Emergency conditions and emergency medical care. Pre-hospital medical care in emergency conditions
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- fainting
- Collapse
- Hypertensive crisis
- Anaphylactic shock
- An attack of angina pectoris
- Acute myocardial infarction
- clinical death
Algorithms for providing first aid in emergency conditions
Fainting
Fainting is an attack of short-term loss of consciousness due to transient cerebral ischemia associated with a weakening of cardiac activity and an acute dysregulation of vascular tone. Depending on the severity of the factors contributing to the violation of cerebral circulation.
There are: cerebral, cardiac, reflex and hysterical types of fainting.
Stages of development of fainting.
1. Harbingers (pre-syncope). Clinical manifestations: discomfort, dizziness, tinnitus, shortness of breath, cold sweat, numbness of the fingertips. Lasts from 5 seconds to 2 minutes.
2. Violation of consciousness (actual fainting). Clinic: loss of consciousness lasting from 5 seconds to 1 minute, accompanied by pallor, decreased muscle tone, dilated pupils, their weak reaction to light. Breathing shallow, bradypnea. The pulse is labile, more often bradycardia is up to 40-50 per minute, systolic blood pressure drops to 50-60 mm. rt. Art. With deep fainting, convulsions are possible.
3. Post-fainting (recovery) period. Clinic: correctly oriented in space and time, pallor, rapid breathing, labile pulse and low blood pressure may persist.
Algorithm of therapeutic measures
2. Unbutton the collar.
3. Provide access to fresh air.
4. Wipe your face with a damp cloth or spray with cold water.
5. Inhalation of ammonia vapors (reflex stimulation of the respiratory and vasomotor centers).
In case of ineffectiveness of the above measures:
6. Caffeine 2.0 IV or IM.
7. Cordiamin 2.0 i/m.
8. Atropine (with bradycardia) 0.1% - 0.5 s / c.
9. When recovering from fainting, continue dental manipulations with measures to prevent relapse: treatment should be carried out with the patient in a horizontal position with adequate premedication and sufficient anesthesia.
Collapse
Collapse is a severe form of vascular insufficiency (decrease in vascular tone), manifested by a decrease in blood pressure, expansion of venous vessels, a decrease in the volume of circulating blood and its accumulation in the blood depots - capillaries of the liver, spleen.
Clinical picture: a sharp deterioration in the general condition, severe pallor of the skin, dizziness, chills, cold sweat, a sharp decrease in blood pressure, frequent and weak pulse, frequent, shallow breathing. Peripheral veins become empty, their walls collapse, which makes it difficult to perform venipuncture. Patients retain consciousness (during fainting, patients lose consciousness), but are indifferent to what is happening. Collapse can be a symptom of such severe pathological processes as myocardial infarction, anaphylactic shock, bleeding.
Algorithm of therapeutic measures 1. Give the patient a horizontal position.
2. Provide fresh air supply.
3. Prednisolone 60-90 mg IV.
4. Norepinephrine 0.2% - 1 ml IV in 0.89% sodium chloride solution.
5. Mezaton 1% - 1 ml IV (to increase venous tone).
6. Korglucol 0.06% - 1.0 IV slowly in 0.89% sodium chloride solution.
7. Polyglukin 400.0 IV drip, 5% glucose solution IV drip 500.0.
Hypertensive crisis
Hypertensive crisis - a sudden rapid increase in blood pressure, accompanied by clinical symptoms from target organs (often the brain, retina, heart, kidneys, gastrointestinal tract, etc.).
clinical picture. Sharp headaches, dizziness, tinnitus, often accompanied by nausea and vomiting. Visual impairment (grid or fog before the eyes). The patient is excited. In this case, there is trembling of the hands, sweating, a sharp reddening of the skin of the face. The pulse is tense, blood pressure is increased by 60-80 mm. rt. Art. compared to usual. During a crisis, angina attacks, acute cerebrovascular accident may occur.
Algorithm of therapeutic measures 1. Intravenously in one syringe: Dibazol 1% - 4.0 ml with papaverine 1% - 2.0 ml (slowly).
2. In severe cases: clonidine 75 mcg under the tongue.
3. Intravenous Lasix 1% - 4.0 ml in saline.
4. Anaprilin 20 mg (with severe tachycardia) under the tongue.
5. Sedatives - Elenium inside 1-2 tablets.
6. Hospitalization.
It is necessary to constantly monitor blood pressure!
first aid fainting
Anaphylactic shock
A typical form of drug-induced anaphylactic shock (LASH).
The patient has an acute state of discomfort with vague painful sensations. There is a fear of death or a state of inner unrest. There is nausea, sometimes vomiting, coughing. Patients complain of severe weakness, tingling and itching of the skin of the face, hands, head; a feeling of a rush of blood to the head, face, a feeling of heaviness behind the sternum or chest compression; the appearance of pain in the heart, difficulty breathing or the inability to exhale, dizziness or headache. Disorder of consciousness occurs in the terminal phase of shock and is accompanied by impaired verbal contact with the patient. Complaints occur immediately after taking the drug.
The clinical picture of LASH: hyperemia of the skin or pallor and cyanosis, swelling of the eyelids of the face, profuse sweating. Noisy breathing, tachypnea. Most patients develop restlessness. Mydriasis is noted, the reaction of pupils to light is weakened. The pulse is frequent, sharply weakened in the peripheral arteries. Blood pressure decreases rapidly, in severe cases, diastolic pressure is not detected. There is shortness of breath, shortness of breath. Subsequently, the clinical picture of pulmonary edema develops.
Depending on the severity of the course and the time of development of symptoms (from the moment of antigen injection), lightning-fast (1-2 minutes), severe (after 5-7 minutes), moderate (up to 30 minutes) forms of shock are distinguished. The shorter the time from drug administration to the onset of the clinic, the more severe the shock, and the less chance of a successful outcome of treatment.
Algorithm of therapeutic measures Urgently provide access to the vein.
1. Stop the administration of the drug that caused anaphylactic shock. Call for an ambulance.
2. Lay the patient down, raise the lower limbs. If the patient is unconscious, turn his head to the side, push the lower jaw. Humidified oxygen inhalation. Ventilation of the lungs.
3. Intravenously inject 0.5 ml of 0.1% adrenaline solution in 5 ml of isotonic sodium chloride solution. If venipuncture is difficult, adrenaline is injected into the root of the tongue, possibly intratracheally (puncture of the trachea below the thyroid cartilage through the conical ligament).
4. Prednisolone 90-120 mg IV.
5. Diphenhydramine solution 2% - 2.0 or suprastin solution 2% - 2.0, or diprazine solution 2.5% - 2.0 i.v.
6. Cardiac glycosides according to indications.
7. With obstruction of the respiratory tract - oxygen therapy, 2.4% solution of aminophylline 10 ml intravenously for physical. solution.
8. If necessary - endotracheal intubation.
9. Hospitalization of the patient. Allergy identification.
Toxic reactions to anesthetics
clinical picture. Restlessness, tachycardia, dizziness and weakness. Cyanosis, muscle tremor, chills, convulsions. Nausea, sometimes vomiting. Respiratory distress, decreased blood pressure, collapse.
Algorithm of therapeutic measures
1. Give the patient a horizontal position.
2. Fresh air. Let the vapors of ammonia be inhaled.
3. Caffeine 2 ml s.c.
4. Cordiamin 2 ml s.c.
5. In case of respiratory depression - oxygen, artificial respiration (according to indications).
6. Adrenaline 0.1% - 1.0 ml per physical. solution in / in.
7. Prednisolone 60-90 mg IV.
8. Tavegil, suprastin, diphenhydramine.
9. Cardiac glycosides (according to indications).
An attack of angina pectoris
An attack of angina pectoris is a paroxysm of pain or other unpleasant sensations (heaviness, constriction, pressure, burning) in the region of the heart lasting from 2-5 to 30 minutes with characteristic irradiation (to the left shoulder, neck, left shoulder blade, lower jaw), caused by an excess of myocardial consumption in oxygen over its intake.
An attack of angina pectoris provokes an increase in blood pressure, psycho-emotional stress, which always occurs before and during treatment with a dentist.
Algorithm of therapeutic measures 1. Termination of dental intervention, rest, access to fresh air, free breathing.
2. Nitroglycerin tablets or capsules (bite the capsule) 0.5 mg under the tongue every 5-10 minutes (total 3 mg under BP control).
3. If the attack is stopped, recommendations for outpatient monitoring by a cardiologist. Resumption of dental benefits - to stabilize the condition.
