Providing emergency care for collapse in children. Acute vascular insufficiency in children

COLLAPSE

This is a life-threatening acute vascular insufficiency, characterized by a sharp decrease in vascular tone, a decrease in circulating blood volume, signs of brain hypoxia and inhibition of vital body functions.

The most common causes of collapse in children: severe acute infectious pathology (intestinal infection, pneumonia, etc.); acute adrenal insufficiency; overdose of antihypertensive drugs; acute blood loss; serious injury.

The collapse clinic develops, as a rule, during the height of the underlying disease and is characterized by a progressive deterioration in the general condition of the patient. Depending on the clinical manifestations, three phases (variants) of collapse are conventionally distinguished: sympathotonic, vagotonic and paralytic.

Sympathotonic collapse

He caused by impaired peripheral circulation due to spasm of arterioles and centralization of blood circulation, compensatory release of catecholamines. It is characterized by the child's excitement and increased muscle tone; pallor and marbling of the skin, cold hands and feet; tachycardia, normal and increased. However, these symptoms are short-lived, and collapse is more often diagnosed in the following phases.

Vagotonic collapse

In this phase, a significant expansion of arterioles and arteriovenous anastomoses is noted, which is accompanied by the deposition of blood in the capillary bed. Clinically characteristic: lethargy, adynamia, decreased muscle tone, severe pallor of the skin with marbling, severe acrocyanosis, a sharp decrease. The pulse is usually weak, bradycardia is often noted, noisy and rapid breathing of the Kussmaul type, and oliguria may occur.

Paralytic collapse

It is caused by passive expansion of capillaries due to the depletion of blood circulation regulation mechanisms. This condition is characterized by: lack of consciousness with suppression of skin and bulbar reflexes, the appearance of blue-purple spots on the skin of the trunk and limbs, bradycardia, bradycardia with transition to periodic, decreases to critical numbers, thread-like pulse, anuria. In the absence of emergency assistance, death occurs.

Urgent Care

Treatment measures must be started immediately!

It is necessary to lay the child horizontally on his back with a slight
head thrown back, cover with warm heating pads, provide
fresh air flow.
Ensuring free patency of the upper respiratory tract
(perform an inspection of the oral cavity, remove restrictive clothing).

In case of symptoms of sympathotonic collapse, it is necessary to remove
spasm of peripheral vessels with intramuscular injection of antispasmodics (2% solution
papaverine thief 0.1 ml/year of life or drotaverine solution 0.1 ml/year
life).
In cases of vagotonic and paralytic collapse, it is necessary
we go:

Provide access to a peripheral vein and begin infusion therapy with rheopolyglucin solution or crystalloids (0.9% solution or Ringer's solution) at a rate of 20 ml/kg for 20-30 minutes;

Simultaneously administer corticosteroids in a single dose: hydro
cortisone 10-20 mg/kg IV or 5-10 mg/kg IV or
into the floor of the mouth, or 0.3-0.6 mg/kg i.v.

For intractable arterial hypotension, it is necessary to:
re-introduce a 0.9% solution intravenously or
Ringer's solution in a volume of 10 ml/kg in combination with a solution of re-
opolyglucin 10 ml/kg under control of blood pressure and diuresis;
prescribe a 1% solution of mezaton 0.1 ml/year of life intravenously
slowly or 0.2% norepinephrine solution 0.1 ml/year of life i.v.
drip (in 50 ml of 5% glucose solution) at a rate of 10-20 ka
drops per minute (in very severe cases - 20-30 drops per minute
chickpeas) under blood pressure control.

According to indications, primary cardiopulmonary resuscitation is performed, after which the patient is hospitalized in the intensive care unit after emergency measures are provided.

One of the acute forms of vascular insufficiency is called collapse. It occupies an intermediate position between fainting and a state of shock. It is characterized by a drop (collapse means fallen) pressure, dilation of veins and arteries with the accumulation of blood in them.

It happens with infections, allergies, blood loss, insufficient functioning of the adrenal glands, or under the influence of strong antihypertensive drugs. Treatment requires emergency hospitalization and administration of drugs that increase systemic pressure.

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Causes of acute vascular collapse

The following can lead a patient to a collaptoid state:

sharp pain;
injuries;
blood loss, general dehydration;
acute infectious processes;
low cardiac output (, );
severe allergic reactions;
intoxication due to internal (kidney, liver, intestinal diseases, acute inflammation) or external (various poisonings) entry of toxic substances into the blood;
administration of drugs for general or spinal anesthesia, barbiturates, overdose of sleeping pills, narcotics, medications for the treatment of arrhythmia, hypertension;
decreased synthesis of catecholamines in the adrenal glands;
a drop in blood sugar or its sharp increase.

