UFO definition. Dosimetry and dosage of ultraviolet rays
Mechanism of action: ultraviolet irradiation penetrates tissue to a depth of 0.1-1 mm and activates biological processes in the body, changes the structure of cells (denaturation and coagulation of protein molecules) and DNA.
Basic steps UV irradiation: photochemical (formation of vitamin D), bactericidal, anti-inflammatory, accelerates the development of connective tissue and epithelization of the skin (its barrier role increases), reduces pain sensitivity, stimulates erythrocytopoiesis, reduces blood pressure in the initial stage of hypertension, normalizes lipid metabolism.
When carrying out ultraviolet irradiation, it should be remembered that the light sensitivity of different people and even different areas of the skin has individual fluctuations: the skin of the torso is the most sensitive to UV irradiation, the skin of the extremities is the least sensitive.
Indications for UV irradiation: respiratory disease (bronchitis, pneumonia, pleurisy); digestive organs (peptic ulcer, gastritis, cholecystitis); skin (eczema, trophic ulcers); hypertension, rheumatism, arthritis, neuralgia, myositis. Pregnant women undergo UV irradiation to prevent rickets in children and premature infants; for hardening, healing, increasing the body's resistance to infectious diseases; persons who work in the north, in mines, in the metro to compensate for natural UV deficiency.
Contraindication to UV irradiation: malignant tumors, bleeding tendency, hyperthyroidism, blood disease, active pulmonary tuberculosis, stage III hypertension and others.
The most common source of UV radiation is gas-discharge lamps, in particular a mercury arc tube lamp (MAT) with a quartz tube at the end of which tungsten electrodes are soldered. The air is pumped out of the tube, and its cavity is filled with mercury vapor and a small amount of argon gas. After turning on the llama in the electrical network, an arc discharge occurs in the mercury vapor. The normal mode of the lamp is set 5-10 minutes after switching on. DRT lamps are used in various stationary and portable emitters - VUSH-1, VPU, BVD-9 and others.
Safety precautions. When carrying out irradiation, it is necessary to protect the eyes of the patient and personnel with protective glasses. Insufficient eye protection can lead to the development of acute conjunctivitis as a result of ultraviolet ray burns of the conjunctiva and cornea of the eyes (pain, photophobia, lacrimation, redness of the conjunctiva). Symptoms last for several days, and cold lotions and eye drops with dicaine are recommended.
The sequence of determining biodoses for a patient:
1. The patient puts on safety glasses
2. A BD-2 biodosimeter (a metal plate with 6 holes that are closed with a movable barrier) is applied to the area that will be irradiated in order to determine the minimum intensity of irradiation that can lead to the formation of erythema; other parts of the body are covered with a sheet.
3. The irradiator with an already heated mercury-quartz lamp is installed perpendicular to the surface of the irradiation site at a distance of 50 cm.
4. Open the first hole of the biodosimeter and irradiate the skin over it for 30 s. Then, every 30 s, the next holes are opened, continuing to irradiate the areas under the previously opened holes, until all 6 holes are opened.
5. After 24 hours, when examining the patient’s skin, erythema stripes are visible corresponding to the holes of the biodosimeter.
6. Count the number of erythema stripes and determine the time required for the formation of a minimally pronounced stripe: if the patient has 3 stripes, then the minimum biodose is 2 minutes.
Remember! 1 strip – 3 minutes, 2 strips – 2.5 minutes, 3 strips – 2 minutes, 4 strips – 1.5 minutes, 5 strips – 1 minute, 6 strips – 0.5 minutes.
There are two main methods of UV irradiation: general (whole body) and local (part of the body or its individual parts). General UV irradiation can be group (for the purpose of prevention) and individual (for treatment).
Individual general UV irradiation begins with 1/4-1/2 of an individually determined biodose. After every 2-3 procedures, the dose is doubled and brought to 2-3 biodoses at the end of the course of treatment. The procedures are carried out every other day.
Local irradiation carried out with erythemal doses of UV rays at a distance of 50 cm over an area of no more than 600-800 cm 2. Only one field is irradiated in one day, and it is re-irradiated after 2-3 days as the erythema decreases, but no more than 5 times.
HYDRO TREATMENT
Hydrotherapy is the use of fresh (hydrotherapy) and mineral water (balneotherapy) for therapeutic purposes. Treatment with fresh water includes dousing, rubbing, wrapping, baths, showers; balneotherapy – mineral baths. The use of water for medicinal purposes is due to its properties: heat capacity and thermal conductivity.
The main mechanism of action of water: influence on the skin of temperature, mechanical and chemical factors.
Temperature factor. Depending on the water temperature, baths are cold (below 20 °C), cool (up to 33 °C), indifferent (34-36 °C), warm (37-39 °C), hot (over 40 °C). The duration of the baths ranges from 3 to 30 minutes depending on the temperature. For example, warm and hot lasting 10-15-20 minutes, cold - 3-5 minutes. The temperature factor affects the heat exchange of the patient's body, namely: changes in sweating and breathing, blood redistribution, irritation of the sensitivity of the nerve endings of the skin, which has a beneficial effect on the functioning of all organs and systems of the body.
Baths– these are water procedures that are taken for hygienic, therapeutic and preventive purposes. Baths are distinguished: are common when the patient is completely immersed in water (excluding the head and heart area) and local- immersing part of the body in water (up to the lower back - half; pelvis, lower abdomen and upper thighs - sessile or pelvic; hand and forearm - hand; feet and lower leg - leg and others).
In particular, when the patient is immersed in cold bath a spasm of the blood vessels of the skin occurs and metabolic processes intensify, which lead to a decrease in heat transfer and increased heat generation; hot bath leads to the opposite effect. All these processes depend on the temperature of the water, the surface of the body and the duration of the procedure.
Cool baths have a tonic effect, enhance metabolism, stimulate the function of the cardiovascular and nervous systems. Cool baths are prescribed for neuroses with a depressed state, apathy, decreased appetite, etc.; Contraindicated for elderly and senile patients, persons prone to vasospasm.
Cool baths are prepared as follows: first, water at a temperature of 34-35 ° C is poured into the bath, and then, by adding cold water, the water temperature is reduced to the required level (32-33 ° C). Bath duration is 2-5 minutes. When the patient is in such a bath, the upper part of his body is rubbed with a towel. After the bath, the patient is dried with a warm sheet, put on a shirt, wrapped in a warm blanket and put to bed.
