Treatment of emergency conditions in children. Emergency conditions in children emergency conditions
The body of a young child is functionally and anatomically imperfect, which makes it highly vulnerable. In these children, emergency conditions are more common, the outcome of which is largely determined by the timeliness and correctness of first aid and the adequacy of the subsequent tactical decision. Therefore, the staff of paramedic and paramedic-midwife stations must be prepared to provide assistance to a child in an emergency. Emergency condition characterized by the presence of life-threatening symptoms (convulsions, hyperthermia, coma, etc.) and requires urgent treatment. The most typical mistakes when providing assistance to children with an emergency condition, according to our data, are incorrect dosing of medications, the use of irrational combinations, unjustifiably frequent use of analeptic drugs (cordiamin, caffeine,
analeptic mixture, etc.), as well as medicinal mixtures that mask the signs of the underlying disease, which complicates its diagnosis when the child is admitted to the hospital. The unification of emergency care for children is based on the principle “First of all, do no harm” . Hyperthermic syndrome. Diagnostic criteria: persistent increase in temperature above 38.5°C in the absence of effect from taking and administering antipyretic drugs. Progressive deterioration in the child's general condition. Emergency care volume:
place the child in a well-ventilated area and undress;
wipe the child’s skin with 30% alcohol or camphor oil;
Inject intramuscularly or intravenously a lytic mixture of the following composition: 1% amidopyrine solution - 0.6 ml per 1 kg of body weight, 50% analgin solution - 0.02 ml/kg, 0.25% novocaine solution - 0.5 ml/kg; in case of severe agitation and convulsions, administer a 0.25% solution of droperidol intramuscularly at the rate of 0, "2 ml per 1 kg of body weight, but not more than 2 ml.
Hospitalization is required if there is no effect from the measures taken; Children with chronic diseases and those who are often ill are also sent to the hospital, regardless of the effectiveness of the measures taken. Foreign bodies of the respiratory tract. Diagnostic criteria: difficulty breathing, hoarseness up to complete aphonia, obsessive cough, attacks of suffocation associated with changes in body position, auscultation - weakening of breathing up to its complete absence in one of the lungs or part of it. Scope of emergency care: reduce the child’s anxiety by administering a 0.25% solution of droperidol<0,2 мл/кг) или 0,5% раствор седуксена (0,1 мл/кг, но не более 2 мл) внутривенно или внутримышечно; выбрать положение тела, улучшающее состояние ребенка; при цианозе и акроцианозе сделать ингаляцию увлажненного кислорода. Госпитализации подлежат все дети с диагностированным инородным телом дыхательных путей или с подозрением на него. Clinical death. Diagnostic criteria: absence of pulsation of large arteries (carotid, femoral), absence of heart sounds, dilation of the pupils and lack of reaction to light. Scope of emergency care: clean the oral cavity and pharynx mechanically (finger, spatula) using foot or electric suction; start artificial respiration using the mouth-to-mouth or mouth-to-nose method; insert a probe into the stomach, begin chest compressions - rhythmic pressure on the lower third of the sternum with a frequency of 60 times per minute; administer intravenously or sublingually; 0.1% solution of atropine sulfate - 0.05 ml for 1 year of life, 1:1000 adrenaline hydrochloride - 0.05 ml for 1 year of life. The primary resuscitation complex is used until a stable clinical effect is obtained (restoration of breathing and cardiac activity), but not more than 30 minutes. If successful, hospitalization is required. Mechanical asphyxia. Diagnostic criteria: the presence of a strangulation groove on the neck, hemorrhages under the conjunctiva and on the upper half of the body, disturbances of consciousness, often in the form of depression, and sometimes cardiac arrhythmias. Mechanical asphyxia is often encountered in schoolchildren when the chest is compressed by hands (girth from behind), in those covered with earth, in those caught in a “heap of small things,” etc. Scope of emergency care: artificial respiration using the mouth-to-mouth method, through an 8-shaped tube or using the mask of the RPA apparatus. When breathing is maintained - inhalation of humidified oxygen for 20-30 minutes; in case of cardiac arrest (see clinical death) - primary resuscitation complex: insert a tube into the stomach. Mandatory hospitalization to the nearest hospital (regardless of its profile). Burn shock. Diagnostic criteria: presence of signs of thermal damage on the skin (blisters, redness). To determine the area of the lesion, the “rule of the palm” is used, the area of which, regardless of age, is 1% of the body surface. Shock can occur in young children with damage to 3-5% of the body surface of the second degree (bubbles). Scope of emergency care: administer pain relief by administering a 1% solution of promedol or a 50% solution of analgin at the rate of 0.01 ml per 1 kg of body weight intravenously or intramuscularly; administration of neuro-plegs - 0.2 ml/kg droperidol or 0.1 ml/kg 0.5% seduxen solution (but not more than 2 ml) intravenously or intramuscularly. Apply a sterile bandage with furatsilin 1:5000, rivanol 1:1000 or 0.25-0.5-1% novocaine solution to the burn surface. You can use aerosols “Livian”, “Panthenol”, etc. Drink plenty of fluids (hot tea, milk, juices, etc.). Newborns and infants are subject to mandatory hospitalization, regardless of the degree and area of the burn: children over 3 years of age are hospitalized for first-degree burns with an area of 10% or more, as well as when at least 3% of the burn surface of the second degree or deeper is detected. Convulsive syndrome. Diagnostic criteria: convulsive twitching of the muscles of the limbs or facial muscles, generalized spasms in all muscle groups with breathing problems. Possible disturbances of consciousness of varying degrees of severity - excitement, depression, stupor, coma. Volume of emergency care: intravenously administer 0.1 ml per 1 kg of body weight 0.5% solution of seduxen or 0.2 ml/kg droperidol (but not more than 2 ml) or 0.5 ml/kg sodium hydroxybutyrate. If there is no effect, administer a 2% solution of chloral hydrate in a starch enema within 30 minutes at the rate of 1 ml/kg (after cleansing the intestines); in case of severe respiratory failure (cyanosis and acrocyanosis), inhale oxygen for 20-30 minutes. In case of respiratory depression, administer intramuscularly a 24% solution of aminophylline at the rate of 0.1 ml/kg with glucose. Hospitalization in the children's department or children's hospital is mandatory. Traumatic brain injury. Diagnostic criteria: traces of damage to the facial or cerebral parts of the skull, disturbances of consciousness of varying severity, up to coma. Headache, nausea, vomiting. With bruise and compression of the brain, the development of intracranial hematoma, focal symptoms appear: smoothness of the nasolabial fold, deviation of the tongue, decreased tendon reflexes and the appearance of their unevenness, anisocoria, bradycardia. Scope of emergency care: lay the victim down and ensure complete rest, insert a tube into the stomach (prevention of regurgitation and aspiration), in case of breathing problems, remove the lower jaw, insert an air duct; in the absence or impairment of consciousness - position on the right side, aspiration of mucus from the oral cavity and oropharynx with a bulb or suction; when excited, administer 0.2 ml/kg of a 0.25% solution of droperidol or 0.1 ml/kg of a 0.5% solution of seduxen (but not more than 2 ml) intramuscularly. Hospitalization of all children is mandatory and is carried out in the nearest surgical hospital or department. Shock is traumatic or hemorrhagic. Diagnostic criteria: disturbances of consciousness (excitement or depression), pallor of the skin and mucous membranes, acrocyanosis of varying severity, arterial hypotension, tachycardia, the presence of mechanical damage and signs of external or internal bleeding. Scope of emergency care: stop external bleeding by applying a pressure bandage or tourniquet, in the absence of blood pressure or its decrease below 60 mm Hg. Art. urgently establish intravenous administration of polyglucin (up to 20-30 ml/kg). Intramuscularly (if there are signs of bone damage or traces of bruises and in the absence of damage to internal organs and traumatic brain injury) administer: 1% solution of promedol - 0.1 ml per year of life, 1% solution of diphenhydramine 0.1 ml/kg body weight (but not more than 2 ml); immobilize the injured limb using transport splints or other available materials; in the absence of damage to internal organs - warm, plenty of fluids (tea, coffee, juices, milk) and warming (hot water bottles, blankets, etc.). After carrying out the specified complex, transport to the nearest surgical department. Anaphylactic shock. Diagnostic criteria: anxiety, fear, itching of the mucous membranes and skin, cardiac dysfunction, arterial hypotension, and sometimes respiratory problems. A polymorphic allergic rash and Quincke's edema may be observed. Scope of emergency care: administer a solution of adrenaline 1:1000 at the rate of 0.1 ml per 1 year of life (but not more than 0.7 ml at a time) subcutaneously; prednisolosh at the rate of 2 mg/kg intramuscularly (if possible intravenously); in the absence of prednisolone - hydrocortisone (suspension at the rate of 4-7 mg/kg) intramuscularly; insert a probe into the stomach (prevention of regurgitation and aspiration), in the absence of a pulse and a decrease in blood pressure below 60 mm Hg. Art. arrange intravenous administration of polyglucin (up to 20 ml/kg). After stabilization of blood pressure and normalization of cardiac activity, be sure to hospitalize the patient at the nearest hospital. Electrical injury. Diagnostic criteria: marks from the action of electric current are a constant sign. Depending on the direction of passage of the current - loss of consciousness, breathing disturbances up to its stop, disturbances in the rhythm of cardiac activity up to asystole. Scope of emergency care: interrupt contact with the damaging factor (wearing rubber gloves!), lay the victim down, give him complete rest and provide access to fresh air; if breathing stops, perform artificial respiration using the mouth-to-mouth method; if the heart stops, perform indirect cardiac massage (see section “Clinical death”). When excited, administer 0.2 ml/kg of a 0.25% solution of droperidol intramuscularly; for extensive and deep burns, administer promedol (0.1 ml for 1 year of life) intramuscularly; Apply a sterile bandage with furatsilin, rivanol or novocaine to the burn surface. It is acceptable to use aerosols such as “Livian”, “Panthenol”, etc. Hospitalization of the child is mandatory and is carried out after complete restoration of vital functions in the nearest hospital. To provide emergency care to children at a paramedic and paramedic-obstetric station, it is advisable, in our opinion, to have the following equipment: a tonometer with a set of cuffs (by age); metal spatulas; mouth dilator and tongue holder; a set of sterile syringes and needles; a set of gastric tubes of all sizes; electric suction or foot aspirator, bulb; a set of catheters for aspiration from the oral cavity and oropharynx; rubber tourniquet (hemostatic); set for artificial respiration type RPA; transport tires (like Kramer tires); bix with sterile dressing material; blood transfusion systems (single use). Of the medicines and solutions you must have the following: adrenaline 1:1000, ampoules of 1 ml - 5 pieces; atropine sulfate 0.1%, 1 ml ampoules (list A) - 3 pieces; amidopyrine 4%, 5 ml ampoules - 10 pieces; analgin 50%, ampoules 2 ml - 10 pieces; hydrocortisone, suspension, bottles of 125 mg - 2 pieces; Diphenhydramine 1%, 1 ml ampoules - 10 pieces; droperidol 0.25%, 10 ml bottles - 1 piece; isotonic sodium chloride solution 0.9%, ampoules 5 ml - 10 pieces; novocaine 0.5% solution, 5 ml ampoules - 10 pieces; sodium hydroxybutyrate 20% solution, ampoules 10 ml - 5 pieces; prednisolone 30 mg, ampoules - 3 pieces; promedol 1%, ampoules 1 ml (list A) - 3 pieces; seduxen, 0.5% solution, 2 ml ampoules - 5 pieces; polyglucin 400 ml, bottles - 1 piece; furatsilin 1:5000, 200 ml bottles (sterile) - 2 pieces; aerosol "Livian" (Panthenol) - 1 pack.
Chapter 10. Emergency conditions in children
Allergic shock (anaphylactic shock)
Children react to various poorly tolerated factors to a much greater extent than adults. If a child comes into contact with such harmful substances, an allergic reaction occurs. This could be bee or wasp venom, food products (most often cow's milk, chicken protein, fish, nuts), medications or allergens that enter the body through breathing (pollen, animal hair). With high sensitivity to these allergens, both local manifestations are possible, as we have already discussed, as well as general reactions of the body - up to shock with dysfunction of the respiratory and cardiovascular systems. This process is not associated with mental shock that occurs during significant emotional stress.
The clinical picture of shock is usually beyond doubt. The child's skin is pale and cold sweat appears. The pulse is frequent and difficult to detect. Breathing is frequent and shallow. Consciousness is confused, and loss of consciousness is possible in the future. With allergic shock, breathing difficulties (suffocation) associated with swelling of the mucous membrane of the respiratory tract, as well as swelling of the face and skin manifestations, are possible.
At the slightest suspicion of shock Call a doctor immediately!
Experience shows that most parents, who are aware of their children’s predisposition to allergic reactions, have at home, in agreement with the attending physician, the appropriate emergency medications that need to be used.
Until the ambulance arrived
In many cases, an excellent effect can be obtained from homeopathic medicines.
Apis mellifica D200, 1000 take 2 grains of whatever you have on hand; If necessary, you can repeat the reception. The drug is effective for allergic blisters and urticaria (urticaria) of any severity, as well as for swelling of the conjunctiva, eyelids, lips, and mouth.
Acidum carbolicum D200 is given to the child once - 2 grains. This is an adjuvant for anaphylactic shock with dysfunction of the cardiovascular and respiratory systems.