4. If the attack is not stopped: baralgin 5-10 ml or analgin 50% - 2 ml intravenously or intramuscularly.
5. In the absence of effect - call an ambulance and hospitalization.
Acute myocardial infarction
Acute myocardial infarction - ischemic necrosis of the heart muscle, resulting from an acute discrepancy between the need for oxygen in the myocardium and its delivery through the corresponding coronary artery.
Clinic. The most characteristic clinical symptom is pain, which is more often localized in the region of the heart behind the sternum, less often captures the entire front surface of the chest. Irradiates to the left arm, shoulder, shoulder blade, interscapular space. The pain usually has a wave-like character: it intensifies, then weakens, it lasts from several hours to several days. Objectively noted pale skin, cyanosis of the lips, excessive sweating, decreased blood pressure. In most patients, the heart rhythm is disturbed (tachycardia, extrasystole, atrial fibrillation).
Algorithm of therapeutic measures
1. Urgent termination of intervention, rest, access to fresh air.
2. Calling a cardiological ambulance team.
3. With systolic blood pressure? 100 mm. rt. Art. sublingually 0.5 mg nitroglycerin tablets every 10 minutes (total dose 3 mg).
4. Compulsory relief of pain syndrome: baralgin 5 ml or analgin 50% - 2 ml intravenously or intramuscularly.
5. Inhalation of oxygen through a mask.
6. Papaverine 2% - 2.0 ml / m.
7. Eufillin 2.4% - 10 ml per physical. r-re in / in.
8. Relanium or Seduxen 0.5% - 2 ml 9. Hospitalization.
clinical death
Clinic. Loss of consciousness. Absence of pulse and heart sounds. Stopping breathing. Paleness and cyanosis of the skin and mucous membranes, lack of bleeding from the surgical wound (tooth socket). Pupil dilation. Respiratory arrest usually precedes cardiac arrest (in the absence of respiration, the pulse on the carotid arteries is preserved and the pupils are not dilated), which is taken into account during resuscitation.
Algorithm of therapeutic measures REANIMATION:
1. Lay on the floor or couch, throw back your head, push your jaw.
2. Clear the airways.
3. Insert an air duct, carry out artificial ventilation of the lungs and external heart massage.
during resuscitation by one person in the ratio: 2 breaths per 15 compressions of the sternum; during resuscitation together in the ratio: 1 breath for 5 compressions of the sternum. Take into account that the frequency of artificial respiration is 12-18 per minute, and the frequency of artificial circulation is 80-100 per minute. Artificial ventilation of the lungs and external heart massage are carried out before the arrival of "resuscitation".
During resuscitation, all drugs are administered only intravenously, intracardiac (adrenaline is preferable - intratracheally). After 5-10 minutes, the injections are repeated.
1. Adrenaline 0.1% - 0.5 ml diluted 5 ml. physical solution or glucose intracardiac (preferably - intertracheally).
2. Lidocaine 2% - 5 ml (1 mg per kg of body weight) IV, intracardiac.
3. Prednisolone 120-150 mg (2-4 mg per kg of body weight) IV, intracardiac.
4. Sodium bicarbonate 4% - 200 ml IV.
5. Ascorbic acid 5% - 3-5 ml IV.
6. Cold to the head.
7. Lasix according to indications 40-80 mg (2-4 ampoules) IV.
Resuscitation is carried out taking into account the existing asystole or fibrillation, which requires electrocardiography data. When diagnosing fibrillation, a defibrillator (if the latter is available) is used, preferably before medical therapy.
In practice, all of these activities are carried out simultaneously.
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Hypertensive crisis as one of the most frequent and dangerous complications of hypertension, its clinical manifestations and characteristic symptoms, forms and rules of first aid. Differential diagnosis of hypertensive crises and its complications.
Angina.
angina pectoris
Symptoms:
Nurse tactics:
| Actions | Rationale |
| Call a doctor | To provide qualified medical care |
| Soothe, comfortably seat the patient with lowered legs | Reducing physical and emotional stress, creating comfort |
| Loosen tight clothing, provide fresh air | To improve oxygenation |
| Measure blood pressure, calculate heart rate | Condition control |
| Give nitroglycerin 0.5 mg, nitromint aerosol (1 press) under the tongue, repeat the drug if there is no effect after 5 minutes, repeat 3 times under the control of blood pressure and heart rate (BP not lower than 90 mm Hg. Art.). | Removal of spasm of the coronary arteries. The action of nitroglycerin on the coronary vessels begins after 1-3 minutes, the maximum effect of the tablet is at 5 minutes, the duration of action is 15 minutes |
| Give Corvalol or Valocardin 25-35 drops, or Valerian tincture 25 drops | Removal of emotional stress. |
| Put mustard plasters on the heart area | To reduce pain as a distraction. |
| Give 100% humidified oxygen | Reduced hypoxia |
| Control of heart rate and blood pressure. | Condition control |
| Take an ECG | In order to clarify the diagnosis |
| Give if pain persists - give a 0.25 g aspirin tablet, chew slowly and swallow |
1. Syringes and needles for i/m, s/c injections.
2. Preparations: analgin, baralgin or tramal, sibazon (seduxen, relanium).
3. Ambu bag, ECG machine.
Evaluation of what has been achieved: 1. Complete cessation of pain
2. If pain persists, if this is the first attack (or attacks within a month), if the primary stereotype of an attack is violated, hospitalization in the cardiology department, resuscitation is indicated
Note: if a severe headache occurs while taking nitroglycerin, give a validol tablet sublingually, hot sweet tea, nitromint or molsidomine inside.
Acute myocardial infarction
myocardial infarction is an ischemic necrosis of the heart muscle, which develops as a result of a violation of the coronary blood flow.
Characterized by retrosternal pain of unusual intensity, pressing, burning, tearing, radiating to the left (sometimes right) shoulder, forearm, shoulder blade, neck, lower jaw, epigastric region, pain lasts more than 20 minutes (up to several hours, days), may be undulating (it intensifies, then subsides), or growing; accompanied by a feeling of fear of death, lack of air. There may be violations of the heart rhythm and conduction, instability of blood pressure, taking nitroglycerin does not relieve pain. Objectively: skin is pale, or cyanosis; extremities are cold, cold clammy sweat, general weakness, agitation (the patient underestimates the severity of the condition), motor restlessness, thready pulse, may be arrhythmic, frequent or rare, deafness of heart sounds, pericardial rub, fever.
atypical forms (options):
Ø asthmatic- asthma attack (cardiac asthma, pulmonary edema);
Ø arrhythmic Rhythm disturbances are the only clinical manifestation
or prevail in the clinic;
Ø cerebrovascular- (manifested by fainting, loss of consciousness, sudden death, acute neurological symptoms like a stroke;
Ø abdominal- pain in the epigastric region, may radiate to the back; nausea,
vomiting, hiccups, belching, severe bloating, tension in the anterior abdominal wall
and pain on palpation in the epigastric region, Shchetkin's symptom
Blumberg negative;
Ø asymptomatic (painless) - vague sensations in the chest, unmotivated weakness, increasing shortness of breath, causeless fever;
Ø with atypical irradiation of pain in - neck, lower jaw, teeth, left arm, shoulder, little finger ( superior - vertebral, laryngeal - pharyngeal)
When assessing the patient's condition, it is necessary to take into account the presence of risk factors for coronary artery disease, the appearance of pain attacks for the first time or a change in habitual
Nurse tactics:
| Actions | Rationale |
| Call a doctor. | Providing qualified assistance |
| Observe strict bed rest (lay with a raised head end), calm the patient | |
| Provide access to fresh air | To reduce hypoxia |
| Measure blood pressure and pulse | Status control. |
| Give nitroglycerin 0.5 mg sublingually (up to 3 tablets) with a break of 5 minutes if blood pressure is not lower than 90 mm Hg. | Reducing spasm of the coronary arteries, reducing the area of necrosis. |
| Give an aspirin tablet 0.25 g, chew slowly and swallow | Thrombus Prevention |
| Give 100% humidified oxygen (2-6 L/min.) | Reduction of hypoxia |
| Pulse and BP control | Condition control |
| Take an ECG | To confirm the diagnosis |
| Take blood for general and biochemical analysis | to confirm the diagnosis and conduct a tropanin test |
| Connect to heart monitor | To monitor the dynamics of the development of myocardial infarction. |
Prepare tools and preparations:
1. System for intravenous administration, tourniquet, electrocardiograph, defibrillator, heart monitor, Ambu bag.
2. As prescribed by a doctor: analgin 50%, 0.005% fentanyl solution, 0.25% droperidol solution, promedol solution 2% 1-2 ml, morphine 1% IV, tramal - for adequate pain relief, Relanium, heparin - for the purpose of prevention repeated blood clots and improvement of microcirculation, lidocaine - lidocaine for the prevention and treatment of arrhythmia;
Hypertensive crisis
Hypertensive crisis - a sudden increase in individual blood pressure, accompanied by cerebral and cardiovascular symptoms (disorder of cerebral, coronary, renal circulation, autonomic nervous system)
- hyperkinetic (type 1, adrenaline): characterized by a sudden onset, with the onset of intense headache, sometimes pulsating, with predominant localization in the occipital region, dizziness. Excitation, palpitations, trembling throughout the body, hand tremor, dry mouth, tachycardia, increased systolic and pulse pressure. The crisis lasts from several minutes to several hours (3-4). The skin is hyperemic, moist, diuresis is increased at the end of the crisis.