Hot baths dilate the blood vessels of the skin, increase sweating, reduce the intensity of redox processes, that is, heat transfer increases and heat generation decreases. Hot baths are prescribed for chronic diseases of the joints, peripheral nerves (radiculitis, polyneuritis), metabolic disorders (gout), and attacks of renal colic. Hot baths are contraindicated in elderly and senile patients, with cardiovascular diseases, hypertension, bleeding tendency, cachexia.
Hot baths are prepared as follows: first, water at a temperature of 34-35 °C is poured into the bath, and then hot water is added, bringing the water temperature to the required level (40-43 °C). The duration of the procedure is short - 5-10 minutes (hot baths tire the patient, lead to general weakness, palpitations, dizziness). When taking a bath and after the procedure, carefully monitor the patient’s condition, primarily the pulse. If general weakness, palpitations, or dizziness occur during the procedure, the patient is taken out of the bath, the head and face are moistened with cold water. After the bath, the patient is dried with a towel, wrapped warmly and allowed to rest for at least 30 minutes.
Warm baths reduce pain, relieve muscle tension, calm the nervous system, improve sleep. Bath water temperature is 37-39 °C, procedure duration is 15-20 minutes.
Indifferent baths have a slight tonic and refreshing effect on the body, due to the mechanical and chemical effects of water on skin receptors, eliminating the influence of the thermal factor on the body. Bath water temperature is 34-36 °C, procedure duration is 20-30 minutes.
Mechanical factor – This is the pressure of the water layer, which stimulates lymphatic drainage, and the outflow of venous blood improves the functioning of the heart.
The mechanical effect of the bath is to compress the chest, as a result of which the number of its respiratory movements decreases, as well as compression of the abdominal cavity. To reduce the mechanical effect, foam baths are used (neuralgia, obesity, skin itching, menopausal syndrome). To enhance the mechanical effect, an underwater shower is used - massage, which increases all types of metabolism, especially fat and salt (obesity, diseases of the musculoskeletal and peripheral nervous systems). Gas (“pearl”) baths are of particular importance - air bubbles surround the body in the form of a cloak and promote the redistribution of blood.
Chemical factor due to components that are dissolved in water. Chemicals that settle on the surface of the skin increase irritation of skin receptors and affect the visual and olfactory analyzers.
Chemical action of the bath determined by the nature of the drugs that are added to the water. According to their composition, waters can be fresh, fragrant, medicinal, mineral and gas.
For therapeutic purposes, baths with gas impurities (oxygen, hydrogen sulfide, radon, carbon dioxide), minerals or special medications are most often used. In addition to mechanical and thermal effects, mineral baths also have a chemical effect on the patient’s skin. Gas bubbles covering the skin irritate it and reflexively cause capillaries to expand, causing the skin to turn red and redistribution of circulating blood. Gas baths have a beneficial effect on the cardiovascular system.
Hydrogen sulfide and radon baths prescribed for diseases of the peripheral nervous system, arthritis, some diseases of the skin and peripheral blood vessels. Water temperature 36-37 °C, duration 5-15 minutes, course of treatment 12-18 baths daily or every other day.
Turpentine baths used for diseases of peripheral nerves (radiculitis, neuritis), joints (polyarthritis, arthrosis), bronchopneumonia. Water temperature 36-37 °C, procedure duration 10-15 minutes, course of treatment 10-15 baths every other day.
Pine baths indicated for functional disorders of the nervous system (neuroses, irritability, insomnia). Water temperature 36-37 °C, procedure duration for adults 15-30 minutes, for children 7-10 minutes, treatment course 15-20 baths every other day.
Starch baths prescribed for skin manifestations of exudative diathesis, they reduce itching and dry out the skin. Water temperature 37-38 °C, procedure duration for adults 30-45 minutes, for children 8-10 minutes, treatment course 10-12 baths daily or every other day.
Sage baths prescribed when it is necessary to reduce pain in diseases and consequences of injuries to peripheral nerves, consequences of injuries to the musculoskeletal system, and in chronic inflammatory processes of the female genital area. Water temperature 35-37 °C, procedure duration 8-15 minutes, course of treatment 12-18 baths daily or every other day.
Sanitary and hygienic requirements for the premises: the room must be tiled, the air temperature in the room is not lower than 25 ° C, the windows must be closed. The junior nurse washes the bathtub with a washcloth or brush with soap and hot water, rinses it with a disinfectant solution (1-1.5% chloramine solution or 3% Lysol solution) and then rinses the bathtub several times with hot water.
Fill the bath with water immediately before taking the procedure: first cold and then hot. Water temperature is measured with a water thermometer. The patient sits in the bath in such a way that during the procedure he can relax, and his back and legs have support (his back rests on one wall of the bath, and his legs on the other). If the patient cannot reach the wall of the bathtub with his feet, then a shield or a special device is placed under his feet.
Caring for the patient during the procedure. For each patient, a set of clean linen, soap and a clean washcloth should be prepared, which is boiled after each patient. In the treatment room, in the cabinet there should be a set of necessary medications to provide first aid if the patient’s condition worsens. When taking any bath (hygienic or therapeutic), the patient should not be left alone. The nurse should monitor the general condition of the patient, his skin and pulse. If the patient turns pale, becomes dizzy, or loses consciousness, it is necessary, with the help of a junior nurse, to get the patient out of the bath, dry him with a towel, put him on the sofa with the foot end slightly raised, rub his temples and let him smell ammonia. For pain in the heart area, give validol and urgently call a doctor.
Along with baths, the local effect of mineral waters – medicinal drinking – is widely used.
Medicinal mineral water differs from ordinary water in its physical and chemical properties:
1. High mineralization (soft, medium, high mineralization).
2. Ionic composition (bicarbonate, chlorides, sulfate ions, sodium, potassium, calcium, magnesium ions).
3. The presence of microelements (iron, copper, manganese, flint, arsenic, etc.).
4. The presence of microflora (saprophytes).
5. The presence of organic substances (carbohydrates of petroleum origin).
6. A certain gas composition (oxygen, nitrogen, carbon dioxide, hydrogen sulfide, radon).
7. The concentration of hydrogen ions is of great importance - the pH of the water (strongly acidic, acidic, weakly acidic, neutral, slightly alkaline and alkaline).
