Algorithms for providing first aid in emergency conditions. The paramedic broke it down: “You will learn to provide first aid no worse than I did!” Providing first emergency aid
Conditions that require emergency care are called emergencies. First aid in these cases consists of a timely and accurate assessment of the victim’s condition, giving him an optimal position and performing the necessary priority actions to ensure patency of the airway, breathing and blood circulation.
FAINTING
Fainting is a sudden, short-term loss of consciousness that occurs as a result of impaired blood circulation in the brain.
Fainting can last from a few seconds to several minutes. Usually a person comes to his senses after a while. Fainting in itself is not a disease, but rather a symptom of a disease.
Fainting can be due to various reasons:
1. Unexpected sharp pain, fear, nervous shock.
They can cause an immediate decrease in blood pressure, resulting in a decrease in blood flow, disruption of blood supply to the brain, which leads to fainting.
2. General weakness of the body, sometimes aggravated by nervous exhaustion.
General weakness of the body, resulting from a variety of reasons, ranging from hunger, poor nutrition and ending with constant anxiety, can also lead to low blood pressure and fainting.
3. Staying in a room with insufficient oxygen.
Oxygen levels can be reduced due to large numbers of people indoors, poor ventilation, and air pollution from tobacco smoke. As a result, the brain receives less oxygen than needed, and the victim faints.
4. Staying in a standing position for a long time without moving.
This leads to stagnation of blood in the legs, a decrease in its flow to the brain and, as a result, to fainting.
Symptoms and signs of fainting:
Reaction - short-term loss of consciousness, the victim falls. In a horizontal position, blood supply to the brain improves and after some time the victim regains consciousness.
Breathing is rare and shallow. Blood circulation - pulse is weak and rare.
Other signs are dizziness, tinnitus, severe weakness, blurred vision, cold sweat, nausea, numbness of the limbs.
First aid for fainting
1. If the airways are clear, the victim is breathing and his pulse is palpable (weak and rare), he must be placed on his back and his legs raised.
2. Unfasten tight parts of clothing, such as collars and belts.
3. Place a wet towel on the victim's forehead or wet his face with cold water. This will lead to vasoconstriction and improve blood supply to the brain.
4. When vomiting, the victim must be moved to a safe position or at least turned his head to the side so that he does not choke on the vomit.
5 It must be remembered that fainting can be a manifestation of a serious, including acute, illness that requires emergency care. Therefore, the victim always needs to be examined by a doctor.
6. You should not rush to raise the victim after he has regained consciousness. If conditions allow, the victim can be given hot tea, and then helped to rise and sit down. If the victim feels faint again, he must be placed on his back and his legs raised.
7. If the victim is unconscious for several minutes, most likely it is not fainting and qualified medical assistance is needed.
SHOCK
Shock is a condition that threatens the life of the victim and is characterized by insufficient blood supply to tissues and internal organs.
The blood supply to tissues and internal organs can be impaired for two reasons:
Heart problems;
Reducing the volume of fluid circulating in the body (severe bleeding, vomiting, diarrhea, etc.).
Symptoms and signs of shock:
Reaction - the victim is usually conscious. However, the condition can worsen very quickly, even to the point of loss of consciousness. This is due to a decrease in blood supply to the brain.
The airways are usually free. If there is internal bleeding, there may be problems.
Breathing is frequent and shallow. This breathing is explained by the fact that the body is trying to get as much oxygen as possible with a limited blood volume.
Blood circulation - pulse is weak and frequent. The heart tries to compensate for the decrease in circulating blood volume by speeding up blood circulation. A decrease in blood volume leads to a drop in blood pressure.
Other signs are skin that is pale, especially around the lips and earlobes, and cool and clammy. This is because the blood vessels in the skin close to direct blood to vital organs like the brain, kidneys, etc. The sweat glands also increase their activity. The victim may feel thirsty due to the fact that the brain senses a lack of fluid. Muscle weakness occurs due to the fact that blood from the muscles goes to the internal organs. There may be nausea, vomiting, chills. Chills mean lack of oxygen.
First aid for shock
1. If the shock is caused by a circulatory disorder, then first of all you need to take care of the brain - ensure the supply of oxygen to it. To do this, if the injury allows, the victim must be laid on his back, his legs raised and the bleeding stopped as quickly as possible.
If the victim has a head injury, then the legs cannot be raised.
The victim must be placed on his back with something under his head.
2. If shock is caused by burns, then first of all it is necessary to ensure that the effect of the damaging factor ceases.
Then cool the affected area of the body, if necessary, lay the victim with his legs elevated and cover him with something to keep warm.
3. If shock is caused by cardiac dysfunction, the victim must be placed in a semi-sitting position, placing pillows or folded clothing under the head and shoulders, as well as under the knees.
It is not advisable to lay the victim on his back, as this will make it more difficult for him to breathe. Give the victim an aspirin tablet to chew.
In all of the above cases, it is necessary to call an ambulance and, until it arrives, monitor the condition of the victim, being ready to begin cardiopulmonary resuscitation.
When providing assistance to a victim in shock, it is unacceptable:
Move the victim, except when necessary;
Allow the victim to eat, drink, smoke;
Leave the victim alone, except in cases where it is necessary to leave to call an ambulance;
Warm the victim with a heating pad or some other heat source.
ANAPHYLACTIC SHOCK
Anaphylactic shock is an immediate widespread allergic reaction that occurs when an allergen enters the body (insect bites, medicinal or food allergens).
Anaphylactic shock usually develops within a few seconds and is an emergency that requires immediate attention.
If anaphylactic shock is accompanied by loss of consciousness, immediate hospitalization is necessary, since the victim in this case may die within 5-30 minutes due to asphyxia or after 24-48 hours or more due to severe irreversible changes in vital organs.
Sometimes death can occur later due to changes in the kidneys, gastrointestinal tract, heart, brain and other organs.
Symptoms and signs of anaphylactic shock:
Reaction - the victim feels anxiety, a sense of fear, and as shock develops, loss of consciousness is possible.
Airways - swelling of the airways occurs.
Breathing - similar to asthmatic. Shortness of breath, a feeling of tightness in the chest, coughing, intermittent, difficult, may stop completely.
Blood circulation - the pulse is weak, rapid, and may not be palpable on the radial artery.
Other signs are a tense chest, swelling of the face and neck, swelling around the eyes, redness of the skin, rash, red spots on the face.
First aid for anaphylactic shock
1. If the victim is conscious, give him a semi-sitting position to facilitate breathing. It is better to sit him on the floor, unbutton the collar and loosen other pressing parts of the clothing.
2. Call an ambulance.
3. If the victim is unconscious, move him to a safe position, control breathing and blood circulation and be ready to begin cardiopulmonary resuscitation.
ATTACK OF BRONCHIAL ASTHMA
Bronchial asthma is an allergic disease, the main manifestation of which is an attack of suffocation caused by obstruction of the bronchial tubes.
An attack of bronchial asthma is caused by various allergens (pollen and other substances of plant and animal origin, industrial products, etc.)
Bronchial asthma is expressed in attacks of suffocation, experienced as a painful lack of air, although in reality it is based on difficulty in exhaling. The reason for this is the inflammatory narrowing of the airways caused by allergens.
Symptoms and signs of bronchial asthma:
Reaction - the victim may be alarmed, during severe attacks he may not be able to utter several words in a row, and he may lose consciousness.
Airways may be narrowed.
Breathing - characterized by difficult, prolonged exhalation with a lot of wheezing, often heard at a distance. Shortness of breath, cough, dry at first, and at the end with viscous sputum.
Blood circulation - at first the pulse is normal, then it becomes rapid. At the end of a prolonged attack, the pulse may become thread-like until the heart stops.
Other signs are anxiety, extreme fatigue, sweating, tension in the chest, speaking in a whisper, bluish skin, nasolabial triangle.
First aid for an attack of bronchial asthma
1. Take the victim out into the fresh air, unfasten the collar and loosen the belt. Sit leaning forward and focusing on your chest. In this position, the airways open.
2. If the victim has any medications, help them use them.
3. Call an ambulance immediately if:
This is the first attack;
The attack did not stop after taking the medicine;
The victim has difficulty breathing and finds it difficult to speak;
The victim showed signs of extreme exhaustion.
HYPERVENTILATION
Hyperventilation is pulmonary ventilation that is excessive in relation to the level of metabolism, caused by deep and (or) frequent breathing and leading to a decrease in carbon dioxide and an increase in oxygen in the blood.
