to breathe, either wheezing is heard or nothing is heard; the victim opens his mouth wide, but cannot inhale;
the face, initially red, quickly becomes pale, and then acquires a bluish color, especially in the area of the upper lip);
within a few tens of seconds, loss of consciousness occurs due to respiratory arrest;
very short term the heart stops working and clinical death occurs.

First aid for foreign bodies in the respiratory tract

A person who knows how to recognize this pathology will not waste a second. The situation is developing rapidly and delay in providing first aid can cost the victim his life.

The algorithm of actions for this pathology is as follows:

Contact the victim with the question “What happened?” You may look stupid, but in reality this question is needed to understand whether the person is breathing at all. Your further tactics will depend on this.
If a person is somehow breathing, encourage him with the words “Cough, harder, more, come on” - any words that will “break through” to his consciousness. Often this is enough for a small foreign body that has entered the upper respiratory tract to come out on its own.
If spontaneous release of FB does not occur within 30 seconds or if the person is not breathing from the very beginning, then the Heimlich maneuver should be applied.

Heimlich maneuver

The technique for doing it is as follows:

Stand behind the victim.
Grasp his torso with both hands, cover his fist right hand palm of your left hand and use the knuckle of your right thumb to press five times firmly on the top part belly. Direction – up and towards yourself. Restoration of breathing is a sign of removal of the foreign body from the respiratory tract.

Please note: The Heimlich maneuver should be performed until the FB leaves the airway or until the person loses consciousness. In the latter case, attempts to remove the foreign body should be stopped and instead.

Features of the Heimlich maneuver in children and pregnant women

When removing a foreign body from the respiratory tract in children under 1 year of age, the rescuer must sit down and place the child on left forearm face down, holding with fingers folded into a “claw” lower jaw baby. The baby's head should be below the level of the body. After this, you should apply five medium-force blows with the heel of your palm to the interscapular area of the back. The second stage - the child turns face up on the right forearm, after the forehead the rescuer makes five jerking movements along the sternum to a point located 1 finger below the internipple line. Don't press too hard to avoid breaking your ribs.

If a foreign body appears in the oropharynx, it is visible and can be removed without the danger of pushing it back - it is removed. If not, repeat the entire cycle either until IT appears or until cardiac arrest, after which cardiopulmonary resuscitation must begin

In children 1-8 years old, the Heimlich maneuver is performed by placing the child on the rescuer's thigh. The remaining actions are performed according to the general rules.

More detailed information O emergency care if a child gets a foreign body into the respiratory tract, you will receive it by watching a video review by a pediatrician, Dr. Komarovsky:

Important question: “What if a pregnant woman was injured?” Indeed, pressing on the belly of a woman who is heavily pregnant is guaranteed to lead to serious complications. In this case, the pressure is applied not to the stomach, but to the bottom part sternum, like that of infants.

Typical mistakes when removing foreign bodies from the respiratory tract

The first thing that comes to mind when a foreign body enters the respiratory tract is to knock on the back. The correct algorithm for how to knock is described above. However, most of us simply pound our backs as hard as we can. The danger of this method is that any foreign body is affected by gravity. Incorrect tapping may cause the FB to penetrate lower into the tracheobronchial tree and may cause complete obstruction of the airway. First aid in this case is to perform a tracheotomy, and even if by some miracle there is a nearby qualified specialist, the chance of saving the victim will become scanty.

Never turn your baby upside down to shake him. Spasm of the larynx reduces your attempts to remove the foreign body to zero. You might dislocate instead cervical vertebrae baby. The fact is that when a child loses consciousness, the tone of the neck muscles decreases; during shaking, his head begins to dangle in all directions, which can lead to dislocation of the cervical vertebrae and even their fracture. By saving a baby from death, you risk making him disabled or even killing him.

So extremely unpleasant situation, as entry into the respiratory tract (nasopharynx, larynx) of a foreign object occurs quite often. High probability its occurrence occurs in children under 5 years of age. It is at this age that he actively explores the world around him, using not only his hands, but also his mouth. There is also a possibility that a small object may simply be inhaled by a child.

At an older age, a foreign body enters the respiratory tract during games, jokes, eating too quickly, or unsuccessful experiments. How to behave in such a situation, how to help the victim, and what first signs you should pay attention to, we will consider in this article.