It is best to take water from a source. In case of secretory insufficiency, you need to drink water in separate sips, in case of hyperfunction - quickly; to get a braking effect - in one gulp, in large sips. For patients with reduced gastric secretion, chloride, carbonic acid waters in cold form (Mirgorodskaya, etc.). For patients with high acidity, waters that have an inhibitory effect are recommended - hydrocarbonate, hydrocarbonate-sulfate waters in warm form (Borjomi, Karpatskaya, Lugansk, Novoberezovskaya, etc.).
Control questions
1. Classification of drugs.
2. How are narcotic drugs stored and used in the department?
3. What are the ways of distributing medicines to patients?
4. How to properly introduce drops into the eyes, ear, nose?
5. Technique for intradermal injections; possible complications and their prevention.
6. Technique for subcutaneous injections; possible complications and their prevention.
7. Technique for intramuscular injections; possible complications and their prevention.
8. Prevention of AIDS when working with blood
9. Sequence of applying a warm compress.
10. What effect does the temperature factor have on the body?
11. Indications and contraindications for prescribing warm and hot baths.
12. What is the effect of mechanical and chemical factors on the body?
13. How do ultraviolet rays affect the human body?
14. For the treatment of what diseases are thermal electrophysical procedures used?
15. What methods of UV irradiation exist and their purpose.
16. Features of dispensing physiotherapeutic procedures to elderly patients.
TOPIC 8. GENERAL AND SPECIAL CARE
Ultraviolet radiation from the Sun and artificial sources is a spectrum of electromagnetic oscillations in the range of 180-400 nm. According to the biological effect on the body and depending on the wavelength, the UV spectrum is divided into three parts:
A (400-320nm) - long-wave UV radiation (LUV)
B (320-280 nm) - mid-wave (SUV);
C - (280-180 nm) - short-wave (SWF).
The mechanism of action of UV rays is based on the ability of certain atoms and molecules to selectively absorb light energy. As a result, tissue molecules enter an excited state, which triggers photochemical processes in UV-sensitive protein, DNA and RNA molecules.
Photolysis of epidermal cell proteins leads to the release of biologically active substances (histamine, acetylcholine, prostaglandins, etc.), which, when entering the bloodstream, cause vasodilation and migration of leukocytes. Equally important are reflex reactions caused by the activation of numerous receptors by photolysis products and biologically active substances, as well as the humoral effect on the nervous, endocrine, immune and other systems of the body. Naturally, UV radiation causes responses from the human body, which form the basis for the physiological and therapeutic effects of UV rays.
One of the main components of this therapeutic effect is the effects associated with the formation of ultraviolet (or photochemical) erythema. SUV radiation with a wavelength of 297 nm has the maximum erythema-forming property.
UV erythema has anti-inflammatory, desensitizing, trophic-regenerative, and analgesic effects. The antirachitic effect of UV rays lies in the fact that, under the influence of this radiation, vitamin D is formed in the irradiated skin. Therefore, UV irradiation is a specific therapeutic and preventive procedure for children suffering from rickets.
The bactericidal effect of ultraviolet radiation is widely used. There are direct and indirect bactericidal effects of UV rays. As a result of direct action, coagulation and denaturation of microbial proteins occur on the surface of the wound and mucous membrane, which leads to the death of the bacterial cell. The indirect effect of UV radiation is associated with changes in the immunobiological reactivity of the body under the influence of UV rays.
UV rays actively affect lipid, protein and carbohydrate metabolism. Under the influence of their suberythemal doses, vitamin D3 is synthesized in the skin from cholesterol derivatives, which controls phosphorus-calcium metabolism. They reduce the content of atherogenic blood cholesterol in patients with atherosclerosis.
UV rays in small doses improve the processes of higher nervous activity, improve cerebral circulation, affect the tone of cerebral vessels, and increase the body's resistance to adverse environmental factors. The tone of the autonomic nervous system changes depending on the dose of UV radiation: large doses reduce the tone of the sympathetic system, and small doses activate the sympathoadrenal system, the adrenal cortex, the function of the pituitary gland, and the thyroid gland.
Due to its diverse effects, ultraviolet irradiation (along with UHF therapy and ultrasound therapy) has found wide application for the prevention and treatment of a wide range of diseases.
Determination of biodose
UV radiation is dosed using the Gorbachev-Duckfeld biological method. The method is simple and is based on the property of UV rays to cause erythema when irradiating the skin. The unit of measurement in this method is one biodose. One biodose is taken to be the minimum time of irradiation of a given patient from a certain distance with a certain source of UV rays, which is necessary to obtain a weak, but clearly defined erythema. Time is measured in seconds or minutes.
The biodose is determined in the abdomen, buttocks or on the back of the forearm of any hand from a distance of 10-50 cm from the emitter to the irradiated part of the body. The biodosimeter is fixed on the body. Alternately after 30-60 seconds. The skin is irradiated through the six holes of the biodosimeter by opening the shutter in front of the windows (previously closed by it). Thus, if each window is opened after 60 seconds, the skin in the area of the first window will be irradiated for 6 minutes, in the area of the second - 5 minutes. etc., in the sixth zone - 1 min.
The result of biodosometry is checked after 24 hours. One biodose will be considered the weakest skin hyperemia. With a change in the distance from the emitted surface to obtain the same biodose, the irradiation time changes in inverse proportion to the square of the distance. For example, if the time to receive one biodose from a distance of 20 cm is 2 minutes, then from a distance of 40 cm it will take 8 minutes. The irradiation time can be selected discretely from 30 seconds. up to 60 seconds, and the distance from the body (its skin) to the emitter is from 10 cm to 50 cm. It all depends on the type of skin, but you need to choose these parameters in such a way as to get a clear picture of skin erythema.
Skin sensitivity to UV rays depends on many reasons, among which the most important are the location of exposure, skin color, time of year, age and initial condition of the patient. The diseases that a person suffers also play a significant role. With photodermatoses, eczema, gout, liver diseases, hyperthyroidism, etc., the sensitivity of the skin to UV rays is increased, with other pathologies (bedsores, frostbites, trophic wounds, gas gangrene, erysipelas, diseases of the peripheral nerves and spinal cord below the level of the lesion, etc. .) skin sensitivity to UV rays, on the contrary, is reduced. In addition, there is a large list of contraindications for treatment with UV rays that you need to know. Therefore, in order to successfully and correctly apply ultraviolet irradiation treatment, it is necessary to consult with your doctor, a specialist in the field of physical methods of treatment.