The cause of hyperventilation is most often panic or serious anxiety caused by fright or some other reason.
Feeling extreme anxiety or panic, a person begins to breathe more quickly, which leads to a sharp decrease in carbon dioxide levels in the blood. Hyperventilation sets in. As a result, the victim begins to feel even more anxious, which leads to increased hyperventilation.
Symptoms and signs of hyperventilation:
Reaction - the victim is usually alarmed and feels confused. The airways are open and free.
Breathing is naturally deep and frequent. As hyperventilation develops, the victim breathes more and more frequently, but subjectively feels suffocated.
Blood circulation - does not help to recognize the cause.
Other signs include the victim feeling dizzy, a sore throat, tingling in the arms, legs or mouth, and the heart rate may increase. Seeks attention, help, may become hysterical, faint.
First aid for hyperventilation.
1. Bring a paper bag to the victim's nose and mouth and ask him to breathe the air that he exhales into the bag. In this case, the victim exhales air saturated with carbon dioxide into the bag and inhales it again.
Typically, after 3-5 minutes, the level of blood carbon dioxide saturation returns to normal. The respiratory center in the brain receives the appropriate information about this and sends a signal: breathe more slowly and deeply. Soon the muscles of the respiratory organs relax, and the entire respiratory process returns to normal.
2. If the cause of hyperventilation is emotional arousal, it is necessary to calm the victim, restore his sense of confidence, and persuade the victim to sit calmly and relax.
ANGINA
Angina pectoris (angina pectoris) is an attack of acute pain in the chest caused by transient coronary circulatory failure and acute myocardial ischemia.
The cause of an attack of angina is insufficient blood supply to the heart muscle, caused by coronary insufficiency due to a narrowing of the lumen of the coronary artery of the heart due to atherosclerosis, vascular spasm, or a combination of these factors.
Angina pectoris can occur as a result of psycho-emotional stress, which can lead to spasm of the pathologically unchanged coronary arteries of the heart.
However, most often angina still occurs when the coronary arteries are narrowed, which can account for 50–70% of the lumen of the vessel.
Symptoms and signs of angina:
Reaction - the victim is conscious.
The airways are clear.
Breathing is shallow, the victim does not have enough air.
Blood circulation - pulse is weak and frequent.
Other signs - the main sign of pain syndrome is its paroxysmal nature. The pain has a fairly clear beginning and end. The nature of the pain is squeezing, pressing, sometimes in the form of a burning sensation. As a rule, it is localized behind the sternum. Irradiation of pain into the left half of the chest, into the left arm to the fingers, left shoulder blade and shoulder, neck, and lower jaw is typical.
The duration of pain during angina pectoris, as a rule, does not exceed 10-15 minutes. They usually occur during physical activity, most often when walking, and also during stress.
First aid for angina pectoris.
1. If an attack develops during physical activity, it is necessary to stop the exercise, for example, stop.
2. Place the victim in a semi-sitting position, placing pillows or folded clothing under his head and shoulders, as well as under his knees.
3. If the victim has previously had angina attacks for which he used nitroglycerin, he can take it. For faster absorption, a nitroglycerin tablet must be placed under the tongue.
The victim should be warned that after taking nitroglycerin, a feeling of fullness in the head and headache, sometimes dizziness, and, if standing, fainting may occur. Therefore, the victim should remain in a semi-sitting position for some time even after the pain goes away.
If nitroglycerin is effective, the angina attack goes away within 2–3 minutes.
If the pain does not disappear a few minutes after taking the drug, you can take it again.
If, after taking the third tablet, the victim’s pain does not go away and lasts for more than 10–20 minutes, it is necessary to urgently call an ambulance, since there is a possibility of developing a heart attack.
HEART ATTACK (MYOCARDIAL INFARCTION)
Heart attack (myocardial infarction) is necrosis (death) of a section of the heart muscle due to disruption of its blood supply, which manifests itself in impaired cardiac activity.
A heart attack occurs due to blockage of a coronary artery by a thrombus - a blood clot that forms at the site of narrowing of the vessel due to atherosclerosis. As a result, a more or less extensive area of the heart “turns off,” depending on which part of the myocardium the blocked vessel supplied with blood. The clot stops the supply of oxygen to the heart muscle, resulting in necrosis.
The causes of a heart attack can be:
Atherosclerosis;
Hypertonic disease;
Physical activity combined with emotional stress - vasospasm during stress;
Diabetes mellitus and other metabolic diseases;
Genetic predisposition;
Environmental influence, etc.
Symptoms and signs of a heart attack (heart attack):
Reaction - in the initial period of a painful attack, restless behavior, often accompanied by fear of death, later loss of consciousness is possible.
The airways are usually free.
Breathing is frequent, shallow, and may stop. In some cases, attacks of suffocation are observed.
Blood circulation - pulse is weak, fast, and may be intermittent. Possible cardiac arrest.
Other signs are severe pain in the heart area, usually occurring suddenly, often behind the sternum or to the left of it. The nature of the pain is squeezing, pressing, burning. It usually radiates to the left shoulder, arm, and shoulder blade. Often during a heart attack, unlike angina, the pain spreads to the right of the sternum, sometimes involves the epigastric region and “radiates” to both shoulder blades. The pain is growing. The duration of a painful attack during a heart attack is calculated in tens of minutes, hours, and sometimes days. There may be nausea and vomiting, the face and lips may turn blue, and severe sweating. The victim may lose the ability to speak.
First aid for a heart attack.
1. If the victim is conscious, give him a semi-sitting position, placing pillows or folded clothes under his head and shoulders, as well as under his knees.
2. Give the victim an aspirin tablet and ask him to chew it.
3. Loosen tight parts of clothing, especially around the neck.
4. Call an ambulance immediately.
5. If the victim is unconscious but breathing, place him in a safe position.
6. Monitor breathing and blood circulation; in case of cardiac arrest, immediately begin cardiopulmonary resuscitation.
STROKE
Stroke is an acute disturbance of blood circulation in the brain or spinal cord caused by a pathological process with the development of persistent symptoms of damage to the central nervous system.
The cause of a stroke may be a cerebral hemorrhage, cessation or weakening of the blood supply to any part of the brain, blockage of a vessel by a thrombus or embolus (a thrombus is a dense clot of blood in the lumen of a blood vessel or heart cavity, formed during life; an embolus is a substrate circulating in the blood, not occurs under normal conditions and can cause blockage of blood vessels).
Strokes are more common in older people, although they can occur at any age. More often observed in men than in women. About 50% of stroke victims die. Of those who survive, approximately 50% are crippled and have another stroke weeks, months or years later. However, many stroke survivors regain their health with the help of rehabilitation measures.
Symptoms and signs of stroke:
Reaction - consciousness is confused, there may be loss of consciousness.
The airways are clear.
Breathing - slow, deep, noisy, wheezing.
Blood circulation - pulse is rare, strong, with good filling.
Other signs are a severe headache, the face may turn red, become dry, hot, disturbances or slowing of speech may be observed, and the corner of the lips may sag even if the victim is conscious. The pupil on the affected side may be dilated.
With a minor lesion there is weakness, with a significant one - complete paralysis.
First aid for stroke
1. Call qualified medical assistance immediately.
2. If the victim is unconscious, check whether the airway is open, and restore airway patency if it is compromised. If the victim is unconscious but breathing, move him to a safe position on the side of the injury (to the side where the pupil is dilated). In this case, the weakened or paralyzed part of the body will remain at the top.
3. Be prepared for rapid deterioration of the condition and for cardiopulmonary resuscitation.
4. If the victim is conscious, place him on his back with something under his head.
5. The victim may have a mini-stroke, in which there is a slight speech disorder, slight clouding of consciousness, slight dizziness, and muscle weakness.
In this case, when providing first aid, you should try to protect the victim from falling, calm and support him, and immediately call an ambulance. Control DP - D - K and be ready to provide emergency assistance.
EPILEPTIC ATTACK
Epilepsy is a chronic disease caused by brain damage, manifested by repeated convulsive or other seizures and accompanied by a variety of personality changes.
An epileptic seizure is caused by excessively intense stimulation of the brain, which is caused by an imbalance in the human bioelectric system. Typically, a group of cells in one part of the brain becomes electrically unstable. This creates a strong electrical discharge that rapidly spreads to surrounding cells, disrupting their normal functioning.