False croup
This is one of the special forms of laryngitis (inflammation of the larynx). The mucous membrane below the level of the vocal cords is inflamed and swollen, which significantly complicates the passage of air when the child breathes. Since in earlier times the name "croup" was associated with diphtheria, this disease, which has similar symptoms, is designated "false croup". The disease is usually associated with a viral infection, so it is most common during the cold season.
Sometimes, often unexpectedly and at night, a dry, barking, rough cough and wheezing when inhaling suddenly appear - signs of suffocation. This is the so-called false croup. This lack of breathing is expressed primarily in anxiety and a feeling of fear and can even lead to loss of consciousness. In children under one year of age, this disease is rare, since maternal immunity apparently plays a major role. Most often, false croup occurs in the second year of life, and boys are more often susceptible to this pathology than girls. As the child grows, the possibility of illness becomes less and less common. If you know that your child is prone to it, carry out preventive treatment in the fall, from the beginning of September. As one old pediatrician noted, foggy autumn provokes cough attacks.
Experience has long been accumulated in treating this process using natural means.
First aid for an acute attack
The most important thing for parents is to remain calm, not to lose their heads and try to calm the child, because the more scared he is, the worse he feels.
At the same time, you need to ensure a sufficient flow of fresh and cool air.
Try increasing the humidity in the room: place a wet towel on the hot radiator, turn on hot water in the bathroom (the steam should not be scalding); for repeated illnesses, it is better to purchase a special humidifier for a battery or device.
It is advisable to make a warm foot or general bath with a water temperature of 37–40 ° C, and you can add mustard to the foot bath (2 tablespoons per bucket of water). Mustard plasters can be placed on the chest, wrapping the child well.
Sometimes warm compresses on the neck and warm drinks help: milk with soda or Borjomi, fruit drinks, etc.
Doctors practicing anthroposophical methods actively use the simplest and most effective remedy. It is necessary to finely chop the onion, mix with a small amount of oil, heat this mass in a frying pan for so long until the onion becomes transparent (but do not fry!). Place everything on a cloth, cool until warm, cover the top with a thin cloth and place it on the larynx, and wrap a woolen scarf on top. Usually the attack goes away within 2-3 minutes. The same compress can be done prophylactically if you know that your child has already had attacks of false croup, you notice that the child has a cold, and you suspect that your baby may have an attack at night. In this case, it is better to make a compress at night.
Homeopathic medicines
In case of an acute attack of cough, give 5 grains every 5 minutes, in turn, the following drugs - Spongia D6, Rumex D6, Sambucus D6, Apis D6.
When improvement occurs, the intervals between taking medications are longer (10–20 minutes). You can place a hot chamomile infusion nearby for evaporation. Experience shows that in most cases such treatment can prevent the prescription of hormones (corticosteroids). In extreme situations, however, you should not give up suppositories with cortisone. If symptoms are dramatic, consult a doctor.
Anthroposophical preparations
Bryonia/Spongia comp. relieves an attack well if you give the remedy 3-5 grains every 10 minutes.
Larings D30 is a larynx organomedicine that allows you to relieve an attack instantly, so if your child is prone to such attacks, we recommend that you always have this drug at the ready during the cold season.
Autumn prevention of false croup
It is advisable to take 3 drugs: Spongia D12, Rumex D12, Aconite D12 - 5 grains of each drug once a day (in the morning - Spongia, in the afternoon - Rumex and in the evening - Aconite), the course is at least a month.
Convulsions
Seizures are a fairly common condition in children. There are many reasons for their occurrence: an increase in body temperature above 39.5 ° C, infectious disease, acute poisoning, brain damage. During cramps, twitching may occur in the muscles and limbs, and in some cases, on the contrary, tension in the limbs develops with their maximum extension. During convulsions, the child seems to freeze with his head thrown back and his arms and legs frantically extended forward. This condition can last from a few seconds to 10 minutes or even longer. In some cases, convulsive twitching is observed only in certain muscle groups and may go unnoticed by parents. During an attack of convulsions, the child, as a rule, loses consciousness, the eyes close, twitching is possible in the eyelids and other facial muscles, and the teeth are clenched tightly. Sometimes foam appears on the lips. Involuntary urination often occurs. During an attack of generalized convulsions that lasts more than 2–3 minutes, the child’s lips may suddenly become bluish as breathing is temporarily interrupted and becomes convulsive.
Parents should know that any sudden loss of consciousness with convulsions that occurs for the first time requires immediate consultation with a doctor.
First aid before the doctor arrives
If your child suddenly begins to have seizures, try not to panic (although the sight of a child with seizures is indeed frightening), your child needs your composure at the moment. Take simple steps to ensure your child is not harmed during an attack.
First of all, without moving the child, turn him on his side so that he does not choke on saliva.
Make sure that there are no hard or sharp objects near his head that could hurt him during an attack.
Once you're sure there's nothing obstructing your baby's breathing, place a hard but not sharp object between your baby's teeth to prevent him from accidentally biting his tongue - this could be anything you have on hand, such as a folded leather glove (but not your finger!) or wallet.
After these activities, you can call your doctor.
After an attack, you need to transfer the child to the bed, free him from disturbing clothes and give him the opportunity to sleep.
After an attack, the child is drowsy, so you should not give him food or drink for 1–1.5 hours, so that due to drowsiness he cannot choke.
If a child has a high temperature, then even before the doctor arrives, you can begin to reduce it as indicated in the section on temperature.
If you stay in a stuffy room for a long time or stand in one place for a long time (during special events, etc.), the child may faint. In rare cases, this can happen with a sudden change in body position, such as getting out of bed quickly. Sometimes fainting can be caused by nervous tension, for example when taking a blood test.
Fainting occurs due to insufficient blood circulation to the brain, as a result of which the child loses consciousness and falls. Before this, he experiences unpleasant sensations, turns pale, the skin becomes covered with cold sweat, tinnitus and nausea occur. Most often, having fallen during a faint, a child quickly comes to his senses, since in a horizontal position the blood flows to the brain more intensely.
First aid
If they manage to support a child who has lost consciousness, he should still be put down. Raise your legs and lower your head to facilitate blood flow to the head. The window in the room must be opened to allow fresh air to enter. It is necessary to free the child from tight clothing, unfasten the buttons on the neck, and loosen the belt or strap. You can splash your face with cold water, rub your temples with a cotton swab soaked in ammonia, and let it smell.
In the hall, in a narrow passage between rows of chairs, they leave the unconscious person in place, in a sitting position, tilt the torso forward so that the head hangs as low as possible (due to compression of the abdomen, the blood flow rushes to the heart and head). The child should be allowed to remain in this position until he feels well again, but for at least 5 minutes.
Homeopathic medicines
Aconite D30 is given once 5 grains in case of fainting from fright.
Ipecac D6 is indicated, 3 grains every 10–15 minutes, if fainting is associated with disgust at the sight of blood.
Ipecac D6 or Carbo vegetabilis D6 is recommended in the above doses in case of significant heat or stuffiness.
Nux vomica D6 has a positive effect after mental fatigue; it is given 3-5 grains every 2 hours.
Sun and heat stroke
This condition is caused by overexposure to the sun's rays on your baby's uncovered head and neck. Prolonged stay without protection at high temperatures or in the sun, especially during physical exertion, leads to overheating of the head and brain and ends in sunstroke.
You should always think about making sure your child drinks plenty of juice (juices, water, or a mixture of both) on hot days. Make sure that your child, especially on vacation in warm countries, does not fall asleep in the sun. In extreme heat, especially with severe humidity, you should stay in the shade more. In summer, do not leave your child alone in a closed car, as the temperature in it often rises sharply.
Symptoms of sunstroke manifest themselves very vigorously: the head becomes hot, the face turns red, headaches appear, anxiety, dizziness, nausea to vomiting, a stunned state, and in the worst case, an unconscious state. If at the same time the body temperature rises sharply to 40 °C, then they speak of heat stroke. The condition worsens, loss of consciousness and convulsions are possible.
First aid
Sunstroke, especially severe cases of heatstroke, requires immediate medical attention. Before the doctor arrives, it is necessary to place the child in the shade, raising his head slightly, for example, placing him on the lap of the person accompanying him. Wet a cotton handkerchief with cold water, wring it out and place it on your head and forehead, wipe your body with a towel soaked in cold water. Repeat the procedure after 10 minutes.
Homeopathic medicines
Camphor D3 - as the first remedy, the drug should be given in 3-4 doses of 3 grains every 10 minutes, and then Cactus D3 in 2 doses after 10 minutes, and then repeat after 1-2 hours. You can give Camphor and Cactus at the same time using the “glass of water” method.
Aconite D3 and Belladonna D3 or Gelsemium D3 and Glonoin D3 are also very effective when used using the “glass of water method”.
Apis D6 is indicated for severe headaches and tension in the occipital region - 5 grains 3-4 times a day.
Natrium carbonicum D12-30 is useful when, after sunstroke, complaints of fever, headaches, dizziness, and inability to think when exposed to the sun reappear; accepted the same way.
In case of unstable blood circulation or loss of consciousness, call a doctor immediately.
Poisoning
If a toxic substance enters the body, it leads to poisoning, causing impairment and sometimes death. The most common causes of poisoning are medications, household chemicals (acetic acid, turpentine, soapstone solution, gasoline, household insecticides), poisonous plants and berries (wrestler, datura, henbane, wolfberry, hemlock, wild rosemary, marsh bogul and etc.), poisonous mushrooms, means for exterminating agricultural pests (herbicides), fertilizers, washing powders and other detergents, gas.
Most poisonings occur in early childhood and preschool age, when, due to extreme curiosity, children, without thinking, put all sorts of objects in their mouths. The attractive packaging of liquids may lead them to believe that it is delicious lemonade. Naturally, poisoning can often be prevented, but, unfortunately, some parents understand this after the accident has already occurred.
Medicines and household chemicals should be kept out of the reach of children!
The initial symptoms of poisoning can be severe nausea, vomiting, and abdominal pain. In case of poisoning with chemicals, a child may become lethargic, drowsy, indifferent, and in some cases the opposite picture is possible - extremely agitated. Possible loss of balance, convulsions, loss of consciousness.
Sometimes the child feels relatively well at first, but the condition may worsen gradually if the toxic substance is absorbed slowly from the stomach. Even 1-2 tablets of sleeping pills, antipyretic drugs or cardiac medications can cause severe, sometimes fatal poisoning.
First aid
In all cases, you should consult a doctor, even if the origin of the poisoning is known. If you find that the child has eaten (or drank) some medicines or chemicals, you must take the package (bottle) to the hospital so that doctors can select the necessary antidote.
The task of first aid for poisoning food is the fastest possible removal of poison from the body. To do this, you need to immediately do a gastric lavage. Give the child a large amount of warm water to drink, then pick him up and tilt him over a basin or bucket and induce vomiting by pressing on the root of the tongue with a finger or spoon. When washing again, you can add a 1% solution of baking soda to the water (1 teaspoon of soda per 0.5 liter of water).
In case of poisoning with corrosive substances (alkalis, acids) vomiting cannot be caused, because on the way back these fluids damage the esophagus again. In this case, immediately give plenty of fluids (water, tea) to dilute the toxic substance in the stomach.
Whatever the cause of poisoning - a chemical, plant, medicine or gas - the main task of parents is to immediately call an ambulance, since any measures taken before the ambulance arrives may be ineffective. And here the most logical and most expedient solution is hospitalization.
After eating poor quality food, effective remedies are recommended.
Homeopathic medicines
Nux vomica D6 perfectly helps with feelings of fullness in the stomach, bloating, nausea, vomiting, constipation.
Veratrum album D6 is useful for vomiting and diarrhea associated with the intake of poor quality products.
Hamomilla D6 relieves vomiting with abdominal pain.
Sepia D3 and Okoubaka D6 are effective against poisoning from poor-quality fish.
Pulsatilla D3 is given for poisoning due to consumption of fatty foods, pies, and pastries.
All these drugs can be given using the “glass of water” method.
Burns of the esophagus
This is a lesion of the mucous membrane of the organ, resulting from accidentally drinking a strong acid or alkali. This usually happens to curious young children who are attracted by unknown bottles. They may contain concentrated vinegar or hydrochloric acid, ammonia or a solution of potassium permanganate (potassium permanganate). The severity of the burn to the mouth, pharynx and esophagus depends on the amount of liquid swallowed. Since the burn causes severe pain, the child begins to scream loudly.