- hypokinetic (type 2, norepinephrine): develops slowly, from 3-4 hours to 4-5 days, headache, "heaviness" in the head, "veil" before the eyes, drowsiness, lethargy, the patient is inhibited, disorientation, "ringing" in the ears, transient visual impairment , paresthesia, nausea, vomiting, pressing pains in the region of the heart, such as angina pectoris (pressing), swelling of the face and pastosity of the legs, bradycardia, diastolic pressure mainly increases, pulse rate decreases. The skin is pale, dry, diuresis is reduced.
Nurse tactics:
| Actions | Rationale |
| Call a doctor. | To provide qualified assistance. |
| Reassure the patient | |
| Observe strict bed rest, physical and mental rest, remove sound and light stimuli | Reducing physical and emotional stress |
| Lay with a high headboard, with vomiting, turn your head to one side. | With the aim of outflow of blood to the periphery, prevention of asphyxia. |
| Provide fresh air or oxygen therapy | To reduce hypoxia. |
| Measure blood pressure, heart rate. | Condition control |
| Put mustard plasters on the calf muscles or apply a heating pad to the legs and arms (you can put the brushes in a bath of hot water) | To dilate peripheral vessels. |
| Put a cold compress on your head | In order to prevent cerebral edema, reduce headache |
| Ensure the intake of Corvalol, motherwort tincture 25-35 drops | Removing emotional stress |
Prepare preparations:
Nifedipine (Corinfar) tab. under the tongue, ¼ tab. capoten (captopril) under the tongue, clonidine (clophelin) tab., amp; anaprilin tab., amp; droperidol (ampoules), furosemide (lasix tab., ampoules), diazepam (relanium, seduxen), dibazol (amp), magnesia sulfate (amp), eufillin amp.
Prepare tools:
Apparatus for measuring blood pressure. Syringes, intravenous infusion system, tourniquet.
Evaluation of what has been achieved: Reduction of complaints, gradual (in 1-2 hours) decrease in blood pressure to the normal value for the patient
Fainting
Fainting this is a short-term loss of consciousness that develops due to a sharp decrease in blood flow to the brain (several seconds or minutes)
Causes: fright, pain, blood type, blood loss, lack of air, hunger, pregnancy, intoxication.
Pre-fainting period: feeling of lightheadedness, weakness, dizziness, darkening in the eyes, nausea, sweating, ringing in the ears, yawning (up to 1-2 minutes)
Fainting: consciousness is absent, pallor of the skin, decreased muscle tone, cold extremities, breathing is rare, shallow, the pulse is weak, bradycardia, blood pressure is normal or reduced, the pupils are constricted (1-3-5 min, prolonged - up to 20 min)
Post-mortem period: consciousness returns, pulse, blood pressure normalize , weakness and headache are possible (1-2 min - several hours). Patients do not remember what happened.
Nurse tactics:
| Actions | Rationale |
| Call a doctor. | To provide qualified assistance |
| Lay without a pillow with raised legs at 20 - 30 0. Turn head to side (to prevent aspiration of vomit) | To prevent hypoxia, improve cerebral circulation |
| Provide fresh air or remove from a stuffy room, give oxygen | To prevent hypoxia |
| Unfasten tight clothes, pat on the cheeks, splash cold water on the face. Give a sniff of cotton wool with ammonia, rub the body, limbs with your hands | Reflex effect on vascular tone. |
| Give a tincture of valerian or hawthorn, 15-25 drops, sweet strong tea, coffee | |
| Measure blood pressure, control respiratory rate, pulse | Condition control |
Prepare tools and preparations:
Syringes, needles, cordiamine 25% - 2 ml / m, caffeine solution 10% - 1 ml s / c.
Prepare preparations: eufillin 2.4% 10ml IV or atropine 0.1% 1ml s.c. if syncope is due to transverse heart block
Evaluation of what has been achieved:
1. The patient regained consciousness, his condition improved - a doctor's consultation.
3. The patient's condition is alarming - call for emergency assistance.
Collapse
Collapse- this is a persistent and prolonged decrease in blood pressure, due to acute vascular insufficiency.
Causes: pain, trauma, massive blood loss, myocardial infarction, infection, intoxication, a sharp drop in temperature, a change in body position (getting up), getting up after taking antihypertensive drugs, etc.
Ø cardiogenic form - with heart attack, myocarditis, pulmonary embolism
Ø vascular form- with infectious diseases, intoxication, a critical drop in temperature, pneumonia (symptoms develop simultaneously with symptoms of intoxication)
Ø hemorrhagic form - with massive blood loss (symptoms develop several hours after blood loss)
Clinic: general condition is severe or extremely severe. First there is weakness, dizziness, noise in the head. Disturbed by thirst, chilliness. Consciousness is preserved, but patients are inhibited, indifferent to the environment. The skin is pale, moist, the lips are cyanotic, acrocyanosis, the extremities are cold. BP less than 80 mm Hg. Art., pulse is frequent, thready", breathing is frequent, shallow, heart sounds are muffled, oliguria, body temperature is reduced.
Nurse tactics:
Prepare tools and preparations:
Syringes, needles, tourniquet, disposable systems
cordiamine 25% 2 ml i/m, caffeine solution 10% 1 ml s/c, 1% mezaton solution 1 ml,
0.1% 1 ml of adrenaline solution, 0.2% norepinephrine solution, 60-90 mg of prednisolone polyglucin, reopoliglyukin, saline.
Evaluation of what has been achieved:
1. Condition improved
2. Condition has not improved - be prepared for CPR
shock - a condition in which there is a sharp, progressive decline in all vital body functions.
Cardiogenic shock develops as a complication of acute myocardial infarction.
Clinic: a patient with acute myocardial infarction develops severe weakness, skin
pale wet, "marble" cold to the touch, collapsed veins, cold hands and feet, pain. BP is low, systolic about 90 mm Hg. Art. and below. The pulse is weak, frequent, "filamentous". Breathing shallow, frequent, oliguria
Ø reflex form (pain collapse)
Ø true cardiogenic shock
Ø arrhythmic shock
Nurse tactics:
Prepare tools and preparations:
Syringes, needles, tourniquet, disposable systems, heart monitor, ECG machine, defibrillator, Ambu bag
0.2% norepinephrine solution, mezaton 1% 0.5 ml, saline solution, prednisolone 60 mg, reopo-
liglyukin, dopamine, heparin 10,000 IU IV, lidocaine 100 mg, narcotic analgesics (promedol 2% 2 ml)
Evaluation of what has been achieved:
Condition has not worsened
Bronchial asthma
Bronchial asthma - chronic inflammatory process in the bronchi, predominantly of an allergic nature, the main clinical symptom is an asthma attack (bronchospasm).
During an attack: a spasm of the smooth muscles of the bronchi develops; - swelling of the bronchial mucosa; formation in the bronchi of viscous, thick, mucous sputum.
Clinic: the appearance of seizures or their increase is preceded by exacerbation of inflammatory processes in the bronchopulmonary system, contact with an allergen, stress, meteorological factors. The attack develops at any time of the day, often at night in the morning. The patient has a feeling of "lack of air", he takes a forced position relying on his hands, expiratory dyspnea, unproductive cough, auxiliary muscles are involved in the act of breathing; there is retraction of the intercostal spaces, retraction of the subclavian fossae, diffuse cyanosis, puffy face, viscous sputum, difficult to separate, breathing is noisy, wheezing, dry wheezing, heard at a distance (remote), boxed percussion sound, pulse frequent, weak. In the lungs - weakened breathing, dry rales.