Determining the cause of collapse is not difficult if it occurs against the background of an existing disease. When it develops suddenly, it is the first manifestation of emergency conditions (for example, ectopic pregnancy, bleeding from a stomach ulcer). In older people, acute vascular insufficiency often accompanies myocardial infarction or pulmonary embolism.

Symptoms of deficiency

The first signs of collapse are sudden general weakness, yawning, and dizziness. Then they quickly join:

When fainting, a spasm of cerebral vessels occurs, and even with a mild form, patients lose consciousness. It is also important to distinguish collapse from shock. In the latter case, heart failure, severe metabolic disorders and neurological disorders occur. It should be noted that the boundary between these conditions (fainting, collapse, shock) is often quite arbitrary; they can transform into each other as the underlying disease progresses.

Types of collapses

Depending on the causes and leading mechanism of development, several types of vascular collapse have been identified:

orthostatic– with a sharp change in body position in case of ineffective regulation of arterial tone (recovery from infections, taking antihypertensive drugs, rapid decrease in body temperature, pumping fluid out of cavities, uncontrollable vomiting);
infectious– a decrease in arterial tone occurs under the influence of bacterial or viral toxins;
hypoxic– occurs when there is a lack of oxygen or low atmospheric pressure;
dehydration– it is caused by loss of fluid during severe infections with diarrhea and vomiting, excessive excretion of urine during forced diuresis, diabetes mellitus with high hyperglycemia, and internal or external bleeding;
cardiogenic– associated with myocardial damage during heart attack, cardiomyopathy;
sympathicotonic– blood loss or dehydration, neuroinfection, occurs with vascular spasm at normal pressure;
vagotonic– severe pain, stress, anaphylaxis, low blood sugar or lack of adrenal hormones. The sharp difference between , ;
paralytic– severe diabetes, infectious processes, depletion of compensation reserves, paralytic vasodilation with a sharp decrease in blood circulation.

According to the severity of the patient's condition, there are:

easy– the pulse increases by a third, the pressure is at the lower limit of normal, the pulse (the difference between systolic and diastolic) is low;
moderate severity– heart rate increased by 50%, pressure about 80-60/60-50 mm Hg. Art., urine output decreases;
heavy– consciousness changes to a state of stupor, lethargy, pulse is increased by 80 - 90%, maximum pressure is below 60 mm Hg. Art. or not determined, anuria, intestinal motility arrest.

Features of vascular insufficiency in children

In childhood, a common cause of collapse is infection, dehydration, intoxication and oxygen starvation due to diseases of the lungs, heart, and nervous system.

Minor external influences can lead to vascular insufficiency in premature and weakened children. This is due to the physiological inferiority of the mechanisms regulating the tone of arteries and veins, the predominance of vagotonia, and the tendency to acidosis (a shift in the blood reaction to the acidic side) in this category of patients.

Signs of the onset of a collaptoid reaction are a deterioration in the child’s condition - against the background of the underlying disease, severe weakness, lethargy and even adynamia (low motor activity) appear.

There is chills, pale skin, cold hands and feet, increased heart rate, which becomes thread-like. Then the blood pressure decreases, the peripheral veins lose their tone, while maintaining consciousness, children lose their reaction to their surroundings, and convulsive syndrome is possible in newborns.

Emergency care before the ambulance arrives

Collapse can only be treated in a hospital, so you should call emergency help as quickly as possible. All the time before the doctor arrives, the patient must be in a horizontal position with his legs raised (place a blanket or clothes rolled up in a cushion).

It is necessary to ensure the flow of fresh air - unfasten the collar, loosen the belt. If the attack occurred indoors, then you need to open the windows, while covering the victim with a warm blanket. Additionally, you can apply a warm heating pad or bottles of non-hot water to the sides of the body.

To improve peripheral blood circulation, rub the hands, feet, and press the ears into the cavity between the base of the nose and the upper lip. You should not try to sit the patient up or give him medications yourself, since the most common drugs (Corvalol, No-shpa, Validol, especially Nitroglycerin) can significantly worsen the condition and turn collapse into shock. For external bleeding, apply a tourniquet.

Watch the video about first aid for fainting and vascular collapse:

Medical therapy

Before transporting the patient to the hospital, the introduction of vasoconstrictors can be used - Cordiamin, Caffeine, Mezaton, Norepinephrine. If collapse occurs due to loss of fluid or blood, then the administration of such drugs is carried out only after restoration of the volume of circulating blood with the help of Reopoliglucin, Stabizol, Refortan or saline solutions.