Indications for UV irradiation
General UFO is used for:
Local ultraviolet radiation has a wider range of indications and is used:
With regard to the differentiated use of UV rays of different wavelengths, the following can be noted. Indications for long-wave ultraviolet irradiation (UV-400 nm * 320 nm) are acute inflammatory diseases of internal organs (especially the respiratory system), diseases of joints and bones of various etiologies, burns and frostbite, slow-healing wounds and ulcers, psoriasis, eczema, vitiligo, seborrhea. (Equipment: OUFk-01 and OUFk-03 "Solnyshko")
General UV irradiation is prescribed, taking into account the individual characteristics and sensitivity of the skin to UV irradiation according to the basic or accelerated scheme. To normalize the immune status in chronic sluggish inflammatory processes, as well as for the prevention of acute respiratory viral infections, non-erythema general ultraviolet irradiation is carried out with long and medium waves from a distance of 50-100 cm.
The front, back and side surfaces of the body are irradiated successively. During all procedures, protective glasses are worn over the eyes. UV irradiation using the PUVA therapy method (or photochemotherapy) is carried out as follows. Patients with psoriasis or parapsoriatic diseases are given orally or externally furocoumarin preparations (puvalen, psoralen, beroxan, etc.) in an appropriate dose. The drugs are taken only on the day of the procedure, 1 time 2 hours before irradiation after meals, washed down with milk. The patient's individual photosensitivity is determined in the usual way with a biodosimeter, but also 2 hours after taking the drug. The procedure begins with minimal suberythemal doses.
Medium-wave ultraviolet irradiation is indicated for acute and subacute inflammatory diseases of internal organs, consequences of injuries to the musculoskeletal system, diseases of the peripheral nervous system of vertebrogenic etiology with severe pain, rickets, secondary anemia, metabolic disorders, erysipelas. (Equipment: OUFd-01, OUFv-02 “Solnyshko”).
Short-wave ultraviolet irradiation is used for acute and subacute diseases of the skin, nasopharynx, inner ear, for the treatment of wounds with the risk of anaerobic infection, and skin tuberculosis. (Equipment: OUFb-04 "Sun").
Contraindications for local and general UV irradiation are malignant neoplasms, systemic connective tissue diseases, active form of pulmonary tuberculosis, hyperthyroidism, febrile states, tendency to bleeding, circulatory failure of II and III degrees, arterial hypertension of III degree, severe atherosclerosis, kidney and liver diseases with insufficiency of their function, cachexia, malaria, increased sensitivity to UV rays, photodermatoses, myocardial infarction (first 2-3 weeks), acute cerebrovascular accident.
Some private methods of ultraviolet therapy
Flu.
The face, chest and back are irradiated daily with erythema doses for 2-3 days. For catarrhal symptoms in the pharynx, the pharynx is irradiated for 4 days through a tube. In the latter case, irradiation begins with 1/2 biodose, adding 1-1/2 biodoses in subsequent irradiations.
Infectious and allergic diseases.
Application of ultraviolet radiation to the skin of the chest using a perforated oilcloth localizer (PCL). The PCL determines the area to be irradiated (prescribed by the attending physician). Dose - 1-3 biodoses. Irradiation every other day, 5-6 procedures.
Acute respiratory diseases.
In the first days of the disease, ultraviolet irradiation of the nasal mucosa in suberythemal doses is prescribed, counting on the bactericidal effect of UV radiation.
Rhinitis is acute.
UV irradiation of the plantar surfaces of the feet is prescribed. Dose 5-6 biodoses daily. The course of treatment is 4-5 procedures. UV irradiation through a tube of the nasal mucosa in the stage of attenuation of exudative phenomena. Irradiation begins with one biodose. By adding 1/2 biodose daily, the irradiation intensity is increased to 4 biodoses.
Acute laryngotracheitis.
UV irradiation is carried out on the trachea area and on the skin of the back of the neck. Radiation dose - 1 biodose. Irradiation is carried out every other day, adding 1 biodose each, the course of treatment is 4 procedures. If the disease is prolonged, then after 10 days a UV irradiation of the chest is prescribed through an oilcloth perforated localizer. Dose - 2-3 biodoses daily. The course of treatment is 5 procedures.
Acute bronchitis (tracheobronchitis).
UV irradiation is prescribed from the first days of the disease on the anterior surface of the neck, sternum, and interscapular region. Dose - 3-4 biodoses. Irradiation alternates every other day on the posterior and anterior surfaces of the chest. Course of treatment 4 procedures.
Chronic catarrhal bronchitis.
UV irradiation of the chest is prescribed 5-6 days after the onset of the disease. UV irradiation is carried out through a localizer. Dose - 2-3 biodoses daily. The course of treatment is 5 irradiations. During the period of remission of the disease, general ultraviolet radiation is prescribed according to the basic regimen daily. The course of treatment is 12 procedures.
Bronchial asthma.
Both general and local irradiation can be used. The chest is divided into 10 sections, each measuring 12x5 centimeters. Every day, only one area is irradiated with erythema doses, limited by a line connecting the lower corners of the shoulder blades, and on the chest - by a line passing 2 cm below the nipples.
Lung abscess
(Carried out in combination with UHF, SMV, infrared and magnetotherapy). In the early stage (before the formation of a purulent cavity), ultraviolet irradiation is prescribed. Dose - 2-3 biodoses. Irradiation every other day. Course of treatment 3 procedures.
Hidradenitis axillary
(In combination with SMV, UHF, infrared, laser and magnetotherapy). In the infiltration stage, ultraviolet irradiation of the axillary area every other day. Radiation dose - 1-2-3 biodoses successively. Treatment course: 3 irradiations.
Purulent wounds.
Irradiation is carried out with a dose of 4-8 biodoses in order to create conditions for the best rejection of disintegrated tissues. In the second phase - in order to stimulate epithelization - irradiation is carried out in small suberythemal (i.e., not causing erythema) doses. The irradiation is repeated after 3-5 days. UV irradiation is carried out after primary surgical treatment. Dose - 0.5-2 biodoses, course of treatment 5-6 irradiations.
Clean wounds.
Irradiation is used in 2-3 biodoses, and the surface of undamaged skin surrounding the wound is also irradiated at a distance of 3-5 cm. Irradiation is repeated after 2-3 days.