Electrical phenomena can affect the entire brain or just part of it. Accordingly, major and minor epileptic seizures are distinguished.
A minor epileptic seizure is a short-term disruption of brain activity, leading to temporary loss of consciousness.
Symptoms and signs of petit mal seizure:
Reaction - temporary loss of consciousness (from several seconds to a minute). The airways are open.
Breathing is normal.
Blood circulation - pulse is normal.
Other signs are a blank gaze, repeated or twitching movements of individual muscles (head, lips, arms, etc.).
A person comes out of such a seizure as suddenly as he entered it, and he continues the interrupted actions, not realizing that a seizure was happening to him.
First aid for petit mal seizure
1. Eliminate the danger, sit the victim down and calm him down.
2. When the victim wakes up, tell him about the seizure, since this may be his first seizure and the victim does not know about the illness.
3. If this is the first seizure, consult a doctor.
A grand mal seizure is a sudden loss of consciousness accompanied by severe spasms (convulsions) of the body and limbs.
Symptoms and signs of grand mal seizure:
Reaction - begins with sensations close to euphoric (unusual taste, smell, sound), then loss of consciousness.
The airways are clear.
Breathing may stop, but is quickly restored. Blood circulation - pulse is normal.
Other signs are that the victim usually falls to the floor unconscious, and begins to experience sudden convulsive movements of the head, arms and legs. There may be a loss of control over physiological functions. The tongue is bitten, the face turns pale, then becomes cyanotic. The pupils do not react to light. Foam may appear at the mouth. The total duration of the seizure ranges from 20 seconds to 2 minutes.
First aid for grand mal seizure
1. If you notice that someone is on the verge of a seizure, you need to try to ensure that the victim does not hurt himself if he falls.
2. Make room around the victim and place something soft under his head.
3. Unbutton the clothing around the victim's neck and chest.
4. Do not attempt to restrain the victim. If his teeth are clenched, do not try to unclench his jaws. Do not try to put anything into the victim’s mouth, as this can lead to injury to the teeth and closure of the respiratory tract with fragments.
5. After the convulsions have stopped, move the victim to a safe position.
6. Treat any injuries sustained by the victim during the seizure.
7. After the seizure has stopped, the victim must be hospitalized if:
The seizure happened for the first time;
There was a series of seizures;
There is damage;
The victim was unconscious for more than 10 minutes.
HYPOGLYCEMIA
Hypoglycemia - low blood glucose levels Hypoglycemia can occur in a diabetic patient.
Diabetes is a disease in which the body does not produce enough of the hormone insulin, which regulates the amount of sugar in the blood.
If the brain does not receive enough sugar, then just like with a lack of oxygen, brain functions are impaired.
Hypoglycemia can occur in a diabetic patient for three reasons:
1) the victim injected insulin, but did not eat on time;
2) with excessive or prolonged physical activity;
3) in case of insulin overdose.
Symptoms and signs of hypoglycemia:
Reaction: consciousness is confused, loss of consciousness is possible.
The airways are clean and free. Breathing is rapid, shallow. Blood circulation - rare pulse.
Other signs are weakness, drowsiness, dizziness. Feelings of hunger, fear, pale skin, profuse sweat. Visual and auditory hallucinations, muscle tension, trembling, convulsions.
First aid for hypoglycemia
1. If the victim is conscious, give him a relaxed position (lying or sitting).
2. Give the victim a sugar drink (two tablespoons of sugar per glass of water), a piece of sugar, chocolate or candy, maybe caramel or cookies. Sweetener doesn't help.
3. Ensure rest until the condition is completely normalized.
4. If the victim loses consciousness, transfer him to a safe position, call an ambulance and monitor his condition, and be ready to begin cardiopulmonary resuscitation.
POISONING
Poisoning is intoxication of the body caused by the action of substances entering it from the outside.
Toxic substances can enter the body in various ways. There are different classifications of poisoning. For example, poisoning can be classified according to the conditions under which toxic substances enter the body:
During meals;
Through the respiratory tract;
Through the skin;
When bitten by an animal, insect, snake, etc.;
Through mucous membranes.
Poisoning can be classified according to the type of poisoning:
Food poisoning;
Drug poisoning;
Alcohol poisoning;
Chemical poisoning;
Gas poisoning;
Poisoning caused by insect, snake, and animal bites.
The task of first aid is to prevent further exposure to poison, to accelerate its elimination from the body, to neutralize the remains of poison and to support the activity of affected organs and systems of the body.
To solve this problem you need:
1. Take care of yourself so as not to get poisoned, otherwise you will need help yourself, and the victim will have no one to help.
2. Check the victim's reaction, airway, breathing and blood circulation, and take appropriate measures if necessary.
5. Call an ambulance.
4. If possible, determine the type of poison. If the victim is conscious, ask him about what happened. If unconscious, try to find witnesses to the incident, or packaging of toxic substances or some other signs.
The most important thing before the doctors arrive is to stop the influence of factors that worsen the well-being of the injured person. This step involves eliminating life-threatening processes, for example: stopping bleeding, overcoming asphyxia.
Determine the actual status of the patient and the nature of the disease. The following aspects will help with this:
- what are the blood pressure values?
- are bleeding wounds visible?
- the patient has a reaction of the pupils to light;
- has your heart rate changed?
- respiratory functions are preserved or not;
- how adequately a person perceives what is happening;
- whether the victim is conscious or not;
- if necessary, ensuring respiratory functions by accessing fresh air and ensuring that there are no foreign objects in the air ducts;
- carrying out non-invasive ventilation (artificial respiration using the “mouth to mouth” method);
- performing indirect (closed) in the absence of a pulse.
Quite often, the preservation of health and human life depends on the timely provision of high-quality first aid. In case of emergency, all victims, regardless of the type of illness, require competent emergency actions before the arrival of the medical team.
First aid for emergency conditions cannot always be offered by qualified doctors or paramedics. Every modern person must have the skills of pre-medical measures and know the symptoms of common diseases: the result depends on the quality and timeliness of measures, the level of knowledge, and the skills of witnesses to critical situations.
ABC Algorithm
Emergency pre-medical actions involve the implementation of a set of simple therapeutic and preventive measures directly at the scene of the tragedy or near it. First aid for emergency conditions, regardless of the nature of the illness or received, has a similar algorithm. The essence of the measures depends on the nature of the symptoms exhibited by the injured person (for example: loss of consciousness) and on the expected causes of the emergency (for example: a hypertensive crisis in arterial hypertension). Rehabilitation measures within the framework of first aid in emergency conditions are carried out according to uniform principles - the ABC algorithm: these are the first English letters denoting:
- Air (air);
- Breathing (breathing);
- Circulation (blood circulation).
ALGORITHMS FOR PROVIDING FIRST MEDICAL AID IN EMERGENCY CONDITIONS
FAINTING
Fainting is an attack of short-term loss of consciousness caused by transient cerebral ischemia associated with weakening of cardiac activity and acute dysregulation of vascular tone. Depending on the severity of factors contributing to cerebrovascular accident.
There are: cerebral, cardiac, reflex and hysterical types of fainting states.
Stages of development of fainting.
1. Precursors (pre-fainting state). Clinical manifestations: discomfort, dizziness, tinnitus, lack of air, cold sweat, numbness of the fingertips. Lasts from 5 seconds to 2 minutes.
2. Impaired consciousness (fainting itself). Clinic: loss of consciousness lasting from 5 seconds to 1 minute, accompanied by pallor, decreased muscle tone, dilated pupils, and weak reaction to light. Shallow breathing, bradypnea. The pulse is labile, most often bradycardia up to 40 - 50 per minute, systolic blood pressure decreases to 50 - 60 mm. rt. Art. With deep fainting, convulsions are possible.
3. Post-syncope (recovery) period. Clinic: correctly oriented in space and time, pallor, rapid breathing, labile pulse and low blood pressure may persist.
2. Unfasten the collar.
3. Provide access to fresh air.
4. Wipe your face with a damp cloth or sprinkle with cold water.
5. Inhalation of ammonia vapor (reflex stimulation of the respiratory and vasomotor centers).
If the above measures are ineffective:
6. Caffeine 2.0 IV or IM.
7. Cordiamine 2.0 i/m.
8. Atropine (for bradycardia) 0.1% - 0.5 s.c.
9. When recovering from a fainting state, continue dental procedures with measures taken 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 (decreased vascular tone), manifested by a decrease in blood pressure, dilation of venous vessels, a decrease in the volume of circulating blood and its accumulation in blood depots - capillaries of the liver, spleen.
