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Как подправить крыловидную мышцу?

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Мастер класс "Зачем массажисту тестировать мышцы?"

Мастер класс "Зачем массажисту тестировать мышцы?"

Channel: Краснодарский колледж прикладной кинезиологии

КРАНИАЛЬНЫЕ нарушения: ДИАГНОСТИКА!

КРАНИАЛЬНЫЕ нарушения: ДИАГНОСТИКА!

Channel: ПРИКЛАДНАЯ КИНЕЗИОЛОГИЯ UAAK

#ЧОКЧЕМУ с доктором Циванюком. О мышцах

#ЧОКЧЕМУ с доктором Циванюком. О мышцах

Channel: Краснодарский колледж прикладной кинезиологии

Диагностика и коррекция дисковых нарушений (Михаил Савиных)

Диагностика и коррекция дисковых нарушений (Михаил Савиных)

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ЭКГ при жизнеугрожающих аритмиях

ЭКГ при жизнеугрожающих аритмиях

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Все о трапециевидной мышце (Глеб Кирдогло)

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Эмоциональная коррекция. АЛГОРИТМ работы с пациентом.

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Воспалительные заболевания кишечника: диагностика и лечение (лекция для врачей)

Воспалительные заболевания кишечника: диагностика и лечение (лекция для врачей)

Channel: Клиника ЭКСПЕРТ

заболевания

болезнь

гастроэнтеролог

гастроэнтерология

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доктор

медицинский

медицина

наука

лечение

терапия

12пк

кишечник

кишка

жкт

желудочно-кишечный

тракт

двенадцатиперстная

обучение врачей

лекции для врачей

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препараты

пробиотики

пребиотики

лекарства

желудок

энтеральное питание

пациент

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[music]

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since it is used here in

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stepping mode, that is, from the English word

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citizen, that is, drinking in small sips and

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through some kind of straw,

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they gulp not the entire volume at a time,

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eat in small portions on their own,

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the patient either swallows or through a straw

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and the second option is a lawsuit vision through a

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probe, it can be passive, that is, this is the

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same classic dropper,

00:01:57

seen by the nurse, at what speed

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approximately the doctor said, so I wo

00:02:01

n’t give an example, or what is

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actually correct, this is an active method of

00:02:07

management when there is a device in the institution,

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they are called pumps in different

00:02:15

modifications which can be

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programmed at a certain speed a

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certain volume and the patient clearly

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receives what he needs during the

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day in these small portions at a

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certain time of day blinking can

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constantly

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this really exposes the task reduces

00:02:33

the percentage of adverse events but for

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this the pump must

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literally say a few words about what we often

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see in the Hubble hospital, then

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undoubtedly we can also see this

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when they talk about tube feeding,

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many colleagues, unfortunately, still

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perceive through the prism of that very

00:02:56

Soviet probe that became one, come on, the diet

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was not developed long enough

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because there was no mixture of natural

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mixtures and Of course, they don’t

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eat enough, they are difficult for a few season, that

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is, relatively speaking, porridge, soups,

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meat is pureed and somehow they are

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pushed with a syringe, all of this is incorrect,

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all the options are information, milk, sweet

00:03:24

solutions, this is not all relevant

00:03:27

because, firstly, it is not balanced, and secondly, it

00:03:29

cannot be provided with nutrition at all with adequate

00:03:32

nutrition, the patient found a release and we

00:03:34

can introduce a maximum of up to 500 kilocalories per day did

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not give what we need, so the

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probes are the

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same diet should not be used, there should be no

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regrets, continue why use

00:03:46

now let’s move on to the general characteristics of

00:03:48

neutral mixtures because the

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question of Nobel often arises: can you

00:03:53

use a mixture of the patient’s central

00:03:57

with lactose intolerance, but here is the

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patient's goals and is it or is there no

00:04:01

gluten by chance, so I removed the

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virtual answers to these questions all

00:04:08

mixtures are made in this way all

00:04:11

registered mixtures are made in such a

00:04:12

way that they do not contain lactose does not

00:04:15

contain gluten does not contain chicken

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can be used by patients with

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gout does not contains sucrose

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cholesterol and does not seem to increase

00:04:25

your cholesterol directly in a thin form, we

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mean to give the case of foods

00:04:30

high in cholesterol all the

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mixtures here, of course, we are talking about ready-made

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liquid mixtures,

00:04:37

they have enough to say that the

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density if you have a ready-made mixture in a

00:04:41

commercially carried out and on death at

00:04:44

least 1 kalka sea per milliliter

00:04:46

can be more at least all mixtures are

00:04:51

adapted read in a standard

00:04:54

mixture of one and a half liters contains everything that

00:04:57

the patient needs for a normal life so

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normal life for a normal

00:05:06

state you understand the embellishment that this is

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still not a replacement equivalent to regular

00:05:14

food, that is we can’t just recommend to a patient,

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let’s

00:05:18

use a natural mixture instead of food, but

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if it is clinically necessary, sometimes

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patients are only on a mental

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mixture without regular food, we understand that the

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required volume contains everything that the

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patient needs, not only proteins, fats,

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carbohydrates, but also vitamins, micro

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macroelements, patients the mixture

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must have optimal osmolarity, this

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question is quite complex, but

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daughter let's talk about what

00:05:46

osmolarity is and the lower the better it is

00:05:49

tolerated, so it is

00:05:52

advisable to pay attention to this one,

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optimally if it is less there is 300

00:05:57

at least 340

00:06:00

mixtures should have low viscosity in

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order to not be able to administer a drip

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through a probe and the decree should be the place of

00:06:08

production of the mixture

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everywhere modern mixtures are all together

00:06:12

this central mixture is divided into 4

00:06:16

large groups although they are currently available

00:06:19

well accessible and

00:06:22

diverse the first three groups are a

00:06:24

standard floor elemental network of the mixture

00:06:26

directed the action that we will now

00:06:28

analyze with you will be a little complicated

00:06:31

because there are many groups with their hands

00:06:33

to emphasize for themselves the type of mixture that can be

00:06:38

useful in their practice because in

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reality many mixtures are used in each