Nurse tactics:
| Actions | Rationale |
| Call a doctor | The condition requires medical attention |
| Reassure the patient | Reduce emotional stress |
| If possible, find out the allergen and dissociate the patient from it | Termination of the impact of the causal factor |
| Seat with emphasis on hands, unbutton tight clothing (belt, trousers) | To make breathing easier heart. |
| Provide fresh air | To reduce hypoxia |
| Offer to do a volitional breath-hold | Reduction of bronchospasm |
| Measure blood pressure, count pulse, respiratory rate | Condition control |
| Help the patient to use a pocket inhaler, which the patient usually uses no more than 3 times per hour, 8 times a day (1-2 breaths of ventolin N, berotek N, salbutomol N, bekotod), which the patient usually uses, if possible, use a metered dose inhaler with a spencer, use a nebulizer | Reducing bronchospasm |
| Give 30-40% humidified oxygen (4-6 L/min) | Reduce hypoxia |
| Give a warm fractional alkaline drink (warm tea with soda on the tip of a knife). | For better sputum discharge |
| If possible, make hot foot and hand baths (40-45 degrees water is poured into a bucket for legs and into a basin for hands). | To reduce bronchospasm. |
| Monitor breathing, cough, sputum, pulse, respiratory rate | Condition control |
Features of the use of freon-free inhalers (N) - the first dose is released into the atmosphere (these are vapors of alcohol that have evaporated in the inhaler).
Prepare tools and preparations:
Syringes, needles, tourniquet, intravenous infusion system
Medications: 2.4% 10 ml solution of eufillin, prednisolone 30-60 mg IM, IV, saline solution, adrenaline 0.1% - 0.5 ml s / c, suprastin 2% -2 ml, ephedrine 5% - 1 ml.
Evaluation of what has been achieved:
1. Suffocation has decreased or stopped, sputum comes out freely.
2. The condition has not improved - continue the ongoing activities until the arrival of the ambulance.
3. Contraindicated: morphine, promedol, pipolfen - depress breathing
Pulmonary bleeding
Causes: chronic lung diseases (BEB, abscess, tuberculosis, lung cancer, emphysema)
Clinic: cough with the release of scarlet sputum with air bubbles, shortness of breath, possible pain when breathing, lowering blood pressure, skin is pale, moist, tachycardia.
Nurse tactics:
Prepare tools and preparations:
Everything you need to determine the blood type.
2. Calcium chloride 10% 10ml IV, vikasol 1%, dicynone (sodium etamsylate), 12.5% -2 ml IM, IV, aminocaproic acid 5% IV drops, polyglucin, reopoliglyukin
Evaluation of what has been achieved:
Decrease in cough, decrease in the amount of blood in the sputum, stabilization of the pulse, blood pressure.
hepatic colic
Clinic: intense pain in the right hypochondrium, epigastric region (stabbing, cutting, tearing) with irradiation to the right subscapular region, scapula, right shoulder, collarbone, neck, jaw. Patients rush about, moan, scream. The attack is accompanied by nausea, vomiting (often with an admixture of bile), a feeling of bitterness and dryness in the mouth, and bloating. Pain worsens with inhalation, palpation of the gallbladder, positive Ortner's symptom, subicteric sclera, dark urine, fever
Nurse tactics:
Prepare tools and preparations:
1. Syringes, needles, tourniquet, intravenous infusion system
2. Antispasmodics: papaverine 2% 2 - 4 ml, but - shpa 2% 2 - 4 ml i / m, platifillin 0.2% 1 ml s / c, i / m. Non-narcotic analgesics: analgin 50% 2-4 ml, baralgin 5 ml IV. Narcotic analgesics: Promedol 1% 1 ml or Omnopon 2% 1 ml IV.
Do not inject morphine - causes spasm of the sphincter of Oddi
Renal colic
Occurs suddenly: after physical exertion, walking, shaky driving, copious fluid intake.
Clinic: sharp, cutting, unbearable pain in the lumbar region radiating along the ureter to the iliac region, groin, inner thigh, external genital organs lasting from several minutes to several days. Patients toss and turn in bed, moan, scream. Dysuria, pollakiuria, hematuria, sometimes anuria. Nausea, vomiting, fever. Reflex intestinal paresis, constipation, reflex pain in the heart.
On examination: asymmetry of the lumbar region, pain on palpation along the ureter, a positive symptom of Pasternatsky, tension in the muscles of the anterior abdominal wall.
Nurse tactics:
Prepare tools and preparations:
1. Syringes, needles, tourniquet, intravenous infusion system
2. Antispasmodics: papaverine 2% 2 - 4 ml, but - shpa 2% 2 - 4 ml i / m, platifillin 0.2% 1 ml s / c, i / m.
Non-narcotic analgesics: analgin 50% 2-4 ml, baralgin 5 ml IV. Narcotic analgesics: Promedol 1% 1 ml or Omnopon 2% 1 ml IV.
Anaphylactic shock.
Anaphylactic shock- this is the most formidable clinical variant of an allergic reaction that occurs with the introduction of various substances. Anaphylactic shock can develop when ingested:
a) foreign proteins (immune sera, vaccines, extracts from organs, poisons on-
insects...);
b) medicines (antibiotics, sulfonamides, B vitamins…);
c) other allergens (plant pollen, microbes, food products: eggs, milk,
fish, soybeans, mushrooms, tangerines, bananas...
d) with insect bites, especially bees;
e) in contact with latex (gloves, catheters, etc.).
Ø lightning form develops 1-2 minutes after the administration of the drug;
characterized by the rapid development of the clinical picture of an acute ineffective heart, without resuscitation, it ends tragically in the next 10 minutes. Symptoms are poor: severe pallor or cyanosis; dilated pupils, lack of pulse and pressure; agonal breathing; clinical death.
Ø mild shock, develops 5-7 minutes after the administration of the drug
Ø severe form develops in 10-15 minutes, maybe 30 minutes after the administration of the drug.
Most often, shock develops within the first five minutes after the injection. Food shock develops within 2 hours.
Clinical variants of anaphylactic shock:
- Typical shape: a feeling of heat "doused with nettles", fear of death, severe weakness, tingling, itching of the skin, face, head, hands; sensation of a rush of blood to the head, tongue, heaviness behind the sternum or chest compression; pain in the heart, headache, shortness of breath, dizziness, nausea, vomiting. With a lightning-fast form, patients do not have time to complain before losing consciousness.
- Cardiac variant manifested by signs of acute vascular insufficiency: severe weakness, pallor of the skin, cold sweat, "thready" pulse, blood pressure drops sharply, in severe cases, consciousness and breathing are depressed.
- Asthmoid or asphyxial variant manifested by signs of acute respiratory failure, which is based on bronchospasm or swelling of the pharynx and larynx; there is a feeling of tightness in the chest, coughing, shortness of breath, cyanosis.
- cerebral variant manifested by signs of severe cerebral hypoxia, convulsions, foaming at the mouth, involuntary urination and defecation.
5. Abdominal variant manifested by nausea, vomiting, paroxysmal pain in
stomach, diarrhea.
Urticaria appears on the skin, in some places the rash merges and turns into a dense pale edema - Quincke's edema.
Nurse tactics:
| Actions | Rationale |
| Provide a doctor call through an intermediary. The patient is not transportable, assistance is provided on the spot | |
| If anaphylactic shock has developed on intravenous administration of the drug | |
| Stop drug administration, maintain venous access | Allergen Dose Reduction |
| Give a stable lateral position, or turn your head to the side, remove dentures | |
| Raise the foot end of the bed. | Improving blood supply to the brain, increasing blood flow to the brain |
| Reduced hypoxia | |
| Measure blood pressure and heart rate | Status control. |
| With intramuscular injection: stop the administration of the drug by first pulling the piston towards you. In case of an insect bite, remove the sting; | In order to reduce the administered dose. |
| Provide intravenous access | To administer drugs |
| Give a stable lateral position or turn your head on its side, remove dentures | Prevention of asphyxia with vomit, retraction of the tongue |
| Raise the foot end of the bed | Improving the blood supply to the brain |
| Access to fresh air, give 100% humidified oxygen, no more than 30 min. | Reduced hypoxia |
| Put a cold (ice pack) on the injection or bite area or apply a tourniquet above | Slowing down the absorption of the drug |
| Chop the injection site with 0.2-0.3 ml of 0.1% adrenaline solution, diluting them in 5-10 ml of saline. solution (dilution 1:10) | To reduce the rate of absorption of the allergen |
| In case of an allergic reaction to penicillin, bicillin - enter penicillinase 1,000,000 IU IM | |
| Monitor the patient's condition (BP, respiratory rate, pulse) |
Prepare tools and preparations:
tourniquet, ventilator, tracheal intubation kit, Ambu bag.
