Emergency medical care in emergency conditions. Lectures on first aid in emergencies

AT Everyday life: at work, at home, during outdoor recreation, unforeseen situations occur and injury occurs. In such situations, it is important not to get confused by others and help the victim. What is the order in which urgent first aid is provided? health care(PMP), everyone should know, because a person's life can depend on knowledge and skills.

What is first aid

The complex of urgent measures for PHC is aimed at saving lives and alleviating the condition of the victim in case of accidents or sudden illnesses. Such activities are carried out at the scene by the injured or bystanders. From the quality of timely delivery emergency assistance the further condition of the victim strongly depends.

To save the victim, a first-aid kit is used, which should be at work, in educational institutions, in cars. In its absence, improvised materials are used. An individual first-aid kit includes standard equipment:

Assistance materials: arterial tourniquet, bandage, cotton wool, limb immobilization splints.
Medications: antiseptics, validol, ammonia, soda tablets, petroleum jelly and others.

Types of first aid

Depending on the type of qualification of medical personnel, the place of emergency medical measures, assistance to the victim is classified:

First aid. Unskilled workers are provided at the scene until the ambulance arrives.
First aid. Provided by a medical worker (nurse, paramedic) at the scene, at the feldsher-obstetric station, in an ambulance.
First aid. Provided by doctors necessary tools in the ambulance, emergency room, emergency rooms.
Qualified medical care. Carried out in a hospital medical institution.
Specialized medical care. Doctors provide a complex of medical measures in specialized medical institutions.

First aid rules

What do first aid victims need to know? In case of accidents, it is important for others not to get confused, to quickly and smoothly carry out the necessary measures. To do this, one person must issue commands or perform all actions independently. The first aid algorithm depends on the type of damage, but there are general rules behavior. The lifeguard needs:

Make sure that he is not in danger and proceed with the necessary measures.
Perform all actions carefully so as not to worsen the patient's condition.
Assess the situation around the victim, if he is not in danger - do not touch until examined by a specialist. If there is a threat, it must be removed from the lesion.
Call an ambulance.
Check the presence of the victim's pulse, breathing, pupillary reaction.
Take measures to restore and maintain vital functions before the arrival of a specialist.
Protect the victim from cold and rain.

Help

The choice of necessary measures depends on the condition of the victim and the type of injury. To restore vital functions, there is a set of resuscitation measures:

Artificial respiration. Produced at sudden stop breathing. Before carrying out, it is necessary to clean the mouth and nose from mucus, blood, trapped objects, apply gauze bandage or a piece of cloth on the victim's mouth (to prevent infection) and throw back his head. After pinching the nose of the patient with the thumb and forefinger, quick exhalations are made from mouth to mouth. The movement of the chest of the victim indicates the correct conduct of artificial respiration.
Indirect cardiac massage. It is done in the absence of a pulse. It is necessary to lay the victim on a hard, flat surface. The base of the palm of one hand of the rescuer is placed just above the narrowest part of the victim's sternum and covered with the other hand, the fingers are raised and quick jerky pressures are applied to the chest. Heart massage is combined with artificial respiration - two mouth-to-mouth exhalations alternate with 15 pressures.
The imposition of a tourniquet. It is produced to stop external bleeding in case of injuries that are accompanied by vascular damage. A tourniquet is applied to the limb above the wound, and a soft bandage is placed under it. In the absence of a personal means, stop arterial bleeding you can use a tie, scarf. Be sure to record the time the tourniquet was applied and attach it to the victim's clothing.

Stages

Post-accident first aid includes the following steps:

Elimination of the source of damage (power outage, analysis of the blockage) and evacuation of the victim from the danger zone. Provide surrounding faces.
Carrying out measures to restore the vital functions of the injured or sick. Persons with the necessary skills can perform artificial respiration, stop bleeding, and heart massage.
Transportation of the victim. Mostly carried out by ambulance in the presence of a medical worker. He must provide correct position patient on a stretcher and on the road, to prevent the occurrence of complications.

How to provide first aid

During the provision of medical care it is important to follow the sequence of actions. It should be remembered:

The provision of first aid to the victims should begin with resuscitation measures - artificial respiration and heart massage.
If there are signs of poisoning, induce vomiting with a large volume of water and allow to take Activated carbon.
When fainting, give the victim a sniff of ammonia.
With extensive injuries, burns, an analgesic should be given to prevent shock.

For fractures

There are cases when fractures are accompanied by injuries, damage to the arteries. When providing PMP to the victim, the following sequence of actions must be observed:

stop bleeding with a tourniquet;
disinfect and bandage the wound with a sterile bandage;
immobilize the injured limb with a splint or improvised material.

With dislocations and sprains

In the presence of stretching or damage to tissues (ligaments), there is observed: swelling of the joint, pain, hemorrhage. The victim must:

fix the damaged area by applying a bandage with a bandage or improvised materials;
apply cold to the affected area.

With a dislocation, the bones are displaced and observed: pain, joint deformity, restriction motor functions. The patient is immobilized limb:

Dislocation of the shoulder or elbow joint the hand is hung on a scarf or bandaged to the body.
A splint is applied to the lower limb.

For burns

There are radiation, thermal, chemical, electrical burns. Before treating the damage, the affected area should:

free from clothes;
cut off the stuck fabric, but do not tear off.

In case of damage by chemicals, first, the remainder of the chemical is washed off the damaged surface with water, and then neutralized: acid - with baking soda, alkali - acetic acid. After neutralization of chemicals or in case of thermal burns, apply sterile dressing with the help of a dressing medical package after events:

disinfection of lesions with alcohol;
plot irrigation cold water.

When blocking the airways

When foreign objects enter the trachea, a person begins to choke, cough, turn blue. In such a situation, you need:

Stand behind the victim, wrap your arms around him at the level of the middle of the abdomen and sharply bend the limbs. Repeat steps until restart normal breathing.
In case of fainting, you need to put the victim on his back, sit on his hips and put pressure on the lower costal arches.
The child must be placed on the stomach and gently pat between the shoulder blades.

With a heart attack

You can determine a heart attack by the presence of symptoms: pressing (burning) pain in the left side chest or shortness of breath, weakness, and sweating. In such cases, the procedure is as follows:

call a doctor;
open a window;
put the patient to bed and raise his head;
give to chew acetylsalicylic acid and under the tongue - nitroglycerin.

With a stroke

The onset of a stroke is evidenced by: headache, impaired speech and vision, loss of balance, a wry smile. If such symptoms are detected, it is necessary to provide the victim with PMP in the following sequence:

call a doctor;
calm the patient;
give him a semi-lying position;
Turn your head to the side if you are vomiting.
loosen clothing;
provide fresh air;

With heat stroke

Overheating of the body is accompanied by: fever, redness of the skin, headache, nausea, vomiting, increased heart rate. In such a situation, first aid to the victims is carried out in the following order:

move a person into the shade or cool room;
loosen tight clothing
put cold compresses on different parts of the body;
constantly drink cold water.

When hypothermia

The onset of hypothermia of the body is evidenced by the following signs: blue nasolabial triangle, pallor skin, chills, drowsiness, apathy, weakness. The patient must be gradually warmed up. For this you need:

change into dry warm clothes or wrap with a blanket, if possible, give a heating pad;
give hot sweet tea and warm food.