Ligament and muscle ruptures.
UV irradiation is used in the same way as when irradiating clean wounds.
Bone fractures.
UV-bactericidal radiation of the fracture site or segmented zones is carried out after 2-3 days, each time increasing the dose by 2 biodoses, the initial one - 2 biodoses. Treatment course: 3 procedures for each zone.
General ultraviolet radiation is prescribed 10 days after the fracture according to the basic regimen daily. The course of treatment is 20 procedures.
UV irradiation in the postoperative period.
Ultraviolet radiation after tonsillectomy of the tonsil niches is prescribed 2 days after the operation. Irradiation is prescribed with 1/2 biodose on each side. Daily increasing the dose by 1/2 biodose, the irradiation intensity is increased to 3 biodoses. The course of treatment is 6-7 procedures.
Boils, hidradenitis, phlegmon and mastitis.
UFO begins with a suberythemal dose and quickly increases to 5 biodoses. Radiation dose - 2-3 biodoses. The procedures are carried out after 2-3 days. The lesion is protected from healthy areas of the skin using a sheet or towel.
Chronic tonsillitis.
UV irradiation of the tonsils through a tube with a 45% cut bevel begins with 1/2 biodose, daily increased by 1/2 biodose every 2 procedures. Courses are held 2 times a year. A sterile tube is used to press the tongue through the patient’s wide open mouth so that the tonsil becomes accessible to UV irradiation. The right and left tonsils are irradiated alternately.
Otitis externa.
UV irradiation through the ear canal tube. Dose - 1-2 biodoses daily. The course of treatment is 6 procedures.
Furuncle of the nose.
UV exposure of the nasal vestibule through a tube. Dose - 2-3 biodoses every other day. The course of treatment is 5 procedures.
Tuberculosis of bones.
UV irradiation with the long-wave part of the spectrum is prescribed according to a slow scheme. The course of treatment is 5 procedures.
Eczema.
UFO is prescribed according to the basic scheme daily. The course of treatment is 18-20 procedures.
Psoriasis.
Ural irradiation is prescribed as RUVA therapy (photochemotherapy). Long-wave UV irradiation is performed in combination with a photosensitizer (puvalene, aminefurin) taken by the patient 2 hours before irradiation at a dose of 0.6 mg per kilogram of body weight. The dose of radiation is prescribed depending on the sensitivity of the patient’s skin to UV rays. On average, ultraviolet radiation begins with a dose of 2-3 J/cm 2 and is increased to 15 J/cm 2 by the end of the course of treatment. Irradiation is carried out for 2 consecutive days with a rest day. The course of treatment is 20 procedures.
Ultraviolet radiation with a mid-wave spectrum (SUV) starts with 1/2 according to an accelerated scheme. The course of treatment is 20-25 irradiations.
Gastritis is chronic.
UV irradiation is prescribed for the anterior abdominal skin and skin of the back. UFO is carried out in zones with an area of 400 cm2. Dose - 2-3 biodoses for each area every other day. The course of treatment is 6 irradiations.
Vulvitis.
Appointed:
1. Ultraviolet irradiation of the external genitalia. Irradiation is carried out daily or every other day, starting with 1 biodose. Gradually adding 1/2 biodoses, the intensity of the effect is increased to 3 biodoses. The course of treatment is 10 irradiations.
2. General ultraviolet irradiation according to an accelerated scheme. Irradiation is carried out daily, starting with 1/2 biodose. Gradually adding 1/2 biodoses, the intensity of the effect is increased to 3-5 biodoses. The course of treatment is 15-20 irradiations.
Bartholinitis.
Ultraviolet irradiation of the external genitalia is prescribed. Radiation dose - 1-3 biodoses daily or every other day. The course of treatment is 5-6 irradiations.
Colpitis.
Ultraviolet irradiation using a tube is prescribed. Dose - 1/2-2 biodoses daily. The course of treatment is 10 procedures. Cervical erosion. Ultraviolet irradiation of the cervical area is prescribed using a tube and a gynecological speculum. Dose - 1/2-2 biodoses daily. Doses are increased every two procedures by 1/2 biodose. The course of treatment is 10-12 procedures.
For inflammation of the uterus, appendages, pelvic peritoneum and tissue
Ultraviolet irradiation of the skin of the pelvic area in fields is prescribed. Dose - 2-5 biodoses for each field. Irradiation is carried out daily. Each field is irradiated 3 times with a break of 2-3 days. The course of treatment is 10-12 procedures.
In the treatment and rehabilitation of patients with various diseases, therapeutic physical factors, both natural and artificially obtained, occupy a large place.
Therapeutic physical factors have a homeostatic effect on various organs and systems, help increase the body's resistance to adverse effects, enhance its protective and adaptive mechanisms, have a pronounced sanogenic effect, increase the effectiveness of other therapeutic agents and reduce the side effects of drugs. Their use is accessible, highly effective and cost-effective.
It is very important to understand that ultraviolet physiotherapy is one of the most important components of the entire complex of physical methods of treatment and rehabilitation of patients. The advantage of therapeutic physical factors is fully realized when they are used correctly and combined with other therapeutic, preventive and rehabilitation measures.
1. Position the patient lying or sitting, wearing sunglasses.
2. A biodosimeter with closed windows is attached to the corresponding area of the skin; for general irradiation, it is placed on the lower abdomen.
3. Fix the biodosimeter on the patient’s body using ribbons.
4. Areas of the body that are not subject to irradiation are covered with a sheet.
5. The lamp is installed above the biodosimeter at a distance of 50 cm.
6. Plug in the lamp using the power cord, turn the switch knob to the on position, and warm up for 2 minutes.
7. Open the biodosimeter holes sequentially every 30 seconds and conduct irradiation.
8. After irradiating the 6th hole, quickly move the reflector with the lamp to the side.
9. Determine the biodose 20-24 hours after irradiation (erythema).
11. Calculate the biodose using the formula: X = t (m – n + 1), where X is the biodose value, t is the irradiation time of the last hole (30 sec), m is the number of biodosimeter holes (6 pieces), n is the number of erythema stripes that appear . The result is the formula : X = 30 (6 – n + 1).
12. After calculating the biodose, set the irradiation time for a certain area of the body.
Algorithm for conducting UV irradiation on the skin
Ultraviolet irradiator on a tripod.