2. Standard set of drugs "Anaphylactic shock" (0.1% adrenaline solution, 0.2% noradrenaline, 1% mezaton solution, prednisolone, 2% suprastin solution, 0.05% strophanthin solution, 2.4% aminophylline solution, saline .solution, albumin solution)
Medical care for anaphylactic shock without a doctor:
1. Intravenous administration of adrenaline 0.1% - 0.5 ml per physical. r-re.
After 10 minutes, the introduction of adrenaline can be repeated.
In the absence of venous access, adrenaline
0.1% -0.5 ml can be injected into the root of the tongue or intramuscularly.
Actions:
Ø adrenaline enhances heart contractions, increases heart rate, constricts blood vessels and thus increases blood pressure;
Ø adrenaline relieves spasm of the smooth muscles of the bronchi;
Ø adrenaline slows down the release of histamine from mast cells, i.e. fights an allergic reaction.
2. Establish intravenous access and start fluid administration (physiological
solution for adults> 1 liter, for children - at the rate of 20 ml per kg) - replenish the volume
fluid in the vessels and increase blood pressure.
3. The introduction of prednisolone 90-120 mg IV.
By doctor's prescription:
4. After stabilization of blood pressure (BP above 90 mm Hg) - antihistamines:
5. With a bronchospastic form, eufillin 2.4% - 10 iv. On saline. When on-
cyanosis, dry rales, oxygen therapy. Possible inhalations
alupenta
6. With convulsions and strong arousal - in / in sedeuxen
7. With pulmonary edema - diuretics (lasix, furosemide), cardiac glycosides (strophanthin,
corglicon)
After removing from shock, the patient is hospitalized for 10-12 days..
Evaluation of what has been achieved:
1. Stabilization of blood pressure, heart rate.
2. Restoration of consciousness.
Urticaria, angioedema
Hives: allergic disease , characterized by a rash on the skin of itchy blisters (edema of the papillary layer of the skin) and erythema.
Causes: medicines, serums, foodstuffs…
The disease begins with intolerable skin itching in various parts of the body, sometimes on the entire surface of the body (on the trunk, extremities, sometimes the palms and soles of the feet). The blisters protrude above the surface of the body, from point sizes to very large ones, they merge, forming elements of various shapes with uneven clear edges. Rashes can remain in one place for several hours, then disappear and reappear in another place.
There may be fever (38 - 39 0), headache, weakness. If the disease lasts more than 5-6 weeks, it becomes chronic and is characterized by an undulating course.
Treatment: hospitalization, withdrawal of drugs (stop contact with the allergen), fasting, repeated cleansing enemas, saline laxatives, activated charcoal, polypefan orally.
Antihistamines: diphenhydramine, suprastin, tavigil, fenkarol, ketotefen, diazolin, telfast ... orally or parenterally
To reduce itching - in / in the solution of sodium thiosulfate 30% -10 ml.
Hypoallergenic diet. Make a note on the title page of the outpatient card.
Conversation with the patient about the dangers of self-medication; when applying for honey. with the help of the patient should warn the medical staff about intolerance to the drugs.
Quincke's edema- characterized by edema of the deep subcutaneous layers in places with loose subcutaneous tissue and on the mucous membranes (when pressed, the fossa does not remain): on the eyelids, lips, cheeks, genitals, back of the hands or feet, mucous membranes of the tongue, soft palate, tonsils, nasopharynx, gastrointestinal tract (clinic of acute abdomen). When the larynx is involved in the process, asphyxia may develop (anxiety, puffiness of the face and neck, increasing hoarseness, "barking" cough, difficulty stridor breathing, lack of air, cyanosis of the face), with swelling in the head region, the meninges are involved in the process (meningeal symptoms) .
Nurse tactics:
| Actions | Rationale |
| Provide a doctor call through an intermediary. Stop contact with the allergen | To determine the further tactics of providing medical care |
| Reassure the patient | Relieve emotional and physical stress |
| Find the stinger and remove it along with the venom sac | In order to reduce the spread of poison in the tissues; |
| Apply cold to the bite | A measure that prevents the spread of poison in the tissue |
| Provide access to fresh air. Give 100% humidified oxygen | Reduction of hypoxia |
| Drop vasoconstrictor drops into the nose (naphthyzinum, sanorin, glazolin) | Reduce swelling of the mucous membrane of the nasopharynx, facilitate breathing |
| Pulse control, blood pressure, respiratory rate | Pulse control, blood pressure, respiratory rate |
| Give Cordiamin 20-25 drops | To support cardiovascular activity |
Prepare tools and preparations:
1. System for intravenous infusion, syringes and needles for i/m and s/c injections,
tourniquet, ventilator, tracheal intubation kit, Dufo needle, laryngoscope, Ambu bag.
2. Adrenaline 0.1% 0.5 ml, prednisolone 30-60 mg; antihistamines 2% - 2 ml of suprastin solution, pipolfen 2.5% - 1 ml, diphenhydramine 1% - 1 ml; fast-acting diuretics: lasix 40-60mg IV bolus, mannitol 30-60mg IV drip
Inhalers salbutamol, alupent
3. Hospitalization in the ENT department
First aid for emergency conditions and acute diseases
Angina.
angina pectoris- this is one of the forms of coronary artery disease, the causes of which may be: spasm, atherosclerosis, transient thrombosis of the coronary vessels.
Symptoms: paroxysmal, squeezing or pressing pain behind the sternum, loads lasting up to 10 minutes (sometimes up to 20 minutes), passing when the load is stopped or after taking nitroglycerin. The pain radiates to the left (sometimes right) shoulder, forearm, hand, shoulder blade, neck, lower jaw, epigastric region. It can be manifested by atypical sensations in the form of lack of air, inexplicable sensations, stabbing pains.
Nurse tactics:
Definition. Emergency conditions are pathological changes in the body that lead to a sharp deterioration in health, threaten the life of the patient and require emergency therapeutic measures. There are the following emergency conditions:
Immediate life threatening
Not life-threatening, but without assistance, the threat will be real
Conditions in which failure to provide emergency assistance will lead to permanent changes in the body
Situations in which it is necessary to quickly alleviate the patient's condition
Situations requiring medical intervention in the interests of others due to inappropriate behavior of the patient
restoration of respiratory function
relief of collapse, shock of any etiology
relief of convulsive syndrome
prevention and treatment of cerebral edema
CARDIO-PULMONARY REANIMATION.
Definition. Cardiopulmonary resuscitation (CPR) is a set of measures aimed at restoring lost or severely impaired vital body functions in patients in a state of clinical death.
The main 3 receptions of CPR according to P. Safar, "rule ABC":
A ire way open - ensure airway patency;
B reath for victim - start artificial respiration;
C irculation his blood - restore blood circulation.
A- carried out triple trick according to Safar - tilting the head, the maximum forward displacement of the lower jaw and opening the patient's mouth.
Give the patient an appropriate position: lay on a hard surface, putting a roller of clothes on his back under the shoulder blades. Tilt your head as far back as possible
Open your mouth and examine the oral cavity. With convulsive compression of the masticatory muscles, use a spatula to open it. Clear the oral cavity of mucus and vomit with a handkerchief wound around the index finger. If the tongue is sunk, turn it out with the same finger
Rice. Preparation for artificial respiration: push the lower jaw forward (a), then move the fingers to the chin and, pulling it down, open the mouth; with the second hand placed on the forehead, tilt the head back (b).
Rice. Restoration of airway patency.
a- opening the mouth: 1-crossed fingers, 2-capturing the lower jaw, 3-using a spacer, 4-triple reception. b- cleaning of the oral cavity: 1 - with the help of a finger, 2 - with the help of suction. (fig. by Moroz F.K.)