For head injury

Due to trauma to the head, a concussion (closed craniocerebral injury) is possible. The victim has a headache, dizziness, nausea, vomiting, sometimes loss of consciousness, impaired breathing and cardiac activity. In a skull fracture, damage to the brain from bone fragments can occur. A sign of this condition is: the outflow of a clear liquid from the nose or ear, bruising under the eyes. In case of a head injury, the actions should be as follows:

Check pulse and respiration and, if absent, perform resuscitation.
Provide the victim with peace in the supine position, head turned to one side.
If there are wounds, they must be disinfected and carefully bandaged.
Transport the victim in a supine position.

Video

Introduction

Anaphylactic shock

Arterial hypotension

angina pectoris

myocardial infarction

Bronchial asthma

Coma states

Hepatic coma. Vomiting "Coffee grounds"

convulsions

poisoning

Defeat electric shock

Renal colic

List of sources used

urgent condition (from Latin urgens, urgent) is a condition that poses a threat to the life of the patient / victim and requires urgent (within minutes-hours, not days) medical and evacuation measures.

Primary requirements

1. Readiness to provide emergency medical care in the proper amount.

Complete set of equipment, tools and medicines. Medical personnel must be proficient in the necessary manipulations, be able to work with equipment, know the doses, indications and contraindications for the use of essential medicines. It is necessary to get acquainted with the operation of the equipment and read manuals in advance, and not in an emergency.

2. Simultaneity of diagnostic and therapeutic measures.

For example, a patient with a coma of unknown origin sequentially intravenously injected with a therapeutic and diagnostic purpose: thiamine, glucose and naloxone.

Glucose - the initial dose of 80 ml of a 40% solution. If the reason coma- hypoglycemic coma, the patient will regain consciousness. In all other cases, glucose will be absorbed as an energy product.

Thiamine - 100 mg (2 ml of 5% thiamine chloride solution) for the prevention of acute Wernicke's encephalopathy (a potentially fatal complication of alcohol coma).

Naloxone - 0.01 mg/kg in case of opiate poisoning.

3. Orientation primarily to the clinical situation

In most cases, lack of time and insufficient information about the patient do not allow to formulate a nosological diagnosis and treatment is essentially symptomatic and/or syndromic. It is important to keep pre-worked out algorithms in mind and be able to pay attention to the most important details necessary for diagnosis and emergency care.

4. Remember about your own safety

The patient may be infected (HIV, hepatitis, tuberculosis, etc.). The place where it turns out urgent care, - dangerous (poisonous substances, radiation, criminal conflicts, etc.) Misbehavior or errors in the provision of emergency care may be a reason for prosecution.

What are the main reasons for the development anaphylactic shock?

It's life threatening acute manifestation allergic reaction. Often develops in response to parenteral administration medicines, such as penicillin, sulfonamides, sera, vaccines, protein preparations, radiopaque substances, etc., and also appears during provocative tests with pollen and less often food allergens. Anaphylactic shock may occur with insect bites.

The clinical picture of anaphylactic shock is characterized by the speed of development - a few seconds or minutes after contact with the allergen. There is depression of consciousness, a fall blood pressure, there are convulsions, involuntary urination. The lightning-fast course of anaphylactic shock ends in death. For most, the disease begins with the appearance of a feeling of heat, flushing of the skin, fear of death, arousal, or, conversely, depression, headache, chest pain, and suffocation. Sometimes laryngeal edema develops according to the type of Quincke's edema with stridor breathing, appear pruritus, rashes, rhinorrhea, dry hacking cough. Blood pressure drops sharply, the pulse becomes thready, can be expressed hemorrhagic syndrome with petechyl eruptions.

How to provide emergency care to the patient?

It is necessary to stop the introduction of drugs or other allergens, apply a tourniquet proximal to the injection site of the allergen. Assistance must be provided locally; for this purpose, it is necessary to lay the patient down and fix the tongue to prevent asphyxia. Inject 0.5 ml of 0.1% adrenaline solution subcutaneously at the site of allergen injection (or at the bite site) and intravenously drip 1 ml of 0.1% adrenaline solution. If blood pressure remains low, after 10-15 minutes, the administration of the adrenaline solution should be repeated. Great importance to remove patients from anaphylactic shock have corticosteroids. Prednisolone should be injected into a vein at a dose of 75-150 mg or more; dexamethasone - 4-20 mg; hydrocortisone - 150-300 mg; if it is impossible to inject corticosteroids into a vein, they can be administered intramuscularly. Introduce antihistamines: pipolfen - 2-4 ml of a 2.5% solution subcutaneously, suprastin - 2-4 ml of a 2% solution or diphenhydramine - 5 ml of a 1% solution. In case of asphyxia and suffocation, inject 10-20 ml of a 2.4% solution of aminophylline intravenously, alupent - 1-2 ml of a 0.05% solution, isadrin - 2 ml of a 0.5% solution subcutaneously. If signs of heart failure appear, introduce corglicon - 1 ml of a 0.06% solution in an isotonic sodium chloride solution, lasix (furosemide) 40-60 mg intravenously rapidly in an isotonic sodium chloride solution. If a allergic reaction developed on the introduction of penicillin, enter 1,000,000 IU of penicillinase in 2 ml of isotonic sodium chloride solution. The introduction of sodium bicarbonate (200 ml of a 4% solution) and antishock liquids is shown. If necessary, resuscitation is carried out, including closed heart massage, artificial respiration, bronchial intubation. With swelling of the larynx, a tracheostomy is indicated.

What are the clinical manifestations arterial hypotension?

With arterial hypotension, there is a headache of a dull, pressing nature, sometimes paroxysmal throbbing pain, accompanied by nausea and vomiting. During a headache attack, patients are pale, the pulse is weak filling, blood pressure drops to 90/60 mm Hg. Art. and below.

2 ml of a 20% solution of caffeine or 1 ml of a 5% solution of ephedrine is administered. Hospitalization is not required.

What is characteristic of pain in the heart caused by angina pectoris?

The most important point in the treatment of angina pectoris is the relief of pain attacks. Pain in angina pectoris is characterized by compressive pain behind the sternum, which may occur either after physical activity(angina pectoris) or at rest (angina at rest). The pain lasts for several minutes and is relieved by taking nitroglycerin.

To relieve an attack, the use of nitroglycerin is shown (2-3 drops of a 1% alcohol solution or in tablets of 0.0005 g). The drug must be absorbed into the oral mucosa, so it should be placed under the tongue. Nitroglycerin causes vasodilation of the upper half of the body and coronary vessels. In the case of the effectiveness of nitroglycerin, pain disappears after 2-3 minutes. If after a few minutes after taking the drug the pain has not disappeared, you can take it again.

With severe prolonged pain, you can enter intravenously 1 ml of a 1% morphine solution with 20 ml of a 40% glucose solution. The infusion is done slowly. Considering that a severe prolonged attack of angina pectoris can be the beginning of myocardial infarction, in cases where intravenous administration of narcotic analgesics is required, 5000-10000 IU of heparin should be administered intravenously together with morphine (in the same syringe) to prevent thrombosis.

An analgesic effect is given by intramuscular injection of 2 ml of a 50% solution of analgin. Sometimes its use allows you to reduce the dose of administered narcotic analgesics, since analgin enhances their action. Sometimes a good analgesic effect is given by the use of mustard plasters on the heart area. Irritation of the skin in this case causes a reflex expansion coronary arteries and improves myocardial blood supply.

What are the main causes of myocardial infarction?

Myocardial infarction - necrosis of a section of the heart muscle, which develops as a result of a violation of its blood supply. immediate cause myocardial infarction is the closure of the lumen of the coronary arteries or the narrowing of an atherosclerotic plaque or thrombus.

