collapse treatment. Collapse (collaptoid condition, vascular insufficiency)

Collapse- one of the forms of acute vascular insufficiency, which is characterized by a fall vascular tone and a decrease in the volume (mass) of circulating blood (BCC), accompanied by sharp drop blood pressure and leading to the decline of all vital processes.

Here is such a “simple”, according to many doctors, wording of the concept of “collapse” can easily be found on the pages of sites medical profile. It's great, really! Of course, everyone understands everything! Since it is clear to us (practicing physicians) that you do not understand anything, we propose to put this “case”, as they say, on the shelves.

If we translate this phrase into a commonly understood human language, it will immediately become clear that collapse is a condition in which the vessels of the human body cannot provide an influx the right amount blood to all organs. The most important thing you need to understand is that the brain and heart do not receive oxygenated blood. And, as it is known from the school bench, the brain of many is “the head of everything”, well, the heart is also a very, very necessary organ.

A natural question arises: “why does a collapse occur?”

Causes of collapse:

sudden massive blood loss. As a rule, this is associated with a rupture of internal organs or serious external injuries to the body.

sudden violation of the rhythm of the heart or a violation of its contractility.

Both reasons lead to the fact that the heart does not push the right amount of blood into the vessels. Examples of such diseases are: myocardial infarction, blockage large vessels lung thrombus or air blockage (pulmonary embolism), all kinds of sudden cardiac arrhythmias.

a sharp expansion of peripheral vessels. This condition can occur against the background of high temperature and humidity. environment, during illness with various acute infectious diseases (pneumonia, sepsis, typhoid fever etc.), severe allergic reaction, drug overdose.

in adolescents in puberty collapse may occur due to a strong emotional experience, as negative character, as well as positive.

a sharp change in body position in debilitated patients.

Regardless of the cause that caused the collapse, the manifestations of the signs of this condition in people of any age are almost always similar.

Clinical manifestations of collapse:

deterioration in well-being occurs suddenly.

there are complaints about headache, tinnitus, weakness, discomfort in the region of the heart, darkening in the eyes.

consciousness is preserved, but some lethargy is possible, in the absence of help, loss of consciousness is possible.

blood pressure drops sharply and by significant numbers.

the skin becomes wet, cold, pale.

facial features are sharpened, the look becomes dull.

breathing becomes shallow, frequent.

the pulse is palpable.

Emergency first aid for collapse:

Whatever the reason was the impetus for the development of the collaptoid state, a doctor's examination is needed in any case. The patient himself may object to the examination, but you must remember that the collapse is the result of a serious problem in the body. A momentary improvement in the patient's well-being is not at all a guarantee of well-being in the future. Calling a doctor is a prerequisite for full assistance. In the meantime, you are waiting for the ambulance team to do the following:

lay the patient on a hard surface. A flat and hard surface is the best platform for resuscitation should the need arise.

raise your legs (put a chair or things under them). This is done to increase blood flow to the brain and heart.

ensure the flow fresh air. Simply open a window or balcony door.

loosen tight clothing. To improve overall blood flow, you need to unfasten the belt, collar and cuffs of clothing.

give a sniff of cotton wool with ammonia. Absence ammonia can be replaced by stimulation (light massage) nerve endings earlobes, temples, dimples of the upper lip.

if the collapse is caused by blood loss from an external wound, try to stop the bleeding.

Remember!

In no case do not give the patient nitroglycerin, validol, no-shpu, valocordin, corvalol. These drugs dilate the vessels, which in this case are already not in good shape.

It is impossible to give medicines and drink to the victim through the mouth if he is unconscious!

It is impossible to bring the patient to life with blows on the cheeks!

Indications for hospitalization:

This issue is considered in each case by physicians.

Addition:

There are differences between the concepts of "collapse" and "shock". We will separately consider briefly this issue, because often people confuse these concepts. It may not be of practical importance for first aid, but for general development, this information does not hurt.

Shock is, like collapse, a general reaction of the body to a powerful damaging factor. This factor can be all kinds of injuries, poisoning, death of a large section of the heart muscle, loss of most of the blood, severe pain. The state of shock begins to develop from the phase of excitation of the patient, and then abruptly gives way to a pronounced depression of consciousness and motor activity of a person. Arterial pressure in shock, it decreases to such an extent that the excretory function of the kidneys stops. On my own without drug treatment blood pressure does not rise.

They can develop abruptly, catching a person and the people around him by surprise. Such pathological conditions can be relatively harmless, but in some cases they can carry serious threat health and life. Therefore, in no case should they be left unattended, the victim should be given first aid. Quite common disorders of this type include vascular collapse, causes, symptoms and treatment in a little more detail.

What is vascular collapse?

The term vascular collapse means a variety, with such a pathological condition, a sharp decrease in vascular tone occurs, which in turn causes a sharp decrease in arterial and venous pressure and loss of consciousness.