First aid
First of all, you need to quickly find out what the child has swallowed. Before the ambulance arrives, the child's face and mouth should be rinsed generously with cold running water for several minutes. You need to make sure that water does not flow into your eyes. You can rinse your child's mouth with a rubber bulb. To dilute the acid or alkali in the esophagus and stomach, you need to give the child a glass of cold water or milk to drink, but not more than the specified dose, so as not to cause vomiting. Often, due to the prevalence of the process, the child has to be hospitalized in the hospital. From the book Ambulance. Guide for paramedics and nurses author Arkady Lvovich Vertkin
Lecture No. 6. Emergency conditions in cardiology 1. Myocardial infarction Myocardial infarction is a discrepancy between the myocardial need for oxygen and its delivery, resulting in the formation of limited necrosis of the heart muscle. The most common cause is a blood clot, less often -
From the book Nursing: A Guide author Alla Konstantinovna Myshkina From the book Complete Guide to Symptoms. Self-diagnosis of diseases by Tamara Rutskaya From the book Emergency Care Directory author Elena Yurievna Khramova From the author's book From the author's book From the author's bookChapter 4 Emergency conditions Treatment measures for emergency conditions Anaphylactic shock Anaphylactic shock develops in response to the introduction of a foreign protein. All treatment measures are carried out promptly and comprehensively. To do this you should: 1) lay
From the author's bookChapter 1
General principles of pediatric emergency care
TACTICS OF PROVIDING EMERGENCY MEDICAL CARE TO CHILDREN AT THE PREHOSPITAL STAGE
At the prehospital stage, the pediatrician must assess the symptoms of the patient’s pathological condition, make a diagnosis, prescribe and carry out emergency treatment measures corresponding to the diagnosis according to life-saving indications (primary tactical decision). Then you should clarify the diagnosis and determine further tactics for providing medical care (leave the child at home or hospitalize him). When developing a tactical decision, it is important to remember that decompensation of the condition in children occurs faster than in adults.
Features of child examination
To collect anamnesis and maintain a calm state of the patient during examination, it is necessary to establish productive contact with his parents or guardians.
To make a correct diagnosis and develop the right medical tactics, you should definitely find out:
Reason for seeking medical help;
Circumstances of illness or injury;
Duration of the disease;
The time when the child’s condition worsened;
Means and medications used before the doctor’s arrival.
It is necessary to completely undress the child in room temperature and good lighting.
It is necessary to follow the rules of asepsis, especially when providing care to newborns (it is imperative to use a clean gown over clothing).
Options for pediatric tactical actions
You can leave your child at home (be sure to send a call to the clinic) if:
The disease does not threaten the patient’s life and cannot disable him;
The condition has improved to satisfactory and remains stable;
The child’s material and living conditions are satisfactory and he is guaranteed the necessary care that excludes a threat to life.
A child should be hospitalized if:
The nature and severity of the disease threatens the patient’s life and can disable him;
The prognosis of the disease is unfavorable, the unsatisfactory social environment and age characteristics of the patient suggest treatment only in a hospital setting;
Constant medical supervision of the patient is necessary.
It is necessary to hospitalize the child accompanied by an EMS doctor.
If the treatment measures carried out by the pediatrician of the outpatient clinic and the EMS doctor are ineffective, and the child in a state of decompensation remains at home (due to the refusal of the parents or guardian to be hospitalized), then it is necessary to report this to the senior doctor of the EMS station and the chief physician of the outpatient clinic. Any refusal of examination, medical care or hospitalization must be recorded and certified by the signatures of the child’s parents or guardians. If a child or his parent (guardian) does not want to formalize the refusal of hospitalization in the form prescribed by law, it is necessary to attract at least two witnesses and record the refusal.
If hospitalization is refused or if there is a continuing possibility of deterioration of the condition, it is necessary to ensure continued treatment of the child at home and active dynamic visits
the patient by a pediatrician at an outpatient clinic and an emergency physician.
FEATURES OF DIAGNOSIS OF EMERGENCY CONDITIONS IN CHILDREN
Specifics of the diagnostic and treatment process and features of the work of an outpatient pediatrician:
The opportunity to actively and long-term monitor the child, additionally examine him with medical specialists, and conduct general clinical studies;
The ability to call an ambulance team to carry out emergency treatment measures for life-saving reasons if the patient’s condition worsens and there are no conditions for independent provision of emergency care in sufficient quantities;
The need to know the anatomical and physiological characteristics of the body of children aged 0 to 18 years;
The advisability of early prescription of medications, including antibacterial and antiviral agents;
The sanitary standards of the population are often low. The primary task of examining a sick child is to identify
symptoms that determine the severity of the patient’s condition, rather than the cause of the disease.
Initially, the degree of impairment of vital functions should be clarified, then the state of the central nervous system (level of consciousness, the presence of common symptoms of brain damage, convulsive syndrome), central hemodynamics, respiratory system should be assessed and, if necessary, emergency measures should be taken.
If the state of the central nervous system, central hemodynamics and respiratory system is sufficiently stable, then the doctor should begin a typical examination of the patient.
Anamnesis
The severity of the patient’s condition forces the doctor to collect the data that is necessary to develop the right tactics and determine the scope of emergency measures.
When collecting an anamnesis of a disease in a young child, special attention is paid to changes in behavior, the appearance of hypodynamia,
mias, lethargy or hyperactivity, changes in appetite, sleep disturbance. Drowsiness and lethargy in a normally active child may be symptoms of central nervous system depression. Regurgitation, vomiting, one or two loose stools in young children do not necessarily indicate an infectious lesion of the gastrointestinal tract - this is how any disease can begin.
It is important to identify signs of perinatal damage to the central nervous system, as well as find out whether the child is being monitored by specialist doctors. It is necessary to clarify the allergy history, collect information about the child’s vaccinations and post-vaccination reactions, and find out whether he has had contact with infectious patients.
Physical examination
The difficulty of conducting a physical examination of young children is due to the peculiarities of their anatomical, physiological, psychomotor and speech development.
Examination of the skin
The examination should begin with an assessment of the color of the skin, for which the child must be completely undressed (necessarily in a warm room).
Pallor
Most often, pale skin is caused by:
Anemia;
Intoxication;
Cerebral hypoxia;
CHD of the “pale” type;
Spasm of peripheral vessels (marble skin pattern).
After ruling out anemia, the cause of vascular spasm is determined (toxicosis of various origins or hypovolemia).
Hypovolemia and general dehydration are characterized by:
Dry mucous membranes;
Slow straightening of the skin fold;
Retraction of the large fontanel;
Decreased diuresis.
Cyanosis
There are local and diffuse, as well as permanent and transient cyanosis.
Cyanosis of the lips and visible mucous membranes of the oral cavity are the leading symptoms of congenital heart disease with blood shunting from right to left. Diffuse cyanosis most often occurs with “blue” type congenital heart disease (for example, tetralogy of Fallot).
Skin rash
Detection of exanthema is important for making a diagnosis, assessing the prognosis and severity of the child’s condition. Any rash with hemorrhagic elements requires differential diagnosis with meningococcal infection.
Palpation of the large fontanel helps to diagnose dehydration, assess its degree, and identify the syndrome of increased intracranial pressure (with hydrocephalus, meningitis, etc.).
Research of the cardiovascular and respiratory systems
The principles of examining children are not fundamentally different from those of adults. Children in the first year of life are characterized by physiological tachycardia and tachypnea.
Age norms for heart rate, blood pressure and respiratory rate
Pulse pressure in all age groups is normally 40-45 mmHg. In preschool children, the limits of relative cardiac dullness are greater than in schoolchildren.
Central nervous system examination
The level of consciousness when verbal contact is impossible (due to age) is determined by the child’s activity - by how he follows
follows you and objects, whether he plays with a toy, how he screams or cries (a monotonous cry is characteristic of meningitis).
Children are prone to diffuse cerebral reactions; they more often develop convulsive syndrome (febrile seizures), as well as nonspecific toxic encephalopathies (neurotoxicosis).
If you suspect meningitis, your doctor should check:
Kernig's sign (normally detected up to 3 months of life);
Brudzinski's sign;
Stiff neck;
Hyperesthesia to all stimuli;
The presence of elements of the “pointing dog” pose;
The presence of a monotonous cry;
Symptom of "suspension".
Pain syndrome
With pain syndrome, the child is restless, cries, his sleep is disturbed, sometimes regurgitation appears, and his appetite worsens.
Features of diagnosing pain in children of the first year of life.
Headache with increased intracranial pressure or swelling of the brain is accompanied by a monotonous cry, often tremor of the chin and limbs, pulsation of the large fontanelle, positive Graefe's sign, regurgitation and vomiting. When the position of the child's head changes, anxiety, screaming and crying increase.
If there is pain in a limb, the range of active movements is limited, the child “spares” it.
When there is pain in the abdomen, the child twists his legs, presses them to his stomach, screams, intermittently sucks the pacifier, and burps.
Abdominal pain
In young children, abdominal pain occurs due to eating disorders, flatulence, constipation, intussusception, ulcerative necrotizing enterocolitis.
In older children, pronounced abdominal syndrome often appears during the manifestation of diabetes mellitus.
Pain during intussusception accompanies the appearance of large peristaltic waves with a frequency of 10-15 minutes. Child suddenly
He begins to worry, scream, and kick his legs. After the peristaltic wave stops, the pain subsides. Constant abdominal pain is characteristic of acute appendicitis, in which intestinal motility sharply subsides, which leads to bloating.
ROUTES OF ADMINISTRATION OF MEDICINES
The choice of route of drug administration depends on the severity of the patient’s condition, the required duration of their continuous administration, the nature of the disease, the patient’s age and the practical skills of medical workers.
Subcutaneous route administration does not allow urgent delivery of the drug into the bloodstream in an emergency.
Intravenous route administration is preferable in situations where it is necessary to quickly influence any functions of the body. Catheterization of the peripheral vein(s) is the method of choice in cases where it is necessary to repeatedly administer the drug, carry out infusion therapy, transport the patient and at the same time carry out therapy. If catheterization is impossible, venipuncture is performed. The most accessible for placing a peripheral catheter and venipuncture are:
Veins of the elbow (v. cephalica, v. basilica, v. mediana cubiti);
Veins of the back of the hand (v. cephalica, v. metacarpeae dorsales);
The great saphenous vein of the leg, located anterior to the medial malleolus (v. saphena magna).
In children in the first six months of life, veins located in front and above the auricle can be used for venipuncture (vv. temporales superficiales).
Intratracheal drugs are administered through an endotracheal tube (if intubation has been performed), lig. conica or through the tracheal rings with a needle for intramuscular injection. The dose of the drug is doubled and diluted in 1-2 ml of 0.9% sodium chloride solution. The total volume of drugs administered once can reach 20-30 ml.
Sublingual tract injection (into the muscles of the oral cavity) ensures urgent delivery of the drug into the blood in a small dose. It is used in cases where there is no time for venipuncture. In this case follow
the “three twos” rule: stepping back 2 cm from the edge of the chin, a needle for intramuscular injection is inserted to a depth of 2 cm into the muscles of the floor of the mouth in the direction of the crown; the total volume of administered drugs should not exceed 2 ml (1 ml for children under 3 years of age). The drugs are administered in a standard dose, without dilution.
Rectal route used when it is necessary to achieve peak concentration of the drug in the blood faster than with intramuscular injection, and when it is impossible to use the oral route. The drugs are administered using microenemas, diluted in 3-5 ml of warm (37-40 ° C) 0.9% sodium chloride solution, with the addition of 0.5-1.0 ml of 70% ethyl alcohol (if this does not cause inactivation of the drug) . 1-10 ml of the drug is administered once.
Intramuscular route injections are used when the effect of the drug is desired within 15-20 minutes. Standard injection sites: superior lateral quadrant of the buttock (m. gluteus maximus), anterolateral part of the thigh (m. rectus femoris), lateral part of the shoulder (m. triceps brachii).
Usage intranasal route administration is advisable in situations where it is desirable to combine the urgency of the drug with the effect it has on the epithelium of the upper respiratory tract.
Infusion therapy at the prehospital stage
In an outpatient clinic, infusion therapy is carried out if necessary to stabilize the child’s condition before the arrival of the emergency medical technician, and to prepare him for transportation to the hospital. Intravenous drip administration of drugs allows you to urgently correct metabolic and electrolyte disorders and replenish the volume of circulating blood.
If the child’s systolic blood pressure is not lower than 60-80 mm Hg. (the pulse on the radial artery is preserved) and the hemodynamic condition does not deteriorate within an hour - infusion therapy is started with a dose of 20 ml/(kgh).
If systolic blood pressure is below 60 mm Hg. (a thread-like pulse is felt on the radial artery) and it can be assumed that the hemodynamic condition will worsen within an hour, and also in the absence of a positive effect from the infusion within 20 minutes.
On-therapy at a dose of 20 ml/(kghch) - drug solutions are administered at a dose of 40 ml/(kghh). If the pulse is palpable only in the carotid artery, as well as in the absence of a positive effect from infusion therapy at a dose of 40 ml/(kGHH) within 20 minutes, solutions are administered in a dose exceeding 40 ml/(KGHH).
Urgent correction of hypoglycemia
First, a 40% glucose solution is administered as a bolus at a rate of 5 ml/kg body weight. Then a 5% glucose solution is administered intravenously at a dose of 10 ml/kg body weight.
Urgent correction of acidosis
In cases where it is not possible to maintain stable hemodynamics and systolic blood pressure not lower than 60 mm Hg, as well as during cardiopulmonary resuscitation, when presumably more than 10 minutes have passed from the moment of cardiac arrest to the start of resuscitation measures, a 4% sodium bicarbonate solution is administered in a dose of 1 -2 ml/kg body weight.
Urgent correction of hypocalcemia
A 10% calcium chloride solution is administered at a dose of 1-2 ml/kg body weight.
Intravenous drip administration of adrenergic agonists
The dose of the administered adrenergic agonist should be minimal, but sufficient to maintain stable hemodynamics and systolic blood pressure not lower than 60 mm Hg.