The main symptom of a heart attack is a strong compressive pain behind the sternum on the left. The pain radiates to the left shoulder blade, arm, shoulder. Repeated multiple intake of nitroglycerin during a heart attack does not relieve pain, it can last for hours, and sometimes days.

emergency care in acute stage infarction includes, first of all, the removal of a painful attack. If a preliminary repeated intake of nitroglycerin (0.0005 g per tablet or 2-3 drops of 1% alcohol solution) did not relieve the pain, it is necessary to introduce promedol (1 ml of a 2% solution), pantopon (1 ml of a 2% solution) or morphine (1 cl of a 1% solution) subcutaneously, together with 0.5 ml of a 0.1% solution of atropine and 2 ml of cordiamine . If subcutaneous administration of narcotic analgesics did not have an analgesic effect, one should resort to intravenous infusion of 1 ml of morphine with 20 ml of 40% glucose solution. Sometimes anginal pain can be removed only with the help of anesthesia with nitrous oxide mixed with oxygen in a ratio of 4:1, and after the cessation of pain - 1:1. In recent years, fentanyl, 2 ml of a 0.005% solution intravenously with 20 ml of saline, has been used to relieve pain and prevent shock. Together with fentanyl, 2 ml of a 0.25% solution of droperidol is usually administered; this combination allows you to enhance the analgesic effect of fentanyl and make it last longer. The use of fentanyl shortly after the administration of morphine is undesirable due to the risk of respiratory arrest.

The complex of urgent measures in the acute stage of myocardial infarction includes the use of drugs against acute vascular and heart failure and direct-acting anticoagulants. With a slight decrease in blood pressure, sometimes enough cordiamine, caffeine, camphor, injected subcutaneously. A significant drop in blood pressure (below 90/60 mm Hg), the threat of collapse require the use of more powerful tools- 1 ml of 1% mezaton solution or 0.5-1 ml of 0.2% norepinephrine solution subcutaneously. If collapse persists, these drugs should be re-introduced every 1 to 2 hours. In these cases, intramuscular injections are also indicated. steroid hormones(30 mg of prednisolone or 50 mg of hydrocortisone), contributing to the normalization of vascular tone and blood pressure.

What is the general characteristic of an asthma attack?

The main manifestation of bronchial asthma is an asthma attack with dry wheezing audible at a distance. Often an attack of atonic bronchial asthma is preceded by a prodromal period in the form of rhinitis, itching in the nasopharynx, dry cough, and a feeling of pressure behind the sternum. An attack of atonic bronchial asthma usually occurs upon contact with an allergen and quickly ends when such contact ceases.

If there is no effect, administer glucocorticoids intravenously: 125-250 mg of hydrocortisone or 60-90 mg of prednisolone.

What are the manifestations and causes of collapse?

Collapse is an acute vascular insufficiency, which is manifested by a sharp decrease in blood pressure and a disorder of the peripheral circulation. The most common cause of collapse is massive blood loss, trauma, myocardial infarction, poisoning, acute infections, etc. Collapse can be the direct cause of the patient's death.

The appearance of the patient is characteristic: pointed facial features, sunken eyes, pale gray skin color, small drops of sweat, cold bluish extremities. The patient lies motionless, lethargic, lethargic, less often restless; breathing is rapid, shallow, the pulse is frequent, small filling, soft. Arterial pressure falls: the degree of its decrease characterizes the severity of the collapse.

The severity of symptoms depends on the nature of the underlying disease. So with acute blood loss, the pallor of the skin and visible mucous membranes is striking; with myocardial infarction, cyanosis of the skin of the face, acrocyanosis, etc. can often be noted.

When the patient collapses, it is necessary to give a horizontal position (remove pillows from under the head), put heating pads on the limbs. Call a doctor immediately. Prior to his arrival, it is necessary to introduce the patient with cardiovascular agents (cordiamin, caffeine) subcutaneously. As prescribed by the doctor, a set of measures is carried out depending on the cause of the collapse: hemostatic therapy and blood transfusion for blood loss, the introduction of cardiac glycosides and painkillers for myocardial infarction, etc.

What is a coma?

A coma is an unconscious state with a profound impairment of reflexes, a lack of response to stimuli.

A common and main symptom of a coma of any origin is a deep loss of consciousness due to damage to the vital parts of the brain.

A coma may arise suddenly in the midst of relative well-being. Acute development is typical for cerebral coma in stroke, hypoglycemic coma. However, in many cases, a coma that complicates the course of the disease develops gradually (with diabetic, uremic, hepatic coma and many other coma). In these cases, a coma, a deep loss of consciousness, is preceded by a precoma stage. Against the background of an increasing exacerbation of the symptoms of the underlying disease, signs of damage to the central nervous system in the form of deafness, lethargy, indifference, confusion of consciousness with its periodic clarifications. However, during this period, patients retain the ability to respond to strong irritations, belatedly, in monosyllables, but still answer a loudly asked question, they retain pupillary, corneal and swallowing reflexes. Knowing the symptoms of a precoma is especially important, as often timely provision help during this period of the disease prevents the development of coma and saves the life of the sick.

Hepatic coma. Vomiting "Coffee grounds"

When examining the skin, it should be borne in mind that with uremia, cerebral thrombosis, anemia, the skin is pale. At alcoholic coma, cerebral hemorrhage, the face is usually hyperemic. Pink coloration of the skin is characteristic of coma due to carbon monoxide poisoning. Yellowness of the skin is usually observed with hepatic coma. It is important to determine the moisture content of the patient's skin in a coma. Wet, sweaty skin is characteristic of hypoglycemic coma. In a diabetic coma, the skin is always dry. Traces of old scratches on the skin can be noted in patients with diabetic, hepatic and uremic coma. Fresh boils, as well as skin scars from old boils found in patients in a coma, suggest diabetes mellitus.

Of particular importance is the study of skin turgor. In some diseases accompanied by dehydration and leading to the development of coma, there is a significant decrease in skin turgor. This symptom is especially pronounced in diabetic coma. A similar decrease in the turgor of the eyeballs in diabetic coma makes them soft, which is well determined by palpation.

Treatment of coma depends on the nature of the underlying disease. In diabetic coma, the patient is administered insulin subcutaneously and intravenously, sodium bicarbonate, saline as prescribed by the doctor.

Hypoglycemic coma is preceded by a feeling of hunger, weakness and trembling throughout the body. Before the doctor arrives, the patient is given sugar or sweet tea. 20-40 ml of 40% glucose solution is injected into a vein.

In uremic coma, therapeutic measures are aimed at reducing intoxication. For this purpose, the stomach is washed, a cleansing enema is given, an isotonic sodium chloride solution and a 5% glucose solution are dripped.

In case of hepatic coma, glucose solutions, steroid hormones, and vitamins are administered as a drop of glucose solutions.

What is the pathogenesis and main causes of syncope?

Fainting is a sudden short-term loss of consciousness with a weakening of the activity of the cardiac and respiratory systems. Fainting is mild form acute vascular brain failure and is due to anemia of the brain; occurs more often in women. Fainting may result from mental trauma, at the sight of blood, pain irritation, with prolonged stay in a stuffy room, with intoxication and infectious diseases.

The severity of fainting may be different. Syncope is usually characterized sudden onset mild clouding of consciousness in combination with dizziness of a non-systemic type, ringing in the ears, nausea, yawning, increased intestinal motility. Objectively, there is a sharp pallor of the skin, coldness of the hands and feet, drops of sweat on the face, dilated pupils. Pulse of weak filling, arterial pressure is lowered. The attack lasts a few seconds.

In a more severe case of syncope, complete loss of consciousness occurs with switching off muscle tone, the patient slowly settles. At the height of fainting, there are no deep reflexes, the pulse is barely palpable, blood pressure is low, breathing is shallow. The attack lasts several tens of seconds, and then follows a quick and complete recovery of consciousness without the effects of amnesia.