Causes of vascular collapse

There are a number of factors that can cause vascular collapse. These can be infectious diseases represented by pneumonia, meningoencephalitis, typhoid fever and some other pathological conditions. Sometimes collapse occurs with ailments of the nervous and, it can be caused by poisoning and sudden loss blood. Also, such a pathological condition is provoked by damage to the heart muscle, the use of certain drugs (for example, with an overdose of insulin), anesthesia (especially spinal). In addition, it can be provoked by taking an excessive amount alcoholic beverages and developed peritonitis. In some cases, vascular collapse occurs during an attack.

How does vascular collapse manifest itself, what are its symptoms?

The collapse manifests itself characteristic symptoms. Patients suddenly feel severe weakness and fatigue, they are worried about severe dizziness (sometimes it simply does not allow the patient to stay on his feet). Pathological decline vascular tone is accompanied by chills, a decrease in temperature (the limbs of the victim become cold to the touch). The patient has pale skin and choroids. In some cases, cyanosis occurs.

It is worth noting that the deterioration in the collapse occurs quite sharply. Many patients complain of tinnitus and headache. They may be disturbed by darkening in the eyes. The sight of the victim at the same time becomes dull, and the pulse weakens. Sweating is often observed, convulsions may occur.

With absence timely assistance collapse can turn into loss of consciousness.

How is vascular collapse corrected, what is its treatment?

If a collapse is suspected, the patient needs emergency care, so those around you should immediately call an ambulance. And before her arrival, the patient must be given first aid. First, lay him on his back, on a fairly hard surface and slightly raise his legs. So you will ensure a full flow of blood to the area of \u200b\u200bthe heart and brain. With the development of collapse, it is necessary to organize the supply of fresh air to the victim, so open the window wider. But the patient should not freeze - warm him up.

If you have a first aid kit on hand, let the patient sniff the ammonia. If there is no such medicine, rub the victim's temples, as well as the hole that is located directly above the upper lip, and the earlobes.

If the cause of the collapse was bleeding from an external wound, when providing first aid, measures should be taken to stop the bleeding.

In the event that a loss of consciousness has occurred, it is not necessary to give the patient any drink or medicine. In no case should you try to bring him to consciousness by hitting him on the cheeks.

If there is a suspicion of vascular collapse, the patient should not be given valocordin, validol, and. All these drugs dilate blood vessels.

Further treatment vascular collapse

After the arrival of the ambulance, the doctors put the victim down, slightly lifting him lower limbs and also cover it with a blanket. Next, a subcutaneous injection of two milliliters of a ten percent solution of caffeine-sodium benzoate is carried out. If an infectious collapse has occurred, such therapy is often sufficient. And with orthostatic collapse, the introduction gives a stable positive effect. However, it should be noted that the patient without fail it is necessary to correct the causes of the development of such a violation.

Such etiological treatment aimed at stopping bleeding if the collapse is hemorrhagic in nature. The resulting poisoning requires the elimination of toxic elements from the body, as well as specific antidote therapy. In addition, thrombolytic treatment can be carried out.

If the patient is diagnosed with acute myocardial infarction or thromboembolism pulmonary arteries, the corresponding correction is carried out.

Doctors may infuse the patient with blood, plasma, or a blood-substituting fluid. In the event that indomitable vomiting and diarrhea are observed, it is impossible to do without the introduction hypertonic saline sodium chloride. The same treatment is indicated for adrenal insufficiency, in which case adrenal hormones are also used.

If there is a need to quickly increase blood pressure, intravenous drip introduction norepinephrine or angiotensin. Slightly slower, but at the same time more stable effect gives the use of injections of methasone and fetanol. Almost all patients undergo oxygen therapy.

Alternative treatment

Funds traditional medicine can be used only as general strengthening. Collapse correction can only be carried out under the supervision of a doctor, using medications.

So, in the event of a loss of blood, the patient may need funds based on nettle. You can brew a couple of tablespoons of crushed nettle leaves with a glass of just boiled water. Insist for two to three hours, then strain. Drink the received medicine for a day in three-four receptions. Nettle, by the way, is advised to add to different dishes such as salads, soups, etc.

You can also cope with bleeding and their consequences with the help of an infusion based on. Brew a couple of tablespoons of such raw materials in a thermos with half a liter of boiling water. Insist for one to two hours, strain and take a third or half a glass twice or thrice a day. It is best to take the reception twenty to thirty minutes before a meal.

Folk remedies will also help patients with impaired activity of the heart muscle. To strengthen such a site, you can brew a glass of chopped fresh fruit viburnum liter hot water. Boil on a fire of minimum power for eight to ten minutes, then strain and sweeten with honey. Take half a glass three to four times a day.

If you suffer from a weakening of the heart, a medicine based on St. John's wort will come in handy. Brew one hundred grams of dried grass with two liters of water and boil over a fire of minimum power for ten minutes. Remove the prepared medicine from the heat, strain and sweeten with honey. Pour the finished broth into a convenient bottle and refrigerate for storage. Take half a glass three times a day.

