UFO definition. Dosimetry and dosage of ultraviolet rays
Mechanism of action: ultraviolet irradiation penetrates tissues 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 actions UV irradiation: photochemical (formation of vitamin D), bactericidal, anti-inflammatory, accelerates the development of connective tissue and skin epithelization (its barrier role increases), reduces pain sensitivity, stimulates erythrocytopoiesis, lowers blood pressure in the initial stage of hypertension, normalizes lipid metabolism.
During ultraviolet irradiation, it should be remembered that the light sensitivity of different people and even different parts of the skin has individual fluctuations: the skin of the trunk is the most sensitive to UV irradiation, the skin of the extremities is the least sensitive.
Indication 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, premature babies; for hardening, healing, increasing the body's resistance to infectious diseases; persons who work in the north, in mines, underground to compensate for natural UV deficiency.
Contraindication to UV radiation: malignant tumors, tendency to bleeding, 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 (HRT) with a quartz tube, at the end of which tungsten electrodes are soldered. The air is evacuated from the tube, and its cavity is filled with mercury vapor and a small amount of argon gas. After the llama is connected to the mains, an arc discharge occurs in mercury vapor. Normal lamp mode 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. During irradiation, it is necessary to protect the eyes of the patient and personnel with goggles. Insufficient eye protection can lead to the development of acute conjunctivitis as a result of ultraviolet rays burns the conjunctiva and cornea of the eyes (pain, photophobia, lacrimation, redness of the conjunctiva). Symptoms persist for several days, and cold lotions and eye drops with dicaine are recommended.
The sequence of determining biodoses for the patient:
1. The patient puts on goggles
2. A BD-2 biodosimeter (a metal plate with 6 holes that are closed by a movable barrier) is applied to the area to be irradiated in order to determine the minimum radiation intensity that can lead to the formation of erythema; other parts of the body are covered with a sheet.
3. An 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 opening of the biodosimeter and irradiate the skin above 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, erythemal stripes are distinguished, respectively, of the holes of the biodosimeter.
6. The number of erythemal stripes is counted and the time required for the formation of a minimally pronounced strip is determined: if the patient has 3 strips, 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 (of the whole body) and local (part of the body or its individual parts). General UV exposure can be group (for prevention) and individual (for treatment).
individual general UV irradiation starts with 1/4-1/2 individually determined biodose. After every 2-3 procedures, the dose is doubled and adjusted at the end of the course of treatment to 2-3 biodoses. Procedures are carried out every other day.
Local exposure carry out erythemal doses of UV rays at a distance of 50 cm on an area of not more than 600-800 cm 2. In one day, only one field is irradiated, its repeated irradiation after 2-3 days as the erythema decreases, but not more than 5 times.
HYDROTHERAPY
Hydrotherapy is the use of fresh water (hydrotherapy) and mineral water (balneotherapy) for therapeutic purposes. Fresh water treatment includes dousing, wiping, 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 temperature of the water, there are cold baths (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 varies 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: sweating and breathing, redistribution of blood, irritation of the sensitivity of the nerve endings of the skin, which favorably affects the functioning of all organs and systems of the body.
Baths- these are water procedures that are taken for hygienic, therapeutic and prophylactic purposes. There are baths: general when the patient is completely immersed in water (excluding the head and heart area) and local- immersing a part of the body in water (half to the waist; pelvis, lower abdomen and upper thighs - seated or pelvic; hand and forearm - manual; feet and lower leg - foot and others).
In particular, when the patient is immersed in cold bath a spasm of blood vessels of the skin occurs and metabolic processes are intensified, which lead to a decrease in heat transfer and increased heat generation; hot tub 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, with reduced appetite, etc .; contraindicated in patients of advanced and senile age, 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). The duration of the bath 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 wiped with a warm sheet, put on a shirt, wrapped in a warm blanket and laid in 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 (sciatica, polyneuritis), metabolic disorders (gout), attacks of renal colic. Hot baths are contraindicated in patients of advanced and senile age, with cardiovascular diseases, hypertension, a tendency to bleeding, 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-term - 5-10 minutes (hot baths tire the patient, lead to general weakness, palpitations, dizziness). When taking a bath and after the procedure, the patient's condition is closely monitored, especially the pulse. If during the procedure there is a general weakness, palpitations, dizziness - the patient is taken out of the bath, the head and face are moistened with cold water. After the bath, the patient is wiped 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. The temperature of the bath water is 37-39 °C, the duration of the procedure is 15-20 minutes.