Convulsive fainting is characterized by the addition of convulsions to the picture of fainting. In rare cases, salivation, involuntary urination and defecation are noted. Unconsciousness sometimes lasts for several minutes.

persist after fainting general weakness, nausea, discomfort in the abdomen.

The patient should be laid on his back with his head slightly lowered, the collar should be unbuttoned, fresh air should be provided, a cotton swab moistened with ammonia should be brought to the nose, and the face should be sprayed with cold water. With a more persistent fainting state, 1 ml of a 10% solution of caffeine or 2 ml of cordiamine should be injected subcutaneously, ephedrine - 1 ml of a 5% solution, mezaton - 1 ml of a 1% solution, norepinephrine - 1 ml of a 0.2% solution can be used.

The patient should be examined by a doctor.

What are the hallmarks of a seizure in epilepsy?

One of the most common and dangerous species convulsive states is a generalized convulsive seizure, which is observed in epilepsy. In most cases, patients with epilepsy, a few minutes before its onset, note the so-called aura (harbinger), which is manifested by increased irritability, palpitations, a feeling of heat, dizziness, chills, a feeling of fear, perception of unpleasant odors, sounds, etc. Then the patient suddenly loses consciousness falls. At the beginning of the first phase (in the first seconds) of a seizure, he often lets out a loud cry.

When providing first aid to the patient, first of all, it is necessary to prevent possible bruises of the head, arms, legs during a fall and convulsions, for which a pillow is placed under the patient's head, arms and legs are held. To prevent asphyxia, it is necessary to unfasten the collar. Between the patient's teeth, you need to insert a solid object, such as a spoon wrapped in a napkin, in order to prevent biting the tongue. To avoid inhalation of saliva, the patient's head should be turned to the side.

A dangerous complication of epilepsy that threatens the life of the patient is status epilepticus, in which convulsive seizures follow one after another, so that consciousness does not clear up. Epileptic status is an indication for urgent hospitalization of the patient in the neurological department of the hospital.

In status epilepticus, emergency care is to prescribe an enema with chloral hydrate (2.0 g per 50 ml of water), intravenous administration 10 ml of 25% magnesium sulfate solution and 10 ml of 40% glucose solution, intramuscular injection of 2-3 ml of 2.5% chlorpromazine solution, intravenous infusion of 20 mg of diazepam (seduxen) dissolved in 10 ml of 40% glucose solution. With ongoing seizures, 5-10 ml of a 10% solution of hexenal is slowly injected intravenously. Do spinal puncture with the removal of 10-15 ml of solution.

A convulsive seizure in hysteria differs significantly from an epileptic one. It develops most often after any experiences associated with grief, resentment, fear, and, as a rule, in the presence of relatives or strangers. The patient may fall, but usually does not cause serious injury to himself, consciousness is preserved, there is no tongue bite, involuntary urination. The eyelids are tightly compressed, the eyeballs are turned up. Pupillary response to light was preserved. The patient responds correctly to painful stimuli. Convulsions are in the nature of purposeful movements (for example, the patient raises his hands, as if protecting his head from blows). Movements can be erratic. The patient waves his arms, grimaces. Duration hysterical fit- 15-20 minutes, less often - several hours. The attack ends quickly. The patient comes to a normal state, feels relief. There is no state of stupor, drowsiness. Unlike an epileptic seizure, a hysterical seizure never develops during sleep.

When assisting a patient with a hysterical seizure, it is necessary to remove all those present from the room where the patient is located. Talking to the patient calmly, but in an imperative tone, they convince him of the absence of a dangerous disease and inspire the idea of a speedy recovery. To stop a hysterical seizure, sedatives are widely used: sodium bromide, valerian tincture, motherwort herb decoction.

What is the general characteristic of poisoning?

Poisoning is a pathological condition caused by the effects of poisons on the body. Causes of poisoning may be poor quality food products and poisonous plants, various chemicals used in everyday life and at work, drugs, etc. Poisons have a local and general effect on the body, which depends on the nature of the poison and the way it enters the body.

For all acute poisoning, emergency care should pursue the following goals: 1) the fastest removal of the poison from the body; 2) neutralization of the poison remaining in the body with the help of antidotes (antidotes); 3) the fight against respiratory and circulatory disorders.

If poison enters through the mouth, immediate gastric lavage is necessary, which is carried out where the poisoning occurred (at home, at work); it is advisable to cleanse the intestines, for which they give a laxative, put an enema.

If the poison gets on the skin or mucous membranes, it is necessary to immediately remove the poison mechanically. For detoxification, as prescribed by a doctor, solutions of glucose, sodium chloride, gemodez, polyglucin, etc. are injected subcutaneously and intravenously. If necessary, the so-called forced diuresis is used: 3-5 liters of liquid and fast-acting diuretics are simultaneously administered. To neutralize the poison, specific antidotes are used (unithiol, methylene blue, etc.), depending on the nature of the poisoning. Oxygen is used to restore respiratory and circulatory function, cardiovascular agents, respiratory analeptics, artificial respiration, including hardware.

What is the pathogenesis of the action of current on the body and the causes of injury?

Electric shock above 50 V causes thermal and electrolytic effects. Most often, the defeat occurs due to non-compliance with safety precautions when working with electrical appliances, both at home and at work.

First of all, the victim is released from contact with electric current (if this has not been done before). Turn off the power supply, and if this is not possible, then discard the broken wire with a dry wooden stick. If the person providing assistance is dressed in rubber boots and rubber gloves, then you can drag the victim away from the electrical wire. When breathing stops, artificial respiration is carried out, cardiac and cardiovascular agents are administered (0.1% adrenaline solution - 1 ml, cordiamine - 2 ml, 10% caffeine solution - 1 ml subcutaneously), respiratory stimulants (1% lobelin solution - 1 ml intravenously slowly or intramuscularly). Sterile dressing is applied to the electrical burn wound.

The patient is transported on a stretcher to the burn or surgical department.

What are the causes of renal colic?

Renal colic develops when there is a sudden obstruction to the outflow of urine from the renal pelvis. Most often, renal colic develops as a result of the movement of a stone or the passage of a conglomerate of dense crystals through the ureter, as well as due to impaired patency of the ureter during inflection, inflammatory processes.

The attack starts suddenly. Most often it is caused physical stress, but it can also come in the midst of complete rest, at night during sleep, often after heavy drinking. The pain is cutting with periods of calm and exacerbation. Patients are restless, tossing about in bed in search of a position that would alleviate their suffering. An attack of renal colic often takes a protracted character and with short remissions can last several days in a row. As a rule, the pain begins in the lumbar region and spreads to the hypochondrium and abdomen and, which is especially characteristic, along the ureter to the side. Bladder, scrotum in men, labia in women, on the thighs. In many cases, the intensity of pain is greater in the abdomen or at the level of the genitals than in the kidney area. The pain is usually accompanied by increased urge to urinate and cutting pain in the urethra.

Prolonged renal colic may be accompanied by an increase in blood pressure, and with pyelonephritis - an increase in temperature.

First aid is usually limited to thermal procedures - a heating pad, a hot bath, which are supplemented by taking antispasmodic and painkillers from a home medicine cabinet (usually available in a patient with frequent attacks of renal colic): Avisan - 0.5-1 g, cystenal - 10-20 drops, papaverine - 0.04 g, baralgin - 1 tablet. As prescribed by the doctor, atropine and narcotic analgesics are administered.