00:06:43

specific clinical situation, let's start

00:06:46

with standard mixtures and for the title it

00:06:48

is clear that these are the most

00:06:52

familiar Most doctors are

00:06:55

mixtures that contain all the necessary

00:06:59

macro-micronutrients in accordance with the

00:07:02

human daily needs of

00:07:04

the body; proteins are presented there; no one

00:07:07

is sold, that is, not split,

00:07:09

either milk or soy,

00:07:11

or both in combination in the form of

00:07:16

vegetable oils, sunflower owls,

00:07:18

corn, in different ways in different

00:07:19

manufacturers of these oils, they all have their own

00:07:25

carbohydrates, apparently fedex trinnov, that is, these are

00:07:28

starch hydrolysates, we are talking

00:07:32

about a standard mixture, they should be

00:07:33

used in most clinical

00:07:35

situations, if we touch again,

00:07:38

remember a patient who has a

00:07:41

dental problem, she may

00:07:43

not have any diseases, but he needs to

00:07:46

increase it a little caloric content fear we

00:07:50

put in the diet we zucchini of his food

00:07:53

which he can shake yes we

00:07:55

add a standard mixture there are they there are

00:07:58

no other diseases it can in

00:08:01

most situations when there are no

00:08:03

pronounced disturbances of digestion and

00:08:06

absorption of nutrients

00:08:08

organ pathology we talk further and

00:08:10

liver and kidney pathology there are no

00:08:12

disturbances of carbohydrate metabolism

00:08:15

we can use a standard

00:08:16

enteral mixture, an ideal mixture is created

00:08:18

and is divided into several subgroups

00:08:20

based on the ecological

00:08:23

density of the standard language logical

00:08:25

laugh those that contain one

00:08:28

kilocalorie per milliliter I

00:08:32

further in my gardens represent

00:08:37

almost all of these rally mixtures that

00:08:40

exist on our market, maybe

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somewhere

00:08:43

some of the information will not be relevant

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because we don’t always even know that they

00:08:48

receive information that the mixture,

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for example, has been discontinued,

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or that it’s easier to go through re-registration to

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always find out when a

00:08:56

new enteral formula has appeared, a mixture from different

00:08:59

manufacturers, but in order to

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understand because each specific the

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patient individually, well, can

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tolerate one mixture well; the standard one does not

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tolerate another well; if the doctor

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only knows about one option, this is not entirely

00:09:10

correct; we must give the patient from a

00:09:14

specific clinical background, based on a

00:09:16

specific clinical situation,

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several options; therefore, I always

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present several

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2 subgroup of standard natural

00:09:25

mixtures: those mixtures which contain more

00:09:28

calories than

00:09:29

however you are kilocalories broke Victor they

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call standard hyper to logically

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mixtures of concentrations greater that is, even

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up to one and a half kilocalories per milliliter,

00:09:40

often the name contains the word nrg or

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energy it is not always possible why these

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mixtures are needed, let’s assume we have a situation

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where a patient he cannot consume a large volume of

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the formula, he needs, for example,

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thousands of kilocalories to add the hospital, he

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cannot drink this liter of standard formula

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in this situation, for example, the

00:10:02

gyproc mixture is logical more

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concentrated will require the use of a

00:10:06

smaller volume

00:10:07

he with the same thousands of kilocalories

00:10:10

before the patient in this situation we

00:10:13

feed adequately but he can drink this amount,

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so probably in this

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situation we have recruited people namely guitar

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logical mixture and the third subgroup of

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standard mixtures which, apart from the

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author, stands out

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standard Hitler to logical guitar

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nitro nitrogen I have a little typo

00:10:34

all mixtures that contain not only

00:10:37

a lot of kilocalories but also a lot protein, if

00:10:41

you look even at that - 2 kilocalories and

00:10:43

this is up to 10, some mixtures even up to 14

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grams of protein are very often used in

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situations where the patient has omega-3

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oncology or some serious

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disease that requires a large amount of

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protein energy but consumes a lot of this

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mixture. cannot therefore for 2

00:11:04

kilocalories we mean giving the patient a

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liter we have 2000 kcal calories if we do

00:11:11

this half a liter thousand kilocalories this is

00:11:13

better than the standard mixture with me

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chick lari per milliliter representative

00:11:21

to is a mixture that is hyper to

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logically the printer agent is not

00:11:25

resources on 0 timer you will see that 400

00:11:29

kilocalories in this small jar

00:11:31

is quite a lot and it really makes the

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doctor’s task easier, then the patient does not

00:11:36

need 500 winds, he needs to be given a small

00:11:40

volume in order to

00:11:43

provide adequate all the needs not

00:11:46

only for energy, but also, as you can see,

00:11:48

200 milliliters is 8 science what you

00:11:53

need to remember about these here is about a month of you

00:11:56

low calorie content the higher the

00:11:58

osmolarity osmolarity let me remind you this is the

00:12:00

total concentration of dissolved particles in the

00:12:06

volume of liquid up to if the glass and I remember

00:12:08

according to the given situation on

00:12:10

we consider in one liter of solution from

00:12:12

this mixture the higher the osmolarity the

00:12:15

greater the risk not only diarrhea but also other

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undesirable effects, this rice will certainly

00:12:21

not increase significantly,

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but we must understand that if we

00:12:25

choose a very concentrated mixture,

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we must be more careful in its

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use and tell the patient about this

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that we will wait and how to use it, I

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will tell you further a very important aspect for

00:12:40

doctors only for the patient, we always

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understand that if we don’t tell about

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it, we won’t mean it, then we

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will get not quite half of the patients

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who, at our offer to use the

00:12:53

mixture, say doctor, I tried the

00:12:58

shoulder for weeks, then it’s just like that, I won’t

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like it, I won’t more further