Designed for individual local ultraviolet irradiation.
2. Set the power switch knob to the “On” position.
3. After lighting the lamp, wait 10 minutes to establish the operating mode.
4. Lay or sit the patient down and put on sunglasses.
5. Cover areas not exposed to radiation with a sheet or napkin.
6. Place the lamp in the desired position and perform irradiation (the lamp is installed on the side of the patient at a distance of 50-100 cm.
7. Irradiate the skin. The time depends on the individual biodose.
8. Turning on the irradiator again is possible only after the lamp has completely cooled down after 15-20 minutes.
9. Warn the patient not to go outside for 15-30 minutes.
10. Mark the procedure performed on the procedure sheet.
Algorithm for conducting ultraviolet irradiation on a quartz tube
1. Read the doctor’s prescription.
2. Turn the power switch knob to the “On” position, and the signal light will light up.
3. Insert a removable tube (nose, ear, throat) into the reflector hole.
4. After warming up the lamp, sterile tubes are inserted to a depth of 2-5 cm into the mouth or nose area.
5. Irradiation is carried out according to the scheme, starting from 30 seconds, increasing the exposure time to 2-3 minutes.
6. Turn the power switch knob to the “Off” position.
7. Place the tubes in a container with a disinfectant solution.
8. Mark the procedure performed on the procedure sheet.
Algorithm for paraffin treatment
Cuvette-application technique.
1. Read the doctor’s prescription.
2. Line the cuvette with oilcloth, protruding 5 cm along the edges.
3. Pour the melted paraffin into a cuvette 2-3 cm thick.
4. Allow the paraffin and ozokerite to cool to a temperature of 50 - 55 degrees.
5. Give the desired position. Expose the area of the procedure.
6. Warn the patient about a feeling of warmth and slight pressure as it cools.
7. The frozen but still soft paraffin is removed from the cuvette along with the oilcloth and applied to the area of the body to be exposed for 15 - 20 minutes.
8. Cover the treatment area with a blanket.
9. At the end of the procedure, remove the blanket and remove the oilcloth with coolant.
10. After ozokerite, wipe the skin with a cotton swab moistened with Vaseline.
11. Warn the patient not to go outside for 15-30 minutes.
12. Mark the procedure performed on the procedure sheet.
13. Send paraffin for sterilization.
Light therapy is actively used in medical practice to treat various diseases. It includes the use of visible light, laser, infrared, and ultraviolet rays (UVR). UV physiotherapy is most often prescribed.
It is used for the treatment of ENT pathologies, diseases of the musculoskeletal system, immunodeficiencies, bronchial asthma and other diseases. Ultraviolet irradiation is also used for a bacteriostatic effect in infectious diseases and for treating indoor air.
General concept of ultraviolet irradiation, types of devices, mechanism of action, indications
Ultraviolet irradiation (UVR) is a physiotherapeutic procedure that is based on the effect of ultraviolet rays on tissues and organs. The effect on the body may differ when using different wavelengths.
UV rays have different wavelengths:
- Long wavelength (DUV) (400–320 nm).
- Mid-wave (MW) (320–280 nm).
- Short wavelength (SWF) (280–180 nm).
For physiotherapy, special devices are used. They generate ultraviolet rays of different lengths.
UV-devices for physiotherapy:
- Integral. Generate the entire spectrum of ultraviolet radiation.
- Selective. They produce one type of ultraviolet radiation: short-wave, a combination of short- and medium-wave spectra.
| Integral | Selective |
|
ОУШ-1 (for individual use, local irradiation, general effects on the body); OH-7 (suitable for the nasopharynx) OUN 250, OUN 500 - desktop type for local use). The source of irradiation is a mercury-quartz tubular lamp. Power can be different: from 100 to 1000 W. |
Shortwave spectrum (SWF). Sources of bactericidal action: OBN-1 (wall-mounted), OBP-300 (ceiling-mounted). Used for disinfecting premises. Short rays for local exposure (irradiation of skin, mucous membranes): BOP-4. The mid-wave spectrum is generated by luminescent erythema sources with ultraviolet-transmitting glass: LE-15, LE-30. Long wave sources (LW) are used for general effects on the body. |
In physiotherapy, ultraviolet irradiation is prescribed for the prevention and treatment of various diseases. The mechanism of exposure to ultraviolet radiation is as follows: metabolic processes are activated, the transmission of impulses along nerve fibers improves. When UV rays come into contact with the skin, the patient develops erythema. It looks like redness of the skin. The invisible period of erythema formation is 3-12 hours. The resulting erythematous formation remains on the skin for several more days; it has clear boundaries.
The long-wave spectrum does not cause very pronounced erythema. Medium-wave rays are able to reduce the number of free radicals and stimulate the synthesis of ATP molecules. Short UV rays very quickly provoke an erythematous rash.
Small doses of medium and long UV waves are not capable of causing erythema. They are needed for a general effect on the body.
The benefits of small dosages of UV irradiation:
- Enhances the formation of red blood cells and other blood cells.
- Increases the function of the adrenal glands and the sympathetic system.
- Reduces the formation of fat cells.
- Improves the performance of the name system.
- Stimulates immune reactions.
- Normalizes blood glucose levels.
- Reduces the amount of blood cholesterol.
- Regulates the excretion and absorption of phosphorus and calcium.
- Improves heart and lung function.
Local radiation helps stimulate immune reactions in the area where the rays hit, increases blood flow and lymph outflow.
Dosages of irradiation that do not provoke the appearance of redness have the following properties: increase regenerative function, enhance tissue nutrition, stimulate the appearance of melanin in the skin, increase immunity, stimulate the formation of vitamin D. Higher doses that cause erythema (usually AF) can kill bacterial agents, reduce the intensity of pain, reduce inflammation in the mucous membranes and skin.