Indifferent baths have a light tonic and refreshing effect on the body, due to the mechanical and chemical effects of water on skin receptors, eliminate the effect of the thermal factor on the body. The temperature of the bath water is 34-36 °C, the duration of the procedure is 20-30 minutes.
Mechanical factor - this is the pressure of the water layer, stimulating lymph flow, and the outflow of venous blood improves the functioning of the heart.
The mechanical effect of the bath is to compress the chest, resulting in a decrease in the number of its respiratory movements, as well as compression of the abdominal cavity. To reduce the mechanical effect, foam baths are used (neuralgia, obesity, pruritus, 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). Of particular importance is gas ("pearl") baths - air bubbles surround the body in the form of a raincoat and contribute to the redistribution of blood.
chemical factor due to components that are dissolved in water. Chemical substances that settle on the surface of the skin increase the irritation of skin receptors, affect the visual and olfactory analyzers.
The chemical action of the bath determined by the nature of the drugs that are added to the water. According to its composition, waters can be fresh, fragrant, medical, mineral and gas.
For therapeutic purposes, baths with gas impurities (oxygen, hydrogen sulfide, radon, carbon dioxide), minerals or special medicines 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, reflexively cause the expansion of capillaries, as a result of which the skin turns red and redistribution of circulating blood occurs. Gas baths have a positive 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 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 (sciatica, neuritis), joints (polyarthritis, arthrosis), bronchopneumonia. The water temperature is 36-37 °C, the duration of the procedure is 10-15 minutes, the course of treatment is 10-15 baths every other day.
Coniferous baths indicated for functional disorders of the nervous system (neurosis, irritability, insomnia). The water temperature is 36-37 °C, the duration of the procedure for adults is 15-30 minutes, for children 7-10 minutes, the course of treatment is 15-20 baths every other day.
starch baths prescribed for skin manifestations of exudative diathesis, they reduce itching and dry the skin. The water temperature is 37-38 °C, the duration of the procedure for adults is 30-45 minutes, for children 8-10 minutes, the course of treatment is 10-12 baths daily or every other day.
Sage baths prescribed when it is necessary to reduce pain in diseases and consequences of injuries of peripheral nerves, consequences of injuries of the musculoskeletal system, in chronic inflammatory processes of the female genital area. Water temperature 35-37 °C, procedure duration 8-15 minutes, treatment course 12-18 baths daily or every other day.
Sanitary and hygienic requirements for the premises: the room should be tiled, the air temperature in the room should not be lower than 25 °C, the windows should be closed. The junior nurse washes the bath with a washcloth or brush with soap and hot water, rinses with a disinfectant solution (1-1.5% chloramine solution or 3% Lysol solution) and then rinses the bath with hot water several times.
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 are supported (the back rests on one wall of the bath, and the legs on the other). If the patient does not reach the wall of the bath with his feet, then a shield or a special device is placed under his feet.
Patient care 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 closet there should be a set of necessary medicines for first aid in case of deterioration of the patient's condition. 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, dizziness appears or he loses consciousness, it is necessary with the help of a junior nurse to get the patient out of the bath, wipe it with a towel, put it on the sofa with the foot end slightly raised, rub the temples and let the ammonia smell. With pain in the region of the heart, they give validol and urgently call a doctor.
Along with baths, the local effect of mineral waters is widely used - medicinal drinking.
Healing 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 trace elements (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. Of great importance is the concentration of hydrogen ions - the pH of water (strongly acidic, acidic, slightly acidic, neutral, slightly alkaline and alkaline).
It is best to take water from a spring. With secretory insufficiency, you need to drink water in separate sips, with hyperfunction - quickly; to get a braking effect - in one gulp, in large sips. Patients with reduced gastric secretion are shown cold chloride, carbonic acid waters (Mirgorodskaya, etc.). Patients with high acidity are recommended waters that have an inhibitory effect - hydrocarbonate, hydrocarbonate-sulfate waters in a warm form (Borjomi, Carpathian, Lugansk, Novoberezovskaya, etc.).
test questions
1. Classification of drugs.
2. How are narcotic drugs stored and used in the department?
3. What are the ways to distribute medicines to patients?
4. How to correctly inject 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. The sequence of applying a warming compress.