00:13:03

use this mixture and Doctor Who 5

00:13:05

because he remembers only one

00:13:07

name on the Internet and does not

00:13:11

even know sometimes, often unfortunately, that there is an

00:13:13

alternative, first of all,

00:13:16

the content pays attention to the taste of the

00:13:19

existing mixture, which allows in many

00:13:22

cases to have some alternatives

00:13:24

one the mixture has several taste

00:13:28

positions, often patients

00:13:32

perceive neutral mixtures well, which

00:13:34

practically do not have such a bright taste of

00:13:37

fruit or vanilla, and these mixtures are the

00:13:40

easiest to use because he

00:13:42

can even add some kind of

00:13:43

natural food in order to get the

00:13:47

usual favorite taste, it is very often

00:13:50

used vanilla and other options

00:13:54

that will allow,

00:13:55

if we are talking about some kind of

00:13:58

short-term arena, we required

00:14:02

the use of a mixture, let’s say

00:14:04

the patient took it for two to three weeks

00:14:07

without regular food, this will not be

00:14:10

relevant, well, because he has a taste for it and is

00:14:13

not quite familiar the not-quite-loved one

00:14:16

subsists on regular food and problems more

00:14:18

often occur in situations where the patient

00:14:20

practically

00:14:22

uses only natural mixtures

00:14:24

in large volumes if you don’t

00:14:26

feed everything there from chocolate it’s

00:14:28

z negative on the MTS card I won’t eat

00:14:30

vanilla very often I don’t like it

00:14:33

at first I seem to like it then it gets boring

00:14:35

this situation should have

00:14:37

some alternative

00:14:40

level 2 options for the convenience of our

00:14:45

outpatients with and lanterns

00:14:46

always who is not in the laboratory practice of

00:14:48

the patient to continue to work live on a

00:14:50

business trip we know you must that the

00:14:53

natural mixture some have different ones

00:14:57

even purchased tin cans somewhere

00:15:01

here somewhere there is a plastic container where

00:15:06

they come that are tight packages if the

00:15:12

patient is storing a business trip and it would be more

00:15:15

logical to take a vacation package for a

00:15:20

penny that can be opened and

00:15:22

closed, here is a jar I thought of taking into account it

00:15:25

will be stored or at work if there is a

00:15:27

separate place this is not entirely relevant

00:15:29

for everyone patient aspect, but nevertheless, for

00:15:33

our patients, this is also important, this is the

00:15:34

most important point for patients, this is the

00:15:37

consistency in which the mixture is presented,

00:15:40

dry or liquid, sell them others, there is none of

00:15:43

this, either 1 or another dry form

00:15:46

has passed, we will save

00:15:47

jars of dry mixture, which needs to be

00:15:50

diluted with

00:15:52

plastic cats there is a liquid mixture that is

00:15:55

ready to eat and there are pros here and there and

00:15:58

cons here and there dry powders they

00:16:01

are stored open for a long time

00:16:03

opened the jar for several days but

00:16:06

there is always an encore for the bank you can

00:16:08

use scoop this mixture dilute the

00:16:11

disadvantage it is necessary to dilute water is

00:16:14

convenient when the patient can

00:16:16

serve himself and he is

00:16:17

attentive enough he has time for himself

00:16:19

when he is then I’m in the forest, it’s faster to

00:16:23

come home from work or at work to

00:16:25

drink faster, he sometimes forgets this, it’s

00:16:28

inconvenient for him or all the dignity when the patient is not

00:16:30

caring for a

00:16:32

person home heavy heavy nurses and

00:16:36

they always take on this matter

00:16:38

then of course it’s more urgent I prepare

00:16:40

liquid mixtures everything is fine with them except for the

00:16:42

shelf life of 24 hours we

00:16:45

need this jar you so they made it for

00:16:48

me very large

00:16:51

I really need it sometimes there are liter volumes

00:16:54

which patients don’t always need

00:16:56

during today's day ago, but

00:16:59

can you really be comfortable about eugenics okay

00:17:05

today I passed it's not a question I'll answer

00:17:07

it about the situation sucked no

00:17:11

lactose queen of police Irina gluten

00:17:14

but the patient who is not

00:17:17

lactose intolerant is allergic to

00:17:19

cow's milk protein and we need it

00:17:21

Always keep in mind that all mixtures

00:17:24

practically

00:17:26

contain whole protein, sometimes this

00:17:31

milk protein is always practical white, very

00:17:34

rarely a milk mixture now that

00:17:37

contains pure soy protein, sometimes

00:17:40

soy plus milk again, I’m

00:17:42

talking about standard mixtures and

00:17:45

most even specialized

00:17:46

mixtures, the protein is always whole form,

00:17:49

therefore, if you have a patient who has proven

00:17:54

people or milk protein, you should take either a

00:17:56

mixture with soy protein or a

00:18:00

specialized gender elements of the mixture,

00:18:02

which we will say further the next point

00:18:05

where the protein is in the floor

00:18:06

split or split in the video does

00:18:08

not cause an allergy,

00:18:11

this is an important point they are only

00:18:13

a cent in fact still pay attention

00:18:15

to 40 it contains soy leg pressure gauge

00:18:17

100 percent genetically modified I

00:18:19

don’t even tell me anything I

00:18:22

won’t consume you must then

00:18:24

choose the mixture that does not contain the

00:18:27

second group big prices were

00:18:30

standard communication the second group large

00:18:32

is the floor elements of the mixture they are now

00:18:36

used more often and more often mixtures that

00:18:39

also contain everything that

00:18:41

patients need both macro and micro nutrients proteins

00:18:44

fats carbohydrates vitamins micro

00:18:46

macroelements in accordance with the appropriate

00:18:48

needs such a feature the first

00:18:51

feature proteins are contained in the form of

00:18:53

peptides and amino acids, either that is

00:18:55

or semi split or completely

00:18:58

split proteins and, accordingly, they

00:19:02

definitely should not give an allergy

00:19:08

if the patient has a logical reaction to the

00:19:11

heat of cow's milk protein, these mixtures contain the form of so-

00:19:15

called medium chain fats, fatty

00:19:19

acids, which are very convenient and then we

00:19:22

will talk about why they are convenient for

00:19:24

the body and well carbohydrates are so standard in

00:19:27

visible mixtures and why and when an

00:19:31

interesting mixture is indicated and they

00:19:33

are prescribed in a situation where

00:19:35

patients have severe

00:19:37

digestive disorders, absorb other functions of the

00:19:39

small intestine, pain absorption, diarrhea,

00:19:44

including in the early postoperative period,

00:19:47

including the patient has

00:19:49

short small intestine syndrome intestines when the pounding peed does

00:19:51

not decrease, the body needs to

00:19:54

quickly absorb something to give,

00:19:57

including on we can use, for example,

00:19:58

patients with impaired

00:20:00

pancreatic function, we know all the

00:20:02

situations with the period of exacerbation of

00:20:05

chronic pancreatitis chronically

00:20:07

conquer the snow external secretory

00:20:10

insufficiency,

00:20:11

that is, when there is a problem with the flow of

00:20:14

digestive secretions there the intestine

00:20:16

is there, accordingly, ordinary food is

00:20:20

digested poorly in the central mixture,

00:20:24

including the floor, the elemental ones

00:20:25

will be absorbed much faster, why is

00:20:28

this happening

00:20:29

hands here, the floor is already split or in a

00:20:31

split form, respectively, it is not

00:20:33

absorbed, it is not absorbed much faster

00:20:35

due to other mechanisms than ordinary

00:20:38

forks, even in a standard mixture on the Internet

00:20:41

medium-term fatty acids are again

00:20:44

absorbed in a different way than

00:20:47

ordinary fats,

00:20:48

that is, the

00:20:51

intake into the system is immediately absorbed in

00:20:54

just a few microns, and if we remember what

00:20:57

this is like regular food, it

00:20:59

immediately enters the

00:21:03

portal vein system and, accordingly, the

00:21:06

absorption time of this mixture is reduced,

00:21:09

costs are reduced,

00:21:11

including the energy digestive

00:21:13

enzymes of the body are less than even on a

00:21:16

regular one, there is an equal taranus and

00:21:18

therefore it is logical that in the case of these

00:21:20

problems and also to reduce the load

00:21:23

and the pancreas can give

00:21:25

half a thousand there are two types of these

00:21:27

mixtures for us, after all, for adults

00:21:30

doctors were relevant partially

00:21:32

generalized

00:21:33

beat mixtures with a partially detailed corner

00:21:37

because this is more common in childhood,

00:21:40

but patients, for example, children who have the

00:21:42

same food allergies, but not only

00:21:46

for us, this is the second subgroup, the

00:21:49

main central mixtures are listed here,

00:21:55

what is the peculiarity of these mixtures may not

00:21:57

always be on a

00:21:58

particularly sensitive court patient may say that the

00:22:00

mixtures may have a bitter taste, the

00:22:05

manufacturers of the man successfully masks

00:22:08

the taste of food additives, the taste of vanilla

00:22:13

joins in there, and in reality, if we

00:22:15

try a

00:22:16

high-quality gender elemental mixture, it is

00:22:18

almost imperceptible, although according to Igorevich,

00:22:21

if the patient distinguishes the taste very well,

00:22:23

he can complain about it,

00:22:25

well accordingly if it is food .