Clinical picture: a sharp deterioration in general condition, severe pallor of the skin, dizziness, chills, cold sweat, a sharp decrease in blood pressure, rapid and weak pulse, frequent, shallow breathing. Peripheral veins become empty, their walls collapse, which makes venipuncture difficult. Patients remain conscious (if they faint, 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 treatment measures
1. Place the patient in a horizontal position.
2. Provide a flow of fresh air.
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. Korglyukol 0.06% - 1.0 IV slowly in 0.89% sodium chloride solution.
7. Polyglucin 400.0 IV drip, 5% glucose solution IV drip 500.0.
HYPERTENSIVE CRISIS
Hypertensive crisis is a sudden rapid increase in blood pressure, accompanied by clinical symptoms from target organs (usually the brain, retina, heart, kidneys, gastrointestinal tract, etc.).
Clinical picture. Severe headaches, dizziness, tinnitus, often accompanied by nausea and vomiting. Visual impairment (mesh or fog before the eyes). The patient is excited. In this case, there is trembling of the hands, sweating, and sharp redness of the skin of the face. The pulse is tense, blood pressure is increased by 60-80 mmHg. compared to usual. During a crisis, angina attacks and acute cerebrovascular accident may occur.
Algorithm of treatment measures
1. Intravenously in one syringe: dibazol 1% - 4.0 ml with papaverine 1% - 2.0 ml (slow).
2. For severe cases: clonidine 75 mcg sublingually.
3. Intravenous Lasix 1% - 4.0 ml in saline solution.
4. Anaprilin 20 mg (for severe tachycardia) under the tongue.
5. Sedatives – elenium 1-2 tablets orally.
6. Hospitalization.
It is necessary to constantly monitor blood pressure!
ANAPHYLACTIC SHOCK
A typical form of drug-induced anaphylactic shock (DAS).
The patient experiences an acute state of discomfort with vague painful sensations. A fear of death or a state of internal anxiety appears. Nausea, sometimes vomiting, and cough are observed. Patients complain of severe weakness, tingling and itching of the skin of the face, hands, and head; a feeling of a rush of blood to the head, face, a feeling of heaviness behind the sternum or compression of the chest; the appearance of pain in the heart area, difficulty breathing or the inability to exhale, dizziness or headache. Disorder of consciousness occurs in the terminal phase of shock and is accompanied by disturbances in speech contact with the patient. Complaints arise immediately after taking the drug.
Clinical picture of LAS: hyperemia of the skin or pallor and cyanosis, swelling of the eyelids of the face, profuse sweating. Breathing is noisy, tachypnea. Most patients develop motor restlessness. Mydriasis is noted, the reaction of the pupils to light is weakened. The pulse is frequent, sharply weakened in the peripheral arteries. Blood pressure decreases quickly; in severe cases, diastolic pressure is not determined. Shortness of breath and difficulty breathing appear. 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 administration), fulminant (1-2 minutes), severe (after 5-7 minutes), moderate severity (up to 30 minutes) forms of shock are distinguished. The shorter the time from drug administration to the onset of clinical symptoms, the more severe the shock, and the less chance of a successful treatment outcome.
Algorithm of treatment measures
Urgently provide access to the vein.
1. Stop administering the drug that caused anaphylactic shock. Call an ambulance for yourself.
2. Lay the patient down, raise the lower limbs. If the patient is unconscious, turn the head to the side and extend the lower jaw. Inhalation of humidified oxygen. Ventilation of the lungs.
3. Inject intravenously 0.5 ml of a 0.1% solution of adrenaline in 5 ml of isotonic sodium chloride solution. If venipuncture is difficult, adrenaline is injected into the root of the tongue, possibly intratracheally (a 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 IV.
6. Cardiac glycosides according to indications.
7. For airway obstruction - oxygen therapy, 2.4% aminophylline solution 10 ml IV in saline solution.
8. If necessary, endotracheal intubation.
9. Hospitalization of the patient. Allergy identification.
TOXIC REACTIONS TO ANESTHETICS
Clinical picture. Anxiety, tachycardia, dizziness and weakness. Cyanosis, muscle tremors, chills, convulsions. Nausea, sometimes vomiting. Respiratory disorder, decreased blood pressure, collapse.
Algorithm of treatment measures
1. Place the patient in a horizontal position.
2. Fresh air. Allow the ammonia vapor to inhale.
3. Caffeine 2 ml s.c.
4. Cordiamine 2 ml s.c.
5. In case of respiratory depression - oxygen, artificial respiration (according to indications).
6. Adrenaline 0.1% - 1.0 ml in saline solution intravenously.
7. Prednisolone 60-90 mg IV.
8. Tavegil, suprastin, diphenhydramine.
9. Cardiac glycosides (according to indications).
ATTACK OF ANGINA
An attack of angina pectoris is a paroxysm of pain or other unpleasant sensations (heaviness, compression, pressure, burning) in the heart area lasting from 2-5 to 30 minutes with characteristic irradiation (to the left shoulder, neck, left shoulder blade, lower jaw), caused by excess myocardial consumption in oxygen above its supply.
An angina attack is provoked by an increase in blood pressure and psycho-emotional stress, which always occurs before and during treatment by a dentist.
Algorithm of treatment measures
1. Termination of dental intervention, rest, access to fresh air, free breathing.
2. Nitroglycerin in tablets or capsules (bite the capsule) 0.5 mg under the tongue every 5-10 minutes (total 3 mg under blood pressure control).
3. If the attack is stopped, recommendations for outpatient monitoring by a cardiologist. Resumption of dental benefits - upon stabilization of the condition.
4. If the attack is not stopped: baralgin 5-10 ml or analgin 50% - 2 ml IV or IM.
5. If there is no effect, call an ambulance and hospitalization.
ACUTE MYOCARDIAL INFARCTION.
Acute myocardial infarction is 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 often localized in the region of the heart behind the sternum, less often affecting the entire anterior surface of the chest. Irradiates to the left arm, shoulder, scapula, interscapular space. The pain usually has a wave-like character: it increases and decreases, it lasts from several hours to several days. Objectively, pale skin, cyanosis of the lips, increased sweating, and decreased blood pressure are noted. In most patients, the heart rhythm is disturbed (tachycardia, extrasystole, atrial fibrillation).
Algorithm of treatment measures
1. Urgent cessation of intervention, rest, access to fresh air.
2. Call the cardiology ambulance team.
3. With systolic blood pressure; 100 mmHg. sublingually 0.5 mg of nitroglycerin tablets every 10 minutes (total dose 3 mg).
4. Mandatory pain relief: baralgin 5 ml or analgin 50% - 2 ml IV or IM.
5. Oxygen inhalation through a mask.
6. Papaverine 2% – 2.0 ml IM.
7. Eufillin 2.4% – 10 ml per saline. i.v. solution
8. Relanium or Seduxen 0.5% - 2 ml
9. Hospitalization.
CLINICAL DEATH
Clinic. Loss of consciousness. Absence of pulse and heart sounds. Stopping breathing. Pale and cyanotic skin and mucous membranes, absence of bleeding from the surgical wound (tooth socket). Pupil dilation. Respiratory arrest usually precedes cardiac arrest (in the absence of breathing, the pulse in the carotid arteries is preserved and the pupils are not dilated), which is taken into account during resuscitation.
Algorithm of treatment measures
RESUSCITATION:
1. Lay on the floor or couch, throw back your head, push out your jaw.
2. Clear the airways.
3. Insert an air duct, perform artificial ventilation and external cardiac massage.
during resuscitation by one person in the ratio: 2 breaths per 15 sternal compressions;;
during resuscitation by two people in the ratio: 1 breath per 5 compressions of the sternum.;
Keep in mind that the frequency of artificial respiration is 12-18 per minute, and the frequency of artificial circulation is 80-100 per minute. Artificial ventilation and external cardiac massage are carried out before the arrival of the “resuscitation”.
During resuscitation, all drugs are administered only intravenously, intracardiacly (adrenaline is preferable - intertracheal). After 5-10 minutes, the injections are repeated.
1. Adrenaline 0.1% – 0.5 ml in a dilution of 5 ml. physical solution or glucose intracardially (preferably intertracheally).