Adrenergic agonists are chosen depending on the urgent state of the child:
Cardiopulmonary resuscitation - epinephrine (adrenaline);
Anaphylactic shock - phenylephrine (mesaton) or epinephrine;
Traumatic shock - dopamine or epinephrine;
Infectious-toxic shock - phenylephrine or epinephrine.
FEATURES OF CARDIOPULMONARY RESUSCITATION IN CHILDREN
Task primary cardiopulmonary resuscitation- ensure the minimum systemic blood flow and external respiration necessary to maintain life during the time required for the arrival of the emergency medical team.
Task advanced life support- carry out a set of life support measures to stabilize the body’s condition on site and during subsequent transportation of the victim to the hospital.
Primary cardiopulmonary resuscitation at the prehospital stage is carried out by eyewitnesses directly at the site of a critical condition, without using medical instruments, medications, oxygen, etc.
Preparatory stage
When organizing care at the prehospital stage, it is necessary to ensure the safest possible conditions for the child and the person providing medical care, as well as to exclude further exposure to a damaging factor.
Sequence of actions in preparation for primary resuscitation.
1. You should make sure that the conditions for resuscitation are safe.
2. It is necessary to check the presence of contact with the child (his level of consciousness) and if there is no contact, immediately call for help.
3. It is necessary to make sure that there are no foreign objects or liquids in the oropharynx, clear the airways if necessary, after which the child’s head should be tilted back and his chin raised.
4. After establishing airway patency, you should check for spontaneous breathing in the child - determine whether chest excursions occur (whether it rises during inhalation and falls during exhalation), try to listen to breathing sounds, and feel the movement of the stream of exhaled air.
5. If an injury to the cervical spine is suspected, all actions related to changing the position of the child’s body should be carried out especially carefully, making sure to secure the cervical spine.
6. If the child is not breathing or makes ineffective breaths, effective artificial respiration should be started (five stages).
7. It is necessary to assess the presence of blood circulation in the child: determine the pulse in the carotid artery (in a baby, on the brachial artery passing along the inner surface of the shoulder, near the elbow).
8. In the absence of direct or indirect signs of blood circulation or persistent bradycardia, you need to start chest compressions, i.e. to closed cardiac massage, combining it with mechanical ventilation.
Artificial respiration technique for a child over one year old
After inhaling, wrap your lips around the child’s slightly open mouth, while closing his nostrils with two fingers of your right hand, while simultaneously throwing back his head with the heel of the palm of the same hand and lifting his chin with the fingers of your left hand.
Slowly (within 1 second) and evenly, without high pressure, exhale the air, watching the chest. Remove your lips from the child's face and watch the passive exhalation (1 s) as the chest lowers. Repeat inhalations 5 times.
If you are sure of the presence of blood circulation, continue artificial respiration until it is restored.
Features of artificial respiration for infants
Cover your baby's nose and mouth with your mouth and press your lips firmly against the skin of his face.
Slowly (within 1-1.5 s) inhale air evenly until the chest expands visible. Leave the same amount of time for passive exhalation (1-1.5 s). Give five such artificial breaths.
Chest compression technique
For infants, chest compressions are usually performed with two fingers; for older children, depending on their age, with one or two hands with the fingers locked (as in adults).
If cardiopulmonary resuscitation techniques are performed by one person, then after every 15 compressions 2 artificial breaths should be performed. To properly perform chest compressions, force
applied to the lower third of the sternum in a strictly vertical (sagittal) direction, with the child (infant) in a strictly horizontal position on his back. With effective closed cardiac massage, the chest is compressed to approximately 1/3 of its anteroposterior size. When performing compressions, it is necessary to allow the chest to expand freely without removing your hands (fingers) from it. Compressions should be performed at a rate of 100 per minute.
When signs of resumption of spontaneous circulation (with the appearance of a pulse) appear, chest compressions are stopped, continuing to perform auxiliary ventilation. When effective external respiration appears, artificial breaths are stopped, but airway patency continues to be monitored.
Advanced prehospital resuscitation
Advanced resuscitation at the prehospital stage begins immediately after the arrival of the ambulance team, continuing to carry out life-sustaining measures.
To ensure airway patency, oropharyngeal airways are inserted, laryngeal masks are applied, or tracheal intubation is performed.
To carry out infusion therapy, a peripheral vein is catheterized. An alternative route for administering medications and fluids to young children (up to 6 years of age) is intraosseous. Medicines can be administered intratracheally, while the usual doses of drugs are doubled and diluted in 2-3 ml of 0.9% sodium chloride solution.
Adrenalin*(epinephrine) is used for severe bradycardia, asystole and ventricular fibrillation. The drug is administered at a dose of 0.01 mg/kg body weight, and in the absence of information about the child’s body weight, the dose is determined at the rate of 0.1 ml of a 0.1% solution per year of life. The drug can be administered repeatedly at intervals of 3-5 minutes. If cardiopulmonary resuscitation is ineffective within 10-15 minutes, the dose of epinephrine can be doubled.
Atropine used for bradycardia and in a complex of therapeutic measures for asystole. The drug is administered at a dose of 0.01 mg/kg, and in the absence of information about the child’s body weight, the dose is determined at the rate of 0.1 ml of a 0.1% solution per year of life. The drug can be administered repeatedly at intervals of 3-5 minutes until a total dose of 0.04 mg/kg is achieved.
Lidocaine administered for stable ventricular fibrillation at a dose of 1 mg/kg. For injection use a 10% solution.
Sodium bicarbonate used for prolonged cardiopulmonary resuscitation (more than 20 minutes, in the absence of effect, and with adequate ventilation). The drug is administered intravenously slowly at a dose of 2 ml/kg body weight. For injection use a 4% solution.
Isotonic sodium chloride solution administered as a bolus at a dose of 20 ml/kg body weight over 20 minutes with signs of shock decompensation (systolic blood pressure is less than the lower limit of the age norm).
Colloidal solutions administered at a dose of 10 ml/kg body weight in the absence of the expected effect from double administration of an adequate amount of crystalloid solutions.
Glucose administered only when hypoglycemia is established (or suspected).
Prehospital electrical defibrillation
Electrical defibrillation is performed when ventricular fibrillation or pulseless ventricular tachycardia is diagnosed. The defibrillation technique is the same as for adults, but the electrode plates are smaller (pediatric). When discharging, the force of pressure on the electrodes for infants should be 3 kg, for older children - 5 kg. A discharge with an energy dose of 4 J/kg is carried out once. Even when sinus rhythm is restored after a shock, closed cardiac massage is performed until the central pulse appears. If the discharge is ineffective and ventricular fibrillation persists, subsequent discharges are repeated with the same energy dose. In case of asystole, electrical defibrillation is not indicated.
Chapter 2
Violation of thermoregulation
FEVER
Depending on the degree of increase in body temperature, subfebrile (not higher than 37.9 ° C), moderate (38.0-39.0 ° C), high (39.1-41.0 ° C) and hyperthermic (more than 41.0 ° C) are distinguished. 0°C) fever.
Diagnostics
There are 2 main variants of the clinical course of fever.
With “red” (“pink”) fever, the skin is moderately hyperemic, the skin is hot to the touch, and may be moist (increased sweating). The child's behavior practically does not change, heat production corresponds to heat transfer, and there are no signs of centralization of blood circulation. This variant of fever has a favorable prognosis.
. “White” (“pale”) fever is accompanied by pronounced signs of centralization of the blood circulation. The skin is pale with a “marble” pattern, the color of the lips and fingertips is cyanotic, and the extremities are cold. Characterized by a feeling of cold and chills. Fever is accompanied by tachycardia and shortness of breath, and convulsions and delirium may occur.
Indications for antipyretic therapy
High fever (39°C) regardless of the patient’s age.
Moderate fever (38° C) in children with epilepsy, convulsive syndrome, hypertension syndrome, perinatal encephalopathy and its consequences, as well as against the background of other risk factors.
. "Pale" fever.
Moderate fever in children of the first three years of life.
Urgent Care
For pink fever
Paracetamol is prescribed orally or rectally in a single dose of 10-15 mg/kg body weight.
For children over one year old, ibuprofen is prescribed as initial therapy in a single dose of 5-10 mg/kg body weight.
Physical cooling methods should be used (wiping with water at room temperature, applying an ice pack at a distance of approximately 4 cm above the head area). Rubbing begins immediately after prescribing antipyretic drugs. Physical methods of lowering body temperature are used once for no more than 30-40 minutes.
If the body temperature does not decrease, then antipyretic drugs are administered intramuscularly. Children under one year of age are administered a 50% solution of metamizole sodium (analtgin) at the rate of 0.01 ml/kg of body weight, over one year - 0.1 ml for each year of life. At the same time, a 2.5% solution of promethazine (pipolfen) is administered to children under one year of age - at a dose of 0.01 ml/kg, over one year - 0.1 ml for each year of life, but not more than 1 ml (you can use a solution of clemastine (Tavegil) or chloropyramine (suprastin);
If there is no effect from the above-described therapy, the same emergency measures are carried out within 20-30 minutes as for “pale” fever.
For "pale" fever
The following is administered intramuscularly: 50% solution of metamizole sodium at the rate of 0.1 ml for each year of the child’s life, 2% solution of papaverine (for children under one year - 0.1-0.2 ml, over one year - 0.1-0.2 ml per every year of life) or drotaverine (noshpa) (at the rate of 0.1 ml for every year of life). School-age children are administered a 1% solution of bendazole (dibazole) at the rate of 0.1 ml for each year of life. The infusion of the above drugs is combined with the administration of a 2.5% solution of promethazine at the rate of 0.1 ml for each year of the child’s life. Instead of promethazine, you can use a solution of clemastine or chloropyramine in the same doses.
Metamizole sodium (doses indicated above) and 1% solution of nicotinic acid are administered intramuscularly at the rate of 0.05 ml/kg body weight. This scheme is most suitable for older children.
If one option of initial therapy is ineffective, a second one can be used.
For persistent fever
With increasing severity of signs of centralization of blood circulation (the difference between axillary and rectal temperatures,
temperature is more than 1°C), a 0.25% solution of droperidol is administered intramuscularly at the rate of 0.1 ml/kg body weight (0.05 mg/kg body weight), combining it with antipyretics.
If the patient has symptoms of “convulsive readiness” or convulsive syndrome, treatment of fever, regardless of its type, begins with the administration of a 0.5% diazepam solution at the rate of 0.1 ml/kg body weight, but not more than 2.0 ml once. For more severe epileptic manifestations, solutions of metamizole sodium and droperidol are used.
When treating fever, oxygen therapy is mandatory.
Evaluation of therapy effectiveness
For “pink” fever, treatment is considered effective, as a result of which the body temperature (axillary) decreases by 0.5 ° C in 30 minutes.
A positive effect in case of “pale” fever is considered to be its transition to “pink” and a decrease in the child’s axillary body temperature by 0.5 ° C in 30 minutes.
Lack of effect from using two or more treatment regimens.
Ineffective use of initial therapy for “pale” fever in children of the first year of life.
Combination of persistent fever and prognostically unfavorable risk factors (convulsive, hypertension, hydrocephalic syndromes, etc.).
Note
After the administration of droperidol, the development of adverse reactions is possible - extrapyramidal disorders with a convulsive component (tonic contractions of the muscles of the face and neck).
HYPOCOOLING
Hypothermia quickly occurs in newborns and children under one year of age due to the immaturity of the thermoregulation system.
Diagnostics
Mild degree, adynamic stage
The skin turns pale and acquires a “marble” pattern.
General weakness, drowsiness appear, consciousness is impaired, even stupor.
The ability to move independently, which initially remained, is gradually lost.
Muscle tremors appear, and then rigor.
Blood pressure remains within the age norm or decreases slightly.
Body temperature drops to 30-32 °C.
Moderate degree, stuporous stage
The skin becomes sharply pale, and the “marble” pattern disappears.
The degree of impairment of consciousness increases to coma I-II degrees.
Muscle rigidity manifests itself, up to the inability to straighten the limb, the child takes the pose of a “crooked man.”
Bradycardia and bradypnea develop, and breathing becomes shallow.
Blood pressure decreases.
Body temperature drops to 28-29 °C.
Severe degree, comatose stage
The sharp pallor of the skin and mucous membranes remains.
Muscle rigidity persists, and trismus of the masticatory muscles appears.
Impaired consciousness corresponds to stage II-III coma.
Bradycardia is replaced by electromechanical dissociation or cardiac fibrillation.
Bradypnea is replaced by Cheyne-Stokes or Biot type breathing, then stops.
Body temperature drops to 26-27° C.
Urgent Care
Measures that must be taken regardless of the severity of hypothermia:
Monitor airway patency, breathing, circulation (ABC);
Eliminate exposure to low temperatures immediately.
Mild degree
The victim must be brought into a warm room and his cold, wet clothes removed.
Measures should be taken to prevent the victim from losing heat (so-called passive rewarming): if possible, wrap them in heat-insulating materials (“space blanket” - with foil inward).
You can perform a gentle massage - stroking.
It is advisable to give the child a warm, sweet drink, preferably tea (the temperature of the liquid to drink should be no more than 20-30° C above body temperature).
Moderate degree
Oxygen therapy with warm humidified oxygen (40-60% oxygen) is indicated.
All methods of passive and active warming should be used, and the temperature of the external heat source should not be higher than the temperature of the victim’s skin.