00:22:28

the probe is no problem here, not a

00:22:31

representative of the elemental mixture,

00:22:33

it is a mixture of stamina in several

00:22:36

options, yes it is either even for

00:22:37

enteral nutrition or platoon

00:22:41

nutrition inter which can be

00:22:44

used, here again we will give

00:22:46

clinical situations that we can

00:22:49

see in our practice of celiac disease there is

00:22:54

chronic diarrhea of an incomprehensible even for

00:22:56

example this so even the

00:22:59

differential diagnosis of genesis that

00:23:02

chamber of gardens cope with the

00:23:04

pancreas very often aesthetic Crohn's disease

00:23:09

witch's one type when there is a problem already

00:23:12

entire party of various genesis

00:23:14

infectious most often earlier

00:23:17

postoperative period of intensive

00:23:21

care 3 pages 3

00:23:22

when we see that the problem is

00:23:24

digestion socialists intestines and there is

00:23:26

or it is necessary reduce the load

00:23:29

and you need to give an enteral mixture, we are giving

00:23:31

you the floors of the

00:23:34

third large group, here you should

00:23:37

tune in because the large group is a

00:23:40

mixture that is used in each

00:23:42

specific pathology and we see that there are

00:23:45

quite a lot of them for yourself, just write down

00:23:49

someone will choose the mixture that is most

00:23:51

likely will use what

00:23:53

she is doing for this problem

00:23:56

up to 10 and a mixture that corrects

00:24:00

some kind of metabolic disorder, some specific

00:24:04

situation, perhaps let’s start with

00:24:07

seconds of the mixture, they are now quite

00:24:09

popular and relevant mixtures that

00:24:12

contain a high amount of a large

00:24:15

amount of biologically active protein,

00:24:18

ordinary enriched various

00:24:21

amino acids, antioxidants, omega-3

00:24:24

fatty acids, a mixture that

00:24:27

specialists

00:24:30

involved in intensive care really like to use in the

00:24:32

department of this initiative with herbs,

00:24:38

burns, polytrauma, and also very

00:24:42

relevant applications in the pre- and

00:24:44

postoperative period that, in principle,

00:24:47

their composition is quite interesting

00:24:53

omega-3 fatty acids that

00:24:55

promote the synthesis of

00:24:58

anti-inflammatory

00:25:01

components of a mixture with glutamine, the situation is

00:25:06

so well-known that why was tomin

00:25:09

reduces the permeability of the intestinal wall,

00:25:14

and in the situation of severely ill critically

00:25:17

ill patients, this interferes with the incredible sound of

00:25:19

real translocation now, although in case of

00:25:21

sepsis these mixtures are not entirely

00:25:24

approved by everyone, but this is precisely the prevention

00:25:27

of the preoperative and postoperative

00:25:28

period and in difficult situations, you can

00:25:33

calculate the media these sports can be

00:25:35

used, usually we have something like

00:25:39

this set in Russia, I want to

00:25:42

say again that all the mixtures are represented by a kindergarten, what kind of

00:25:43

war is Russia

00:25:45

because at the moment at the

00:25:47

time of the lecture because in the world there are

00:25:50

all mixtures in the line there are much more widely

00:25:55

presented options and there are even

00:25:59

quite interesting mixtures of this

00:26:01

salty with the taste of pickled cucumbers

00:26:04

then and so on, that is, this is what we

00:26:07

see now, at the moment in

00:26:09

Russia there may be something somewhere that has

00:26:13

ceased to be relevant today

00:26:16

one in the centers was left to choose the

00:26:19

information that is relevant at the present

00:26:21

moment in the third interval, the mixture again

00:26:24

may have a bitter aftertaste, but

00:26:27

again in

00:26:28

all cases this is not noticeable

00:26:31

since it is often not used in

00:26:34

intensive care for an unconscious patient

00:26:37

to guide through this, again

00:26:41

as it remains not relevant, the

00:26:43

second group is a mixture of directed

00:26:46

action, this is something that we very often,

00:26:50

almost all of us can

00:26:52

use because patients with a

00:26:53

disorder or carbohydrate metabolism, sugar, in the

00:26:57

case of the first type, type 2 with any

00:27:00

hyperglycemia there are short-term,

00:27:02

for example, against the background of hormonal therapy for

00:27:04

patients index home they require a special

00:27:07

mixture this is a mixture and just the so-called

00:27:10

types of diabetes, what is their peculiarity in

00:27:13

comparison with ordinary standard

00:27:14

mixtures, the peculiarity of its composition is

00:27:18

carbohydrates, but it does not contain

00:27:21

exceeded simple and practically simple

00:27:24

carbohydrates like standard mixtures, but

00:27:26

slowly with its small dextrins and