Indications for physiotherapy
| Overall Impact | Local impact |
| Stimulation of immunity in immunodeficiencies. Prevention and treatment of rickets (vitamin D deficiency) in children, pregnancy, and breastfeeding. Purulent lesions of the skin and soft tissues. Increasing immunity in chronic processes. Increased blood cell production. Replacement therapy for UVR deficiency. |
Joint diseases. Pathologies of the respiratory system. Bronchial asthma. Surgical purulent wounds, bedsores, burns, frostbite, abscesses, erysipelas, fractures. Extrapyramidal syndrome, demyelinating pathologies, head injuries, radiculopathy, various types of pain. Stomatitis, gingivitis, periodontal disease, infiltrative formation after tooth extraction. Rhinitis, tonsillitis, sinusitis. Cracked nipples in women, acute gynecological inflammatory diseases. Weeping umbilical wound in newborns, diathesis with exudation, rheumatoid diseases, pneumonia, skin damage by staphylococcus. Psoriasis, eczematous rashes, purulent skin lesions in dermatological patients. |
Contraindications to irradiation are:
- Tumor process.
- Hyperthermia.
- Infectious diseases.
- Overproduction of thyroid hormones.
- Lupus erythematosus.
- Hepatic and renal dysfunction.
Method of ultraviolet irradiation
Before treatment, the physiotherapist must decide on the type of rays. A prerequisite is to calculate the radiation dose to the patient. The load is measured in biodoses. The number of biodoses is calculated using the Gorbachev-Dahlfeld method. It is based on the speed of formation of redness of the skin. One biodose can cause minimal redness from a distance of 50 cm. This dosage is erythemal.
Erythemal doses are divided into:
- small (one or two biodoses);
- medium (three to four biodoses);
- high (five to eight biodoses).
If the radiation dose is more than eight biodoses, then it is called hypererythemal. Irradiation is divided into general and local. General may be intended for one person or a group of patients. Such radiation is produced by integrated devices or long-wave sources.
Children must be irradiated very carefully using general UV radiation. For children and schoolchildren, an incomplete biodose is used. Start with the smallest dosage.
With the general exposure of newborns and very weak babies to UV rays, 1/10–1/8 of a biodose is exposed at the initial stage. For schoolchildren and preschoolers, 1/4 of the biodose is used. The load is increased over time to 1 1/2-1 3/4 biodoses. This dosage remains for the entire treatment phase. Sessions are held every other day. 10 sessions are enough for treatment.
During the procedure, the patient must be undressed and placed on the couch. The device is placed at a distance of 50 cm from the surface of the patient’s body. The lamp should be covered with a cloth or blanket along with the patient. This ensures that the maximum radiation dosage is received. If you do not cover it with a blanket, then some of the rays emanating from the source are scattered. The effectiveness of therapy will be low.
Local exposure to ultraviolet radiation is carried out by devices of a mixed type, as well as those emitting short waves of the UV spectrum. During local physiotherapy, it is possible to influence reflexogenic zones, irradiate with fractions, fields, near the site of damage.
Local irradiation often causes redness of the skin, which has a healing effect. In order to properly stimulate the formation of erythema, after its appearance, the following sessions begin after it fades. The intervals between physical procedures are 1-3 days. The dosage in subsequent sessions is increased by a third or more.
For intact skin, 5-6 physiotherapy procedures are sufficient. If there are purulent lesions or bedsores on the skin, then up to 12 sessions need to be irradiated. For mucous membranes, course therapy is 10-12 sessions.
For children, local use of ultraviolet radiation is permitted from birth. It is limited in area. For a newborn child, the area of exposure is 50 cm2 or more, for schoolchildren it is no more than 300 cm2. The dosage for erythema therapy is 0.5-1 biodose.
In case of acute respiratory diseases, UV treatment of the nasopharyngeal mucosa is performed. For this purpose, special tubes are used. The session lasts 1 minute (adults), half a minute (children). The course of therapy lasts 7 days.
The chest is irradiated across the fields. The duration of the procedure is 3-5 minutes. The fields are processed separately on different days. Sessions are carried out every day. The frequency of field irradiation per course is 2-3 times; oilcloth or perforated fabric is used to highlight it.
For a runny nose in the acute period, ultraviolet exposure is applied to the feet from the sole. The source is installed at a distance of 10 cm. The course of treatment is up to 4 days. Radiation is also given using a tube into the nose and throat. The first session lasts 30 seconds. In the future, therapy is extended to 3 minutes. Course therapy consists of 6 sessions.
For otitis media, ultraviolet exposure is applied to the ear canal. The session lasts 3 minutes. Therapy includes 6 physiotherapy procedures. In patients with pharyngitis, laryngitis, and tracheitis, irradiation is performed along the anterior upper part of the chest. The number of procedures per course is up to 6.
For tracheitis, pharyngitis, and sore throat, you can irradiate the back wall of the pharynx (throat) using tubes. During the session, the patient must say the sound “a”. The duration of the physiotherapy procedure is 1-5 minutes. Treatment is carried out every 2 days. Course therapy consists of 6 sessions.
Pustular skin lesions are treated by ultraviolet irradiation after treatment of the wound surface. The ultraviolet source is installed at a distance of 10 cm. The session duration is 2-3 minutes. Treatment lasts 3 days.
Boils and abscesses are irradiated after opening the formation. Treatment is carried out at a distance of 10 cm to the surface of the body. The duration of one physiotherapy procedure is 3 minutes. Course therapy 10 sessions.
UV treatment at home
Ultraviolet irradiation can be carried out at home. To do this, you can purchase a UFO device at any medical equipment store. To carry out ultraviolet irradiation physiotherapy at home, the “Sun” device (OUFb-04) has been developed. It is intended for local action on mucous membranes and skin.
For general irradiation, you can purchase a mercury-quartz lamp “Sun”. It will replace part of the missing ultraviolet light in winter and disinfect the air. There are also home irradiators for shoes and water.
The “Sun” device for local use is equipped with a tube for the nose, throat, and treatment of other parts of the body. The device is small in size. Before purchasing, you should make sure that the device is in working order, that it has certificates and quality guarantees. To clarify the rules for using the device, you must read the instructions or contact your doctor.
Conclusion
Ultraviolet radiation is often used in medicine to treat various diseases. In addition to treatment, UV devices can be used to disinfect premises. They are used in hospitals and at home. When lamps are used correctly, irradiation does not cause harm, and the effectiveness of treatment is quite high.
Ultraviolet radiation in medicine is used in the optical range of 180-380 nm (integral spectrum), which is divided into short-wave region (C or AF) - 180-280 nm, medium-wave (B) - 280-315 nm and long-wave (A) - 315- 380 nm (DUV).