10. What effect does the temperature factor have on the body?
11. Indication and contraindication 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. What diseases are treated with thermal electrophysical procedures?
15. What are the methods of UV irradiation and their purpose.
16. Features of the release of physiotherapy procedures to elderly patients.
THEME 8. GENERAL AND SPECIAL CARE
The ultraviolet radiation of 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 (DUV)
B (320-280 nm) - medium wave (SUV);
C - (280-180 nm) - shortwave (CUV).
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 protein, DNA, and RNA molecules that are sensitive to UV rays.
Photolysis of proteins of epidermal cells 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 the reflex reactions caused by the activation of numerous receptors by photolysis products and biologically active substances, as well as the humoral effects on the nervous, endocrine, immune and other systems of the body. Naturally, UV radiation causes responses from the human body, which form the basis of the physiological and therapeutic effects of UV rays.
One of the main components of this therapeutic action are the effects associated with the formation of ultraviolet (or photochemical) erythema. The maximum erythema-forming property has UV radiation with a wavelength of 297 nm.
UV erythema has an anti-inflammatory, desensitizing, trophic-regenerative, and analgesic effect. The anti-rachitic effect of UV rays is that under the influence of this radiation, vitamin D is formed in the irradiated skin. Therefore, UVR is a specific treatment and prophylactic procedure for children suffering from rickets.
The bactericidal action of UV radiation is widely used. Distinguish between direct and indirect bactericidal action of UV rays. As a result of direct action, coagulation and denaturation of microbial proteins occur on the surface of the wound, the mucous membrane, which leads to the death of the bacterial cell. The indirect effect of UV radiation is associated with a change in the immunobiological reactivity of the body under the influence of UV rays.
UV rays actively influence 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 action, ultraviolet radiation (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 by the Gorbachev-Dakfeld biological method. The method is simple and is based on the property of UV rays to cause erythema when the skin is irradiated. The unit of measurement in this method is one biodose. For one biodose, the minimum exposure time of a given patient from a certain distance to a certain source of UV rays is taken, which is necessary to obtain a weak, but clearly defined erythema. Time is measured in seconds or minutes.
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 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 hyperemia of the skin. With a change in the distance from the emitted surface to obtain the same biodose, the exposure time changes inversely with 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 exposure time can be selected discretely from 30 sec. up to 60 sec., and the distance from the body (its skin) to the emitter is from 10 cm to 50 cm. It all depends on the skin type, but you need to choose these parameters in such a way as to get a clear picture of skin erythema.
The sensitivity of the skin to UV rays depends on many reasons, among which the most important are the localization of exposure, skin color, season, age and initial condition of the patient. Diseases that a person suffers from also play a significant role. With photodermatosis, eczema, gout, liver diseases, hyperthyroidism, etc., skin sensitivity to UV rays is increased, with other pathologies (pressure sores, frostbite, trophic wounds, gas gangrene, erysipelas, diseases of the peripheral nerves and spinal cord below the level of the lesion, etc. .) skin sensitivity to UV radiation, on the contrary, is reduced. In addition, there is a large list of contraindications for UV treatment that you need to know. Therefore, in order to successfully and correctly apply ultraviolet radiation treatment, it is necessary to consult with your doctor - a specialist in the field of physical therapies.
Indications for UV exposure
General UVR is used for:
Local UVI 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 (UVI-400nm * 320 nm) are acute inflammatory diseases of internal organs (especially the respiratory system), diseases of the joints and bones of various etiologies, burns and frostbite, sluggish wounds and ulcers, psoriasis, eczema, vitiligo, seborrhea. (Instrument: OUFk-01 and OUFk-03 "Solnyshko")
General UVR is prescribed taking into account individual characteristics and skin sensitivity to UV radiation according to the main or accelerated scheme. To normalize the immune status in chronic sluggish inflammatory processes, as well as to prevent acute respiratory viral infections, an erythema-free general UVR is performed with long and medium waves from a distance of 50-100 cm.
The anterior, posterior and lateral surfaces of the body are irradiated sequentially. Protective goggles are worn during all procedures. UV irradiation according to the method of PUVA therapy (or photochemotherapy) is carried out as follows. Patients with psoriasis or parapsoriatic diseases are given in an appropriate dose orally or externally applied preparations of the furocoumarin series (puvalen, psoralen, beroxan, etc.). The drugs are taken only on the day of the procedure 1 time 2 hours before irradiation after meals, washed down with milk. The individual photosensitivity of the patient is determined in the usual way with a biodosimeter, but also 2 hours after taking the drug. Begin the procedure with minimal suberythemal doses.