1. Evdokimov N.M. Provision of first medical aid.-M., 2001

2. Small medical encyclopedia v. 1,2,3 M., 1986

3. First aid: reference book M., 2001

GAPOU TO "Tobolsk Medical College them. V. Soldatov"

METHODOLOGICAL DEVELOPMENT

practical session

PM 04, PM 07 "Performance of work in one or more professions of workers, positions of employees"

MDK "Technology for the provision of medical services"

TOPIC: "Providing first aid in various conditions"

Teacher: Fedorova O.A.,

Cherkashina A.N., Zhelnina S.V.

Tobolsk, 2016

Glossary

A fracture is a complete or partial violation of the integrity of the bone that occurs when an external mechanical effect is closed. The integrity of the skin is not broken. Open fracture. The integrity of the skin is broken over the site of deformation of the fracture or near it. irregular shape with many angles, the wound along its length has different depth with damage to the skin, subcutaneous tissue, muscles Thermal burn this is an injury that occurs under the influence of high temperature on the tissues of the body. Fainting is a sudden short-term loss of consciousness with weakening of the activity of the cardiac and respiratory systems.

Relevance

Emergency conditions that threaten the life and health of the patient require urgent measures at all stages of medical care. These conditions arise due to the development of shock, acute blood loss, respiratory disorders, circulatory disorders, coma, which are caused by acute illnesses internal organs, traumatic injuries, poisoning and accidents.

The most important place in providing assistance to suddenly ill and injured as a result of natural and man-made emergencies in peacetime is given to adequate pre-hospital measures. According to the data of domestic and foreign experts, a significant number of patients and victims as a result of emergencies could be saved if timely and effective assistance was provided at the prehospital stage.

Currently, the importance of first aid in the treatment of emergency conditions has increased tremendously. The ability of nursing staff to assess the severity of the patient's condition, identify priority problems is necessary to provide effective first aid, which can have a greater impact on the further course and prognosis of the disease. Not only knowledge is required from a health worker, but also the ability to quickly provide assistance, since confusion and an inability to collect oneself can even aggravate the situation.

Thus, mastering the methods of providing emergency medical care at the prehospital stage to sick and injured people, as well as improving practical skills, is an important and urgent task.

Modern principles emergency medical care

In world practice, a universal scheme for providing assistance to victims at the prehospital stage has been adopted.

The main steps in this scheme are:

1.Immediate initiation of urgent life-sustaining measures in the event of an emergency.

2.Organization of arrival at the scene qualified specialists in as soon as possible, the implementation of certain measures of emergency medical care during the transportation of the patient to the hospital.

.The fastest possible hospitalization in a specialized medical institution with qualified medical personnel and equipped with the necessary equipment.

Measures to be taken in the event of an emergency

Medical and evacuation activities carried out in the provision of emergency care should be divided into a number of interrelated stages - pre-hospital, hospital and first medical aid.

At the prehospital stage, first, pre-medical and first medical aid is provided.

The most important factor in emergency care is the time factor. The best results in the treatment of victims and patients are achieved when the period from the onset of an emergency to the time of provision of qualified assistance does not exceed 1 hour.

A preliminary assessment of the severity of the patient's condition will help to avoid panic and fuss during subsequent actions, will provide an opportunity to make more balanced and rational decisions in extreme situations, as well as measures for emergency evacuation of the victim from the danger zone.

After that, it is necessary to begin to identify the signs of the most life-threatening conditions that can lead to the death of the victim in the next few minutes:

· clinical death;

· coma;

· arterial bleeding;

· neck wounds;

· chest injury.

The person providing assistance to the injured in an emergency should strictly adhere to the algorithm shown in Scheme 1.

Scheme 1. The procedure for providing assistance in an emergency

Providing first aid in case of an emergency

There are 4 basic principles of first aid that should be followed:

.Inspection of the scene. Ensure safety when providing assistance.

2.Initial examination of the victim and provision of first aid in conditions life threatening.

.Call a doctor or ambulance.

.Secondary examination of the victim and, if necessary, assistance in identifying other injuries, diseases.

Before helping the injured, find out:

· Is the scene of the incident dangerous?

· What happened;

· Number of patients and victims;

· Are those around you able to help?

Of particular importance is anything that can threaten your safety and the safety of others: exposed electrical wires, falling debris, intense road traffic, fire, smoke, harmful fumes. If you are in any danger, do not approach the victim. Call the appropriate rescue service or the police immediately for professional assistance.

Always look for other casualties and, if necessary, ask others to assist you in helping you.

As soon as you approach the victim, who is conscious, try to calm him down, then in a friendly tone:

· find out from the victim what happened;

· explain that you are a healthcare worker;

· offer assistance, obtain the consent of the victim to provide assistance;

· explain what action you are going to take.

You must obtain permission from the casualty before performing emergency first aid. A conscious victim has the right to refuse your service. If he is unconscious, we can assume that you have received his consent to carry out emergency measures.

Bleeding

Distinguish between external and internal bleeding.

There are two types of bleeding: arterial and venous.

arterial bleeding.The most dangerous bleeding injuries of large arteries - femoral, brachial, carotid. Death can come in minutes.

Signs of injury to the arteries:arterial blood "gushes", the color of the blood is bright red, the pulsation of the blood coincides with the heartbeat.

Signs of venous bleeding:venous blood flows out slowly, evenly, the blood is darker in color.

Methods for stopping bleeding:

1.Finger pressure.

2.Tight bandage.

.Maximum limb flexion.

.The imposition of a tourniquet.

.Applying a clamp to a damaged vessel in a wound.

.Tamponade of the wound.

If possible, use a sterile dressing (or clean cloth) to apply a pressure bandage, apply it directly to the wound (excluding eye injury and depression of the calvaria).

Any movement of the limb stimulates blood flow in it. In addition, when blood vessels are damaged, blood coagulation processes are disrupted. Any movement causes additional damage to blood vessels. Splinting limbs can reduce bleeding. Air tyres, or any type of tyre, are ideal in this case.

When applying a pressure dressing to a wound site does not reliably stop bleeding, or there are multiple sources of bleeding supplied by a single artery, local pressure may be effective.

It is necessary to apply a tourniquet only in extreme cases, when all other measures have not given the expected result.

The principles of applying a tourniquet:

§ I apply a tourniquet above the site of bleeding and as close as possible to it over clothing or over several rounds of bandage;

§ it is necessary to tighten the tourniquet only until the peripheral pulse disappears and the bleeding stops;

§ each subsequent tour of the bundle must partially capture the previous tour;

§ the tourniquet is applied for no more than 1 hour in the warm period of time, and no more than 0.5 hours in the cold;

§ a note is inserted under the applied tourniquet indicating the time the tourniquet was applied;

§ after the bleeding has stopped open wound a sterile dressing is applied, bandaged, the limb is fixed and the wounded is sent to the next stage of medical care, i.e. evacuate.

A tourniquet can damage nerves and blood vessels and even lead to limb loss. A loosely applied tourniquet can stimulate more intense bleeding, since it does not stop arterial, but only venous blood flow. Apply the tourniquet as last resort in life-threatening conditions.

fractures

Fracture -this is a complete or partial violation of the integrity of the bone, which occurs under external mechanical action.

Fracture types:

§ closed (the integrity of the skin is not broken);

§ open (violated the integrity of the skin over the place of deformation of the fracture or near it).

Fracture signs:

§ deformation (change in shape);

§ local (local) pain;

§ swelling of soft tissues over the fracture, hemorrhage in them;

§ at open fractures - laceration with visible bone fragments;

§ limb dysfunction;

§ pathological movement.