Main symptoms

Depending on the size of the foreign object in the respiratory tract, it can completely or partially close it, blocking the access of oxygen to the lungs. Besides, foreign body may injure the larynx, vocal cords, causing inflammation and swelling, thereby worsening the situation. With the partial version, breathing will be heavy, labored and intermittent. Sometimes a person can take a breath, but instead of exhaling there will be a creak or a whistle. The most dangerous situation, When foreign object completely blocks the breathing process, blocking the lumen of both bronchi at once. In this case, there is a high risk of death.

How to understand that the cause of suffocation is a foreign body, and not a strong allergic reaction, For example?

Signs of a foreign body in the respiratory tract

A sharp and sudden change in behavior. Movements become chaotic. The person usually grabs his throat and loses the ability to speak.
Redness of the facial skin, enlarged veins in the neck
Coughing as an attempt by the body to get rid of an object
Breathing is difficult. When you inhale, you can hear strong wheezing
Due to a sharp lack of oxygen, the skin upper lip may acquire a bluish tint.
Rapid loss of consciousness

Such symptoms are typical active phase with complete blockage of the respiratory tract, if the object has stopped in the larynx or trachea. The disease develops sharply, and assistance must be provided as quickly and effectively as possible.

If a small object, during a sharp inhalation or cough, passes through the larynx and gets stuck in the bronchi, then sharp first external symptoms may be absent or appear from time to time. In this case, a sluggish inflammatory process which may be accompanied by: increased temperature, short-term attacks asphyxia, coughing fits, shortness of breath, vomiting. The cause can only be determined using x-rays.

It should be remembered that if assistance is provided incorrectly, you can displace a foreign object deeper, and thus only worsen the victim’s condition.

Foreign body in the respiratory tract and first aid

Depending on the age of the victim, you need to act differently to avoid worsening the condition. An adult must be tilted forward so that the head is lower than the body. It is advisable to fix this position by holding your waist with your hand. Hit the back sharply with the heel of your palm in the place between the shoulder blades. The blows must be clear. If 5 attempts were unsuccessful and it was not possible to get rid of the foreign object, then they resort to the Heimlich method.

It is most convenient to use it in a standing position. You need to take a stable position so that if the victim loses consciousness, you can hold him.
From the back, grab the victim with both hands in the abdominal area, just above the stomach.
Make a fist with your working hand and hold it with your other hand. Please note that your thumb the hands were pressed tightly to the fist, otherwise you could injure the person.
Make quick thrusts inward and then upward, pressing your fist into your stomach.
You need to do 5 pushes without a break.

In the case when the victim is unconscious, it is too late to resort to such a technique. Start activities by ( artificial respiration) before the arrival of specialists, or until the victim’s first independent breaths.

Abdominal thrusts should not be given to adults who are overweight or pregnant women. Here you should clasp your hands lower limit chest (above the abdomen) and act according to the described scheme.

Foreign bodies in the upper respiratory tract can be removed from infants or children under 1 year of age using slightly different tactics. The child should be placed with his stomach on his forearm and his head tilted down, holding his neck and keeping his mouth open. Controlling your strength, make 5 claps with your palm between your back shoulder blades. If the object does not come out, then turn the child to face you. Press on the chest with 2 fingers until the foreign body can be removed. Be careful with the force you use; your child's ribs can easily crack.

When the person begins to breathe on his own, turn him on his side and wait for the ambulance to arrive. It will be necessary to call her in any case.

Common first aid mistakes

When a foreign body is inhaled into the respiratory tract, assistance must be provided correctly, promptly and promptly. Such situations pose a threat to human life, so a mistake made can lead to a tragic result.

Very often, people, trying to help, commit the following incorrect actions:

When coughing, do not hit the victim between the shoulder blades. It's best not to intervene at all until you see signs of suffocation. A cough means that the airways are not completely blocked, and the body can cope with this problem on its own.
You don't need to hit your back with all your might, as this could cause damage. internal organs or ribs, and you will achieve just the opposite result. The correct way to do this is to use the heel of your palm clearly and with medium force. After each blow, ensure that the foreign object is still in the airway.
A baby under six months should not be grabbed by the legs, turning his head to the floor, and shake as hard as he can. At this age, the cervical vertebrae are very unstable and mobile; with such movements you can damage or displace them.
Panic reduces time that the victim does not have. Act quickly. To do this, you can take first aid courses or practice on yourself, doing the Heimlich maneuver.

***The Heimlich maneuver is a miraculous method developed by the American doctor Henry Judah Heimlich in 1974. This is a method of providing assistance to a victim, used to quickly clear a person’s respiratory tract from foreign body objects or food debris. The technique is based on creating pressure in abdominal cavity the victim’s abdomen, which allows the foreign body to be pushed out of the oropharynx. More details this method understands the presented video.