Prednisolone should be administered intravenously at a dose of 3-5 mg/kg body weight, 10 ml of a 20-40% glucose solution, 1 ml of a 5% solution of ascorbic acid in a 20% glucose solution.
For bradycardia, it is necessary to inject a 0.1% atropine solution intravenously or into the muscles of the floor of the mouth at the rate of 0.1 ml for each year of life.
When blood pressure decreases to 60 mm Hg. or lower, infusion therapy is carried out with warm solutions for intravenous injections (the temperature of the infusion solution should not be more than 40-42 ° C). It is not advisable to use crystalloid solutions.
Severe degree
The victim must be brought into a warm room and his cold, wet clothes removed.
All passive methods should be used and active warming should be started immediately - infusion of warm solutions, immersion of the child in warm water, application of heat sources to the projections of large vessels, etc. You can perform gastric lavage with warm (40-42 °C) water. Active warming by immersion in warm water should be carried out in such a way that the water temperature rises by no more than 10-15 °C per hour.
Oxygen therapy with warm humidified oxygen is indicated
(80-100% oxygen).
For intravenous administration, warm infusion media are used, the temperature of which should not be higher than 40-42 °C.
Prednisolone is administered intravenously at a rate of 5-10 mg/kg body weight, 10 ml of a 20-40% glucose solution, 1 ml of a 5% solution of ascorbic acid in a 20% glucose solution.
Restoration of consciousness.
Indications for hospitalization
OVERHEATING
Synonyms
Heatstroke, sunstroke.
Diagnostics
Mild degree
Hyperemia of the skin develops, sweating increases.
General weakness appears, headache and nausea occur.
Tachycardia and tachypnea occur.
Blood pressure remains within the age norm, increases, or decreases slightly.
Body temperature rises to 38-39 °C.
Moderate degree
Hyperemia of the skin and increased sweating persist.
A sharp weakness occurs, the headache intensifies, nausea and vomiting appear.
Stupefaction develops, uncertainty in movements, and an unsteady gait appear.
Pulse and breathing increase.
Blood pressure decreases.
Body temperature rises to 39-40° C. Severe degree
The skin gradually acquires a pale cyanotic color, and sweating decreases (an unfavorable sign).
Delusions and hallucinations occur.
Consciousness is impaired to the point of coma.
Clonic and tonic convulsions appear.
Breathing becomes frequent and shallow.
Tachycardia gives way to bradycardia.
Blood pressure decreases to a critical level (systolic blood pressure less than 60 mm Hg).
Body temperature rises to 41-42° C.
In younger children, heat stroke symptoms develop more quickly than in older children, with less exposure to ambient temperature, and are more severe. Belching, nausea, upset, and increased bowel movements may occur.
Urgent Care
Overheating is more severe if the child is given plain water to drink.
Measures that must be taken regardless of the severity of overheating:
Control ABC;
Eliminate heat exposure and remove the child from the overheated area.
Mild degree
You should wet the child's face with cold water and place an ice pack or cold water on his head.
You can let your child inhale ammonia vapor from a cotton swab.
For rehydration, Rehydron* and Oralit* are given orally at the rate of 10 ml/kg of the child’s body weight.
Moderate degree
It is necessary to lay the child in an open area in the shade and free him from outer clothing.
Frequent fanning has a good effect.
In the absence of psychomotor agitation, the child should be allowed to inhale ammonia vapor from a cotton swab.
If the victim is accessible to contact and can swallow, oral rehydration is carried out: Rehydron*, Oralit* at the rate of 10 ml/kg of the child’s body weight (if vomiting is frequent, oral rehydration is useless).
If oral rehydration is not possible, fluid therapy is given.
Severe degree
Activities for this condition should be carried out according to the ABC system.
It is necessary to take the child out of the overheated area, free him from outer clothing and lay him in an open area in the shade in a supine position with his legs elevated.
You should wet the child’s face and body with cold water, place a bubble with ice or cold water on the head and on areas of the body in the projection of large vessels (neck, inguinal folds).
Oxygen therapy is carried out with humidified oxygen (40-60% oxygen).
It is necessary to provide constant access to the venous bed.
Infusion therapy is carried out: prednisolone is administered intravenously at a rate of 5-10 mg/kg body weight, 10 ml 20-40%
glucose solution, 1 ml of 5% ascorbic acid solution in 20% glucose solution.
For convulsions, diazepam is administered intravenously at the rate of 0.1 ml/kg of the child’s body weight, but not more than 2.0 ml.
ABC should be monitored after administration of sedating anticonvulsants.
Criteria for the effectiveness of therapy
Restoration of consciousness.
Restoration of hemodynamic parameters.
Normalization of body temperature.
Indications for hospitalization
Moderate to severe overheating.
Poor response to therapy.
The appearance of seizures.
Chapter 3
Acute airway obstruction
ACUTE STENOSING LARYNGOTRACHEITIS
Definition
Acute stenosing laryngotracheitis is obstruction of the upper respiratory tract below the vocal cords of viral or viral-bacterial etiology, accompanied by the development of acute respiratory failure.
Clinical picture
There are four stages of laryngeal stenosis:
Stage I (compensated) is manifested by a hoarse voice, a rough, barking cough, slight cyanosis of the skin around the mouth, and only if the child is bothered by moderate inspiratory shortness of breath, not accompanied by the participation of auxiliary respiratory muscles;
Stage II (subcompensated) is manifested by the child’s restlessness, tachycardia, frequent barking cough, cyanosis of the skin around the mouth that does not disappear after coughing, shortness of breath, accompanied by the participation of auxiliary muscles at rest;
Stage III (decompensated) is manifested by a sharp deterioration in the child’s condition, pallor, diffuse cyanosis, paradoxical pulse, noisy breathing with severe inspiratory shortness of breath and deep inhalation of the muscles in the epigastric region, intercostal spaces, supraclavicular and jugular fossae;
Stage VI (terminal) - the child tries to inhale, straining the neck muscles, gasps for air with his open mouth, while the pulse becomes irregular, convulsions may appear, a hypoxic coma develops, and then complete asphyxia.
Acute stenosing laryngotracheitis occurs at low-grade body temperature.
Diagnostics
Differential diagnosis
Acute stenosing laryngotracheitis is differentiated from congenital stridor, spasmophilia syndrome with laryngospasm, foreign body of the upper respiratory tract, epiglottitis, laryngeal injuries, Ludwig's angina, retropharyngeal and peritonsillar abscesses, mononucleosis.
Urgent Care
The main task is to reduce the edematous component of stenosis and maintain airway patency. All children with stage II-VI stenosis need oxygen therapy.
For stage I stenosis
The child is given a warm alkaline drink and inhaled with a 0.025% naphazoline solution.
For stage II stenosis
Inhalation is carried out with a 0.025% solution of naphazoline (naphthyzine) for 5 minutes using an inhaler (or nebulizer).
If it is not possible to perform inhalations (lack of an inhaler, high body temperature of the child, etc.), a 0.05% solution of naphazoline should be administered intranasally. For children in the first year of life, 0.2 ml is administered; for children over one year of age, the dose is determined at the rate of 0.1 ml for each subsequent year of life, but not more than 0.5 ml. Naphazoline is administered using a syringe (without a needle) into one nostril of the child in a sitting position with his head thrown back. The effectiveness of the solution getting into the larynx is indicated by the appearance of a cough.
If it is possible to completely stop the stenosis, then the child can be left at home, subject to mandatory active medical supervision. Naphazoline can be administered no more than 2-3 times a day with a break of 8 hours.
In case of incomplete relief of stenosis and if hospitalization is refused, dexamethasone (0.3 mg/kg body weight) or prednisolone (2 mg/kg body weight) should be administered intramuscularly or intravenously. Active visiting of the patient by the doctor is necessary.
For stage III stenosis
Dexamethasone (0.7 mg/kg body weight) or prednisolone (5-7 mg/kg body weight) is administered intravenously.
Inhalations are repeated or a 0.05% naphazoline solution is administered intranasally.
The patient is urgently hospitalized, preferably in a sitting position. If necessary, the trachea is urgently intubated.
Ensure readiness to perform cardiopulmonary resuscitation; if possible, call a specialized resuscitation ambulance team.
For stage IV stenosis
The trachea is intubated.
If it is not possible to perform intubation, a conicotomy is performed. Before conicotomy, a 0.1% atropine solution is injected intravenously or into the muscles of the oral cavity at the rate of 0.05 ml for each year of the child’s life. If the pharyngeal reflex is intact, before conicotomy, a 20% sodium hydroxide solution is administered intravenously at the rate of 0.4 ml/kg body weight (80 mg/kg body weight).
During transportation of the patient, infusion therapy is carried out to correct hemodynamic disturbances.
Note
The ineffectiveness of intranasal administration of naphazoline indicates an obstructive form of stenosis, the treatment of which should be carried out only in a hospital setting.
With prolonged and uncontrolled use of naphazoline, weakness, bradycardia, and severe pallor of the skin may appear due to the systemic adrenomimetic effect of the drug. If the described symptoms appear, any adrenomimetic drugs are contraindicated. If necessary, hemodynamics are maintained using the correct position of the patient's body, infusion therapy, and atropinization for bradycardia.
EPIGLOTTITIS
Clinical picture
The child's condition is serious; he tries to sit up straight, while the symptoms of airway stenosis increase. Characteristic:
High fever;
Severe intoxication;
Severe sore throat;
Hypersalivation;
Severe dysphagia;
Swelling and brightly hyperemic epiglottis and the area of the root of the tongue.
Urgent Care
If the degree of stenosis progresses, it is necessary to call the resuscitation ambulance team.
The patient should be hospitalized in the infectious diseases department in a sitting position.
It is necessary to carry out antipyretic therapy: paracetamol, ibuprofen.
Antibacterial therapy should be started: chloramphenicol (chloramphenicol) 25 mg/kg body weight is administered intramuscularly.
According to indications, nasotracheal tracheal intubation is performed.
FOREIGN BODIES IN THE RESPIRATORY TRACT
Pathogenesis
When a foreign body enters the child's respiratory tract, a cough immediately appears - an effective and safe means of removing the foreign body. Therefore, cough stimulation is a first aid remedy when foreign bodies enter the respiratory tract.
In the absence of cough and its ineffectiveness, with complete obstruction of the respiratory tract, asphyxia quickly develops, which requires urgent measures to evacuate the foreign body.
Clinical picture
When a foreign body enters the respiratory tract, the following occurs:
Sudden asphyxia;
- “causeless”, sudden cough, often paroxysmal (characterized by the sudden appearance of a cough while eating);
Inspiratory (when a foreign body enters the upper respiratory tract) or expiratory (when a foreign body enters the bronchi) shortness of breath;
wheezing;
Hemoptysis (due to foreign body damage to the mucous membrane of the respiratory tract).
Diagnostics
When auscultating the lungs, a weakening of breath sounds is heard on one or both sides.
Urgent Care
Attempts to remove foreign bodies from the respiratory tract should only be made in patients with progressive acute respiratory failure that poses a threat to their life.
1. When a foreign body is detected in the pharynx.
1.1. It is necessary to manipulate with a finger or a forceps to remove the foreign body from the pharynx.
1.2. If there is no positive effect, subdiaphragmatic-abdominal thrusts should be performed.
2. If a foreign body is detected in the larynx, trachea, bronchi:
2.1. It is necessary to perform subdiaphragmatic-abdominal thrusts;
2.2. Babies are given back pats;
2.3. If there is no effect from subdiaphragmatic-abdominal thrusts, conicotomy should be started;
2.4. If after conicotomy the airways remain obstructed, this indicates that the foreign body is located below the site of conicotomy and an attempt should be made to advance the foreign body into the right main bronchus.
3. After performing any of the manipulations, monitor the patency of the airways either by the appearance of spontaneous breathing or if mechanical ventilation is possible.
4. After restoration of spontaneous breathing and when using mechanical ventilation, oxygen therapy must be carried out. For oxygen therapy, an enriched air mixture containing 60-100% oxygen is used, depending on the degree of previous respiratory failure: the greater the severity and duration of respiratory failure, the greater the percentage of oxygen should be in the inhaled mixture.
5. All children with foreign bodies in the respiratory tract must be hospitalized in a hospital where there is an intensive care unit and a thoracic surgery department (or a pulmonology department), and where bronchoscopy can be performed.
Technique of subdiaphragmatic-abdominal thrusts
1. If the victim is conscious.
1.1. The technique must be performed with the victim sitting or standing.
1.2. Stand behind the victim and place your foot between his feet. Wrap your arms around his waist. Make a fist with one hand and press it with your thumb against the victim’s abdomen in the midline just above the navel and well below the end of the xiphoid process (costal angle).
1.3. Grasp the hand clenched into a fist with the hand of the other hand and, with a quick jerk-like movement directed upward, press on the victim’s stomach.
1.4. Perform pushes separately and distinctly until the foreign body is removed or until the victim is able to breathe and speak (or until the victim loses consciousness).
2. If the victim is unconscious.
2.1. Lay the victim on his back, place one hand with the heel of the palm on his stomach along the midline, just above the navel and far enough from the end of the xiphoid process.
2.2. Place your other hand on top and press on the stomach with sharp jerking movements directed towards the head. Perform pushes 5 times with an interval of 1-2 s.
2.3. Check ABC.
Back pats
The baby should be supported face down horizontally or with the head end slightly lowered. It is more convenient to hold the child on your left hand, placed on a hard surface, such as a thigh. The middle and thumb should be used to keep the baby's mouth slightly open.