2. Lidocaine 2% – 5 ml (1 mg per kg of weight) IV, intracardiac.
3. Prednisolone 120-150 mg (2-4 mg per kg of weight) IV, intracardially.
4. Sodium bicarbonate 4% – 200 ml i.v.
5. Ascorbic acid 5% – 3-5 ml i.v.
6. Cold 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 electrocardiographic data. When diagnosing fibrillation, a defibrillator is used (if one is available), preferably before drug therapy.
In practice, all of the above activities are carried out simultaneously.
Article 11 Federal Law of November 21, 2011 No. 323-FZ“On the basics of protecting the health of citizens in the Russian Federation” (hereinafter referred to as Federal Law No. 323) says that in an emergency, a medical organization and a medical worker provides a citizen immediately and free of charge. Refusal to provide it is not allowed. A similar wording was in the old Fundamentals of Legislation on the Protection of Citizens’ Health in the Russian Federation (approved by the Supreme Court of the Russian Federation on July 22, 1993 N 5487-1, no longer in force on January 1, 2012), although the concept “” appeared in it. What is emergency medical care and what is its difference from the emergency form?
An attempt to isolate emergency medical care from emergency or emergency medical care that is familiar to each of us was previously made by officials of the Ministry of Health and Social Development of Russia (since May 2012 -). Therefore, since approximately 2007, we can talk about the beginning of some separation or differentiation of the concepts of “emergency” and “urgent” assistance at the legislative level.
However, in explanatory dictionaries of the Russian language there are no clear differences between these categories. Urgent - one that cannot be postponed; urgent. Emergency - urgent, extraordinary, urgent. Federal Law No. 323 put an end to this issue by approving three different forms of medical care: emergency, urgent and planned.
Emergency
Medical care provided for sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient’s life.
Urgent
Medical care provided for sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient’s life.
Planned
Medical care that is provided during preventive measures, for diseases and conditions that are not accompanied by a threat to the patient’s life, that do not require emergency and emergency medical care, and the delay of which for a certain time will not entail a deterioration in the patient’s condition, a threat to his life and health.
As you can see, emergency and emergency medical care are opposed to each other. At the moment, absolutely any medical organization is obliged to provide only emergency medical care free of charge and without delay. So are there any significant differences between the two concepts under discussion?
The main difference is that EMF occurs in cases of life threatening person, and emergency - without obvious signs of a threat to life. However, the problem is that the legislation does not clearly define which cases and conditions are considered a threat and which are not. Moreover, it is not clear what is considered a clear threat? Diseases, pathological conditions, and signs indicating a threat to life are not described. The mechanism for determining the threat is not specified. Among other things, the condition may not be life-threatening at a particular moment, but failure to provide assistance will subsequently lead to a life-threatening condition.
In view of this, a completely fair question arises: how to distinguish a situation when emergency assistance is needed, how to draw the line between emergency and emergency assistance. An excellent example of the difference between emergency and emergency care is outlined in the article by Professor A.A. Mokhov “Features of legislative regulation of the provision of emergency and emergency care in Russia”:
| Sign | Medical assistance form | |
|---|---|---|
| Emergency | Urgent | |
| Medical criterion | Threat to life | There is no obvious threat to life |
| Reason for providing assistance | The patient’s request for help (expression of will; contractual regime); treatment of other persons (lack of expression of will; legal regime) | Request by the patient (his legal representatives) for help (contractual regime) |
| Terms of service | Outside a medical organization (pre-hospital stage); in a medical organization (hospital stage) | Outpatient (including at home), as part of a day hospital |
| Person obliged to provide medical care | A doctor or paramedic, any medical professional | Medical specialist (therapist, surgeon, ophthalmologist, etc.) |
| Time interval | Help must be provided as quickly as possible | Assistance must be provided within a reasonable time |
But unfortunately, this is also not enough. In this matter, we definitely cannot do without the participation of our “legislators”. Solving the problem is necessary not only for theory, but also for “practice”. One of the reasons, as mentioned earlier, is the obligation of each medical organization to provide emergency medical care free of charge, while emergency care can be provided on a paid basis.
It is important to note that the “image” of emergency medical care is still “collective”. One of the reasons is territorial programs of state guarantees for the free provision of medical care to citizens (hereinafter referred to as TPGG), which contain (or do not contain) various provisions regarding the procedure and conditions for the provision of EMC, emergency criteria, the procedure for reimbursement of expenses for the provision of EMC, and so on.
For example, the 2018 TPGG of the Sverdlovsk region indicates that a case of emergency medical care must meet the criteria of an emergency: suddenness, acute condition, life-threatening. Some TPGGs mention emergency criteria, referring to Order of the Ministry of Health and Social Development of the Russian Federation dated April 24, 2008 No. 194n “On approval of Medical criteria for determining the severity of harm caused to human health” (hereinafter referred to as Order No. 194n). For example, the 2018 TPGG of the Perm Territory indicates that the criterion for emergency medical care is the presence of life-threatening conditions, defined in:
- clause 6.1 of Order No. 194n (harm to health, dangerous to human life, which by its nature directly poses a threat to life, as well as harm to health that caused the development of a life-threatening condition, namely: head wound; contusion of the cervical spinal cord with disruption of it functions, etc. * );
- clause 6.2 of Order No. 194n (harm to health, dangerous to human life, causing a disorder of the vital functions of the human body, which cannot be compensated by the body on its own and usually ends in death, namely: shock of severe III - IV degree; acute, profuse or massive blood loss, etc.*).
* The full list is defined in Order No. 194n.
According to ministry officials, emergency medical care is provided if the patient’s existing pathological changes are not life-threatening. But from various regulations of the Ministry of Health and Social Development of Russia it follows that there are no significant differences between emergency and emergency medical care.
Some TPGGs indicate that the provision of emergency medical care is carried out in accordance with emergency medical care standards, approved by orders of the Russian Ministry of Health, according to conditions, syndromes, diseases. And, for example, the TPGG 2018 of the Sverdlovsk region means that emergency care is provided in outpatient, inpatient and day hospital settings in the following cases:
- when an emergency condition occurs in a patient on the territory of a medical organization (when the patient seeks medical care in a planned form, for diagnostic tests, consultations);
- when the patient self-refers or is delivered to a medical organization (as the closest one) by relatives or other persons in the event of an emergency;
- if an emergency condition occurs in a patient during treatment in a medical organization, during planned manipulations, operations, or studies.
Among other things, it is important to note that if a citizen’s health condition requires emergency medical care, the citizen’s examination and treatment measures are carried out at the place of his appeal immediately by the medical worker to whom he turned.
Unfortunately, Federal Law No. 323 contains only the analyzed concepts themselves without the criteria that “separate” these concepts. As a result, a number of problems arise, the main one of which is the difficulty of determining in practice the presence of a threat to life. As a result, there is an urgent need for a clear description of diseases and pathological conditions, signs indicating a threat to the patient’s life, with the exception of the most obvious (for example, penetrating wounds of the chest, abdominal cavity). It is unclear what the mechanism for identifying a threat should be.
Order of the Ministry of Health of Russia dated June 20, 2013 No. 388n “On approval of the Procedure for providing emergency, including specialized emergency medical care” allows us to identify some conditions that indicate a threat to life. The order states that the reason for calling an ambulance in emergency form are sudden acute diseases, conditions, exacerbations of chronic diseases that pose a threat to the patient’s life, including:
- disturbances of consciousness;
- breathing problems;
- disorders of the circulatory system;
- mental disorders accompanied by the patient’s actions that pose an immediate danger to him or others;
- pain syndrome;
- injuries of any etiology, poisoning, wounds (accompanied by life-threatening bleeding or damage to internal organs);
- thermal and chemical burns;
- bleeding of any etiology;
- childbirth, threat of miscarriage.
As you can see, this is only an approximate list, but we believe that it can be used by analogy when providing other medical care (not emergency).
However, from the analyzed acts it follows that often the conclusion about the presence of a threat to life is made either by the victim himself or by the ambulance dispatcher, based on the subjective opinion and assessment of what is happening by the person who sought help. In such a situation, both an overestimation of the danger to life and a clear underestimation of the severity of the patient’s condition are possible.
I would like to hope that the most important details will soon be more fully spelled out in the acts. At the moment, medical organizations probably still should not ignore the medical understanding of the urgency of the situation, the presence of a threat to the patient’s life and the urgency of action. In a medical organization, it is mandatory (or rather, highly recommendatory) to develop local instructions for emergency medical care on the territory of the organization, which all medical workers must be familiar with.