Medium-wave ultraviolet irradiation is indicated for acute and subacute inflammatory diseases of internal organs, consequences of injuries of the musculoskeletal system, diseases of the peripheral nervous system of vertebrogenic etiology with severe pain, rickets, secondary anemia, metabolic disorders, erysipelas. (Instrument: OUFd-01, OUFv-02 "Sun").
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, skin tuberculosis. (Instrument: OUFb-04 "Solnyshko").
Contraindications for local and general UV irradiation are malignant neoplasms, systemic diseases of the connective tissue, active form of pulmonary tuberculosis, hyperthyroidism, febrile conditions, a tendency to bleeding, circulatory failure II and III degrees, arterial hypertension III degree, severe atherosclerosis, diseases of the kidneys and liver with insufficiency of their function, cachexia, malaria, hypersensitivity to UV rays, photodermatosis, myocardial infarction (the first 2-3 weeks), acute cerebrovascular accident.
Some private methods of ultraviolet therapy
Flu.
The face, chest and back are irradiated daily with erythemal doses for 2-3 days. With catarrhal phenomena 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 biodose in subsequent irradiations.
Infectious-allergic diseases.
Application of UVR to the skin of the chest using a perforated oilcloth localizer (PCL). 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 is prescribed in suberythemic doses, counting on the bactericidal effect of UV radiation.
Rhinitis is acute.
Assign UV irradiation of the plantar surfaces of the feet. Dose 5-6 biodoses daily. The course of treatment is 4-5 procedures. UV irradiation through the tube of the nasal mucosa in the stage of attenuation of exudative phenomena. Irradiation starts with one biodose. By adding 1/2 biodoses daily, the irradiation intensity is adjusted to 4 biodoses.
Acute laryngotracheitis.
UV irradiation is carried out on the trachea and on the skin of the back of the neck. The radiation dose is 1 biodose. Irradiation is carried out every other day, adding 1 biodose, the course of treatment is 4 procedures. If the disease is prolonged, then after 10 days, UVR of the chest is prescribed through a perforated oilcloth 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 of the anterior surface of the neck, sternum, interscapular region. Dose - 3-4 biodoses. Irradiation alternates every other day of the back and front surfaces of the chest. The course of treatment is 4 procedures.
Bronchitis chronic catarrhal.
UV irradiation of the chest is prescribed after 5-6 days from the onset of the disease. UVR 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, a general UVR is prescribed according to the main scheme daily. The course of treatment is 12 procedures.
Bronchial asthma.
Both general and local exposures can be used. The chest is divided into 10 sections, each measuring 12x5 centimeters. Only one area is irradiated daily with erythemal 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
(It is carried out in combination with UHF, SMW, 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. The course of treatment is 3 procedures.
Hydradenitis axillary
(In combination with SMW, UHF, infrared, laser and magnetotherapy). In the stage of infiltration, ultraviolet irradiation of the axillary region every other day. Irradiation dose - sequentially 1-2-3 biodoses. The course of treatment is 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 decayed tissues. In the second phase, in order to stimulate epithelialization, irradiation is carried out in small suberythemal (i.e., not causing erythema) doses. Repetition of irradiation produced in 3-5 days. UVR is carried out after the primary surgical treatment. Dose - 0.5-2 biodoses course of treatment 5-6 exposures.
Clean wounds.
Irradiation is used in 2-3 biodoses, and the surface of intact skin surrounding the wound is also irradiated at a distance of 3-5 cm. Irradiation is repeated after 2-3 days.
Torn ligaments and muscles.
UVR 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 dose is 2 biodoses. The course of treatment is 3 procedures for each zone.
The general UVR is prescribed 10 days after the fracture according to the main scheme daily. The course of treatment is 20 procedures.
UV in the postoperative period.
UVR 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 biodoses, bring the intensity of exposure to 3 biodoses. The course of treatment is 6-7 procedures.
Boils, hydradenitis, phlegmon and mastitis.
UVR is started with a suberythemal dose and rapidly increased to 5 biodoses. The radiation dose is 2-3 biodoses. Procedures are carried out in 2-3 days. The lesion is protected from healthy areas of the skin with the help of sheets, towels.