§ patency check respiratory tract, respiration and circulation;

§ overlay transport immobilization personnel funds;

§ aseptic bandage;

§ anti-shock measures;

§ transportation to the hospital.

Signs of a mandibular fracture:

§ mandibular fracture is more common on impact;

§ in addition to the general signs of fractures, tooth displacement, a violation of the normal bite, difficulty or impossibility of chewing movements are characteristic;

§ with double fractures of the lower jaw, tongue retraction is possible, which causes suffocation.

Emergency first aid:

§ check airway patency, respiration, circulation;

§ temporarily stop arterial bleeding by pressing the bleeding vessel;

§ fix the lower jaw with a sling bandage;

§ if the tongue retracts, making it difficult to breathe, fix the tongue.

Rib fractures.Rib fractures occur with various mechanical influences on the chest. Distinguish between single and multiple fractures ribs.

Rib fracture symptoms:

§ rib fractures are accompanied by sharp local pain when feeling, breathing, coughing;

§ the victim spares the damaged part of the chest; breathing on this side is superficial;

§ with damage to the pleura and lung tissue air from the lungs enters the subcutaneous tissue, which looks like swelling on the damaged side of the chest; subcutaneous tissue crunches when touched (subcutaneous emphysema).

Emergency first aid:

§ apply a circular pressure bandage on the chest as you exhale;

§ With injuries to the chest organs, call an ambulance to hospitalize the victim in a hospital specializing in chest injuries.

Wounds

Wounds are damage to soft tissues, in which the integrity of the skin is violated. At deep wounds subcutaneous tissue, muscles, nerve trunks and blood vessels are injured.

Types of wounds.Allocate cut, chopped, stab and gunshot wounds.

In appearance, the wounds are:

§ scalped - exfoliate areas of the skin, subcutaneous tissue;

§ torn - irregularly shaped defects with many angles are observed on the skin, subcutaneous tissue and muscle, the wound has a different depth along its length. The wound may contain dust, dirt, soil, and pieces of clothing.

Emergency first aid:

§ check ABC (airway patency, respiration, circulation);

§ during the period primary care simply wash the wound with saline or clean water and apply a clean bandage, elevate the limb.

First aid for open wounds:

§ stop major bleeding;

§ remove dirt, debris and debris by irrigating the wound with clean water, saline;

§ apply an aseptic bandage;

§ at extensive wounds fix the limb

lacerationsare divided into:

superficial (including only the skin);

deep (capture underlying tissues and structures).

stab woundsusually not accompanied by massive external bleeding, but be careful about the possibility internal bleeding or tissue damage.

Emergency first aid:

§ do not remove deeply stuck objects;

§ stop bleeding;

§ stabilize foreign body with bulk dressing and, as necessary, immobilization with splints.

§ apply an aseptic bandage.

Thermal damage

burns

Thermal burn -This is an injury that occurs under the influence of high temperature on the tissues of the body.

The depth of the lesion is divided into 4 degrees:

1st degree -hyperemia and edema of the skin, accompanied by burning pain;

2nd degree -hyperemia and swelling of the skin with exfoliation of the epidermis and the formation of blisters filled with a clear liquid; severe pain noted in the first 2 days;

3A, 3B degrees -damaged, in addition to the dermis, subcutaneous tissue and muscle tissue, necrotic scabs are formed; pain and tactile sensitivity is absent;

4th degree -necrosis of the skin and deeper tissues up to the bone tissue, the scab is dense, thick, sometimes black, up to charring.

In addition to the depth of the lesion, the area of the lesion is also important, which can be determined using the “rule of the palm” or the “rule of nine”.

According to the "rule of nine", the area of the skin of the head and neck is equal to 9% of the body surface; breasts - 9%; abdomen - 9%; back - 9%; waist and buttocks - 9%; hands - 9% each; hips - 9% each; shins and feet - 9% each; perineum and external genital organs - 1%.

According to the "rule of the palm", the area of the palm of an adult is approximately 1% of the surface of the body.

Emergency first aid:

§ termination of the thermal factor;

§ cooling the burnt surface with water for 10 minutes;

§ applying an aseptic bandage to the burn surface;

§ warm drink;

§ evacuation to the nearest hospital in the prone position.

Frostbite

Cold has a local effect on the body, causing frostbite of individual parts of the body, and a general one, which leads to general cooling (freezing).

Frostbite according to the depth of the lesion is divided into 4 degrees:

With general cooling, compensatory reactions initially develop (narrowing peripheral vessels, change in breathing, the appearance of trembling). As it deepens, a phase of decompensation begins, accompanied by a gradual depression of the central nervous system, a weakening of cardiac activity and respiration.

A mild degree is characterized by a decrease in temperature to 33-35 C, chills, pallor of the skin, the appearance of "goosebumps". Speech is slowed down, weakness, drowsiness, bradycardia are noted.

The average degree of cooling (stuporous stage) is characterized by a decrease in body temperature to 29-27 C. The skin is cold, pale or cyanotic. Drowsiness, oppression of consciousness, difficulty of movements are noted. The pulse is slowed down to 52-32 beats per minute, breathing is rare, blood pressure is reduced to 80-60 mm. rt. Art.

A severe degree of cooling is characterized by a lack of consciousness, muscle rigidity, convulsive contractions. chewing muscles. Pulse 34-32 beats. in min. Blood pressure is reduced or not determined, breathing is rare, shallow, pupils are constricted. With a decrease in rectal temperature to 24-20 C, death occurs.

Emergency first aid:

§ stop the cooling effect;

§ after removing damp clothing, warmly cover the victim, give a hot drink;

§ provide thermal insulation of the cooled limb segments;

§ evacuate the victim to the nearest hospital in the prone position.

Solar and heat stroke

Symptoms of sun and thermal shock close and appear suddenly.

Sunstrokeoccurs on a clear summer day with prolonged exposure to the sun without a hat. There is noise in the ears, dizziness, nausea, vomiting, body temperature rises to 38-39 C, sweating, redness of the skin of the face are noted, the pulse and respiration increase sharply. In severe cases, severe agitation, loss of consciousness, and even death can occur.

Heatstrokeoccurs after exercise high temperature external environment. The skin becomes moist, sometimes turns pale. The body temperature rises. The victim may complain of weakness, fatigue, nausea, headache. Tachycardia and orthostatic hypertension may occur.

Emergency first aid:

§ move the victim to a cooler place and give him a drink moderate amount liquids;

§ put cold on the head, on the region of the heart;

§ lay the victim on his back;

§ if the victim has low blood pressure, raise the lower limbs.

Acute vascular insufficiency

Fainting- sudden short-term loss of consciousness with a weakening of the cardiac and respiratory systems. The basis of fainting is cerebral hypoxia, the cause of which is transient disorder cerebral blood flow.

In patients with syncope, three periods are distinguished: pre-syncope, syncope proper, and post-syncope.

Pre-fainting statemanifested by a feeling of lightheadedness, darkening of the eyes, ringing in the ears, weakness, dizziness, nausea, sweating, numbness of the lips, fingertips, pallor of the skin. Duration from a few seconds to 1 minute.

During faintingthere is a loss of consciousness, a sharp decline muscle tone, shallow breathing. The pulse is labile, weak, arrhythmic. With a relatively long violation cerebral circulation may be clinically - tonic convulsions, involuntary urination. Fainting lasts up to 1 minute, sometimes more.

post-fainting statelasts from a few seconds to 1 minute and ends full recovery consciousness.