00:27:28

fructose dietary fiber, this allows

00:27:31

you to that this peak saturation of blood

00:27:34

glucose, that is, the curve becomes

00:27:38

smoother, a

00:27:41

slower increase, and thus

00:27:43

the body has time to

00:27:45

utilize glucose, which is so-

00:27:48

called acutely ideal after

00:27:50

eating food, everyone always increases in the blood

00:27:53

due to fiber, we can

00:27:56

get the

00:27:57

prebiotic effect of the pawn function of the

00:28:01

colon here improves this fiber,

00:28:04

we recognize, contributes to the normalization of

00:28:08

stool, including, again,

00:28:11

possible options are presented here and,

00:28:14

fortunately, in recent years, it is still likely that the

00:28:16

line of these mixtures has expanded somewhat,

00:28:19

often to natural with the word

00:28:22

diabetes, and

00:28:23

from the name it will be clear that this mixture

00:28:25

is used by the wine distributor, finish off

00:28:27

and It seems that the third subgroup of

00:28:31

specialized mixtures is able to, these are oil-type mixtures,

00:28:34

they may not always be

00:28:37

relevant to us, although

00:28:39

Satan was carried out by doctors who deal with

00:28:43

flattened kidneys, this mixture will be relevant

00:28:47

because you see, and they are used

00:28:51

in especially situations when there is

00:28:54

terminal chronic renal

00:28:55

disease and if it is corrected

00:28:59

by dialysis smearing that these patients

00:29:01

require a lot of protein energy,

00:29:04

the increased content of this group, but

00:29:07

this protein must be correct and the

00:29:10

mixtures here have a modified amino acid

00:29:12

composition, first of all, these are

00:29:15

essential amino acids,

00:29:17

mainly although there is and is not a certain number of

00:29:21

essential amino acids and very important this is a

00:29:24

reduced amount of potassium and sodium

00:29:27

chloride phosphate vitamin D and he knows that in

00:29:30

patients with renal pathology these

00:29:34

substances are slightly elevated, sometimes even

00:29:37

quite seriously, due to which we

00:29:41

have an effect when using the mixer,

00:29:44

it is known that when administering essential

00:29:47

amino acids, the body simply does not

00:29:49

synthesize the principle, as the name implies, that

00:29:53

is, we are obliged praise and

00:29:55

it is believed that non-essential amino acids are

00:29:58

partially clear that they will not be

00:30:00

synthesized from urea, they

00:30:02

taught that in case of kidney pathology, the

00:30:05

blood is increased with this way we give

00:30:08

the body the opportunity

00:30:10

to utilize part of at least part of the

00:30:12

urea for the synthesis of non-essential amino acids,

00:30:15

which is what happens in the body and,

00:30:18

accordingly It has been proven that it is better

00:30:20

to use a mixture

00:30:22

that contains non-essential and

00:30:24

essential amino acids.

00:30:25

What restrictions in chronic

00:30:27

renal failure do we know

00:30:30

primarily from when it is considered that the

00:30:32

potassium content in the diet should not exceed

00:30:36

these numbers: 2000 grams per day

00:30:38

restrictions on 3 phosphate, this is

00:30:41

undoubtedly their is present and so I took

00:30:44

unfortunately unfortunately unfortunately very unfortunately there are very

00:30:47

few mixtures on the market the first two

00:30:51

mixtures are just a set of amino acids they did not consider

00:30:55

this a complete mixture so I brought

00:30:58

about two liters of the finished mixture

00:31:01

how many knees are contained we can do that

00:31:06

2000 game for example decay is even if

00:31:09

we have two liters of mixture and with pathos

00:31:12

they helped everything fit out of the mixture

00:31:14

which using kidney pathologies

00:31:17

unfortunately we have a problem that is not always possible

00:31:20

when the site is due to the limited range of

00:31:22

mixtures such as the remote control 4 subtypes of

00:31:25

specialized mixtures those mixtures

00:31:27

which, again, are probably not always

00:31:30

relevant for us for outpatient in

00:31:31

practice, but for hospitals this may

00:31:33

be relevant; it is

00:31:34

prescribed for respiratory

00:31:36

failure; patients on mechanical

00:31:37

ventilation may not be completely

00:31:40

insufficient; bex from the lung association;

00:31:42

the patient has difficulty breathing; he walks;

00:31:53

antioxidants there,

00:31:55

beta-carotene is strong, and so on and so

00:31:57

forth, here are options

00:32:02

for what we have on the market,

00:32:05

due to which the effect of

00:32:06

these mixtures is achieved, it is known that it is the oxidation of

00:32:10

each molecule for the oxidation of proteins,

00:32:12

fats, carbohydrates, then I do not waste a

00:32:13

certain amount of oxygen in the body.