Perform up to five fairly strong claps on the baby’s back (between the shoulder blades) with an open palm. The claps must be strong enough. The less time has passed since the aspiration of a foreign body, the easier it is to remove it.
Chest thrusts
If five back slaps do not remove the foreign body, chest thrusts should be performed.
The baby should be turned face up, holding his back on your left arm. The point for performing chest compressions during closed cardiac massage should be determined - approximately a finger's width above the base of the xiphoid process. Perform up to five sharp pushes to this point.
Thrusts in the epigastric region
The Heimlich maneuver can be performed on a child over 2-3 years of age, when the parenchymal organs (liver, spleen) are reliably hidden by the costal frame.
The base of the palm should be placed in the hypochondrium area between the xiphoid process and the navel and pressed inward and upward. The release of a foreign body will be indicated by a whistling or hissing sound of air leaving the lungs and the appearance of a cough.
Conicotomy
It is necessary to feel the thyroid cartilage and slide your finger down along the midline to the next protrusion - the cricoid cartilage, shaped like a wedding ring. The depression between these cartilages is the conical ligament. The neck should be treated with iodine or alcohol before surgery. The thyroid cartilage must be fixed with the fingers of the left hand (for left-handed people - vice versa). With your right hand you need to insert the conicote through the skin and conical ligament into the lumen of the trachea, then the guide can be removed.
For children under 8 years of age, puncture conicotomy is performed with a thick needle such as a Dufault needle. The thyroid cartilage is fixed with the fingers of the left hand (for left-handed people - vice versa). With the right hand, a needle is inserted through the skin and conical ligament into the lumen of the trachea. If a needle is used with a catheter, after reaching the lumen of the trachea, the needle should be removed without changing the position of the catheter. To increase the respiratory flow, several needles can be inserted in succession.
If the patient does not begin to breathe on his own, a test breath should be taken using a ventilator through a conicotome tube or needle. When restoring airway patency, the conicotome tube or needle must be secured with a bandage.
Chapter 4
Emergency conditions in pediatric neurology
CRANIO BRAIN INJURY
Classification
Closed craniocerebral injuries:
Concussion (without division into degrees);
Mild, moderate and severe bruise:
Compression of the brain (often occurs against the background of a bruise).
Open head injuries.
The cause of compression of the brain is most often an intracranial hematoma, but fragments of the skull can also compress the brain in a so-called depressed fracture.
Clinical picture
The clinical picture (and history) of traumatic brain injury is characterized by:
The fact of a blow to the head (or to the head);
Visually detectable damage to the soft tissues of the head and skull bones;
Objective signs of a fracture of the base of the skull;
Impaired consciousness and memory;
Headache, vomiting;
Symptoms of cranial nerve damage;
Signs of focal brain lesions;
Symptoms of damage to the brain stem and (or) meninges. Specifics of the clinical course of brain injury in children
often expressed in the absence of clear neurological symptoms upon examination or several hours after a mild brain injury.
Differences in the clinical manifestations of traumatic brain injury in children:
Young children very rarely lose consciousness when receiving a minor injury, and older children only in 57% of cases;
Children give vague and overly subjective interpretations of the neurological picture;
Neurological symptoms change and disappear very quickly;
General cerebral symptoms predominate over focal ones;
In young children with subarachnoid hemorrhages, there are no symptoms of meningeal irritation;
Intracranial hematomas occur relatively rarely, but cerebral edema occurs quite often;
Neurological symptoms are well regressed.
Impaired consciousness
With a mild traumatic brain injury (concussion or mild bruise of the brain), preschool children rarely lose consciousness.
Classification of consciousness disorders
. Clear consciousness. The child is fully oriented, adequate and active.
. Moderate stun. The child is conscious, partially oriented, answers questions quite correctly, but reluctantly and in monosyllables, and is drowsy.
. Severe stun. The child is conscious, but his eyes are closed, disoriented, answers only simple questions, but in monosyllables and not immediately (only after repeated requests), follows simple commands, drowsiness.
. Sopor. The child is unconscious, eyes closed. He opens his eyes only to pain and calls. It is not possible to establish contact with the patient. Localizes pain well - withdraws the limb during injection, defends itself. Flexion movements in the limbs dominate.
. Moderate coma. The child is unconscious (in a state of “unawakenable”) and reacts to pain with a general reaction (shudders, shows concern), but does not localize it and does not defend himself. Vital functions are stable, the functioning parameters of organs and systems are good.
. Deep coma. The child is unconscious (in a state of “unawakenable”) and does not respond to pain. Muscle hypotension develops. extensor tone dominates.
. Extreme coma. The child is unconscious (in a state of “unawakenable”), does not respond to pain, and sometimes makes spontaneous extension movements. Muscle hypotonia and areflexia persist. Vital functions are grossly impaired: no spontaneous breathing, pulse 120 per minute, blood pressure 70 mm Hg. and below.
Memory disorders
Memory disorders occur in victims with moderate to severe brain contusions after prolonged loss of consciousness. If a child does not remember events that happened before the injury, this is retrograde amnesia; after the injury, it is anterograde amnesia.
Headache
Almost all victims have a headache, with the exception of children under 2 years of age. The pain is diffuse and in case of mild injury is not painful, subsides with rest and does not require the use of analgesics.
Vomit
Occurs in all victims. In case of mild injury, it is usually single, in case of severe injury it is repeated (repeated).
Symptoms of cranial nerve damage
Sluggish reaction of the pupils to light (in case of severe traumatic brain injury there is no reaction).
Uniformly dilated or constricted pupils.
Anisocoria (a symptom of brain dislocation with intracranial hematoma or severe basal contusion).
Language deviation.
Facial asymmetry when closing your eyes and grinning (persistent facial asymmetry indicates a moderate or severe traumatic brain injury).
Reflexes and muscle tone
Corneal reflexes either decrease or disappear.
Muscle tone is changeable: from moderate hypotonia with mild injury, to increased tone in the extensors of the trunk and limbs with severe injury.
Heart rate and body temperature
The pulse rate varies widely. Bradycardia indicates progressive intracranial hypertension - compression of the brain by a hematoma.
Body temperature with mild traumatic brain injury usually remains normal. With subarachnoid hemorrhage, the temperature may rise to subfebrile, and with the diencephalic form of severe brain contusion - up to 40-42 ° C.
Diagnostics
Features of diagnosing traumatic brain injuries in children of the first year of life
The acute period proceeds quickly, and general cerebral symptoms predominate. Sometimes general cerebral and focal symptoms may be absent.
Diagnosis criteria:
A high-pitched scream or short-term apnea at the time of injury;
Convulsive readiness;
The appearance of motor automatisms (sucking, chewing, etc.);
Regurgitation or vomiting;
Autonomic disorders (hyperhidrosis, tachycardia, fever);
Sleep disturbance.
Diagnosis of the severity of traumatic brain injury
Characteristics of a concussion are:
Short-term (up to 10 minutes) loss of consciousness (if more than 15 minutes have passed from the moment of injury to the arrival of the emergency medical team, then the child is already conscious);
Retrograde, less often anterograde amnesia;
Vomiting (usually 1-2 times);
Headache;
Absence of focal symptoms.
When a brain injury occurs:
Loss of consciousness for more than 30 minutes (consciousness is impaired at the time of examination if less than 30 minutes have passed from the moment of injury to the arrival of the team);
Symptoms of focal brain damage;
Visible fractures of the skull bones;
Symptom of “spectacles”, liquorrhea or hemoliquorrhea (suspicion of a fracture of the base of the skull).
To make a diagnosis of brain contusion, the presence of at least one sign in the clinical picture is sufficient.
Brain compression
Compression of the brain is usually combined with a bruise. The main causes of compression of the brain:
Intracranial hematoma;
Depressed fracture of the skull bones;
Brain swelling;
Subdural hygroma.
The main clinical symptoms of cerebral compression:
Paresis of the limbs (contralateral hemiparesis);
Anisocoria (homolateral mydriasis);
Bradycardia;
- “bright” interval - improvement in the child’s condition after injury followed by deterioration (“bright” interval can last from several minutes to several days).
Differential diagnosis
Traumatic brain injuries are differentiated from brain tumors, hydrocephalus, cerebral aneurysms, inflammatory diseases of the brain and its membranes, poisoning, coma due to diabetes mellitus.
Urgent Care
It is necessary to monitor ABC parameters, begin oxygen therapy with an air mixture containing 60-100% oxygen, and apply a cervical collar (if a cervical spine injury is suspected).
In case of deep and extreme coma, the trachea should be intubated after intravenous administration of a 0.1% atropine solution (the dose is determined at the rate of 0.1 ml for each year of the child’s life, but not more than 1 ml).
In deep coma and when signs of hypoxemia appear, mechanical ventilation is performed.
In extreme coma, mechanical ventilation is performed in the mode of moderate hyperventilation.
When systolic blood pressure decreases below 60 mm Hg. Art. begin infusion therapy.
When a diagnosis of brain contusion is made, measures are taken to prevent and treat cerebral edema:
In the absence of hypertension, dexamethasone (0.6-0.7 mg/kg body weight) or prednisolone (5 mg kg body weight) is administered intravenously or intramuscularly;
In the absence of arterial hypotension and symptoms of cerebral compression, furosemide (1 mg/kg body weight) is administered intravenously or intramuscularly.
If the victim develops a convulsive syndrome, psychomotor agitation or hyperthermia, therapy is carried out according to the recommendations for the treatment of these conditions.
Hemostatic therapy is indicated: 1-2 ml of ethamsylate solution is administered intravenously or intramuscularly.
For pain relief, drugs are used that do not depress the respiratory center (tramadol, metamizole sodium) or that depress the respiratory center (narcotic analgesics are indicated for combined trauma), but with mandatory mechanical ventilation:
Trimeperidine is administered intravenously at the rate of 0.1 ml for each year of life (you must be prepared for tracheal intubation and mechanical ventilation, as respiratory depression is possible);
Tramadol is administered intravenously at the rate of 2-3 mg/kg body weight, or a 50% solution of metamizole sodium at the rate of 0.1 ml for each year of the child’s life (10 mg/kg body weight).
Indications for hospitalization
All symptoms of traumatic brain injury in children are variable, which requires careful hourly monitoring. Therefore, all children with suspected traumatic brain injury (even if there is only anamnestic indication of injury, and there are no clinical manifestations) must be hospitalized in a hospital with a neurosurgical and intensive care unit.
CONVIVUS SYNDROME
Classification
Seizures as a nonspecific reaction of the brain to various damaging factors (fever, infections,
injury, vaccination, intoxication, metabolic disorders, etc.).
Symptomatic seizures in diseases of the brain (tumors, abscesses, congenital anomalies, arachnoiditis, hemorrhages, cerebral palsy).
Convulsions in epilepsy.
Convulsions can be local or generalized (convulsive seizure).
Status epilepticus refers to repeated seizures without full recovery of consciousness, accompanied by respiratory and hemodynamic disturbances and the development of cerebral edema.
Treatment
Urgent Care
General events.
Ensure airway patency.
Inhalation of humidified oxygen is carried out.
Measures are taken to prevent head and limb injuries, tongue biting, and aspiration of vomit.
Drug therapy.
A 0.5% solution of diazepam is administered intravenously or intramuscularly at the rate of 0.1 ml/kg of the child’s body weight, but not more than 2 ml at a time. With a short-term effect or incomplete relief of convulsive syndrome, diazepam is re-administered after 15-20 minutes at a dose of 2/3 of the initial one. The total dose of 0.5% diazepam solution should not exceed 4 ml.
In case of incomplete relief of seizures, a 20% sodium oxybate solution is additionally prescribed. The drug is diluted in a 10% glucose solution and administered slowly intravenously or intramuscularly at the rate of 80-100 mg/kg body weight (0.3-0.5 ml/kg).
In the absence of a pronounced effect, an additional 0.25% solution of droperidol is administered at the rate of 0.05 ml/kg body weight (intravenously), or 0.1-0.2 ml/kg body weight (intramuscular).
If status epilepticus continues, doctors from a specialized emergency medical team can transfer the child to mechanical ventilation and hospitalize him in the intensive care unit.
Additional events
In case of convulsive syndrome with persistent impairment of consciousness, furosemide (1-2 mg/kg body weight) and prednisolone (3-5 mg/kg body weight) are administered intravenously or intramuscularly to prevent cerebral edema or in the presence of hydrocephalus.
For febrile convulsions, a 50% solution of metamizole sodium is administered intramuscularly at the rate of 0.1 ml for each year of life (10 mg/kg of body weight) and a 2.5% solution of promethazine at the rate of 0.1 ml for each year of the child’s life.
If you refuse hospitalization after stopping the seizures, you must actively visit the child with an emergency (emergency) doctor after 3 hours.
For hypocalcemic convulsions, a 10% calcium gluconate solution is slowly administered intravenously at the rate of 0.2 ml/kg body weight (the drug is first diluted 2 times with a 20% glucose solution).
For hypoglycemic convulsions, a 20% glucose solution is injected intravenously at a rate of 1.0 ml/kg body weight. Subsequently, the child is hospitalized in the endocrinology department.
Indications for emergency hospitalization
Infant.
Febrile seizures.
Convulsions of unknown origin.