Article 20 of Law No. 323-FZ states that a necessary precondition for medical intervention is the giving of informed voluntary consent (hereinafter referred to as IDS) by a citizen or his legal representative for medical intervention on the basis of complete information provided by a medical worker in an accessible form about the goals and methods of providing medical care. , the associated risk, possible options for medical intervention, its consequences, as well as the expected results of medical care.
However, the situation in providing medical care in emergency form(which is also considered a medical intervention) falls within the exception. Namely, medical intervention is allowed without the consent of a person for emergency reasons to eliminate a threat to a person’s life, if the condition does not allow one to express one’s will, or if there are no legal representatives (clause 1 of part 9 of article 20 of Federal Law No. 323). The basis for disclosing medical confidentiality without the patient’s consent is similar (clause 1 of part 4 of article 13 of Federal Law No. 323).
In accordance with clause 10 of Article 83 of Federal Law No. 323, expenses associated with the provision of free emergency medical care to citizens by a medical organization, including a medical organization of the private healthcare system, are subject to reimbursement. Read about reimbursement of expenses for the provision of emergency medicine in our article: Reimbursement of expenses for the provision of free emergency medical care.
After entry into force Order of the Ministry of Health of Russia dated March 11, 2013 No. 121n“On approval of the Requirements for the organization and performance of work (services) in the provision of primary health care, specialized (including high-tech) ...” (hereinafter referred to as Order of the Ministry of Health No. 121n), many citizens have a well-founded misconception that emergency medical care must be included in the medical license. The type of medical service “emergency medical care”, subject to , is also indicated in Decree of the Government of the Russian Federation dated April 16, 2012 No. 291“On licensing of medical activities.”
However, the Ministry of Health of the Russian Federation, in its Letter No. 12-3/10/2-5338 dated July 23, 2013, gave the following explanation on this topic: “As for the work (service) for emergency medical care, this work (service) was introduced for licensing the activities of medical organizations that, in accordance with Part 7 of Article 33 of Federal Law N 323-FZ, have created units in their structure to provide emergency primary health care. In other cases of providing emergency medical care, obtaining a license providing for the performance of emergency medical care work (services) is not required.”
Thus, the type of medical service “emergency medical care” is subject to licensing only by those medical organizations in whose structure, in accordance with Article 33 of Federal Law No. 323, medical care units are created that provide the specified assistance in an emergency form.
The article uses materials from the article by A.A. Mokhov. Features of providing emergency and emergency care in Russia // Legal issues in healthcare. 2011. No. 9.
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Introduction
Anaphylactic shock
Arterial hypotension
Angina pectoris
Myocardial infarction
Bronchial asthma
Comatose states
Hepatic coma. Vomiting "Coffee Grounds"
Convulsions
Poisoning
Electric shock
Renal colic
List of sources used
Urgent state (from Latin urgens, emergency) is a condition that poses a threat to the life of the patient/injured and requires urgent (within minutes-hours, not days) medical and evacuation measures.
Primary requirements
1. Preparedness to provide emergency medical care in the proper amount.
Availability of equipment, tools and medicines. Medical personnel must master the necessary manipulations, be able to work with equipment, know the doses, indications and contraindications for the use of basic medicines. You need to become familiar with the operation of the equipment and read reference books in advance, and not in an emergency situation.
2. Simultaneity of diagnostic and therapeutic measures.
For example, a patient with a coma of unknown origin is sequentially injected intravenously with therapeutic and diagnostic purposes: thiamine, glucose and naloxone.
Glucose - initial dose 80 ml of 40% solution. If the cause of the comatose state is hypoglycemic coma, the patient will regain consciousness. In all other cases, glucose will be absorbed as an energy product.
Thiamine - 100 mg (2 ml of 5% thiamine chloride solution) for the prevention of acute Wernicke encephalopathy (a potentially fatal complication of alcoholic coma).
Naloxone - 0.01 mg/kg in case of opiate poisoning.
3. Focus primarily on the clinical situation
In most cases, lack of time and insufficient information about the patient do not allow us to formulate a nosological diagnosis and treatment is essentially symptomatic and/or syndromic. It is important to keep pre-developed algorithms in your head and be able to pay attention to the most important details necessary for making a diagnosis and providing emergency care.
4. Remember your own safety
The patient may be infected (HIV, hepatitis, tuberculosis, etc.). The place where emergency care is provided is dangerous (poisonous substances, radiation, criminal conflicts, etc.). Incorrect behavior or errors in providing emergency care may be grounds for prosecution.
What are the main causes of anaphylactic shock?
This is a life-threatening acute manifestation of an allergic reaction. It often develops in response to parenteral administration of drugs, such as penicillin, sulfonamides, serums, vaccines, protein preparations, radiocontrast agents, etc., and also appears during provocative tests with pollen and, less commonly, food allergens. Anaphylactic shock may occur from insect bites.
The clinical picture of anaphylactic shock is characterized by rapid development - a few seconds or minutes after contact with the allergen. There is depression of consciousness, a drop in blood pressure, convulsions, and involuntary urination. The fulminant course of anaphylactic shock ends in death. For most, the disease begins with the appearance of a feeling of heat, skin hyperemia, fear of death, excitement or, conversely, depression, headache, chest pain, suffocation. Sometimes swelling of the larynx develops like Quincke's edema with stridorous breathing, skin itching, rashes, rhinorrhea, and dry hacking cough appear. Blood pressure drops sharply, the pulse becomes threadlike, and hemorrhagic syndrome with petechial rashes may be expressed.
How to provide emergency care to a patient?
The administration of medications or other allergens should be stopped and a tourniquet should be applied proximal to the allergen injection site. Help must be provided on the spot; for this purpose, it is necessary to lay the patient down and fix the tongue to prevent asphyxia. Inject 0.5 ml of 0.1% adrenaline solution subcutaneously at the site of allergen injection (or at the site of the bite) and 1 ml of 0.1% adrenaline solution intravenously. If blood pressure remains low, the injection of adrenaline solution should be repeated after 10-15 minutes. Corticosteroids are of great importance for removing patients from anaphylactic shock. Prednisolone should be administered into a vein at a dose of 75-150 mg or more; dexamethasone - 4-20 mg; hydrocortisone - 150-300 mg; If it is not possible to inject corticosteroids into a vein, they can be administered intramuscularly. Administer antihistamines: pipolfen - 2-4 ml of a 2.5% solution subcutaneously, suprastin - 2-4 ml of a 2% solution or diphenhydramine - 5 ml of a 1% solution. For asphyxia and suffocation, administer 10-20 ml of a 2.4% solution of aminophylline intravenously, alupent - 1-2 ml of a 0.05% solution, and isadrin - 2 ml of a 0.5% solution subcutaneously. If signs of heart failure appear, administer corglicon - 1 ml of 0.06% solution in isotonic sodium chloride solution, lasix (furosemide) 40-60 mg intravenously in a rapid stream in isotonic sodium chloride solution. If an allergic reaction has developed to the administration of penicillin, administer 1,000,000 units of penicillinase in 2 ml of isotonic sodium chloride solution. The administration of sodium bicarbonate (200 ml of 4% solution) and anti-shock fluids is indicated. If necessary, resuscitation measures are carried out, including closed cardiac massage, artificial respiration, and bronchial intubation. For laryngeal edema, tracheostomy is indicated.
What are the clinical manifestations of arterial hypotension?
With arterial hypotension, there is a dull, pressing headache, sometimes paroxysmal throbbing pain, accompanied by nausea and vomiting. During a headache attack, patients are pale, the pulse is weak, and blood pressure drops to 90/60 mmHg. Art. and below.
2 ml of a 20% caffeine solution or 1 ml of a 5% ephedrine solution are administered. No hospitalization required.
What is characteristic of heart pain caused by angina pectoris?
The most important point in the treatment of angina pectoris is the relief of painful attacks. A painful attack during angina pectoris is characterized by compressive pain behind the sternum, which can occur either after exercise (angina pectoris) or at rest (angina pectoris at rest). The pain lasts for several minutes and is relieved by taking nitroglycerin.
To relieve an attack, the use of nitroglycerin is indicated (2-3 drops of a 1% alcohol solution or in tablets of 0.0005 g). The drug must be absorbed into the oral mucosa, so it should be placed under the tongue. Nitroglycerin causes vasodilation of the upper half of the body and coronary vessels. If nitroglycerin is effective, the pain goes away within 2-3 minutes. If the pain does not disappear a few minutes after taking the drug, you can take it again.