B - artificial lung ventilation (ALV). IVL is the blowing of air or an oxygen-enriched mixture into the lungs of a patient without / using special devices. Each breath should take 1-2 seconds, and the respiratory rate should be 12-16 per minute. IVL at the stage of pre-hospital care is carried out "mouth to mouth" or "mouth to nose" exhaled air. At the same time, the effectiveness of inhalation is judged by the rise of the chest and passive exhalation of air. Either an airway, face mask and Ambu bag, or tracheal intubation and Ambu bag are usually used by the ambulance team.
|
Rice. IVL "mouth to mouth". |
Stand on the right side, with your left hand holding the victim's head in a tilted position, at the same time cover the nasal passages with your fingers. With the right hand, the lower jaw should be pushed forward and upward. In this case, the following manipulation is very important: a) hold the jaw by the zygomatic arches with the thumb and middle fingers; b) open the mouth with the index finger; c) with the tips of the ring finger and little finger (fingers 4 and 5) control the pulse on the carotid artery. |
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|
Take a deep breath, clasping the mouth of the victim with your lips and blowing. For hygienic purposes, cover the mouth with any clean cloth. At the moment of inspiration, control the rise of the chest When signs of spontaneous breathing appear in the victim, mechanical ventilation is not immediately stopped, continuing until the number of spontaneous breaths corresponds to 12-15 per minute. At the same time, if possible, the rhythm of breaths is synchronized with the recovering breathing of the victim. ALV "from mouth to nose" is indicated when assisting a drowning person, if resuscitation is carried out directly in the water, with fractures of the cervical spine (tilting the head back is contraindicated). IVL using the Ambu bag is indicated if the provision of assistance is mouth-to-mouth or mouth-to-nose Rice. IVL with the help of simple devices. a - through S - shaped air duct; b- using a mask and an Ambu bag; c- through an endotracheal tube; d- percutaneous transglottal IVL. (fig. by Moroz F.K.) |
Rice. IVL "from mouth to nose" | |||
C - indirect heart massage.
The patient lies on his back on a hard surface. The caregiver stands on the side of the victim and puts the hand of one hand on the lower middle third of the sternum, and the second hand on top, across the first to increase pressure.
the doctor should stand high enough (on a chair, stool, stand, if the patient is lying on a high bed or on the operating table), as if hanging with his body over the victim and putting pressure on the sternum not only with the effort of his hands, but also with the weight of his body.
The rescuer's shoulders should be directly above the palms, the arms should not be bent at the elbows. With rhythmic pushes of the proximal part of the hand, they press on the sternum in order to shift it towards the spine by approximately 4-5 cm. The pressure should be such that one of the team members can clearly determine the artificial pulse wave on the carotid or femoral artery.
The number of chest compressions should be 100 in 1 minute
The ratio of chest compressions to artificial respiration in adults is 30: 2 whether one or two people are doing CPR.
In children, 15:2 if CPR is performed by 2 people, 30:2 if it is performed by 1 person.
simultaneously with the onset of mechanical ventilation and massage intravenous bolus: every 3-5 minutes 1 mg of adrenaline or 2-3 ml endotracheally; atropine - 3 mg intravenously bolus once.
Rice. The position of the patient and assisting with chest compressions.
ECG- asystole ( isoline on the ECG)
intravenously 1 ml of 0.1% solution of epinephrine (adrenaline), repeated intravenously after 3-4 minutes;
intravenous atropine 0.1% solution - 1 ml (1 mg) + 10 ml of 0.9% solution of sodium chloride after 3-5 minutes (until the effect or a total dose of 0.04 mg / kg is obtained);
Sodium bicarbonate 4% - 100 ml is administered only after 20-25 minutes of CPR.
if asystole persists, immediate percutaneous, transesophageal, or endocardial temporary pacing.
ECG- ventricular fibrillation (ECG - teeth of different amplitudes randomly located)
electrical defibrillation (EIT). Shocks of 200, 200 and 360 J (4500 and 7000 V) are recommended. All subsequent discharges - 360 J.
In ventricular fibrillation, after the 3rd shock, cordaron in the initial dose of 300 mg + 20 ml of 0.9% sodium chloride solution or 5% glucose solution, again - 150 mg each (up to a maximum of 2 g). In the absence of cordarone, enter lidocaine- 1-1.5 mg/kg every 3-5 minutes for a total dose of 3 mg/kg.
Magnesia sulfate - 1-2 g IV for 1-2 minutes, repeat after 5-10 minutes.
EMERGENCY AID FOR ANAPHILACTIC SHOCK.
Definition. Anaphylactic shock is a systemic allergic reaction of an immediate type to the repeated administration of an allergen as a result of a rapid massive immunoglobulin-E-mediated release of mediators from tissue basophils (mast cells) and basophilic granulocytes of peripheral blood (R.I. Shvets, E.A. Fogel, 2010 .).
Provoking factors:
taking medications: penicillin, sulfonamides, streptomycin, tetracycline, nitrofuran derivatives, amidopyrine, aminophylline, eufillin, diafillin, barbiturates, anthelmintic drugs, thiamine hydrochloride, glucocorticosteroids, novocaine, sodium thiopental, diazepam, radiopaque and iodine-containing substances.
Administration of blood products.
Food products: chicken eggs, coffee, cocoa, chocolate, strawberries, strawberries, crayfish, fish, milk, alcoholic beverages.
Administration of vaccines and sera.
Insect stings (wasps, bees, mosquitoes)
Pollen allergens.
Chemicals (cosmetics, detergents).
Local manifestations: edema, hyperemia, hypersalivation, necrosis
Systemic manifestations: shock, bronchospasm, DIC, intestinal disorders
Urgent Care:
Stop contact with allergens: stop parenteral administration of the drug; remove the insect sting from the wound with an injection needle (removal with tweezers or fingers is undesirable, since it is possible to squeeze out the remaining poison from the reservoir of the poisonous gland of the insect remaining on the sting) Apply ice or a heating pad with cold water to the injection site for 15 minutes.
Lay the patient down (head above the legs), turn the head to the side, push the lower jaw forward, if there are removable dentures, remove them.
If necessary, perform CPR, tracheal intubation; with laryngeal edema - tracheostomy.
Indications for mechanical ventilation in anaphylactic shock:
Swelling of the larynx and trachea with impaired patency - respiratory tract;
Intractable arterial hypotension;
Violation of consciousness;
Persistent bronchospasm;
Pulmonary edema;
Development - coagulopathy bleeding.
Immediate tracheal intubation and mechanical ventilation is performed with loss of consciousness, a decrease in systolic blood pressure below 70 mm Hg. Art., in the event of stridor.
The appearance of stridor indicates obstruction of the lumen of the upper respiratory tract by more than 70-80%, and therefore the patient's trachea should be intubated with a tube of the largest possible diameter.
Medical therapy:
Provide intravenous access into two veins and start transfusion of 0.9% - 1.000 ml of sodium chloride solution, stabisol - 500 ml, polyglucin - 400 ml
Epinephrine (adrenaline) 0.1% - 0.1 -0.5 ml intramuscularly, if necessary, repeat after 5-20 minutes.
In moderate anaphylactic shock, a fractional (bolus) injection of 1-2 ml of a mixture (1 ml of -0.1% adrenaline + 10 ml of 0.9% sodium chloride solution) is shown every 5-10 minutes until hemodynamic stabilization.
Intratracheal epinephrine is administered in the presence of an endotracheal tube in the trachea - as an alternative to intravenous or intracardiac routes of administration (2-3 ml at a time in a dilution of 6-10 ml in isotonic sodium chloride solution).
prednisolone intravenously 75-100 mg - 600 mg (1 ml = 30 mg prednisolone), dexamethasone - 4-20 mg (1 ml = 4 mg), hydrocortisone - 150-300 mg (if intravenous administration is not possible - intramuscularly).
with generalized urticaria or with a combination of urticaria with Quincke's edema - diprospan (betamethasone) - 1-2 ml intramuscularly.
with Quincke's edema, a combination of prednisolone and new generation antihistamines is indicated: semprex, telfast, clarifer, allertec.
membrane stabilizers intravenously: ascorbic acid 500 mg/day (8–10 10 ml of 5% solution or 4–5 ml of 10% solution), troxevasin 0.5 g/day (5 ml of 10% solution), sodium etamsylate 750 mg/day (1 ml = 125 mg), the initial dose is 500 mg, then every 8 hours, 250 mg.
intravenously eufillin 2.4% 10–20 ml, no-shpa 2 ml, alupent (brikanil) 0.05% 1–2 ml (drip); isadrin 0.5% 2 ml subcutaneously.
with persistent hypotension: dopmin 400 mg + 500 ml of 5% glucose solution intravenously (the dose is titrated until the systolic pressure reaches 90 mm Hg) and is prescribed only after replenishment of the circulating blood volume.
with persistent bronchospasm 2 ml (2.5 mg) salbutamol or berodual (fenoterol 50 mg, iproaropium bromide 20 mg) preferably through a nebulizer
with bradycardia, atropine 0.5 ml -0.1% of the solution subcutaneously or 0.5 -1 ml intravenously.