Chronic tonsillitis.
UV irradiation of the tonsils through a tube with a bevel of 45% of the cut begins with 1/2 biodose, daily increases by 1/2 biodose every 2 procedures. Courses are held 2 times a year. A sterile tube through the patient's wide open mouth is pressed onto the tongue so that the tonsil becomes available for UV irradiation. The right and left tonsils are irradiated alternately.
Otitis externa.
UV irradiation through the tube of the ear canal. Dose - 1-2 biodoses daily. The course of treatment is 6 procedures.
Furuncle of the nose.
UVI of the vestibule of the nose through the tube. Dose - 2-3 biodoses every other day. The course of treatment is 5 procedures.
tuberculosis of the bones.
UV irradiation with the long-wave part of the spectrum is assigned according to a slow scheme. The course of treatment is 5 procedures.
Eczema.
UVI is prescribed according to the main scheme daily. The course of treatment is 18-20 procedures.
Psoriasis.
UVR is prescribed as PUVA therapy (photochemotherapy). Long-wave UV irradiation is performed in combination with taking a photosensitizer (puvalen, aminfurin) by the patient 2 hours before irradiation at a dose of 0.6 mg per kilogram of body weight. The radiation dose is prescribed depending on the sensitivity of the skin to the patient's UV rays. On average, UVI starts with a dose of 2-3 J/cm 2 and is brought to the end of the course of treatment up to 15 J/cm 2 . Irradiation is carried out 2 days in a row with a rest day. The course of treatment is 20 procedures.
UVR with a medium wave spectrum (SUV) starts from 1/2 according to an accelerated scheme. The course of treatment is 20-25 exposures.
Gastritis is chronic.
UVR is assigned to the anterior abdominal skin and the skin of the back. UVR 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.
Vulvit.
Appointed:
1. Ultraviolet irradiation of the external genital organs. Irradiation is carried out daily or every other day, starting with 1 biodose. Gradually adding 1/2 biodoses, bring the intensity of exposure to 3 biodoses. The course of treatment is 10 irradiations.
2. General ultraviolet irradiation according to the accelerated scheme. Irradiation is carried out daily, starting with 1/2 biodose. Gradually adding 1/2 biodoses, bring the intensity of exposure to 3-5 biodoses. The course of treatment is 15-20 exposures.
Bartholinitis.
Ultraviolet irradiation of the external genital organs is prescribed. The radiation dose is 1-3 biodoses daily or every other day. The course of treatment is 5-6 exposures.
Colpitis.
Ultraviolet irradiation is prescribed using a tube. Dose - 1/2-2 biodoses daily. The course of treatment is 10 procedures. Cervical erosion. Ultraviolet irradiation of the cervical region is prescribed with the help of a tube and a gynecological mirror. Dose - 1/2-2 biodoses daily. Doses are increased every two procedures by 1/2 of the biodose. The course of treatment is 10-12 procedures.
With inflammation of the uterus, appendages, pelvic peritoneum and fiber
Ultraviolet irradiation of the skin of the pelvic area is prescribed in the fields. Dose - 2-5 biodoses per 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, a large place is occupied by therapeutic physical factors, both natural and artificially obtained.
Therapeutic physical factors have a homeostatic effect on various organs and systems, 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 application is affordable, highly efficient and cost-effective.
It is very important to understand that ultraviolet physiotherapy is one of the most important components of the whole complex of physical methods of treatment and rehabilitation of patients. The advantage of therapeutic physical factors is fully realized when they are properly applied and combined with other therapeutic and prophylactic and rehabilitation measures.
1. The position of the patient lying or sitting, light-protective glasses in front of the eyes.
2. A biodosimeter with closed windows is fixed on the corresponding area of the skin, with general irradiation - on the lower abdomen.
3. Fix the biodosimeter on the patient's body with ribbons.
4. Parts of the body that are not subject to radiation are covered with a sheet.
5. The lamp is installed above the biodosimeter at a distance of 50 cm.
6. Turn on the lamp in the network with a power cord, turn the switch knob to the on position, warm up for 2 minutes.
7. Open, sequentially, every 30 seconds, the holes of the biodosimeter and irradiate.
8. After irradiation of the 6th hole, quickly take 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 erythemal stripes that appear . The result is the formula : X \u003d 30 (6 - n + 1).