In severe cases and in the absence of peptic ulcer, hormonal drugs (Dexamethasone, Prednisolone, Hydrocortisone) are used.

Inhalation of humidified oxygen is indicated for patients with hypoxic collapse, carbon monoxide poisoning, and severe infections. In case of intoxication, infusion therapy is carried out - the introduction of glucose, isotonic solution, and vitamins. In case of bleeding, plasma substitutes are used.

Patients with heart failure additionally receive cardiac glycosides; in case of arrhythmia, it is necessary to restore the rhythm with the help of Cordarone, Atropine (for conduction block, bradycardia). If collapse develops against the background of a severe attack of angina or heart attack, then intravenous administration of neuroleptics and narcotic analgesics, anticoagulants is carried out.

Forecast

With the rapid elimination of the cause of collapse, it is possible to completely restore normal hemodynamic parameters and recover the patient without consequences. For infections and poisonings, adequate and timely therapy is also often quite effective.

The prognosis is more severe for patients with chronic, progressive diseases of the heart, digestive organs, and pathology of the endocrine system. In such patients, repeated, repeatedly recurrent collaptoid conditions are especially dangerous. Due to the age-related characteristics of the body, collapse is most dangerous for children and the elderly.

Prevention

Prevention of acute vascular insufficiency consists of:

timely diagnosis and treatment of infections, intoxications, bleeding, burns;
taking potent medications to lower blood pressure only on medical advice, under the control of hemodynamic parameters;
correction of metabolic disorders;
maintaining recommended blood glucose levels.

For acute infections with high body temperature, bed rest, a slow transition to a vertical position, and adequate drinking are important, especially with fever, diarrhea and vomiting.

Collapse is an acute vascular insufficiency, it occurs with infection, poisoning, blood loss, dehydration, heart disease, endocrine pathology. The difference from fainting is the absence of an initial loss of consciousness. Manifestations: decreased blood pressure, severe weakness, lethargy, pale and cold skin, sticky sweat.

It is difficult to tolerate in childhood and old age. Emergency assistance consists of placing the patient in a horizontal position, quickly calling a doctor, and providing access to fresh air. For treatment, vasoconstrictors, hormones, infusion solutions and plasma substitutes are administered. A prerequisite for a favorable outcome is the elimination of the cause of the collapse.

Causes of fainting in children and first aid

Fainting- short-term sudden loss of consciousness.

The causes of fainting in children are divided into:

cardiac origin - with increased heart rate, etc.
vascular origin;
endocrine - reducing blood sugar levels;
infectious;
intoxicating.

Emergency care for fainting in children begins with reflex effects - splashing the face with cold water, inhaling ammonia vapor, wiping the temples with cotton wool soaked in ammonia. In case of prolonged fainting, a 10% solution of caffeine (0.1 ml/year of life) or Niketamide (0.1 ml/year of life) is administered through an enema; if blood pressure decreases, 1% phenylephrine (Mezatone) (0.1 ml/year of life).

If fainting is associated with a decrease in sugar levels (in children, suffering), he is given a piece of sugar to suck or 20-40% glucose (2 ml/kg) is administered through an enema. In case of a sharp slowdown in heartbeat, when helping children with fainting, a 0.1% solution of atropine is administered (0.05 ml/year of life).

Clinical signs of collapse in children and emergency care

Collapse- a serious condition of acute vascular insufficiency, manifested by a sharp decrease in vascular tone, signs of oxygen starvation of the brain and, as a consequence, inhibition of the vital functions of the body. The causes of vascular collapse can be acute blood loss, trauma, acute adrenal insufficiency, etc. Vascular insufficiency occurs in three periods:

pre-fainting - weakness, dizziness, nausea, discomfort in the heart, in the abdomen;
fainting itself - partial narrowing of consciousness followed by its loss, decreased muscle tone, paleness of the skin and visible mucous membranes, instability of breathing, pulse, blood pressure; short-term convulsions are possible;
post-fainting state - rapid recovery of consciousness, there may be residual effects in the form of weakness, nausea, slow heartbeat.

During the collapse there are also three stages:

1) the child is excited, inadequate; his skin is pale, marbled, his hands and feet are cold; muscle tone is increased, breathing is rapid, blood pressure may be within the age norm or elevated. A characteristic clinical sign of collapse at this stage is an increased heart rate;

2) the child is inhibited; the skin and mucous membranes take on a gray-bluish tint, the limbs become bluish; muscle tone is reduced, heart rate slows, blood pressure decreases, urination decreases;

3) consciousness and reflexes are depressed; the skin is cold, with blue-purple spots; breathing and heartbeat slow, blood pressure drops to a critical level, and urination stops.