Convulsions due to an infectious disease.
After stopping seizures with a confirmed diagnosis of epilepsy or other organic damage to the central nervous system, the child can be left at home.
Forecast
A prognostically unfavorable sign is an increase in the depth of disturbance of consciousness and the appearance of paresis and paralysis after convulsions.
Note
When anticonvulsants are used in infants and status epilepticus, respiratory arrest may occur. If there is a threat of respiratory arrest due to intractable convulsions, it is necessary to call a pediatric intensive care ambulance team, transfer the child to mechanical ventilation and transport to a hospital (intensive care unit).
HYPERTENSIVE-HYDROCEPHAL
SYNDROME
Etiology
Hypertension syndrome caused by increased intracranial pressure due to perinatal or traumatic damage to the nervous system or infectious disease.
Hypertensive-hydrocephalic syndrome more often it turns out to be a consequence of hypertension syndrome, when symptoms of dilation of the liquor ducts are added.
Clinical picture
Tension or bulging of the large fontanel.
Dilatation of the saphenous veins of the head.
Child's anxiety.
Intermittent sleep.
Regurgitation.
Muscle hypertonicity.
Tremor of the limbs, chin.
Hyperreflexia.
Positive Graefe's sign.
In hypertensive-hydrocephalic syndrome, the symptoms of hypertension syndrome include:
Pathological increase in head size and fontanel size;
Dehiscence of cranial sutures;
Often the child's "brain scream";
Symptom of "setting sun";
Exophthalmos;
Nystagmus;
Strabismus;
Violation of thermoregulation;
Decreased vision.
When percussing the skull, the “cracked pot” phenomenon can be detected.
Neurosonography and MRI of the brain reveal:
Ventriculomegaly;
Expansion of subarachnoid spaces.
Urgent Care
General activities:
It is necessary to give an elevated position to the child's head;
Oxygen therapy should be administered.
Dehydration therapy:
A 1% solution of furosemide is administered intramuscularly at the rate of 0.1 ml/kg body weight per day;
Acetazolamide is prescribed at 40 mg/kg body weight per day;
A 3% solution of potassium and magnesium aspartate and potassium chloride is administered.
Hospitalization in a neurological or neurosurgical department in case of decompensation of the child’s condition.
Chapter 5
Emergency conditions in otorhinolaryngology
NOSE BLEEDINGS
Diagnostics
Differential diagnosis
Nosebleeds must be distinguished from bleeding from varicose veins of the esophagus, pulmonary and gastrointestinal bleeding.
Urgent Care
It is necessary to give the patient an upright position.
Turunda should be administered with 6-8 drops of 0.01% naphazoline solution or 3% hydrogen peroxide solution, then press the wing of the nose to the septum for several minutes. For hemostasis, a hemostatic sponge can be used.
After stopping the bleeding, it is necessary to re-examine the oropharyngeal cavity. Tampons should not be removed. The patient (his parents) should be advised to consult an ENT doctor to remove tampons and a pediatrician to exclude somatic diseases.
Hospitalization
A patient with ongoing bleeding must be hospitalized in a multidisciplinary hospital in a sitting position or with the head end of the stretcher raised.
NOSE BOIL
Diagnostics
Fever ranges from low-grade to high.
Symptoms of general intoxication.
Limited infiltration.
Hyperemia.
Boils most often occur on the tip of the nose, in the vestibule and the area of the bottom of the nasal cavity. The appearance of a boil may be accompanied by swelling of the eyelid, lip or cheek.
Urgent Care
Intravenous 5000 units of sodium heparin.
Hospitalization
It is necessary to transport the patient to the on-duty otolaryngology department or a multidisciplinary hospital.
PARATONZILLITIS
Synonym
Peritonsillar abscess.
Diagnostics
The patient's condition is usually serious.
A sore throat;
Difficulty swallowing or inability to open your mouth completely due to trismus;
Pharynx asymmetry;
Deviation and swelling of the uvula;
Hypersalivation;
Regional lymphadenitis;
High fever;
Symptoms of general intoxication.
Urgent Care
At the prehospital stage, the patient can be given:
Intramuscularly 50% solution of metamizole sodium at the rate of 0.1 ml for each year of the child’s life;
Intramuscularly 1% solution of promethazine.
Hospitalization
Patients with peritonsillar abscess must be hospitalized in the otolaryngology department or a multidisciplinary hospital.
REPHARRYNGEAL ABSCESS
Epidemiology
More often develops in young children.
Diagnostics
In the clinical picture, attention is drawn to:
Fever;
Intoxication;
Difficulty breathing, worse in a horizontal position;
Bulging of the posterior wall of the pharynx, which is manifested by symptoms of laryngeal stenosis;
Hyperemia of the mucous membrane of the pharynx and posterior pharyngeal wall;
Enlargement and pain on palpation of the maxillary and lateral cervical lymph nodes;
Forced position of the head with deviation towards the abscess.
Complications
The course of the abscess can be complicated by the development of laryngeal stenosis, mediastinitis, thrombosis of the internal jugular vein, and sepsis.
Urgent Care
If there is a threat of development of stenosis, the abscess cavity is punctured and the contents are aspirated, the airway is restored.
Hospitalization
Patients with a retropharyngeal abscess should be hospitalized in a sitting position in an otorhinolaryngology department or a multidisciplinary hospital.
ACUTE OTITIS
Diagnostics
In the clinical picture, attention is drawn to:
Body temperature up to 38-39 °C;
Earache;
Hearing loss;
Noise in the ear;
In children of the first year of life - dyspeptic syndrome, bulging fontanel, anxiety, sleep disturbance, the appearance of symptoms of irritation of the meninges;
Purulent discharge from the ear canal;
Pain, screaming and restlessness when pressing on the tragus.
Urgent Care
At the prehospital stage, the patient can be given:
Intramuscularly 50% solution of metamizole sodium at the rate of 0.1 ml for each year of the child’s life;
Intramuscularly 1% solution of promethazine;
In the first stage of otitis:
It is necessary to instill vasoconstrictor drops into the nose (5-8 drops of 0.05% naphazoline solution);
You should apply a source of dry heat and make a warm compress on the ear area.
For ear pain not accompanied by perforation of the eardrum, 4 drops of Otipax* solution (lidocaine + phenazone) should be instilled into the ear.
When pathological discharge appears, a sterile turunda is inserted into the ear canal.
Hospitalization
It is necessary to urgently hospitalize the patient in the otorhinolaryngology department or a multidisciplinary hospital.
Chapter 6
Acute poisoning
Classification
. Parenteral(subcutaneous, intramuscular, intravenous route of entry of poison into the body) - rapid development of clinical signs (minutes), often of an iatrogenic nature.
. Inhalation- rapid development of clinical signs (from minutes to hours), often pose a danger to those providing assistance (often there are several victims).
. Enteral- average in terms of the speed of development of clinical signs (from hours to days), there may be several victims.
. Percutaneous(and through the mucous membranes) - slow in the rate of development of clinical signs (from hours to several days), often of a cumulative nature.
Features of poisoning in children
The most common reason is carelessness.
Often no one knows what and how much the child ate.
The taste parameters of substances are not significant for a child.
Children often hide information about a toxic substance, focusing on the reaction of adults.
Classification
According to the severity of poisoning, they are distinguished:
Mild poisoning - vital functions are not impaired;
Moderate poisoning - vital functions are impaired, but life-threatening conditions do not develop;
Severe poisoning - life-threatening conditions develop.
Clinical picture
Central nervous system dysfunction - changes in behavior, depression of consciousness, psychomotor agitation, hallucinations, delirium, convulsions, changes in reflexes (pupillary, cough, swallowing, corneal).
Changes in the cardiovascular system - tachycardia, bradycardia, arrhythmias, acute vascular failure, acute left and (or) right ventricular heart failure, arterial hypotension or hypertension.
Respiratory system dysfunctions - tachypnea, bradypnea, pathological types of breathing, pulmonary edema.
Changes in color and moisture of the skin and mucous membranes.
Dysregulation of muscle tone.
Nausea, vomiting, changes in peristalsis.
Signs of liver or kidney failure.
Diagnostics
Anamnesis
When collecting anamnesis, it is extremely important to find out from the child or his parents:
Name of the toxic substance, its quantity;
Route of administration;
The time elapsed from the moment the substance enters the body until examination;
The time elapsed from the moment of contact of the substance with the body until the first signs of poisoning appear;
The nature and rate of change in clinical signs of poisoning;
Assistance provided before the doctor arrived;
In case of enteral poisoning, the time of the last meal and its nature.
Urgent Care
ABC control, maintenance (restoration) of vital functions.
Removing unabsorbed poison:
The poison is washed off from the skin and mucous membranes with running water;
From the conjunctiva (cornea), 0.9% sodium chloride solution should be used to wash off the poison;
In case of enteral poisoning, it is necessary to perform gastric lavage, and before the arrival of the emergency medical team, vomiting should be induced by pressing on the root of the tongue (vomiting should not be induced in patients in stupor and coma, in case of poisoning with irritating liquids, petroleum products).
Tube gastric lavage is a mandatory procedure if enteral poisoning is suspected. carried out within 24 hours from the moment of poisoning.
In case of inhalation poisoning by volatile substances, it is necessary to remove the victim from the affected area as soon as possible, achieve independent adequate breathing, or begin mechanical ventilation (including manual ventilation with an AMBU bag).
Gastric tube lavage technique
During tube gastric lavage, the patient should sit; if consciousness is impaired, lie with his head turned to one side.
The depth of insertion of the probe is determined by the distance from the incisors to the xiphoid process or by the gas outlet from the probe.
Water at room temperature is used as a washing liquid; for children under one year of age, a 0.9% sodium chloride solution is used.
The amount of liquid for rinsing is determined at the rate of 1 liter for each year of the child’s life (up to clean water), but not more than 10 liters. For children under one year old, the amount of fluid administered is determined at the rate of 100 ml/kg body weight, but not more than 1 liter.
After gastric lavage, enterosorbent is administered through a tube (hydrolytic lignin - 1 teaspoon for each year of life).
In case of deep coma development (before suppression of the cough reflex) and other life-threatening conditions, tracheal intubation is performed before gastric tube lavage.
If poisoning with cholinomimetics is suspected, as well as bradycardia, atropinization is performed before gastric lavage (a 0.1% atropine solution is administered at the rate of 0.1 ml per year of the child’s life, for children under one year of age - 0.1 ml).
Oxygen therapy
Patients are allowed to breathe with a humidified air mixture (30-60% oxygen, and if signs of cardiovascular or respiratory failure develop - 100% oxygen).
Antidote therapy
The antidote is used only when the nature of the toxic substance and the corresponding clinical picture are precisely established.
In case of poisoning with organophosphorus substances, atropinization is carried out (0.1% atropine solution is administered intravenously or intramuscularly) until the patient’s pupils dilate.
In case of poisoning with iron-containing drugs, deferoxamine is administered intravenously or intramuscularly at the rate of 15 mg/kg body weight.
In case of clonidine poisoning, metoclopramide should be administered intravenously or intramuscularly at the rate of 0.05 ml/kg body weight, but not more than 2.0 ml.
In case of poisoning with anticholinergic drugs, it is necessary to administer aminostigmine intravenously or intramuscularly at the rate of 0.01 mg/kg body weight.
In case of poisoning with haloperidol-containing drugs, the patient is given trihexyphenidyl orally at the rate of 0.1 mg for each year of life.
Features of emergency care
When performing mouth-to-mouth or mouth-to-mouth/mouth-to-nose ventilation, the resuscitator should take precautions to prevent poisoning from the inhaled substance that poisoned the victim. You should breathe through a gauze cloth moistened with water.
Do not use the telephone, electric bell, lighting, or light matches in a room where there is a smell of gas - this may cause a fire or explosion.
When providing assistance to more than one person, the unconscious victim(s) must not be left in a position in which airway obstruction may occur. If it is not possible to maintain airway patency using special devices and methods (air ducts, intubation, etc.), then the victim(s) are placed in a “stable position on the side.”
Indications for hospitalization
All children with suspected acute poisoning require hospitalization.
Children give us a lot of joy, but sometimes they can shock their parents. We are talking not only about injuries, but also about such conditions when a son or daughter urgently needs medical help. The task of parents is to have basic medical knowledge and the ability to provide first aid to the child before the ambulance arrives.
Cardiac emergencies in children
These very serious illnesses require a very quick response, because sometimes we are talking about minutes to save a child’s life:
- Syncope (fainting) . This condition is familiar to everyone as loss of consciousness. And often its cause in a child is disturbances in the functioning of the cardiovascular system (paroxysmal tachycardia, severe bradycardia, thromboembolism, aortic stenosis). In such cases, syncope may occur after cessation of physical activity, especially in a warm room. First aid in this condition before the doctor arrives is to provide an influx of fresh air, a cold compress on the forehead, and rubbing the earlobes. When the young patient regains consciousness, he must be given the medicine prescribed by the attending physician.
- Tetralogy of Fallot . This is the name for a complex congenital heart defect with several developmental anomalies. Its main manifestations are the baby's shortness of breath from the first months and cyanosis of the skin. If the course of the defect is severe, then it is manifested by an attack of shortness of breath, convulsions, and short-term loss of consciousness. All young patients with tetralogy of Fallot urgently need surgical treatment. During an attack that begins with anxiety, you must immediately call an ambulance, try to calm the child down, provide him with an influx of fresh air, preferably inhalation of humidified oxygen. It is necessary to administer rheopolyglucin or aminophylline and glucose intravenously.