12. After calculating the biodose, set the exposure time for a certain area of the body.
Algorithm for conducting UV on the skin
UV irradiator on a tripod.
Designed for individual local ultraviolet irradiation.
2. Set the mains switch knob to the “On” position.
3. After lighting the lamp, wait 10 minutes to establish the operating mode.
4. Lay or seat the patient, put on light-protective glasses.
5. Places not exposed to radiation, cover with a sheet or napkin.
6. Set the lamp in the desired position and irradiate (the lamp is installed on the side of the patient at a distance of 50-100 cm.
7. Perform skin irradiation. The time depends on the individual biodose.
8. Re-enabling the irradiator 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 in the procedure sheet about the procedure performed.
Algorithm for conducting UVR tube quartz
1. Familiarize yourself with the doctor's prescription.
2. Turn the mains switch knob to the “On” position, and the signal lamp lights 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. Set the mains switch knob to the “Off” position.
7. Place the tubes in a container with disinfectant.
8. Mark in the procedure sheet about the procedure performed.
Algorithm for conducting paraffin treatment
Cuvette-application technique.
1. Familiarize yourself with the doctor's prescription.
2. Lay out the cuvette with an oilcloth protruding 5 cm along the edges.
3. Pour the melted paraffin into a cuvette with a thickness of 2-3 cm.
4. Let the paraffin, ozocerite cool down to a temperature of 50 - 55 degrees.
5. Give the desired position. Expose the area of the procedure.
6. Warn the patient about the sensation of warmth as light pressure cools.
7. Frozen, but still soft paraffin is removed from the cuvette together with oilcloth, applied to the area of the body to be affected for 15 - 20 minutes.
8. Cover the treatment area with a blanket from above.
9. At the end of the procedure, remove the blanket, remove the oilcloth with the coolant.
10. After ozokerite, wipe the skin with a cotton swab moistened with petroleum jelly.
11. Warn the patient not to go outside for 15-30 minutes.
12. Mark in the procedure sheet about the procedure performed.
13. Send paraffin for sterilization.
Light therapy is actively used in medical practice for the treatment of various diseases. It includes the use of visible light, laser, infrared, and ultraviolet rays (UVR). The most commonly prescribed UFO-physiotherapy.
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, for indoor air treatment.
General concept of ultraviolet irradiation, types of devices, mechanism of action, indications
Ultraviolet irradiation (UVR) is a physiotherapeutic procedure 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).
- Medium wave (SUV) (320–280 nm).
- Shortwave (CUV) (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 UV radiation.
- Selective. They produce one type of ultraviolet radiation: short-wave, a combination of short-wave and medium-wave spectra.
| Integral | selective |
|
OUSh-1 (for individual use, local exposure, general effects on the body); OH-7 (suitable for the nasopharynx) OUN 250, OUN 500 - desktop type for local use). The radiation source is a mercury-quartz tubular lamp. Power can be different: from 100 to 1000 watts. |
Shortwave Spectrum (SHF). Sources of bactericidal action: OBN-1 (wall-mounted), OBP-300 (ceiling-mounted). Used for disinfection of premises. Short rays for local exposure (irradiation of the skin, mucous membranes): BOP-4. The medium wave spectrum is generated by luminescent erythemal sources with ultraviolet-transmitting glass: LE-15, LE-30. Sources of long waves (DUV) 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 hit 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, 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.
Benefits of small doses of UVR:
- Enhances the formation of red blood cells and other blood cells.
- Increases the function of the adrenal glands, the sympathetic system.
- Reduces the formation of fat cells.
- Improves the performance of the naming system.
- Stimulates immune responses.
- 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 to stimulate immune responses in the area where the rays hit, increases blood flow and lymph outflow.
Radiation doses that do not cause redness have the following properties: increase regenerative function, increase tissue nutrition, stimulate the appearance of melanin in the skin, increase immunity, stimulate the formation of vitamin D. Higher doses that cause erythema (often CUF) are able to kill bacterial agents, reduce the intensity of pain, reduce inflammation on the mucous membranes and skin.