It is advisable to administer antihistamines to the patient only after stabilization of blood pressure, since their action can aggravate hypotension: diphenhydramine 1% 5 ml or suprastin 2% 2-4 ml, or tavegil 6 ml intramuscularly, cimetidine 200-400 mg (10% 2-4 ml) intravenously, famotidine 20 mg every 12 hours (0.02 g of dry powder diluted in 5 ml of solvent) intravenously, pipolfen 2.5% 2-4 ml subcutaneously.
Hospitalization in the intensive care unit / allergology with generalized urticaria, Quincke's edema.
EMERGENCY CARE FOR ACUTE CARDIOVASCULAR FAILURE: CARDIOGENIC SHOCK, FANE COLLAPSE
Definition. Acute cardiovascular failure is a pathological condition caused by the inadequacy of cardiac output to the metabolic needs of the body. It can be due to 3 reasons or a combination of them:
Sudden decrease in myocardial contractility
Sudden decrease in blood volume
Sudden drop in vascular tone.
Causes of occurrence: arterial hypertension, acquired and congenital heart defects, pulmonary embolism, myocardial infarction, myocarditis, cardiosclerosis, myocardiopathies. Conventionally, cardiovascular insufficiency is divided into cardiac and vascular.
Acute vascular insufficiency is characteristic of conditions such as fainting, collapse, shock.
Cardiogenic shock: emergency care.
Definition. Cardiogenic shock is an emergency condition resulting from acute circulatory failure, which develops due to a deterioration in myocardial contractility, pumping function of the heart, or a disturbance in the rhythm of its activity. Causes: myocardial infarction, acute myocarditis, heart injury, heart disease.
The clinical picture of shock is determined by its form and severity. There are 3 main forms: reflex (pain), arrhythmogenic, true.
reflex cardiogenic shock complication of myocardial infarction that occurs at the height of the pain attack. It often occurs with lower-posterior localization of a heart attack in middle-aged men. Hemodynamics normalizes after the relief of the pain attack.
Arrhythmogenic cardiogenic shock a consequence of cardiac arrhythmia, more often against the background of ventricular tachycardia> 150 per 1 minute, atrial fibrillation, ventricular fibrillation.
True cardiogenic shock a consequence of a violation of myocardial contractility. The most severe form of shock against the background of extensive necrosis of the left ventricle.
Weakness, lethargy or short-term psychomotor agitation
The face is pale with a grayish-ash tint, the skin is marbled
cold clammy sweat
Acrocyanosis, cold extremities, collapsed veins
The main symptom is a sharp drop in SBP< 70 мм. рт. ст.
Tachycardia, shortness of breath, signs of pulmonary edema
oliguria
0.25 mg acetylsalicylic acid to chew in the mouth
Lay down the patient with raised lower limbs;
oxygen therapy with 100% oxygen.
With an anginal attack: 1 ml of a 1% solution of morphine or 1-2 ml of a 0.005% solution of fentanyl.
Heparin 10,000 -15,000 IU + 20 ml of 0.9% sodium chloride intravenously drip.
400 ml of 0.9% sodium chloride solution or 5% glucose solution intravenously over 10 minutes;
intravenous jet solutions of polyglucin, refortran, stabisol, reopoliglyukin until blood pressure stabilizes (SBP 110 mm Hg)
With heart rate> 150 per minute. – absolute indication for EIT, heart rate<50 в мин абсолютное показание к ЭКС.
No stabilization of blood pressure: dopmin 200 mg intravenously + 400 ml of 5% glucose solution, the rate of administration is from 10 drops per minute until the SBP is at least 100 mm Hg. Art.
If there is no effect: norepinephrine hydrotartrate 4 mg in 200 ml of 5% glucose solution intravenously, gradually increasing the infusion rate from 0.5 μg / min to SBP 90 mm Hg. Art.
if the SBP is more than 90 mm Hg: 250 mg of dobutamine solution + in 200 ml of 0.9% sodium chloride intravenously by drip.
Hospitalization in the intensive care unit / intensive care unit
First aid for fainting.
Definition. Fainting is an acute vascular insufficiency with a sudden short-term loss of consciousness due to an acute insufficiency of blood flow to the brain. Causes: negative emotions (stress), pain, a sudden change in body position (orthostatic) with a disorder of the nervous regulation of vascular tone.
Tinnitus, general weakness, dizziness, pallor of the face
Loss of consciousness, the patient falls
Pale skin, cold sweat
Pulse is thready, blood pressure drops, extremities are cold
The duration of fainting from a few minutes to 10-30 minutes
Lay the patient down with head down and legs up, free from tight clothing
Give a sniff of 10% aqueous ammonia (ammonia)
Midodrine (gutron) orally 5 mg (tablets or 14 drops of 1% solution), maximum dose - 30 mg / day or intramuscularly, or intravenously 5 mg
Mezaton (phenylephrine) intravenously slowly 0.1-0.5 ml 1% solution + 40 ml 0.9% sodium chloride solution
With bradycardia and cardiac arrest atropine sulfate 0.5 - 1 mg intravenously by bolus
When breathing and circulation stops - CPR
Collapse emergency.
Definition. Collapse is an acute vascular insufficiency that occurs as a result of inhibition of the sympathetic nervous system and an increase in the tone of the vagus nerve, which is accompanied by the expansion of arterioles and a violation of the ratio between the capacity of the vascular bed and the bcc. As a result, venous return, cardiac output and cerebral blood flow are reduced.
Reasons: pain or its expectation, a sharp change in body position (orthostatic), an overdose of antiarrhythmic drugs, ganglioblockers, local anesthetics (novocaine). Antiarrhythmic drugs.
General weakness, dizziness, tinnitus, yawning, nausea, vomiting
Paleness of the skin, cold clammy sweat
Decreased blood pressure (systolic blood pressure less than 70 mm Hg), bradycardia
Possible loss of consciousness
Horizontal position with legs elevated
1 ml 25% cordiamine solution, 1-2 ml 10% caffeine solution
0.2 ml 1% mezaton solution or 0.5 - 1 ml 0.1% epinephrine solution
For prolonged collapse: 3–5 mg/kg hydrocortisone or 0.5–1 mg/kg prednisone
With severe bradycardia: 1 ml -0.15 solution of atropine sulfate
200 -400 ml of polyglucin / rheopolyglucin
Means and methods of transportation of victims
Carrying by hand. It is used in cases where the victim is conscious, does not have fractures of the limbs, spine, pelvic bones and ribs, or abdominal wounds.
Carrying on the back with the help of hands. Designed for the same group of victims.
Carrying on the shoulder with the help of hands. Convenient for carrying the victim, who has lost consciousness.
Carrying by two porters. Carrying on the "lock" is used in cases where the victim is conscious and either does not have fractures, or with fractures of the upper limbs, lower leg, foot (after TI).
Carrying "one by one" used when the casualty is unconscious but not fractured.
Carrying on a sanitary stretcher. This method is not applicable for a fracture of the spine.
Timely and correctly performed cardiopulmonary resuscitation (CPR) is the basis for saving the lives of many thousands of victims who, due to various reasons, suddenly experienced cardiac arrest. There are many such reasons: myocardial infarction, trauma, drowning, poisoning, electrical injury, lightning, acute blood loss, hemorrhage in the vital centers of the brain. Diseases complicated by hypoxia and acute vascular insufficiency, etc. In all these cases, it is necessary to immediately begin measures to artificially maintain breathing and blood circulation (cardiopulmonary resuscitation).
Emergency conditions:
acute dysfunction of the cardiovascular system (sudden cardiac arrest, collapse, shock);
Acute violation of respiratory function (suffocation during drowning, ingress of a foreign body into the upper respiratory tract);
acute dysfunction of the central nervous system (fainting, coma).
clinical death- the final, but reversible stage of dying.
The state that the body experiences within a few minutes after the cessation of blood circulation and respiration, when all external manifestations of vital activity completely disappear, however, irreversible changes have not yet occurred in the tissues. The duration of clinical death under normothermic conditions is 3-4 minutes, maximum 5-6 minutes. With sudden death, when the body does not expend energy to fight a long debilitating dying, the duration of clinical death increases somewhat. Under conditions of hypothermia, for example, when drowning in cold water, the duration of clinical death increases to 15-30 minutes.
biological death- a state of irreversible death of the body.
The presence of biological death in the victim can be ascertained (established) only by a medical worker.
Cardiopulmonary resuscitation- a complex of basic and specialized (medication, etc.) measures to revitalize the body.
Survival depends on three main factors:
early recognition of circulatory arrest;
Immediate start of major activities;
Calling the resuscitation team for specialized resuscitation.
If resuscitation is started in the first minute, the probability of revival is more than 90%, after 3 minutes - no more than 50%. Do not be afraid, do not panic - act, perform resuscitation clearly, calmly and quickly, without fuss, and you will definitely save a person's life.