00:32:15

called this

00:32:17

respiratory coefficient, it is maximum

00:32:19

for carbohydrates, that is, the body requires that in order to

00:32:22

oxidize

00:32:23

so they will throw one kilocalorie of

00:32:25

a substance into a lot of oxygen

00:32:27

compared to the oxidation of fats, we are so

00:32:30

lacking, thank you, I am from a patient, so

00:32:32

it is logical that adding fats in large

00:32:35

quantities to provide energy

00:32:38

is better than adding coal and,

00:32:41

accordingly, various other

00:32:43

components improve trophism,

00:32:45

blood supply and oxygenation, a very

00:32:49

relevant group for us is a mixture of

00:32:52

these packages, taking into account our

00:32:55

environmental orientation, what is the

00:32:58

peculiarity of these mixtures in these mixtures the

00:33:01

content of branched chain amino acids

00:33:05

such as valine and isoleucine leucine is increased and

00:33:09

reduced to almost absence of the

00:33:11

amount of aromatic amino acids

00:33:13

tryptophan Benjamin tyrosine

00:33:16

why is this done well, we understand that

00:33:21

until the end of today the pathogenesis of

00:33:26

hepatic encephalopathy in patients

00:33:30

who have a liver problem is one hundred

00:33:33

percent not voiced there are hypotheses

00:33:35

that are generally recognized, in

00:33:38

particular there is a hypothesis of false

00:33:42

neurotransmitters according to which these

00:33:44

amino acids are automatically

00:33:46

precursors substances

00:33:48

that the

00:33:49

body, the brain, and primarily

00:33:51

perceives as mediators and,

00:33:53

accordingly, has this

00:33:55

inhibitory effect, so it would be logical to

00:33:59

remove these amino acids from the composition

00:34:03

and replace them with other amino acids,

00:34:08

which else is

00:34:12

positive in these mixtures; the high

00:34:14

content of average renal

00:34:16

triglycerides allows us to solve

00:34:19

possible problems in the bloodstream. fats

00:34:22

do patients have cholestasis, that is,

00:34:25

because the mechanization of these fats is somewhat

00:34:27

different from the classic ones

00:34:28

if the patient has little bile and

00:34:31

duodenal intake for cholestasis, we do not

00:34:34

see a malabsorption of lipids,

00:34:36

accordingly there are no problems with the formation of

00:34:38

hormones component for the wall and energy,

00:34:42

especially

00:34:44

patients with ascites we cannot give

00:34:47

a lot of liquid, these mixtures are lost, and often,

00:34:50

well, in fact, we have very little of them,

00:34:52

so they contain, I can say right away

00:34:53

that more than one kilocalorie per

00:34:56

milliliter, in particular, this is a hippo-type mixture

00:34:59

that is available contains 23 10

00:35:02

tank we give less volume we get

00:35:04

higher caloric content than the

00:35:07

standard mixture and we have

00:35:11

recommendations from countries the class of recommendation is

00:35:13

very high at all that it died on the spot and

00:35:15

should be used for

00:35:18

liver pathology, cirrhosis of the liver before the

00:35:20

postoperative period during

00:35:21

transplantation, that is, it has been proven and

00:35:25

is used in everyone, again the problem is a

00:35:30

short list of the

00:35:31

mixture, that’s probably only two because there is

00:35:34

no mention of an amino acid plus

00:35:36

dietary dietary fiber, this is a big

00:35:39

minus there is

00:35:41

no alternative when the patient

00:35:44

cannot use something else, although

00:35:47

for liver pathology

00:35:50

alternatives are still offered, what is it

00:35:52

if we

00:35:56

have plans for the 7th world of the ghetto type and their

00:35:59

Otherwise, in principle, at the moment on the market,

00:36:00

we can recommend that patients

00:36:02

use a mixture of lying hair on

00:36:07

we will talk about them further due to

00:36:09

black we understand perfectly well that dietary

00:36:11

fiber, firstly, normalizes stool 3 in

00:36:15

liver cirrhosis, that it should be

00:36:16

normal, and secondly, they model

00:36:20

the microphone, normal microflora

00:36:23

becomes Let’s say it’s more active

00:36:28

and the opportunistic ones are replaced accordingly,

00:36:32

and the third point is that it still

00:36:35

absorbs an

00:36:36

excess amount of ammonia, so

00:36:39

you can either combine these twenty-two

00:36:41

types of mixtures, or if 1 is not there because

00:36:44

where the pores contain dietary fiber,

00:36:46

when you replace it with a feeder type mixture then

00:36:49

there is one that contains fiber, so I will

00:36:52

we take it out, I hope that

00:36:53

pregnancy is not a pathology in this

00:36:55

state of the mixture, the question always arises

00:36:58

whether we can

00:36:59

prescribe enteral mixtures to pregnant women in the media and

00:37:02

breastfeeding women

00:37:04

because they can also

00:37:06

have concomitant pathology, some

00:37:09

sometimes severe pathology and we must

00:37:11

prescribe something other than the usual food

00:37:14

problems are probably of a legal

00:37:16

nature, we all understand perfectly well that

00:37:18

if the mixtures are all approximately the same, they are not allowed, but

00:37:22

others are not allowed, then

00:37:25

Kirov, focusing on you, the mixtures

00:37:27

that are prescribed in the instructions in the

00:37:30

mixture can be used for

00:37:33

feeding or nailed situations when

00:37:38

we do not have available approved mixtures, we,

00:37:40

as always, weigh the pros and cons

00:37:42

if the risk of using them outweighs the

00:37:46

potential benefits and we refused if,

00:37:49

on the contrary,

00:37:50

the patient has malnutrition, this is

00:37:52

still a high-risk condition,

00:37:55

then we can use them because of

00:37:58

course there is great harm from using them

00:38:02

tralic mixtures we did not expect are

00:38:05

presented here, well, probably not all of them, again,

00:38:07

the instructions are updated, they are not always

00:38:11

fresh to us, but nevertheless,

00:38:13

those options are presented that can

00:38:16

be traffic police professions, and so the

00:38:20

group

00:38:21

that already said this is a mixture and

00:38:23

contains dietary fiber or mixtures

00:38:25

like farmerama again feeder but why is there

00:38:31

so much complexity here I introduced myself to the

00:38:34

first mixture with dietary

00:38:36

fiber, which was created only in

00:38:38

order for patients with not only to

00:38:42

provide protein nutrition with

00:38:43

carbohydrates, but also to add carbohydrates to the diet, this is what the

00:38:46

actual

00:38:48

mixture with dietary fiber is called in them

00:38:51

the name very often is this

00:38:53

word this is square 1 to the cave fibers with

00:38:55

dietary fiber or files in something

00:38:58

special, these are

00:39:00

specially invented mixtures for enriching with fiber,

00:39:03

but there is also a

00:39:06

list of the king of mixtures that we have already studied, the

00:39:08

composition includes dietary fiber

00:39:11

as an addition to almost the entire

00:39:13

hypercar and non-standard mixtures,

00:39:15

it has fiber mixtures of the diabetes type, it is logical

00:39:19

because the composition is not only changed in the

00:39:21

carbohydrate composition but also fibers are added,

00:39:23

they also contain dietary fiber and

00:39:25

other mixtures, immune mixtures, mixtures of the

00:39:29

ghetto type contain in smaller quantities,

00:39:32

undoubtedly, but if you have

00:39:34

a need, this this is to combine

00:39:37

remember that the composition is included in the composition on

00:39:39

each jar for each bag it

00:39:43

is written what the composition is included in what

00:39:46

quantity the osmolarity of

00:39:48

the mixture is also noted, so

00:39:50

don’t be lazy, read on the Internet we

00:39:54

don’t have a jar with us before

00:39:56

prescribing a specific one to the patient

00:39:58

what the fiber cave is for I

00:40:00

remember everything perfectly that the body has a great

00:40:04

need for dietary fiber

00:40:06

20-30 grams per day, unfortunately, we

00:40:10

basically don’t eat them up even as part of your

00:40:12

balanced diet, your sick

00:40:14

patient for this, remember that it’s

00:40:17

easier to collect fruit, still take it,

00:40:19

here he sits without fiber match and get

00:40:23

constipation here fiber they of course

00:40:25

use the kingdoms and we are not the same

00:40:27

groups and we can calmly add this mixture

00:40:31

because we remember that we are

00:40:35

only improving intestinal motility,

00:40:37

we remember that there are other

00:40:42

positive effects, it is very important for

00:40:45

us that the rate of glucose absorption is reduced,

00:40:47

that is this and all

00:40:48

hyperglycemia, if it is not leveled, then the

00:40:52

level of

00:40:55

absorption of

00:40:57

low-density lipoprotein cholesterol is significantly reduced, for us this is also rarely