Indications for physiotherapy
| General impact | Local impact |
| Stimulation of immunity in immunodeficiencies. Prevention and treatment of rickets (vitamin D deficiency) in children, during pregnancy, breastfeeding. Purulent lesions of the skin, soft tissues. Increased immunity in chronic processes. Increased production of blood cells. Replacement therapy for UVR deficiency. |
Diseases of the joints. Pathology 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. Cracks in the nipples in women, acute gynecological inflammatory diseases. Weeping umbilical wound in newborns, diathesis with exudation, rheumatoid diseases, pneumonia, skin lesions with staphylococcus aureus. Psoriasis, eczematous rashes, purulent skin lesions in dermatological patients. |
Contraindications to radiation are:
- tumor process.
- Hyperthermia.
- Infectious diseases.
- Hyperproduction of thyroid hormones.
- Lupus erythematosus.
- Hepatic and renal dysfunction.
The method of conducting ultraviolet irradiation
Before treatment, the physiotherapist must decide on the type of rays. A prerequisite is the calculation of radiation exposure to the patient. The load is measured in biodoses. The calculation of the number of biodoses is carried out according to the Gorbachev-Dalfeld method. It is based on the speed of formation of reddening of the skin. One biodose is capable of causing minimal redness from a distance of 50 cm. This dosage is erythematous.
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 hypererythemic. Irradiation is divided into general and local. The general may be intended for one person or a group of patients. Such radiation is produced by integral devices or sources of long waves.
Children need to be irradiated with general UV very carefully. For a child and a student, an incomplete biodose is used. Start with the smallest dosage.
With a general exposure to UV rays of newborns and very weak babies, at the initial stage, 1/10–1/8 of the biodose is affected. Schoolchildren and preschoolers use 1/4 of the biodose. Over time, the load is increased to 1 1/2-1 3/4 biodoses. This dosage remains for the entire stage of therapy. Sessions are held every other day. 10 sessions are enough for treatment.
During the procedure, the patient must be undressed, put 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 dose of radiation is obtained. If you do not cover with a blanket, then part of the rays emanating from the source is scattered. The effectiveness of therapy in this case will be low.
Local exposure to UV radiation is carried out by devices of a mixed type, as well as emitting short waves of the UV spectrum. During local physiotherapy, it is possible to influence reflexogenic zones, irradiate with fractions, fields, near the injury site.
Local irradiation often causes reddening 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 its blanching. The intervals between physiotherapy are 1-3 days. The dosage in subsequent sessions is increased by a third or more.
For intact skin, 5-6 physiotherapy procedures are enough. If there are purulent lesions, bedsores on the skin, then it is necessary to irradiate up to 12 sessions. For mucous membranes, course therapy is 10-12 sessions.
For children, local use of UVR is permitted from birth. It is limited in area. In a newborn child, the impact area is 50 cm2 or more, for schoolchildren it is not more than 300 cm2. The dosage for erythemotherapy is 0.5-1 biodose.
In acute respiratory diseases, the nasopharyngeal mucosa is treated with UV. For this, special tubes are used. The session lasts 1 minute (adults), half a minute (children). Course therapy is 7 days.
The chest is irradiated in the fields. The duration of the procedure is 3-5 minutes. The fields are processed separately on different days. Sessions take place every day. The multiplicity of field irradiation per course is 2-3 times, oilcloth or perforated fabric is used to isolate it.
With a runny nose in the acute period, ultraviolet exposure is carried out on the legs from the side of the sole. The source is installed at a distance of 10 cm. The course of treatment is up to 4 days. Irradiation is also done with a tube in the nose and throat. The first session lasts 30 seconds. In the future, therapy is extended to 3 minutes. Course therapy is 6 sessions.
With otitis media, ultraviolet exposure is carried out on the site of the ear canal. The session lasts 3 minutes. The therapy includes 6 physiotherapy procedures. In patients with pharyngitis, laryngitis, tracheitis, irradiation is performed along the anterior upper part of the chest. The number of procedures per course is up to 6.
With tracheitis, pharyngitis, tonsillitis, irradiation of the back wall of the pharynx (throat) can be done using tubes. During the session, the patient should say the sound "a". The duration of the physiotherapy is 1-5 minutes. Treatment is carried out every 2 days. Course therapy is 6 sessions.
Pustular skin lesions are treated by UVI after treatment of the wound surface. The source of ultraviolet light is set at a distance of 10 cm. The duration of the session is 2-3 minutes. Treatment continues for 3 days.
Furuncles and abscesses are irradiated after opening the formation. The treatment is carried out at a distance of 10 cm to the surface of the body. The duration of one physiotherapy is 3 minutes. Course therapy 10 sessions.