The sequence of performing the main CPR measures:
State the lack of reaction to external stimuli (lack of consciousness, lack of pupillary reaction to light);
Make sure that there is no reaction of external respiration and pulse on the carotid artery;
correctly lay the resuscitated on a hard, flat surface below the level of the waist of the one who will perform resuscitation;
ensure the patency of the upper respiratory tract;
inflict a precordial blow (with sudden cardiac arrest: electrical injury, pale drowning);
check for spontaneous breathing and pulse;
call assistants and resuscitation team;
If there is no spontaneous breathing, start artificial lung ventilation (ALV) - perform two complete exhalations "mouth to mouth";
check for a pulse on the carotid artery;
Start indirect heart massage in combination with mechanical ventilation and continue them until the arrival of the resuscitation team.
precordial beat applied with a short sharp movement of the fist to a point located 2-3 cm above the xiphoid process. In this case, the elbow of the striking arm should be directed along the body of the victim. The goal is to shake the chest as hard as possible to start a suddenly stopped heart. Very often, immediately after a blow to the sternum, the heartbeat is restored and consciousness returns.
IVL technique:
pinch the nose of the resuscitated;
tilt the head of the victim so that an obtuse angle forms between his lower jaw and neck;
Make 2 slow blows of air (1.5-2 seconds with a 2-second pause). In order to avoid inflation of the stomach, the volume of air blown in should not be too large, and blowing too fast;
IVL is performed at a frequency of 10-12 breaths per minute.
Technique for performing chest compressions:
pressure on the chest for an adult affected person is performed with two hands, for children - with one hand, for newborns - with two fingers;
Place folded hands 2.5 cm above the xiphoid process of the sternum;
Put one hand with the protrusion of the palm on the sternum of the resuscitated, and the second (also with the protrusion of the palm) - on the back surface of the first;
When pressing, the shoulders of the resuscitator should be directly above the palms, the arms should not be bent at the elbows in order to use not only the strength of the hands, but also the mass of the whole body;
carry out short, vigorous movements so as to cause the sternum to sag in an adult by 3.5-5 cm, in children under 8 years old - 1.5-2.5 cm;
If the resuscitator acts alone, then the ratio of the frequency of pressure to the rate of ventilation should be 15:2, if there are two resuscitators - 5:1;
The rhythm of pressure on the chest should correspond to the heart rate at rest - about 1 time per second (for children under 10-12 years old, the number of pressures should be 70-80 per minute);
· After 4 cycles of CPR, stop resuscitation for 5 seconds to determine whether breathing and circulation have returned.
Attention!!! Unacceptable!!!
Apply a precordial blow and conduct an indirect heart massage to a living person (a precordial blow with a preserved heartbeat can kill a person);
stop indirect heart massage even with a fracture of the ribs;
Interrupt chest compressions for more than 15-20 seconds.
Heart failure- This is a pathological condition characterized by circulatory failure due to a decrease in the pumping function of the heart.
The main causes of heart failure can be: heart disease, prolonged overload of the heart muscle, leading to its overwork.
Stroke is an acute violation of blood circulation in the brain, causing the death of brain tissue.
The main causes of stroke can be: hypertension, atherosclerosis, blood disease.
Stroke symptoms:
· Strong headache;
nausea, dizziness;
Loss of sensation on one side of the body
omission of the corner of the mouth on one side;
confusion of speech
blurred vision, asymmetric pupils;
· loss of consciousness.
PMP for heart failure, stroke:
Clear the oral cavity and respiratory tract from mucus and vomit;
Put a heating pad on your feet
If within 3 minutes the patient does not regain consciousness, he should be turned on his stomach and apply cold to his head;
Fainting- short-term loss of consciousness due to ischemia (reduced blood flow) or hypoglycemia (lack of carbohydrates during malnutrition) of the brain.
Collapse- acute vascular insufficiency, characterized by a short-term sharp drop in arterial and venous pressure, a decrease in the volume of circulating blood due to:
lack of oxygen in the inhaled air (rapid climb uphill);
The release of a large amount of the liquid part of the blood into the zone of the infectious process (dehydration with diarrhea, vomiting with dysentery);
overheating, when there is a rapid loss of fluid with profuse sweating and frequent breathing;
delayed reaction of vascular tone to sudden changes in body position (from a horizontal position to a vertical position);
irritation of the vagus nerve (negative emotions, pain, at the sight of blood).
PMP with fainting, collapse:
lay the patient on his back without a pillow, turn his head to one side so that the tongue does not sink;
Make sure that you are breathing (if not, perform mechanical ventilation);
Make sure that there is a pulse on the carotid artery (if there is no pulse, start CPR);
bring a cotton swab with ammonia to the nose;
provide air access, unfasten clothing that makes it difficult to breathe, loosen the waist belt, open the window;
Raise the legs 20-30 cm above the level of the heart; If the patient does not regain consciousness within 3 minutes, he should be turned on his stomach and apply cold to his head;
Urgently call an ambulance.
First aid in emergency situations can save a person's life. Before talking about the types of emergency conditions, an important point should be said, namely the concept of these very conditions. By the name of the definition, it can be seen that emergency conditions are called such, when a patient urgently needs medical care, its expectation cannot be postponed even for a second, because then all this can adversely affect the health, and sometimes the life of a person.
Such conditions are divided into categories, depending on the problem itself.
- Injuries. Injuries include fractures, and burns and damage to blood vessels. In addition, injury is considered damage by electricity, frostbite. Another broad subgroup of injuries is damage to organs that have the status of vital - the brain, heart, lungs, kidneys and liver. Their peculiarity is that they arise most often due to interaction with various objects, that is, under the influence of some circumstance or object.
- Poisoning. Poisoning can be obtained not only through food, respiratory organs and open wounds. Also, poisons can penetrate through the veins and skin. The peculiarity of poisoning is that the damage is not visible to the naked eye. Poisoning occurs inside the body at the cellular level.
- Acute diseases of the internal organs. These include stroke, heart attack, pulmonary edema, peritonitis, acute renal or hepatic failure. Such conditions are extremely dangerous and lead to loss of strength and cessation of the activity of internal organs.
- In addition to the above groups, emergency conditions are bites from poisonous insects, bouts of disease, injuries from catastrophes, etc.
It is difficult to divide all such conditions into groups, the main feature is the threat to life and the urgent intervention of doctors!
Principles of emergency care
To do this, you need to know the rules of first aid and be able to apply them in practice if necessary. Also, the main task of the person who happened to be next to the victim is to remain calm and immediately call for medical help. To do this, always keep the emergency phone number handy or in your cell phone notebook. Do not let the victim harm yourself, try to secure and immobilize him. If you see that the ambulance does not arrive for a long time, take resuscitation actions yourself.
First aid
Algorithm of actions in the provision of first medical aid in emergency conditions
- Epilepsy. This is a seizure in which the patient loses consciousness, makes convulsive movements. Also, he is foaming at the mouth. To help the patient, you need to put him on his side so that his tongue does not sunk, and hold his arms and legs during convulsions. Doctors use chlorpromazine and magnesium sulfate, after which they take the patient to a medical facility.
- Fainting.
- Bleeding.
- Electric shock.
- Poisoning.
Artificial respiration
How to help children
In children, as in adults, there are urgent conditions. But the trouble is that children may not notice something was wrong, and also begin to act up, cry, and adults may simply not believe him. This is a great danger, because timely assistance can save the child's life, and if suddenly his condition worsens, call the doctor immediately. After all, the child's body is not yet strong, and the state of emergency should be urgently eliminated.
- To begin with, calm the child so that he does not cry, does not push, does not kick, and is not afraid of the doctors. Describe to the doctor everything that happened as accurately as possible, more and faster. Tell us what medicines he was given and what he ate, perhaps the child has an allergic reaction.
- Before the doctor arrives, prepare antiseptics, clean clothes and fresh air in a room with a comfortable temperature so that the child breathes well. If you see that the condition is deteriorating rapidly, start resuscitation, cardiac massage, artificial respiration. And also measure the temperature and do not let the child fall asleep until the doctor arrives.
- When the doctor arrives, he will look at the work of the internal organs, the work of the heart and the pulse. In addition, when making a diagnosis, he will definitely ask how the child behaves, his appetite and usual behavior. Have you had any symptoms before. Some parents do not tell the doctor everything, for various reasons, but it is absolutely impossible to do this, because he must have a complete picture of the life and activities of your child, so tell everything as detailed and accurate as possible.