The article is for informational purposes only, you perform all actions at your own peril and risk, remember that qualified assistance No one canceled specialists!

A very useful video, by watching it you can save someone’s life!

– foreign objects accidentally aspirated or entered into the airways through the wound canals and fixed at the level of the bronchi. A foreign body of the bronchus makes itself felt by paroxysmal whooping cough, asphyxia, facial cyanosis, stenotic breathing, hemoptysis, vomiting, and impaired phonation. A foreign body in the bronchi is recognized based on the collected anamnesis, chest X-ray, tomography, bronchography, and bronchoscopy. Removal of a foreign body from the bronchus is carried out endoscopically; in case of wedged foreign bodies, bronchotomy is used.

Reasons for foreign body penetration into the bronchus

Entry of a foreign body into the bronchus can occur by aspiration (when it is inhaled through the mouth, reflux from the esophagus and stomach during gastroesophageal reflux or vomiting), as well as through the wound canal in case of damage to the chest and lung. Penetration of foreign bodies is possible during surgical interventions: tracheotomy, adenotomy, removal of a foreign body from the nose, dental procedures. Among the listed mechanisms, the most common is the aspiration route of foreign bodies entering the bronchi.

Aspiration of foreign bodies into the bronchi is facilitated by the habit of children and adults holding small objects in their mouths. The entry of objects from the oral cavity into the bronchi occurs during play, laughter, crying, talking, coughing, sudden fear, falling, etc. Often the background for the aspiration of foreign bodies into the bronchi is concomitant rhinitis and adenoid growths, a state of anesthesia.

By their nature, bronchial foreign bodies are divided into endogenous and exogenous, organic and inorganic. Endogenous foreign bodies include unremoved pieces of tissue during tonsillectomy and adenotomy, endoscopic removal of benign bronchial tumors, extracted teeth, and roundworms.

The most diverse group of findings consists of exogenous foreign bodies of the bronchi: these can be small objects made of metal, synthetic materials, objects plant origin. Among the exogenous foreign bodies of the bronchus, there are both organic (food particles, seeds and grains of plants, nuts, etc.) and inorganic (coins, paper clips, screws, beads, buttons, toy parts, etc.) objects. Objects of organic origin, synthetic materials and fabrics are the most aggressive and difficult to diagnose. They do not contrast on X-rays and can remain in the lumen of the bronchus for a long time, where they swell, crumble, and decompose; penetrate into the distal parts bronchial tree, causing chronic suppuration of the lungs.

Foreign bodies of the bronchi, having a smooth surface, are capable of movement and forward movement to the periphery. Objects of plant origin (spikelets of cereals and herbs), on the contrary, wedge into the wall of the bronchus and remain fixed. There are cases of single and multiple bronchial foreign bodies.

Pathological changes in bronchial foreign bodies

Pathomorphological changes in the bronchi depend on the size, nature of the foreign body and the time it remains in the respiratory tract. IN initial period generalized bronchospasm, local hyperemia, swelling and ulceration of the bronchial mucosa, and exudation phenomena occur. In more late dates A capsule is formed around the foreign body, granulations grow with their subsequent scarring.

Foreign bodies in the bronchi can occupy different positions, which is why different secondary changes lung tissue. With floating foreign bodies, the lumen of the bronchus is not completely blocked, external breathing is not critically disturbed, secondary inflammatory changes in the lung tissue are moderate.

With valve blockage of the bronchus, there is loose contact of the foreign body with the walls of the bronchus, so when you inhale, air enters the lung, and when you exhale, due to bronchospasm, it cannot come back out. Thus, air retention occurs in the lung tissue with the development of pulmonary emphysema below the site bronchial obstruction. When the bronchus is completely blocked by a foreign body in the underlying non-ventilated parts of the lung, obstructive atelectasis and atelectatic pneumonia occur.

A foreign body of the bronchus always brings with it an infection, which is accompanied by local inflammatory reaction. Therefore, with long-term foreign bodies in the bronchi, unresolved bronchitis, bronchopneumonia, deforming bronchitis, bronchiectasis, lung abscesses, and broncho-pleuro-thoracic fistulas develop.

Symptoms of a bronchial foreign body

IN clinical symptoms bronchial foreign bodies are divided into three periods: the debut phase, the phase of relative compensation of respiratory functions and the phase of secondary complications.