For severe, prolonged pain, 1 ml of a 1% morphine solution with 20 ml of a 40% glucose solution can be administered intravenously. The infusion is done slowly. Considering that a severe prolonged attack of angina pectoris can be the onset of myocardial infarction, in cases where intravenous administration of narcotic analgesics is required, 5000-10000 units of heparin should be administered intravenously along with morphine (in the same syringe) to prevent thrombosis.
An analgesic effect is achieved by intramuscular injection of 2 ml of a 50% analgin solution. Sometimes its use makes it possible to reduce the dose of administered narcotic analgesics, since analgin enhances their effect. Sometimes a good analgesic effect is obtained by applying mustard plasters to the heart area. In this case, skin irritation causes a reflex expansion of the coronary arteries and improves blood supply to the myocardium.
What are the main causes of myocardial infarction?
Myocardial infarction is necrosis of a section of the heart muscle that develops as a result of a disruption in its blood supply. The immediate cause of myocardial infarction is the closure of the lumen of the coronary arteries or narrowing by an atherosclerotic plaque or thrombus.
The main symptom of a heart attack is severe compressive pain behind the sternum on the left. The pain radiates to the left shoulder blade, arm, and shoulder. Repeated repeated administration of nitroglycerin during a heart attack does not relieve pain; it can last for hours, and sometimes for days.
Emergency care in the acute stage of a heart attack includes, first of all, relieving the pain attack. If preliminary repeated administration of nitroglycerin (0.0005 g per tablet or 2-3 drops of 1% alcohol solution) does not relieve the pain, it is necessary to administer promedol (1 ml of 2% solution), pantopon (1 ml of 2% solution) or morphine (1 cl 1% solution) subcutaneously along with 0.5 ml of 0.1% atropine solution and 2 ml of cordiamine. If subcutaneous administration of narcotic analgesics does not have an analgesic effect, you should resort to intravenous infusion of 1 ml of morphine with 20 ml of 40% glucose solution. Sometimes anginal pain can be relieved only with the help of anesthesia with nitrous oxide mixed with oxygen in a ratio of 4:1, and after the pain stops - 1:1. In recent years, to relieve pain and prevent shock, fentanyl 2 ml of a 0.005% solution has been used intravenously with 20 ml of saline. Together with fentanyl, 2 ml of a 0.25% solution of droperidol is usually administered; This combination enhances the pain-relieving effect of fentanyl and makes it last longer. The use of fentanyl soon after administration of morphine is undesirable due to the risk of respiratory arrest.
The complex of emergency measures in the acute stage of myocardial infarction includes the use of drugs against acute vascular and heart failure and direct-acting anticoagulants. With a slight decrease in blood pressure, sometimes cordiamine, caffeine, and camphor administered subcutaneously are sufficient. A significant drop in blood pressure (below 90/60 mm Hg), the threat of collapse requires the use of more powerful agents - 1 ml of a 1% mesatone solution or 0.5-1 ml of a 0.2% norepinephrine solution subcutaneously. If collapse persists, these drugs should be re-administered every 1-2 hours. In these cases, intramuscular injections of steroid hormones (30 mg of prednisolone or 50 mg of hydrocortisone), which help normalize vascular tone and blood pressure, are also indicated.
What are the general characteristics of an asthma attack?
The main manifestation of bronchial asthma is an attack of suffocation with dry wheezing audible from a distance. Often an attack of atonic bronchial asthma is preceded by a prodromal period in the form of rhinitis, itching in the nasopharynx, dry cough, and a feeling of pressure in the chest. An attack of atonic bronchial asthma usually occurs upon contact with an allergen and quickly ends when such contact is stopped.
If there is no effect, administer glucocorticoids intravenously: 125-250 mg of hydrocortisone or 60-90 mg of prednisolone.
What are the manifestations and causes of collapse?
Collapse is an acute vascular failure, which is manifested by a sharp decrease in blood pressure and peripheral circulation disorder. The most common cause of collapse is massive blood loss, trauma, myocardial infarction, poisoning, acute infections, etc. Collapse can be the direct cause of death of the patient.
The patient's appearance is characteristic: pointed facial features, sunken eyes, pale gray skin color, small beads of sweat, cold bluish extremities. The patient lies motionless, lethargic, lethargic, and less often restless; breathing is rapid, shallow, pulse is frequent, small, soft. Blood pressure drops: the degree of its decrease characterizes the severity of the collapse.
The severity of symptoms depends on the nature of the underlying disease. Thus, during acute blood loss, the pallor of the skin and visible mucous membranes is striking; with myocardial infarction, one can often notice bluishness of the facial skin, acrocyanosis, etc.
In case of collapse, the patient must be placed in a horizontal position (pillows removed from under the head) and heating pads placed on the limbs. Call a doctor immediately. Before his arrival, the patient must be given cardiovascular drugs (cordiamin, caffeine) subcutaneously. As prescribed by the doctor, a set of measures is carried out depending on the cause of the collapse: hemostatic therapy and blood transfusion for blood loss, administration of cardiac glycosides and painkillers for myocardial infarction, etc.
What is a coma?
Coma is an unconscious state with profound impairment of reflexes and lack of response to stimulation.
The general and main symptom of a coma of any origin is a deep loss of consciousness caused by damage to vital parts of the brain.
Coma can occur suddenly in the midst of relative well-being. Acute development is typical for cerebral coma during stroke, hypoglycemic coma. However, in many cases, a comatose state, complicating the course of the disease, develops gradually (with diabetic, uremic, hepatic coma and many other comatose states). In these cases, coma, a deep loss of consciousness, is preceded by a precoma stage. Against the background of an increasing exacerbation of the symptoms of the underlying disease, signs of damage to the central nervous system appear in the form of stupor, lethargy, indifference, confusion with periodic clearings. However, during this period, patients retain the ability to respond to strong irritations, belatedly, in monosyllables, but still answer a loudly asked question; they retain pupillary, corneal and swallowing reflexes. Knowledge of the symptoms of a precomatous state is especially important, since often timely provision of assistance during this period of illness prevents the development of coma and saves the life of the patient.
Hepatic coma. Vomiting "Coffee Grounds"
When examining the skin, it should be taken into account that with uremia, thrombosis of cerebral vessels, and anemia, the skin is pale. In alcoholic coma or cerebral hemorrhage, the face is usually hyperemic. Pink coloration of the skin is characteristic of coma due to carbon monoxide poisoning. Yellowness of the skin is usually observed in hepatic coma. Determining the moisture content of the skin of a patient in a coma is important. Moist, sweaty skin is characteristic of a hypoglycemic coma. In a diabetic coma, the skin is always dry. Traces of old scratching on the skin can be noted in patients with diabetic, hepatic and uremic coma. Fresh boils, as well as skin scars from old boils found in comatose patients, suggest diabetes mellitus.
The study of skin turgor is of particular importance. In some diseases accompanied by dehydration of the body and leading to the development of coma, there is a significant decrease in skin turgor. This symptom is especially pronounced in diabetic coma. A similar decrease in the turgor of the eyeballs in diabetic coma makes them soft, which is easily determined by palpation.
Treatment of coma depends on the nature of the underlying disease. In a diabetic coma, the patient is administered insulin subcutaneously and intravenously, sodium bicarbonate, and saline as prescribed by the doctor.
Hypoglycemic coma is preceded by a feeling of hunger, weakness and trembling throughout the body. Before the doctor arrives, the patient is given sugar or sweet tea. 20-40 ml of 40% glucose solution is injected into a vein.
In uremic coma, therapeutic measures are aimed at reducing intoxication. For this purpose, the stomach is washed, a cleansing enema is given, an isotonic sodium chloride solution and a 5% glucose solution are injected dripwise.
In case of hepatic coma, glucose solutions, steroid hormones, and vitamins are administered dropwise as prescribed by the doctor.
What is the pathogenesis and main causes of fainting?
Fainting is a sudden short-term loss of consciousness with weakening of the cardiac and respiratory systems. Fainting is a mild form of acute cerebrovascular insufficiency and is caused by anemia of the brain; occurs more often in women. Fainting can occur as a result of mental trauma, the sight of blood, painful stimulation, prolonged stay in a stuffy room, intoxication and infectious diseases.