Emergency first aid:

§ lay the patient on his back with his head slightly lowered or raise the patient's legs to a height of 60-70 cm in relation to a horizontal surface;

§ loosen tight clothing;

§ provide access to fresh air;

§ bring a cotton swab moistened with ammonia to your nose;

§ splash your face with cold water or pat on the cheeks, rub his chest;

§ make sure that the patient sits for 5-10 minutes after fainting;

If you suspect organic cause fainting requires hospitalization.

convulsions

Seizures -involuntary muscle contraction. Convulsive movements can be widespread and capture many muscle groups of the body (generalized convulsions) or be localized in some muscle group of the body or limb (localized convulsions).

Generalized convulsionscan be stable, lasting for a relatively long period of time - tens of seconds, minutes (tonic), or fast, often alternating states of contraction and relaxation (clonic).

Localized seizurescan also be clonic and tonic.

Generalized tonic convulsions capture the muscles of the arms, legs, torso, neck, face, and sometimes the respiratory tract. The arms are more often in a state of flexion, the legs are usually extended, the muscles are tense, the torso is elongated, the head is thrown back or turned to the side, the teeth are tightly clenched. Consciousness may be lost or retained.

Generalized tonic convulsions are more often a manifestation of epilepsy, but can also be observed in hysteria, rabies, tetanus, eclampsia, cerebrovascular accident, infections and intoxications in children.

Emergency first aid:

§ protect the patient from injury;

§ free him from tight clothes;

medical emergency

§ free the patient's mouth from foreign objects(food, removable dentures);

§ to prevent biting the tongue, insert the corner of a folded towel between the molars.

Lightning strike

Lightning usually strikes people who are out in the open during a thunderstorm. The damaging effect of atmospheric electricity is primarily due to a very high voltage (up to 1,000,0000 W) and discharge power, in addition, the victim may receive traumatic lesions as a result of the action of an air blast wave. Severe burns (up to IV degree) are also possible, since the temperature in the area of the so-called lightning channel can exceed 25,000 C. Despite the short duration of exposure, the condition of the victim is usually severe, which is primarily due to damage to the central and peripheral nervous system.

Symptoms:loss of consciousness from several minutes to several days, conical convulsions; after the restoration of consciousness, anxiety, agitation, disorientation, pain, delirium; hallucinations, paresis of the extremities, hemi - and paraparesis, headache, pain and pain in the eyes, tinnitus, burns of the eyelids and the eyeball, clouding of the cornea and lens, "lightning sign" on the skin.

Emergency first aid:

§ restoration and maintenance of airway patency and artificial lung ventilation;

§ indirect massage hearts;

§ hospitalization, transportation of the victim on a stretcher (better in the side position because of the risk of vomiting).

Electric shock

Most dangerous manifestation electrical injury is clinical death, which is characterized by respiratory arrest and heartbeat.

First aid for electrical injury:

§ free the victim from contact with the electrode;

§ preparation of the victim for resuscitation;

§ carrying out IVL in parallel with a closed heart massage.

Stings of bees, wasps, bumblebees

The venom of these insects contains biological amines. Insect bites are very painful, local reaction on them it is shown in the form of hypostasis and an inflammation. Edema is more pronounced with a bite of the face and lips. Single bites do not give general reaction organism, but the stings of more than 5 bees are toxic, with chills, nausea, dizziness, dry mouth.

Emergency first aid:

· remove the sting from the wound with tweezers;

· treat the wound with alcohol;

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fainting
Collapse
Hypertensive crisis
Anaphylactic shock
An attack of angina pectoris
Acute myocardial infarction
clinical death

Algorithms for providing first aid in emergency conditions

Fainting

Fainting - an attack short term loss consciousness, due to transient cerebral ischemia associated with a weakening of cardiac activity and acute violation regulation of vascular tone. Depending on the severity of the factors contributing to the violation of cerebral circulation.

Allocate: cerebral, cardiac, reflex and hysterical views fainting states.

Stages of development of fainting.

1. Harbingers (pre-syncope). Clinical manifestations: discomfort, dizziness, tinnitus, shortness of breath, cold sweat, numbness of the fingertips. Lasts from 5 seconds to 2 minutes.

2. Violation of consciousness (actual fainting). Clinic: loss of consciousness lasting from 5 seconds to 1 minute, accompanied by pallor, decreased muscle tone, dilated pupils, their weak reaction to light. Breathing shallow, bradypnea. The pulse is labile, more often bradycardia is up to 40-50 per minute, systolic blood pressure drops to 50-60 mm. rt. Art. With deep fainting, convulsions are possible.

3. Post-fainting (recovery) period. Clinic: correctly oriented in space and time, pallor, rapid breathing, labile pulse and low blood pressure may persist.

Algorithm of therapeutic measures

2. Unbutton the collar.

3. Provide access to fresh air.

4. Wipe your face with a damp cloth or spray with cold water.

5. Vapor inhalation ammonia (reflex stimulation respiratory and vasomotor centers).

In case of ineffectiveness of the above measures:

6. Caffeine 2.0 IV or IM.

7. Cordiamin 2.0 i/m.

8. Atropine (with bradycardia) 0.1% - 0.5 s / c.

9. When exiting fainting, continue dental procedures with the adoption of measures to prevent relapse: treatment should be carried out with horizontal position patient with adequate premedication and sufficient anesthesia.

Collapse

Collapse is a severe form vascular insufficiency(decrease in vascular tone), manifested by a decrease in blood pressure, dilation of venous vessels, a decrease in the volume of circulating blood and its accumulation in the blood depots - capillaries of the liver, spleen.

Clinical picture: sharp deterioration general condition, severe pallor of the skin, dizziness, chills, cold sweat, a sharp decrease in blood pressure, frequent and weak pulse, frequent, shallow breathing. Peripheral veins become empty, their walls collapse, which makes it difficult to perform venipuncture. Patients retain consciousness (during fainting, patients lose consciousness), but are indifferent to what is happening. Collapse can be a symptom of such severe pathological processes as myocardial infarction, anaphylactic shock, bleeding.

Algorithm of therapeutic measures 1. Give the patient a horizontal position.

2. Provide fresh air supply.

3. Prednisolone 60-90 mg IV.

4. Norepinephrine 0.2% - 1 ml IV in 0.89% sodium chloride solution.

5. Mezaton 1% - 1 ml IV (to increase venous tone).

6. Korglucol 0.06% - 1.0 IV slowly in 0.89% sodium chloride solution.

7. Polyglukin 400.0 IV drip, 5% glucose solution IV drip 500.0.

Hypertensive crisis

Hypertensive crisis - sudden rapid rise AD, accompanied by clinical symptoms from target organs (often the brain, retina, heart, kidneys, gastrointestinal tract, etc.).

clinical picture. Sharp headaches, dizziness, tinnitus, often accompanied by nausea and vomiting. Visual impairment (grid or fog before the eyes). The patient is excited. In this case, there is trembling of the hands, sweating, a sharp reddening of the skin of the face. The pulse is tense, blood pressure is increased by 60-80 mm. rt. Art. compared to normal. During a crisis, angina attacks, acute cerebrovascular accident may occur.

Algorithm of therapeutic measures 1. Intravenously in one syringe: Dibazol 1% - 4.0 ml with papaverine 1% - 2.0 ml (slowly).

2. In severe cases: clonidine 75 mcg under the tongue.

3. Intravenous Lasix 1% - 4.0 ml in saline.

4. Anaprilin 20 mg (with severe tachycardia) under the tongue.

5. Sedatives- Elenium inside 1-2 tablets.

6. Hospitalization.

It is necessary to constantly monitor blood pressure!

first aid fainting

Anaphylactic shock

A typical form of drug-induced anaphylactic shock (LASH).