In the debut phase, after aspiration of a foreign body, a sudden paroxysmal cough develops; aphonia, breathing disorders up to asphyxia. A similar picture is sometimes observed with diphtheria, but in this case there is no surprise factor, and pathological symptoms(sore throat, fever, etc.) precede the appearance of a cough. With false croup, catarrhal symptoms of the upper respiratory tract also precede an attack of coughing and suffocation. With benign tumors of the larynx, aphonia increases gradually. Coughing attacks are often accompanied by vomiting and cyanosis of the face, reminiscent of a cough with whooping cough: this can cause diagnostic errors, especially in cases where the fact of aspiration is “overlooked”.

Soon after the penetration of a foreign body into the main, lobar or segmental bronchus, a phase of relative compensation begins respiratory function. During this period, due to partial obstruction of the bronchus and bronchospasm, wheezing breathing - inspiratory stridor - can be heard from a distance. There is moderate shortness of breath and pain in the corresponding half of the chest.

Further dynamics pathological process in case of bronchial foreign bodies, it depends on the severity of inflammatory changes developing in the part of the lung that is switched off from breathing. During the complication phase, productive cough with mucopurulent sputum, increased body temperature, hemoptysis, dyspnea. The clinical picture is determined by the developed secondary complication. In some cases, bronchial foreign bodies go unnoticed and are an accidental finding during surgical interventions on the lungs.

Diagnosis of a bronchial foreign body

The difficulty in recognizing bronchial foreign bodies is due to the fact that the fact of aspiration cannot always be noticed. The non-specificity of symptoms often leads to the fact that people with foreign bodies in the bronchi are treated for a long time by a pulmonologist for various bronchopulmonary diseases. The reason to suspect the presence of a foreign body in the bronchus is ineffective therapy for asthmatic bronchitis, chronic bronchitis and pneumonia, whooping cough, bronchial asthma, etc.

Physical findings with bronchial foreign bodies indicate the presence of atelectasis (sharp weakening or absence of breathing, dullness of percussion sound) or emphysema (percussion tone with a boxy tint, weakened breathing). On examination, attention is drawn to the lag of the affected side of the chest during breathing, the participation of auxiliary muscles in the act of breathing, retraction of the jugular fossae and intercostal spaces, etc.

In all cases, if a bronchial foreign body is suspected, a chest x-ray is indicated. In this case, narrowing of the bronchi, local emphysema, atelectasis, focal infiltration lung tissue, etc. Clarification of the localization of the foreign body and its nature local changes in the lungs is performed using X-ray or computed tomography, nuclear magnetic resonance imaging, bronchography.

The most reliable diagnostic method bronchoscopy, which allows visualization of bronchial foreign bodies. Often, due to the severity of local changes, a foreign body cannot be detected immediately. In such cases, granulations are removed, thorough sanitation of the bronchial tree (bronchoalveolar lavage), a course of antibiotic therapy, and then endoscopic examination of the bronchi is repeated.

Treatment of bronchial foreign body

The presence of a bronchial foreign body is an indication for its removal. In most cases, it is possible to perform endoscopic removal of a bronchial foreign body during repeated bronchoscopy. If a foreign body is detected in the lumen of the bronchus, the bronchoscope tube is carefully brought to it, the object is grabbed with forceps and removed.

Metal objects can be removed using a magnet; small foreign bodies of the bronchi - using an electric suction. Then the bronchoscope is reintroduced to inspect the bronchi for the presence of “splinters,” wounds to the walls of the bronchus, etc. In some cases, foreign bodies are removed from the bronchi through a tracheostomy.

Foreign bodies tightly wedged into the bronchial wall are subject to surgical removal during thoracotomy and bronchotomy. Indications for bronchotomy are fixed or impacted foreign bodies that cannot be removed without significant damage to the bronchial walls. TO surgical tactics also move on if complications arise during attempts endoscopic removal foreign bodies (bronchus rupture, bleeding).

Prognosis and prevention of bronchial foreign bodies

If the bronchial foreign body is removed in a timely manner, the prognosis is good. Complications of bronchial foreign bodies can include disabling and life-threatening diseases - pleural empyema, fistulas (thoracobronchial, esophageal-bronchial, broncho-pleural), pneumothorax, pulmonary hemorrhage, bronchial rupture, purulent mediastinitis, etc. In some cases, children may die from sudden asphyxia.

Preventive measures should include control by adults over the quality of toys and their suitability for the child’s age; weaning children from the habit of putting foreign objects in their mouths; explanatory and educational work among the population; Observe caution when performing medical procedures.