UV treatment at home
Ultraviolet irradiation is permissible to carry out at home. To do this, you can purchase a UFO device at any medical equipment store. For the implementation of UV-physiotherapy at home, the apparatus "Sun" (OUFb-04) was 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, disinfect the air. There are also home irradiators for shoes, water.
The device "Sun" for local use is equipped with a tube for the nose, throat, treatment of other parts of the body. The device is small. Before purchasing, you should make sure that the device is in good condition, that there are certificates and quality assurance. 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 for the treatment of various diseases. In addition to treatment, UV devices can be used for disinfection of premises. They are used in hospitals and at home. With the correct use of lamps, 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 (integrated spectrum), which is subdivided into the short-wave region (C or UV) - 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, 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 transformation of the energy of electromagnetic waves into chemical energy.
The mechanism of action of UV radiation - biophysical, humoral and neuro-reflex:
Change in the electronic structure of atoms and molecules, ionic conjuncture, electrical properties of cells;
- inactivation, denaturation and coagulation of the protein;
- photolysis - the breakdown of complex protein structures - the 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 KUF develops 1.5-2 hours, with DUV - 4-24 hours;
- pigmentation;
- thermoregulation.
Ultraviolet radiation has an effect on 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.
Therapeutic effect of ultraviolet radiation
The reaction from organs and systems depends on the wavelength, dose and method of exposure to UV radiation.
Local exposure:
Anti-inflammatory (A, B, C);
- bactericidal (C);
- painkiller (A, B, C);
- epithelizing, 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;
- injury of 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 media, allergic rhinitis, pharyngitis, laryngitis;
- compensation of solar insufficiency, increase of firmness and endurance of an organism.
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 region;
- TMJ diseases;
- facial pain.
Contraindications to UV therapy:
malignant neoplasms,
- predisposition to bleeding
- active tuberculosis,
- functional insufficiency of the kidneys,
- hypertension stage III,
- severe forms of atherosclerosis.
- thyrotoxicosis.
UV devices:
Integrated sources using DRT lamps (arc mercury tubular) of various power:
ORK-21M (DRT-375) - local and general exposure
- OKN-11M (DRT-230) - local irradiation
- Beacon OKB-ZO (DRT-1000) and OKM-9 (DRT-375) - group and general exposure
- OH-7 and UGN-1 (DRT-230). OUN-250 and OUN-500 (DRT-400) - local exposure
- OUP-2 (DRT-120) - otolaryngology, ophthalmology, dentistry.
Selective short-wavelength (180-280 nm) use arc bactericidal lamps (DB) in the glow electric discharge mode in a mixture of mercury vapor with argon. Lamps of three types: DB-15, DB-30-1, DB-60.
Illuminators available:
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 "Izolda" (with a low pressure lamp LB-8).
Selective long-wavelength (310-320 nm) use erythemal luminescent lamps (LE) with a power of 15-30 W from uveolive glass with an internal coating with a phosphor:
Wall type irradiators (OE)
- suspended reflected distribution (OED)
- mobile (OEP).
Beacon type irradiators (EOKS-2000) with xenon arc lamp (DKS TB-2000).
An ultraviolet irradiator on a tripod (ОУШ1) with a fluorescent lamp (LE153), a large beacon ultraviolet irradiator (ОУН), a desktop ultraviolet irradiator (ОУН-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. Plants for general and local irradiation are produced abroad: Puva, Psolylux, Psorymox, Valdman.
Technique and methodology of UV therapy
General exposure
Carried out according to one of the schemes:
Basic (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 each).
Local exposure
Irradiation of the affected area, fields, reflexogenic zones, staged or by zones, extrafocal. fractional.
Features of irradiation with erythemal doses:
One area of the 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 the skin is possible only after the extinction of the erythema. 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 radiation is carried out by determining the biodose, 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). Determination of biodose is carried out by biodosimeter BD-2.
There are doses of ultraviolet radiation:
Suberythemal (less than 1 biodose)
- erythema small (1-2 biodoses)
- medium (3-4 biodoses)
- large (5-6 biodoses)
- hypererythemic (7-8 biodoses)
- massive (over 8 biodoses).
For air disinfection:
Indirect radiation for 20-60 minutes, in the presence of people,
- direct radiation for 30-40 minutes, in the absence of people.