The patient has an acute state of discomfort with vague painful sensations. There is a fear of death or a condition internal restlessness. There is nausea, sometimes vomiting, coughing. Patients complain of severe weakness, tingling and itching of the skin of the face, hands, head; a feeling of a rush of blood to the head, face, a feeling of heaviness behind the sternum or chest compression; the appearance of pain in the heart, difficulty breathing or the inability to exhale, dizziness or headache. Disorder of consciousness occurs in the terminal phase of shock and is accompanied by impaired verbal contact with the patient. Complaints occur immediately after taking the drug.

The clinical picture of LASH: hyperemia of the skin or pallor and cyanosis, swelling of the eyelids of the face, profuse sweating. Noisy breathing, tachypnea. Most patients develop restlessness. Mydriasis is noted, the reaction of pupils to light is weakened. The pulse is frequent, sharply weakened by peripheral arteries. BP drops rapidly, in severe cases diastolic pressure not defined. There is shortness of breath, shortness of breath. Subsequently, the clinical picture of pulmonary edema develops.

Depending on the severity of the course and the time of development of symptoms (from the moment of antigen administration), lightning-fast (1-2 minutes), severe (after 5-7 minutes), moderate (up to 30 minutes) forms of shock are distinguished. The shorter the time from drug administration to the onset of the clinic, the more severe the shock, and the less chance of a successful outcome of treatment.

Algorithm of therapeutic measures Urgently provide access to the vein.

1. Stop the administration of the drug that caused anaphylactic shock. Call for an ambulance.

2. Lay the patient down, raise the lower limbs. If the patient is unconscious, turn his head to the side, push the lower jaw. Humidified oxygen inhalation. Ventilation of the lungs.

3. Intravenously inject 0.5 ml of 0.1% adrenaline solution in 5 ml of isotonic sodium chloride solution. If venipuncture is difficult, adrenaline is injected into the root of the tongue, possibly intratracheally (puncture of the trachea below the thyroid cartilage through the conical ligament).

4. Prednisolone 90-120 mg IV.

5. Diphenhydramine solution 2% - 2.0 or suprastin solution 2% - 2.0, or diprazine solution 2.5% - 2.0 i.v.

6. Cardiac glycosides according to indications.

7. With obstruction of the respiratory tract - oxygen therapy, 2.4% solution of aminophylline 10 ml intravenously for physical. solution.

8. If necessary - endotracheal intubation.

9. Hospitalization of the patient. Allergy identification.

Toxic reactions to anesthetics

clinical picture. Restlessness, tachycardia, dizziness and weakness. Cyanosis, muscle tremor, chills, convulsions. Nausea, sometimes vomiting. Respiratory distress, decreased blood pressure, collapse.

Algorithm of therapeutic measures

1. Give the patient a horizontal position.

2. Fresh air. Let the vapors of ammonia be inhaled.

3. Caffeine 2 ml s.c.

4. Cordiamin 2 ml s.c.

5. In case of respiratory depression - oxygen, artificial respiration (according to indications).

6. Adrenaline 0.1% - 1.0 ml per physical. solution in / in.

7. Prednisolone 60-90 mg IV.

8. Tavegil, suprastin, diphenhydramine.

9. Cardiac glycosides (according to indications).

An attack of angina pectoris

An attack of angina is a paroxysm of pain or other discomfort(heaviness, constriction, pressure, burning) in the region of the heart lasting from 2-5 to 30 minutes with characteristic irradiation (in left shoulder, neck, left shoulder blade, lower jaw), caused by an excess of myocardial oxygen consumption over its intake.

It provokes an attack of angina pectoris, an increase in blood pressure, psycho-emotional stress, which always takes place before and during treatment with a dentist.

Algorithm of therapeutic measures 1. Termination of dental intervention, rest, access to fresh air, free breathing.

2. Nitroglycerin tablets or capsules (bite the capsule) 0.5 mg under the tongue every 5-10 minutes (total 3 mg under BP control).

3. If the attack is stopped, recommendations for outpatient monitoring by a cardiologist. Resumption of dental benefits - to stabilize the condition.

4. If the attack is not stopped: baralgin 5-10 ml or analgin 50% - 2 ml intravenously or intramuscularly.

5. In the absence of effect - call an ambulance and hospitalization.

Acute myocardial infarction

Acute myocardial infarction - ischemic necrosis of the heart muscle, resulting from an acute discrepancy between the need for oxygen in the myocardium and its delivery through the corresponding coronary artery.

Clinic. The most characteristic clinical symptom is pain, which is more often localized in the region of the heart behind the sternum, less often captures the entire front surface of the chest. Irradiates to the left arm, shoulder, shoulder blade, interscapular space. The pain usually has a wave-like character: it intensifies, then weakens, it lasts from several hours to several days. Objectively noted pale skin, cyanosis of the lips, excessive sweating, lowering blood pressure. In most patients, the heart rhythm is disturbed (tachycardia, extrasystole, atrial fibrillation).

Algorithm of therapeutic measures

1. Urgent termination of intervention, rest, access to fresh air.

2. Calling a cardiological ambulance team.

3. With systolic blood pressure? 100 mm. rt. Art. sublingually 0.5 mg nitroglycerin tablets every 10 minutes (total dose 3 mg).

4. Compulsory relief of pain syndrome: baralgin 5 ml or analgin 50% - 2 ml intravenously or intramuscularly.

5. Inhalation of oxygen through a mask.

6. Papaverine 2% - 2.0 ml / m.

7. Eufillin 2.4% - 10 ml per physical. r-re in / in.

8. Relanium or Seduxen 0.5% - 2 ml 9. Hospitalization.

clinical death

Clinic. Loss of consciousness. Absence of pulse and heart sounds. Stopping breathing. Paleness and cyanosis of the skin and mucous membranes, lack of bleeding from the surgical wound (tooth socket). Pupil dilation. Respiratory arrest usually precedes cardiac arrest (in the absence of breathing, the pulse is kept at carotid arteries and pupils are not dilated), which is taken into account during resuscitation.

Algorithm of therapeutic measures REANIMATION:

1. Lay on the floor or couch, throw back your head, push your jaw.

2. Clear the airways.

3. Insert an air duct, carry out artificial ventilation of the lungs and external heart massage.

during resuscitation by one person in the ratio: 2 breaths per 15 compressions of the sternum; during resuscitation together in the ratio: 1 breath for 5 compressions of the sternum. Take into account that the frequency of artificial respiration is 12-18 per minute, and the frequency of artificial circulation is 80-100 per minute. artificial ventilation lungs and external heart massage are carried out before the arrival of "resuscitation".

During resuscitation, all drugs are administered only intravenously, intracardiac (adrenaline is preferable - intratracheally). After 5-10 minutes, the injections are repeated.

1. Adrenaline 0.1% - 0.5 ml diluted 5 ml. physical solution or glucose intracardiac (preferably - intertracheally).

2. Lidocaine 2% - 5 ml (1 mg per kg of body weight) IV, intracardiac.

3. Prednisolone 120-150 mg (2-4 mg per kg of body weight) IV, intracardiac.

4. Sodium bicarbonate 4% - 200 ml IV.

5. Vitamin C 5% - 3-5 ml IV.

6. Cold to the head.

7. Lasix according to indications 40-80 mg (2-4 ampoules) IV.

Resuscitation is carried out taking into account the existing asystole or fibrillation, which requires electrocardiography data. When diagnosing fibrillation, a defibrillator (if the latter is available) is used, preferably before medical therapy.

In practice, everything listed activities are carried out simultaneously.

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