The severity of fainting may vary. Typically, fainting is characterized by the sudden onset of mild fogging of consciousness in combination with non-systemic dizziness, ringing in the ears, nausea, yawning, and increased intestinal motility. Objectively, a sharp pallor of the skin, coldness of the hands and feet, beads of sweat on the face, and dilated pupils are noted. The pulse is weak, blood pressure is reduced. The attack lasts several seconds.
In a more severe case of fainting, complete loss of consciousness occurs with loss of muscle tone, and the patient slowly subsides. At the height of fainting, there are no deep reflexes, the pulse is barely palpable, blood pressure is low, breathing is shallow. The attack lasts several tens of seconds, and is then followed by a rapid and complete restoration of consciousness without amnesia.
Convulsive syncope is characterized by the addition of convulsions to the picture of syncope. In rare cases, drooling, involuntary urination and defecation are observed. The unconscious state sometimes lasts several minutes.
After fainting, general weakness, nausea, and an unpleasant feeling in the stomach persist.
The patient should be laid on his back with his head slightly lowered, the collar should be unbuttoned, fresh air should be provided, a cotton swab moistened with ammonia should be brought to the nose, and the face should be sprayed with cold water. For a more persistent fainting condition, 1 ml of a 10% solution of caffeine or 2 ml of cordiamine should be injected subcutaneously; ephedrine can be used - 1 ml of a 5% solution, mesaton - 1 ml of a 1% solution, norepinephrine - 1 ml of a 0.2% solution.
The patient should be examined by a doctor.
What are the hallmarks of a seizure in epilepsy?
One of the most common and dangerous types of convulsive conditions is a generalized convulsive seizure, which is observed in epilepsy. In most cases, patients with epilepsy, a few minutes before its onset, note the so-called aura (harbinger), which is manifested by increased irritability, palpitations, a feeling of heat, dizziness, chills, a feeling of fear, the perception of unpleasant odors, sounds, etc. Then the patient suddenly loses consciousness falls. At the beginning of the first phase (in the first seconds) of the seizure, he often emits a loud cry.
When providing first aid to a patient, first of all, it is necessary to prevent possible bruises of the head, arms, legs during a fall and convulsions, for which a pillow is placed under the patient’s head, arms and legs are held. To prevent asphyxia, it is necessary to unfasten the collar. A hard object, such as a spoon wrapped in a napkin, must be inserted between the patient’s teeth to prevent tongue bite. To avoid inhaling saliva, the patient's head should be turned to the side.
A dangerous complication of epilepsy that threatens the patient’s life is status epilepticus, in which convulsive seizures follow one after another, so that consciousness does not clear. Status epilepticus is an indication for urgent hospitalization of the patient in the neurological department of the hospital.
For status epilepticus, emergency care consists of prescribing an enema with chloral hydrate (2.0 g per 50 ml of water), intravenous administration of 10 ml of a 25% solution of magnesium sulfate and 10 ml of a 40% glucose solution, intramuscular administration of 2-3 ml of a 2.5% solution aminazine, intravenous infusion of 20 mg of diazepam (seduxen), dissolved in 10 ml of 40% glucose solution. For ongoing seizures, 5-10 ml of a 10% hexenal solution is administered slowly intravenously. A spinal puncture is performed to remove 10-15 ml of solution.
A seizure in hysteria is significantly different from an epileptic seizure. It develops most often after any experiences associated with grief, resentment, fear, and, as a rule, in the presence of relatives or strangers. The patient may fall, but usually does not cause serious injury to himself, consciousness is preserved, there is no tongue biting or involuntary urination. The eyelids are tightly compressed, the eyeballs are turned upward. The reaction of the pupils to light is preserved. The patient responds correctly to painful stimuli. Convulsions are in the nature of purposeful movements (for example, the patient raises his arms, as if protecting his head from blows). Movements can be chaotic. The patient waves his arms and grimaces. The duration of a hysterical attack is 15-20 minutes, less often - several hours. The seizure ends quickly. The patient returns to his normal state and feels relief. There is no state of stupor or drowsiness. Unlike an epileptic seizure, a hysterical seizure never develops during sleep.
When providing assistance to a patient with a hysterical attack, it is necessary to remove all those present from the room where the patient is located. Talking to the patient calmly, but in an imperative tone, they convince him of the absence of a dangerous disease and instill in him the idea of a speedy recovery. To relieve a hysterical attack, sedatives are widely used: sodium bromide, valerian tincture, motherwort herb decoction.
What are the general characteristics of poisonings?
Poisoning is a pathological condition caused by the effects of poisons on the body. The causes of poisoning can be poor-quality food products and poisonous plants, various chemicals used in everyday life and at work, medications, etc. Poisons have a local and general effect on the body, which depends on the nature of the poison and the route of its entry into the body.
For all acute poisonings, emergency care should pursue the following goals: 1) removing the poison from the body as quickly as possible; 2) neutralization of the poison remaining in the body with the help of antidotes (antidotes); 3) combating breathing and circulatory disorders.
If poison enters the mouth, immediate gastric lavage is necessary, which is carried out where the poisoning occurred (at home, at work); It is advisable to cleanse the intestines, for which they give a laxative and give an enema.
If poison gets on the skin or mucous membranes, the poison must be removed immediately mechanically. For detoxification, as prescribed by a doctor, solutions of glucose, sodium chloride, hemodez, polyglucin, etc. are administered subcutaneously and intravenously. If necessary, so-called forced diuresis is used: 3-5 liters of liquid and fast-acting diuretics are simultaneously administered. To neutralize the poison, specific antidotes are used (unithiol, methylene blue, etc.) depending on the nature of the poisoning. To restore respiratory and circulatory function, oxygen, cardiovascular drugs, respiratory analeptics, and artificial respiration, including mechanical respiration, are used.
What is the pathogenesis of the effect of current on the body and the causes of injury?
Electric shock with voltages above 50 V causes thermal and electrolytic effects. Most often, damage occurs as a result of non-compliance with safety precautions when working with electrical devices, both at home and at work.
First of all, the victim is released from contact with electric current (if this has not been done earlier). Turn off the power source, and if this is not possible, then remove the broken wire with a dry wooden stick. If the person providing assistance is wearing rubber boots and rubber gloves, then you can pull the victim away from the electrical wire. If breathing stops, artificial respiration is performed, cardiac and cardiovascular drugs are administered (0.1% adrenaline solution - 1 ml, cordiamine - 2 ml, 10% caffeine solution - 1 ml subcutaneously), drugs that stimulate breathing (1% lobeline solution - 1 ml intravenously slowly or intramuscularly). Apply a sterile bandage to the electrical burn wound.
The patient is transported on a stretcher to the burn or surgical department.
What are the causes of renal colic?
Renal colic develops when there is a sudden obstruction to the outflow of urine from the renal pelvis. Most often, renal colic develops as a result of the movement of a stone or the passage of a conglomerate of dense crystals through the ureter, as well as due to a violation of the patency of the ureter due to kinking or inflammatory processes.
The attack begins suddenly. Most often it is caused by physical stress, but it can also occur in the midst of complete rest, at night during sleep, often after drinking heavily. The pain is cutting with periods of calm and exacerbation. Patients behave restlessly, rushing about in bed in search of a position that would ease their suffering. An attack of renal colic often becomes protracted and, with short remissions, can last for several days in a row. As a rule, pain begins in the lumbar region and spreads to the hypochondrium and abdomen and, most importantly, along the ureter towards the bladder, scrotum in men, labia in women, and thighs. In many cases, the intensity of pain is greater in the abdomen or at the level of the genital organs than in the kidney area. The pain is usually accompanied by an increased urge to urinate and a cutting pain in the urethra.
Long-term renal colic may be accompanied by an increase in blood pressure, and with pyelonephritis - an increase in temperature.
First aid is usually limited to thermal procedures - a heating pad, a hot bath, which are supplemented by taking antispasmodics and painkillers from a home medicine cabinet (usually available to a patient with frequent attacks of renal colic): Avisan - 0.5-1 g, Cystenal - 10-20 drops, papaverine - 0.04 g, baralgin - 1 tablet. Atropine and narcotic analgesics are administered as prescribed by the doctor.
1. Evdokimov N.M. Providing first pre-medical aid.-M., 2001
2. Small medical encyclopedia vol. 1,2,3 M., 1986
3. First medical aid: reference book M., 2001