Physical and physiological effects of ultraviolet radiation
Penetrates into biological tissues to a depth of 0.1-1 mm, is absorbed by molecules of nucleic acids, proteins and lipids, has photon energy sufficient to break covalent bonds, electronic excitation, dissociation and ionization of molecules (photoelectric effect), which leads to the formation of free radicals, ions, peroxides (photochemical effect), i.e. there is a consistent conversion of the energy of electromagnetic waves into chemical energy.
The mechanism of action of UV radiation is biophysical, humoral and neuro-reflex:
Changes in the electronic structure of atoms and molecules, ionic configuration, electrical properties of cells;
- inactivation, denaturation and coagulation of protein;
- photolysis - breakdown of complex protein structures - release of histamine, acetylcholine, biogenic amines;
- photooxidation - increased oxidative reactions in tissues;
- photosynthesis - reparative synthesis in nucleic acids, elimination of damage in DNA;
- photoisomerization - internal rearrangement of atoms in a molecule, substances acquire new chemical and biological properties (provitamin - D2, D3),
- photosensitivity;
- erythema, with CUF it develops within 1.5-2 hours, with DUF - 4-24 hours;
- pigmentation;
- thermoregulation.
Ultraviolet radiation affects the functional state of various human organs and systems:
Leather;
- central and peripheral nervous system;
- autonomic nervous system;
- the cardiovascular system;
- blood system;
- hypothalamus-pituitary-adrenal glands;
- endocrine system;
- all types of metabolism, mineral metabolism;
- respiratory organs, respiratory center.
The healing effect of ultraviolet radiation
The reaction from organs and systems depends on the wavelength, dose and method of exposure to UV radiation.
Local irradiation:
Anti-inflammatory (A, B, C);
- bactericidal (C);
- painkiller (A, B, C);
- epithelializing, regenerating (A, B)
General exposure:
Stimulating immune reactions (A, B, C);
- desensitizing (A, B, C);
- regulation of vitamin balance “D”, “C” and metabolic processes (A, B).
Indications for UV therapy:
Acute, subacute and chronic inflammatory process;
- trauma to soft tissues and bones;
- wound;
- skin diseases;
- burns and frostbite;
- trophic ulcer;
- rickets;
- diseases of the musculoskeletal system, joints, rheumatism;
- infectious diseases - influenza, whooping cough, erysipelas;
- pain syndrome, neuralgia, neuritis;
- bronchial asthma;
- ENT diseases - tonsillitis, otitis, allergic rhinitis, pharyngitis, laryngitis;
- compensation for solar deficiency, increasing the stamina and endurance of the body.
Indications for ultraviolet irradiation in dentistry
Diseases of the oral mucosa;
- periodontal diseases;
- dental diseases - non-carious diseases, caries, pulpitis, periodontitis;
- inflammatory diseases of the maxillofacial area;
- TMJ diseases;
- facial pain.
Contraindications to UV therapy:
Malignant neoplasms,
- predisposition to bleeding,
- active tuberculosis,
- functional kidney failure,
- stage III hypertension,
- severe forms of atherosclerosis.
- thyrotoxicosis.
Ultraviolet radiation devices:
Integrated sources using DRT (mercury arc tube) lamps of various powers:
ORK-21M (DRT-375) - local and general irradiation
- OKN-11M (DRT-230) - local irradiation
- Mayachnye OKB-ZO (DRT-1000) and OKM-9 (DRT-375) - group and general irradiation
- ON-7 and UGN-1 (DRT-230). OUN-250 and OUN-500 (DRT-400) - local irradiation
- OUP-2 (DRT-120) - otolaryngology, ophthalmology, dentistry.
Selective short-wave (180-280 nm) use bactericidal arc lamps (BA) in the glow electric discharge mode in a mixture of mercury vapor and argon. Lamps of three types: DB-15, DB-30-1, DB-60.
Irradiators are produced:
Wall mounted (OBN)
- ceiling (OBP)
- on a tripod (OBSh) and mobile (OBP)
- local (BOD) with lamp DRB-8, BOP-4, OKUF-5M
- for blood irradiation (AUFOK) - MD-73M "Isolde" (with low pressure lamp LB-8).
Selective long-wave (310-320 nm) use fluorescent erythema lamps (LE), 15-30 W, made of uveolian glass with an internal phosphor coating:
Wall-mounted irradiators (OE)
- suspended reflected distribution (OED)
- mobile (OEP).
Beacon-type irradiators (EOKS-2000) with a xenon arc lamp (DKS TB-2000).
An ultraviolet irradiator on a tripod (OUSH1) with a fluorescent lamp (LE153), a large beacon ultraviolet irradiator (OMU), a tabletop ultraviolet irradiator (OUN-2).
Low pressure gas discharge lamp LUF-153 in the UUD-1, UDD-2L units for Puva and therapy, in the UV irradiator for the limbs OUK-1, for the head OUG-1 and in the irradiators EOD-10, EGD-5. Units for general and local irradiation are produced abroad: Puva, Psolylux, Psorymox, Valdman.
Technique and methodology of ultraviolet therapy
General exposure
Carry out according to one of the following schemes:
Main (from 1/4 to 3 biodoses, adding 1/4 each)
- slow (from 1/8 to 2 biodoses, adding 1/8 each)
- accelerated (from 1/2 to 4 biodoses, adding 1/2 at a time).
Local irradiation
Irradiation of the affected area, fields, reflexogenic zones, staged or by zone, extrafocal. factional.
Features of irradiation with erythemal doses:
One area of skin can be irradiated no more than 5 times, and the mucous membrane - no more than 6-8 times. Repeated irradiation of the same area of skin is possible only after the erythema has subsided. The subsequent radiation dose is increased by 1/2-1 biodose. When treating with UV rays, light-protective glasses are used for the patient and medical staff.
Dosing
Dosing of UV irradiation is carried out by determining the biodose, the biodose is the minimum amount of UV radiation sufficient to obtain the weakest threshold erythema on the skin in the shortest time, with a fixed distance from the irradiator (20 - 100 cm). The biodose is determined using a BD-2 biodosimeter.
There are different doses of ultraviolet radiation:
Suberythemal (less than 1 biodose)
- erythema small (1-2 biodoses)
- medium (3-4 biodoses)
- large (5-6 biodoses)
- hypererythemal (7-8 biodoses)
- massive (over 8 biodoses).
For air disinfection purposes:
Indirect radiation for 20-60 minutes, in the presence of people,
- direct radiation for 30-40 minutes, in the absence of people.