00:41:00

relevant legs probiotic 3

00:41:04

paternal action, also

00:41:06

representatives can be considered a

00:41:08

mixture of resource optimum which

00:41:13

also contain river probiotics can be

00:41:18

used it is not only adult

00:41:20

patients but children 7 years old,

00:41:22

you accordingly the indication for use

00:41:25

is what we said this is the

00:41:29

patient’s huts the patient has constipation and

00:41:32

so on and so on, but including

00:41:34

fibers can be used presented

00:41:38

for the fact that the latest data as far as

00:41:41

I remember subgroup 3 groups well what to

00:41:45

name a subgroup photo paste according to the mixture is

00:41:47

presented in a fashionable version in

00:41:49

our country, this is a mixture that is

00:41:51

used for inflammatory

00:41:53

bowel disease, again our

00:41:56

specialization is profit dhikr, it is clearly

00:41:59

called why

00:42:02

this mixture is used a mixture that is enriched with

00:42:06

nature transforming growth factor

00:42:09

beta which has

00:42:10

anti-inflammatory activity is generally

00:42:12

punished, look at the video of the mixture that in children

00:42:15

with moderately severe

00:42:18

Crohn's disease and severe Crohn's disease,

00:42:22

even monotherapy trolled the mixture does not

00:42:24

very often lead to impurities

00:42:27

compared to placebo for adults this has not been

00:42:29

proven, so for adults we

00:42:33

understand here that is, we prescribe an anti-inflammatory

00:42:35

effect when there is

00:42:38

naturally malnutrition or

00:42:40

rice malnutrition

00:42:43

mixture we will have a tasting today, you

00:42:46

and I can evaluate by trying on ourselves

00:42:52

these are the taste sensations that the

00:42:55

patient should follow when he is forced to want and in

00:42:58

case they are forced to use their

00:43:00

natural mixtures regarding in the

00:43:03

mixture modules as I told this is the fourth

00:43:05

group, which is not entirely relevant

00:43:07

at the present time, and therefore

00:43:09

there was a period when we had a module of their mixture

00:43:11

that was very different

00:43:12

than the advantages, we can add

00:43:15

this mixture to the diet to correct

00:43:18

some kind of deficiency, in particular

00:43:22

by adding separate mixtures we could give

00:43:26

a lot There is protein for you, which is about 100

00:43:28

grams and contained 90 grams of protein,

00:43:31

you can add some kind of

00:43:34

metabolism regulator for dishes, amines in carnitine,

00:43:36

that is, targeted corrections of existing

00:43:40

disorders, now there are

00:43:43

practically none of these, and those that are

00:43:46

presented are called specifically

00:43:49

modules, although they also belong to

00:43:51

modular In general, probably for now we can

00:43:54

only imagine that this group exists,

00:43:57

but to use it is not yet

00:44:03

how to mean a natural mixture and an

00:44:05

algorithm exist. Suppose you and I

00:44:08

have a patient who is

00:44:11

undernourished or is already

00:44:13

undernourished, we are faced

00:44:15

with a choice of what to recommend to him,

00:44:18

we must evaluate it ourselves an ordinary

00:44:21

standard patient without any

00:44:22

specialized pathology without

00:44:24

diabetes mellitus and without hyperglycemia

00:44:26

from kidney pathology without any

00:44:28

postoperative period without

00:44:31

malabsorption, obviously just a patient who

00:44:33

has some kind of general pathology that

00:44:36

led me to eat because he feels

00:44:39

nauseous or has a decreased appetite and began

00:44:42

to walk, that is, then we choose a

00:44:45

standard one, change the standard one, and for

00:44:47

whom am I looking for and about logical pathology,

00:44:50

such a situation then we prescribe either a

00:44:53

standard one and tempered majesty or some kind of

00:44:55

environmental if there are no other problems

00:44:57

or eyelashes a specialized mixture,

00:44:59

then we determine whether the patient can eat

00:45:02

on their own more than you accidentally

00:45:03

cannot eat on their own

00:45:05

does not need any umbrella further we will

00:45:08

approximately or exactly consult

00:45:12

a nutritionist to determine how much the patient

00:45:14

needs this mixture per day, taking into account the

00:45:18

needs taking into account that the

00:45:21

patient can be tolerated under the

00:45:23

volume recommended by us and then we give recommendations on

00:45:27

how to use this mixture Having chosen a mixture from the list,

00:45:30

how should the patient consume it, remember that the mixture is

00:45:35

consumed in small portions,

00:45:39

it is better to take it somehow or a straw because you ca

00:45:41

n’t see much growth in one

00:45:44

sip in the jeep mode news film

00:45:47

these are small sips

00:45:50

if the patient cannot and should not

00:45:54

eat anything in addition to natural mixtures, that is, a

00:45:56

large volume of the mixture per day, then you

00:45:58

should, for example, divide one and a half liters

00:46:02

or 2 liters into equal portions,

00:46:04

so even up to 80 times a day,

00:46:08

these small volumes and, accordingly,

00:46:12

approximately once during the

00:46:16

waking period when he needs these mixtures

00:46:19

to use in most cases, we see

00:46:21

situations when the patient eats regular food

00:46:23

and he needs to add some small

00:46:25

volume of the central mixture there is 400-500

00:46:28

milliliters, even for us, and when we

00:46:32

told him that it is better to consume these mixtures

00:46:34

between the main meals

00:46:37

tarkan and lunch in between and dinner,

00:46:41

placing a ladle there, second breakfast,

00:46:45

let’s assume if he needs 500

00:46:47

milliliters a day, then we divide it into

00:46:50

small volumes and again on the tenth

00:46:53

250 milliliters for the Kirov option