- Aortic stenosis . With this cardiac disease, children from an early age experience shortness of breath, pale skin, and tachycardia. From the age of 5-7 they complain of heart pain, dizziness and headaches. If fainting occurs during physical exertion (which is generally prohibited for such children), the child must be provided with fresh air and urgently call a doctor. Treatment of aortic stenosis is surgical.
- Hypertension . The disease very rarely manifests itself in childhood. But high blood pressure can be a sign of kidney disease or endocrine system disease. This means that childhood hypertension in most cases is secondary. And when a child is diagnosed with high blood pressure, it is worth putting him to bed, ensuring rest, and giving folk remedies to lower blood pressure. This is chokeberry or viburnum, a hot heating pad applied to the feet. After normalizing the pressure, it is necessary to undergo a thorough diagnosis and determine the cause of the increase in pressure in the child. Sometimes it is too much mental and physical stress, hormonal disorders in adolescence.
Emergency conditions in children in gastroenterology
Children sometimes experience esophageal burns when swallowing acids or alkalis. Their symptoms are anxiety, cough, black vomit in case of alkali poisoning, green vomit in case of hydrochloric acid burns. First aid in this case is to give the patient milk to drink. Even if the baby is bleeding, you should rinse the stomach with plenty of water. Next, you need to apply a neutralizing solution. For an acid burn, this is baking soda, chalk, magnesium. When alkaline - citric acid.
Often the reason for visiting a doctor is attacks of biliary dyskinesia. This is a manifestation of dull pain in the right hypochondrium, with nausea, sometimes with vomiting. Antispasmodics are used to relieve pain. You can use no-shpu, mebeverine, spasmomen orally. Sedatives in the form of valerian and seduxen are also recommended.
When children develop hepatic colic, analgesics and antispasmodics are administered. For prolonged pain, applying cold to the area of the right hypochondrium, intravenous aminophylline, and novocaine blockade will be effective.
Emergency conditions in children with acute intestinal infections
Most often, among intestinal diseases, it is infections that require emergency care. First, the sick person feels unwell, then the temperature rises, nausea occurs, and sometimes vomiting. The stool becomes frequent and pasty, even watery.
At the stage before hospitalization, you should rinse the stomach with a solution of soda or saline, do a cleansing enema, and prescribe a water-tea break with electrolytes for 6 hours. If the patient’s intoxication is too severe, then an isotonic solution of sodium chloride is administered and glucose-potassium droppers are placed. But this is already in a hospital setting.
Emergency conditions in children in neurology
Epilepsy is seizures that recur in a child with loss of consciousness.
It is urgent to ensure airway patency by holding a hard object between the patient’s teeth. It is also necessary to protect the child so that he does not hit his head on a hard surface. The use of benzodiazepines is required for early control of seizures. If such attacks are not occurring for the first time, then it is possible to use thiopental.
Acute paralysis of the respiratory muscles in children may be associated with damage to the respiratory center. A young patient with expected respiratory failure needs to be placed on assisted breathing.
Convulsive syndrome
This condition may be a nonspecific reaction of the brain to damaging factors. Among them are infections, fever, vaccination, intoxication of the body.
Seizures may be symptomatic in brain tumors and cerebral palsy.
In epilepsy, seizures can be local or generalized. In this case, inhalation of humidified oxygen is necessary. To relieve such seizures, diazepam is usually administered intramuscularly. Its calculation is 0.1 ml per kilogram of the child’s body weight.
Emergency conditions in children with respiratory diseases
False croup is suffocation that occurs in a baby when the larynx narrows. Its cause is most often acute respiratory infections or allergies. The mucous membrane of the throat becomes inflamed and swollen, and attacks of suffocation most often occur in children in the evening, when a dry “barking” cough increases. Inhalation becomes noisy because it is difficult for the child to breathe, the child gets scared, cries, and blushes. First aid in this case is to calm the baby, turn on hot water in the bathroom so that the child can breathe steam. Pulmicort or Benacort may be used. They will effectively eliminate inflammation.
Epiglotitis in a child is characterized by fever, severe sore throat, and severe dysphagia. First aid in this case consists of antipyretic therapy with paracetamol or ibuprofen, and then the young patient is hospitalized in a sitting position and antibacterial therapy is administered in the form of chloramphenicol intramuscularly.
Acute laryngotracheitis in children is accompanied by the development of acute respiratory failure and laryngeal stenosis. The attacks are characterized by shortness of breath and difficulty breathing air. Emergency care consists of reducing the edematous component of the larynx and inhaling a solution of naphazoline. The most convenient way to do this is to use a nebulizer. If this is not possible, then it is necessary to inject naphazoline into one nostril of the child in a sitting position.
Emergency conditions in children in traumatology
Traumatic brain injuries occur very often in children. They are accompanied by impaired consciousness, vomiting, nausea, and headaches. If such an injury compresses the baby’s brain, then there is a smoothness of the nasolabial fold, decreased reflexes, and bradycardia.
Emergency assistance in this case is to ensure rest, insert a probe into the stomach to prevent aspiration. If the child is unconscious, then he should be placed on his right side and a solution of droperidol or seduxen should be administered intramuscularly. The victim is hospitalized in a surgical hospital.
Sprains in children occur more often than other injuries. In such cases, it is necessary to apply ice and a tight bandage to the damaged area.
With fractures of the limbs, swelling spreads much faster than with sprains. A leg or arm may be deformed. First aid - applying a splint and fixing the limb. If the fracture is open, then it is necessary to apply an aseptic bandage to the wound.
With traumatic shock, the child may experience loss of consciousness. In this case, a 1% solution of promedol is administered at a dosage of 0.1 ml per year of life, and a 1% solution of diphenhydramine. Then the victim is provided with plenty of fluids.
Hyperthermic syndrome
This condition in children is characterized by a persistent increase in temperature above 38.5°C, despite the use of antipyretic drugs. In such cases, the child should be placed in a ventilated area and undressed. His skin must be wiped with 30% alcohol. Then he is injected with a lytic mixture.
If, during hyperthermic syndrome, agitation is strongly expressed or convulsions occur, then a 0.25% solution of droperidol is administered intramuscularly to the sick baby.
Hospitalization of the child is mandatory if there is no result from the measures taken. If there is an effect, then it is recommended to place the patient in a hospital if he has chronic diseases.
Especially for - Diana Rudenko
T. V. Pariyskaya, O. A. Borisova, O. A. Zhiglyavskaya, A. E. Polovinko
Emergency conditions in children. Latest Directory
Preface
Emergency and emergency pediatricians and general practitioners need reference literature that allows them to quickly navigate issues of diagnosis and treatment of childhood diseases, especially when providing emergency medical care to a seriously ill child. In the domestic literature, the problems of emergency care are not fully represented. Information published in translated foreign literature on this issue does not always correspond to the realities of domestic healthcare.
This short reference book on emergency conditions in children is presented to our readers and is written on the basis of our own extensive clinical experience and analysis of modern literature. The reference book is based not so much on a syndromic approach, but mainly on the nosological principle of presenting clinical material. This made it possible to comprehensively cover the problems of etiology, pathogenesis, clinical picture and treatment of the most common somatic diseases of childhood, especially their severe forms, and at the same time pay special attention to the provision of emergency care.
Chapter I examines the main methods and approaches to diagnosing diseases, the most common and informative, allowing you to quickly and correctly approach the diagnosis, assess the severity of the patient’s condition and choose the optimal treatment methods. The semiotics of individual nosological syndromes, their diagnosis, emergency care and treatment are also described. Particular attention is paid to severe, life-threatening conditions such as respiratory failure, circulatory failure, acute renal, liver failure, convulsive and other syndromes. The main diagnostic signs of emergency conditions, the main directions of differential diagnosis, and a list of minimally sufficient treatment measures are given.
Chapter II is devoted to diseases of children in the neonatal period. It examines the issues of diagnosis and treatment of the most common skin diseases, the umbilical wound. Much attention is paid to the diagnosis and treatment of the most serious disease – neonatal sepsis.
Chapters III–X contain information about common somatic diseases in children. Diagnosis, intensive care and physician tactics for pathological processes accompanied by airway obstruction (bronchial asthma, bronchiolitis, croup) are discussed in detail. From a modern perspective, the treatment of arrhythmia in children is outlined, attention is drawn to the need for careful diagnosis using ECG, since treatment clearly depends on the nature of the rhythm disturbances. Effective measures for ventricular arrhythmias may have a negative effect for supraventricular arrhythmias, and vice versa.
Chapter III discusses one of the current problems of pediatrics - respiratory distress syndrome, its pathogenesis, and approaches to therapy.
Chapter VIII briefly outlines the physiological mechanisms of blood coagulation and describes in sufficient detail, along with hemorrhagic diathesis, DIC syndrome, its diagnosis, clinical picture and emergency care.
Chapters XI–XII provide descriptions of the clinic and first aid for snake bites and recommendations for emergency care in cases of local and general hypothermia and overheating.
Chapter XIII provides a list of pharmacological drugs used in emergency care and intensive care, gives their brief characteristics, age-specific doses for children and methods of their use.
We hope that the emergency aid guide will be useful to emergency and emergency pediatricians and other specialists providing emergency care to children. The authors will gratefully accept comments and suggestions for its further improvement.
Semiotics and diagnosis of somatic diseases in children
General semiotics
The fundamental methods for diagnosing many diseases and assessing the characteristics of their treatment are a carefully and purposefully collected anamnesis and a systematically conducted clinical examination of a sick child.
Data from laboratory tests and instrumental examinations (x-ray, endoscopic, electrocardiographic, ultrasound, etc.) make it possible to confirm the diagnosis and more fully present the development of the disease.
The diagnostic capabilities of laboratory and instrumental examination methods are constantly expanding, the amount of information received is increasing, but their results should be assessed only in comparison with clinical examination data obtained through personal contact between the doctor and the patient.
The anamnesis includes the patient’s complaints, the history of the onset and development of the present disease, the history of the child’s growth and development, family history and the child’s living conditions.
The history of the disease should contain information about when the child fell ill, under what circumstances and how the disease developed, how it proceeded, what complaints there were, what manifestations of the disease were (fever, chills, rash, shortness of breath, vomiting, anxiety, etc.) , and their changes in dynamics. If the child received treatment, then what medications, for how long (this is especially important to clarify with regard to the use of antibiotics, hormonal drugs, diuretics), their effectiveness and possible undesirable consequences (allergic reactions, etc.).
The life history includes information about the parents (age, health status, living conditions, etc.), the neonatal period, infancy, preschool, and school periods. The younger the child, the more detailed the details of early childhood are usually revealed. To characterize the neonatal period, the features of the course of pregnancy, childbirth, indicators of the physical development of the newborn, the timing of the umbilical cord falling off, the closure of the umbilical wound, etc. are clarified. When characterizing the infancy period, much attention is paid to feeding the child, psychomotor and physical development. In the life history of older children, it is advisable to reflect the characteristics of their behavior at home, in a group, academic performance at school, physical education, and sports.
Data on past diseases, the characteristics of their course, treatment, the presence of exudative diathesis and other manifestations of allergies, information on preventive vaccinations, their timing, reactions to them, tuberculin tests and their results are clarified in detail.
The child’s living conditions, the presence of unfavorable factors (insufficient exposure to air, prolonged viewing of television, irregular nutrition, parental smoking, etc.) are clarified.
For a number of diseases, a genealogical history is necessary.
Objective examination
An objective examination includes data obtained during inspection, palpation, percussion, and auscultation. It begins with an assessment of the patient’s well-being and condition.
Assessment of well-being is carried out by asking the mother or child about pain that bothers him, other unpleasant sensations, sleep, and appetite. The state of health can be assessed as quite satisfactory or unsatisfactory.
A conclusion about the patient’s condition is given not only on the basis of an assessment of his well-being, but mainly on the basis of data obtained during clinical, laboratory and instrumental examinations. The condition can be assessed as satisfactory, moderate, severe and terminal.
An examination of a child of any age includes an assessment of his physical and psychomotor development.
If the patient is in bed, pay attention to his position. In some diseases, children take a forced position (with a severe attack of bronchial asthma, severe circulatory failure, patients feel better in a sitting position with their legs down).
Inspection it is necessary to start with assessing the condition of the skin and mucous membranes of the lips, oral cavity, and tongue. The color of the skin, the presence of rashes, hemorrhages, swelling and other pathological manifestations are of great importance in the diagnosis of many diseases.
The skin of a healthy child is pale pink, soft, elastic.
Pale skin- one of the common symptoms observed in many diseases - anemia, intoxication, cardiovascular pathology, vegetative-vascular dystonia, etc.
Skin cyanosis– a bluish or blue color of the skin that occurs when the saturation of hemoglobin with oxygen decreases. It is observed in cases of impaired pulmonary ventilation (pneumonia, foreign bodies in the respiratory tract, croup, bronchial asthma, etc.), the presence of pathological shunts between the right and left parts of the heart, between arteries and veins, in which venous blood enters the arterial bed, bypassing the lungs ( congenital heart defects - tetralogy of Fallot, truncus arteriosus, etc.), cardiovascular failure, increased concentration of hemoglobin in the blood (polycythemia).