Emergency care for collapse in children begins with placing the child with the lower limbs raised and the head thrown back; provide a flow of fresh air.

For collapse, in addition to the above, prednisolone (2-20 mg/kg), hydrocortisone (4-20 mg/kg), and dexamethasone (0.3-0.6 mg/kg) are administered.

In emergency cases, when helping a child with collapse, mechanical ventilation and indirect cardiac massage are performed.

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A condition in which there is a significant drop in blood pressure. Collapse is acute oxygen starvation, which spreads to the cerebral cortex. This often results in death.

Collapse is divided into several types. The first type of collapse is associated with a pathological increase in the capacity of the venous bed. There is a decrease in venous return to the myocardium. Therefore, the name of the first type of collapse is angiogenic.

Hypovolemic collapse is associated with dehydration. In this case, collapse is associated with massive blood loss and progresses in an upright position. In this case, it is necessary to provide urgent medical assistance.

Cardiogenic collapse is characterized by a lesion. Myocardial dysfunction occurs, in which blood circulation decreases. That is, there is not enough blood flowing into the heart muscle.

A complication of cardiogenic collapse is heart failure. This is the most serious type of collapse. Fatalities are common.

Collapse is the most serious process in terms of severity of consequences. Unlike fainting. Therefore, changes occur in the cerebral cortex. Oxygen starvation can lead to the death of brain cells. And its further functioning is impossible.

What is the main etiology of collapse. Collapse develops in various situations. Moreover, this state of affairs is associated with a life-threatening condition. The following reasons for such conditions are identified:

massive blood loss;
myocardial ischemia;
intoxication of the body;
infectious diseases;
stress;
damage to the endocrine system;
uncontrolled use of medications

Collapse is not an independent disease. It is a consequence of pathological conditions. Which is most often massive blood loss. Stress is less likely to contribute to collapse.

Damage to the endocrine system is also less likely to be a prerequisite for collapse. But uncontrolled use of medications can often provoke the development of collapse. Because some medications have a lot of side effects. In this case, these disorders concern the brain.

Symptoms

The collapse is developing quite rapidly. A sharp drop in pressure is felt. Characterized by general weakness of the body. That is why urgent measures need to be taken.

Also, with collapse, tinnitus is observed. This condition is characterized by some signs:

loss of vision sharpness;
dizziness;
feeling of fear;
decrease in temperature

Sweating may occur. At the same time, cold sweat appears. The pallor of the skin is due precisely to the state of collapse. In this case, it is advisable to measure the pulse.

The pulse is rapid during collapse. It can be felt directly on one arm. How does an attack occur? During collapse, the patient loses consciousness.

The pupils begin to dilate, the skin becomes cold. The patient does not respond to external stimuli. In this condition, it is not advisable to try to help the patient without medical presence.

You urgently need to call a doctor. Otherwise, the patient may die. Hospitalization required. What can you do?

In this case, it is necessary to give the patient a certain position. Usually given a horizontal position. With raised lower limbs. More details in the section: “Treatment”.

What exactly are the objective signs that indicate this condition? The most common characteristics of collapse are:

lethargy of the patient;
sallow face;
body temperature is reduced;
rapid breathing;
pulse is weak and tense;
blood pressure 80-40 mm Hg. Art.

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Specialist consultation required!

Diagnostics

In diagnosing collapse, they resort to direct diagnosis of this condition. This refers to measuring blood pressure. The blood pressure indicator indicates a state of collapse.

It is also very advisable to measure the patient's pulse. At the same time, its frequency, weak filling and tension are observed. Also a necessary technique in diagnosing collapse.

It is also necessary to take blood for analysis. This makes it possible to detect a decrease in the number of red blood cells. That is, a reduced level of blood cells also indicates this condition.

There is no time to carry out more detailed diagnostic measures. Most often, this condition requires urgent resuscitation measures. Otherwise, the patient may die.

If it is possible to get out of this condition, then the diagnosis is the most comprehensive. Includes the following activities:

laboratory research;
instrumental diagnostics;
blood chemistry;
blood pressure measurement;
electrocardiogram

These are the most common diagnostic methods. They are used quite often. Since they allow us to identify the possibility of the occurrence of this condition.

Prevention

Infectious diseases must be treated promptly. This helps prevent conditions such as collapse. It is also important to prevent damage to the cardiovascular system.