00:46:55

because there were situations when the patient was not

00:46:58

told he uses a floor of an elemental

00:47:00

mixture that is well absorbed,

00:47:02

logically this it doesn’t work and the fungus who

00:47:05

uses me to say a liter I

00:47:07

drank liters for 1 at a time of course we understand

00:47:11

that no matter how far she is there

00:47:14

if we give the patient a liter for 1 a

00:47:16

fairly concentrated mixture will come out

00:47:19

this is not water so he shot the mixture

00:47:21

osmotic the effect it will have, it will be

00:47:23

very large,

00:47:24

of course it will carry a blow on his

00:47:26

stomach, it will be so on and so forth, so

00:47:28

we give recommendations not very large

00:47:31

volumes in

00:47:32

different small portions regarding

00:47:36

enteral nutrition, which through he

00:47:38

held

00:47:39

said this literally once again a

00:47:41

reminder that this can be

00:47:43

called nasogastric banal us

00:47:45

analysis depending on where it

00:47:47

was placed a lot or it is not an endoscopic

00:47:51

stoma, the so-called

00:47:53

gastrostomy every before scopic sketch

00:47:55

such patients can come to the

00:47:57

oncology hotel they have a nose

00:48:00

tumor of the esophagus of the

00:48:03

gastric outlet, but at the same time he continues to live, he

00:48:06

cannot eat normally and

00:48:08

imposes a tour and a young 100 mOhm and

00:48:10

introduces a central mixture there because it does

00:48:13

not interfere with the absorption, or

00:48:16

sometimes there is a surgical situation

00:48:18

when he imposes on the surgeon such things as a

00:48:22

guy with a gastami and the sound of a gastami, that is,

00:48:25

100 we are operating rooms as convenient

00:48:27

surgeons

00:48:29

that we can see the purpose this

00:48:32

is the wrong appointment or with the

00:48:34

right one, but this is the ideal

00:48:36

feature, the first situation is due to

00:48:39

complications, this is due to difficulties in

00:48:41

access and the gastrointestinal tract and

00:48:43

shoulders, this situation when we insert a

00:48:46

probe may become clogged, the

00:48:49

project is named, it is always washed before the

00:48:51

next vision, damage to the

00:48:54

nasopharynx, esophagus by analysis is incorrect

00:48:56

simply I’ll put it then it’s better it

00:48:57

will stop, this situation we can

00:49:00

see in any

00:49:01

clinical case with any clinical

00:49:04

use of the rally mixture through zolan or we can

00:49:06

independently apply

00:49:08

this gastrointestinal disorder

00:49:10

diarrhea this is the most common probably bloating

00:49:14

dyspeptic symptoms

00:49:17

nauseating vomiting rarely vomiting

00:49:19

functional syndrome can easily be a

00:49:22

very high concentration

00:49:25

nutrients and and carbohydrates including the patient

00:49:28

quickly and the demand of the duodenum

00:49:30

that I began to take all I have

00:49:33

palpitations weakness the desire to lie down shortness

00:49:36

of breath all such phenomena smoke syndrome

00:49:38

can be very often due to

00:49:41

improper use

00:49:43

fast mixing speed the mixture seems to be in

00:49:47

small portions to us quickly quickly

00:49:49

quickly especially if this is a drip

00:49:50

injection,

00:49:51

so here you can ask

00:49:53

initially to give recommendations then

00:49:55

ask how he has it from him

00:49:57

how he uses a large volume

00:49:59

once exit from the mixture as I already

00:50:02

said, no need to drink half a liter in one gulp

00:50:04

in adobe muse it happens

00:50:06

naturally individual

00:50:07

intolerance no matter how hard you and I

00:50:09

try mixer world nozzle if this

00:50:12

standard mixture is poorly tolerated,

00:50:13

you can ask the patient to change to an

00:50:16

element-by-element mixture or we should have

00:50:18

diabetes and less carbohydrates if there is

00:50:20

dumping syndrome,

00:50:22

so all our recommendations should

00:50:26

be based on the fact that this is not food just

00:50:29

like any other drugs, medications

00:50:32

that may

00:50:34

not have their own effects, to which patients

00:50:37

are warned and try to overdose,

00:50:39

this mixture requires the selection of a certain

00:50:45

specific situation, we select this

00:50:47

mixture, we determine the same route of

00:50:51

administration and select the required volume

00:50:55

that is required for this patient,

00:50:57

the editor must always also says that we

00:51:00

can’t change the usual food very

00:51:02

often you can replace it at all

00:51:04

usually I’m going inter whether it’s the same thing here

00:51:06

I’m not the same neither the same thing no matter how

00:51:08

close they are to the physiology of

00:51:10

the body it doesn’t bequeath food to in principle,

00:51:15

but in

00:51:16

pathological conditions it

00:51:17

naturally has an effect on this

00:51:19

patient who needs it, we must

00:51:23

choose the right relevant mixture,

00:51:26

probably that’s all I wanted to talk about today

Description:

Применение нутриционной поддержки при помощи энтерального питания актуально для многих категорий пациентов: гастроэнтерологических, хирургических, онкологических, гериатрических и других. Своевременная и адекватная нутриционная поддержка позволяет в значительной степени сократить частоту инфекционных осложнений и летальность больных, добиться повышения качества жизни пациентов и ускорить их реабилитацию. В лекции врач-гастроэнтеролог, к.м.н. Андрей Геннадьевич Харитонов рассмотрит следующие вопросы: - показания для энтерального питания - его виды и методы проведения - классификация энтеральных смесей - перечень заболеваний, требующих назначения энтерального питания - отдельно рассматривается вопрос выбора смесей и способа их применения. Подробнее о враче: https://expert-clinica.ru/doctors/haritonov-andrey-gennadevich

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