In this case, it is necessary to see doctors more often. Especially if there are abnormalities in cardiac activity. Extensive intoxication also contributes to the development of this condition.

To prevent intoxication, it is necessary not to self-medicate, take medications only as indicated, and treat various infections in a timely manner.

In preventing collapse, it is important to prevent stress. This refers to a strong emotional shock. Only certain sedatives will help you cope with stress.

If there is a serious endocrine pathology, then it is necessary to take hormonal drugs. Hormone therapy is aimed at replacing necessary hormones. This means necessary therapy for this condition.

If there is a toxic factor. For example, in case of poisoning. Necessary measures should be taken immediately. Treat this condition. Otherwise, severe poisoning will lead to the development of collapse.

Treatment

What needs to be done to treat collapse. Treatment of this condition will be aimed at using several techniques:

lay in a horizontal position with raised lower limbs;
warm the patient (cover with a blanket or warm with heating pads);
inject a caffeine solution subcutaneously;
oxygen therapy;
administer prednisolone;
administer polyglucin intravenously

If hemorrhagic collapse occurs, it is important to stop the bleeding and administer hemostatic agents. Among the hemostatic drugs used:

vikasol;
sodium ethamsylate;
aminocaproic acid;
calcium chloride

If cardiogenic collapse occurs, then drugs aimed at treating myocardial infarction are prescribed. It is also advisable to carry out detoxification therapy aimed at reducing general intoxication of the body.

When the heart stops, electrical pacing must be used. This allows the patient to return to life. And in some cases, this event does not bring the patient back to life.

In adults

Collapse in adults is quite severe. In this case, there is a condition that requires urgent medical attention. The most common causes of this condition in adults are:

period of intoxication;
infections (chronic);
cardiac pathology;
massive blood loss;
severe stress

At any age, a person can be overcome by extreme stress. And this process is pathological. In this case, the cerebral cortex suffers. Brain hypoxia occurs.

In adults, cardiogenic collapse may occur. As a consequence of heart disease. Typically, this pathology occurs more often in males. Women are also susceptible, but less so.

Intoxication can cause collapse. Alcohol intoxication may usually be present. Drug poisoning. Excessive alcohol consumption leads to various vascular disorders.

Massive blood loss is an unexpected condition. May require urgent medical attention. Hospitalization is mandatory.

In children

Collapse in children is a life-threatening acute vascular failure. What is the main etiology of the disease in children? The main causes of collapse are:

severe course of the infectious process;
adrenal insufficiency;
overdose of antihypertensive drugs;
severe injury;
severe blood loss

The infectious process in children can take a more severe form. This is due to inadequate treatment or insufficient treatment. This condition may be caused by the following infections:

intestinal infection;
flu;
acute respiratory viral disease;
pneumonia;
pyelonephritis

As you can see, any infection can cause this condition. However, it can be bacterial or viral. Depending on the pathogen.

What kind of help does a child need in this condition? The child must be given first aid:

lay in a horizontal position;
ensure airway patency;
cover with heating pads;
introduce a solution of papaverine, dibazole, no-shpa solution;
administer hydrocortisone and prednisolone;

If indicated, provide cardiopulmonary resuscitation. Hospitalization in the intensive care unit is required. To prevent death.

Forecast

With collapse, the prognosis is often unfavorable. Especially if first aid was not provided in a timely manner. The prognosis may be favorable.

Favorable prognosis if help is provided on time and the patient recovers from this condition. At the same time, the functioning of the heart and respiratory system was restored. There may even be a complete recovery.

The prognosis worsens with untimely, inadequate treatment of collapse. And also when the patient is not hospitalized in the intensive care unit on time. Which is one of the most necessary assistance measures.

Exodus

Death occurs when assistance is not provided in a timely manner. Recovery is possible in some cases. Much depends on the provision of first aid.

First aid can be provided by a paramedic. But it is important to ensure medicinal administration of drugs. This allows you to restore functionality.

The outcome depends on the severity of the disease, as well as on the type of collapse. Cardiogenic collapse is associated with cardiac pathology. Therefore, it is advisable to carry out certain therapeutic therapy. Most often, hypovolemic collapse ends unfavorably.

Lifespan

Life expectancy and its quality depend on many factors. At the same time, there is speed and timeliness of assistance. With successful emergency care measures, life expectancy increases.

However, even after successfully completed assistance measures, it is necessary to monitor pressure. It is important to maintain a daily routine and bed rest. This helps prolong the patient's life.

Long-term rehabilitation is also necessary. But only under the supervision of a specialist. Self-medication can lead to a reduction in life expectancy. So follow these steps!