Folk remedies will also help patients who have had a myocardial infarction. They will improve general state speed up recovery after a heart attack. So a good effect is given by the collection of equal parts of valerian roots, motherwort grass and cumin fruits. Brew a tablespoon of this mixture with a glass of boiling water, soak in a water bath for a quarter of an hour. Insist for half an hour, then strain. Squeeze out the vegetable raw materials, and take the infusion in a glass before going to bed.

After a heart attack. Even after a myocardial infarction, you can take medicine from rose hips. We will complement it with a few strawberry leaves. Combine fifty grams of such raw materials, brew half a liter of boiling water and heat in a water bath for a quarter of an hour. Next, completely cool the broth, strain it, and squeeze the plant mass. You need to take such a remedy for half a glass twice a day shortly before a meal.

Collapse is a rather serious condition that requires close attention and adequate timely therapy. Appropriateness of application folk remedies after suffering a vascular collapse, you must definitely discuss with your doctor.

Ekaterina, www.site
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Almost all of us have experienced this painful condition like a vascular collapse on own experience or from the experience of loved ones. If the collapse is accompanied by loss of consciousness, then this condition is called fainting. But quite often the collaptoid state develops against the background of intact consciousness.

Collapse is, by definition, acutely developing vascular insufficiency. The name "collapse" comes from the Latin word collapsus, meaning "weakened" or "fallen".

At the first signs of the development of cardiovascular collapse, first aid is necessary. This condition often leads to the death of the patient. To prevent negative consequences one should know the causes that cause collapse and be able to
properly prevent them.

How does acute vascular insufficiency develop?

The collapse is characterized by a decrease in vascular tone, which is accompanied by a relative decrease in the volume of blood circulating in the body. In simple words, the vessels dilate in a short period of time, and the blood available in the bloodstream becomes insufficient for the blood supply to the vital organs. The body does not have time to quickly respond to a change in vascular tone and release blood from the blood depots. acute vascular insufficiency, collapse develops acutely and rapidly.

If the collapse is accompanied by a critical violation of the blood supply to the brain, then there is a faint, or loss of consciousness. But this does not happen in all cases.
collaptoid state.

With the development of collapse, the state of health worsens, dizziness appears, pallor of the skin and mucous membranes, cold sweat may appear. Breathing becomes frequent and superficial, the heartbeat quickens, blood pressure decreases.

Cardiovascular collapse: first aid

As a rule, collapse develops against the background of a weakening of the body after serious illnesses, infections, intoxications, pneumonia, with physical and mental overstrain, with a decrease or increase in blood sugar levels. If the collaptoid state or syncope lasts more than 1-2 minutes, then any serious illness and call an ambulance.

First aid for cardiovascular collapse and syncope should be as follows: eliminate potential hazards ( electricity, fire, gas), make sure that the patient has free breathing or provide it (unfasten the collar, belt, open the window), pat on the cheeks and splash the face with cold water.

If such conditions occur repeatedly, their duration and frequency increase, then it is necessary to carry out a complete clinical examination to determine their cause.

In medicine collapse om (from the Latin collapse - fallen) characterizes the patient's condition with a sharp drop in blood pressure, vascular tone, as a result of which the blood supply to vital organs worsens. In astronomy, there is a term "gravitational collapse”, which implies hydrodynamic compression of a massive body under the action of own strength gravitation, which leads to a strong decrease in its size. Under "transport collapse om" means a traffic jam, in which any violation of the movement of vehicles leads to a complete blockage Vehicle. On the public transport- with a full load of one vehicle, the number of waiting passengers is close to the critical point. Economic collapse- this is a violation of the balance between supply and demand for services and goods, i.e. a sharp decline in the economic condition of the state, which appears in the recession of the economy of production, bankruptcy and disruption of established industrial relations. There is a concept " collapse wave function”, which means an instantaneous change in the description of the quantum state of an object.

In other words, the wave function characterizes the probability of finding a particle at some point or time interval, but when you try to find this particle, it ends up at one specific point, which is called collapse ohm.Geometric collapse ohm is a change in the orientation of an object in space, fundamentally changing its geometric property. For example, under collapse ohm rectangularity refers to the instantaneous loss of this property. The popular word " collapse” did not leave indifferent the developers of computer games. Yes, in game Deus Ex collapse om is an event taking place in the 21st century, when a crisis of power has matured in society with very rapid development science, the creation of revolutionary nanotechnologies and intelligent cybersystems. In 2009, the American director C. Smith's film "Collapse" was released on television. The film is based on a TV interview with Michael Rupert, author of notorious books and articles, and accused of conspiracy theories.

Collapse

Collapse is an acute vascular insufficiency characterized by sharp decline vascular tone and a drop in blood pressure.

The collapse is usually accompanied by a violation of the blood supply, hypoxia of all organs and tissues, a decrease in metabolism, depression of vital important functions organism.

Causes

Collapse can develop due to many diseases. Most often, collapse occurs with pathology cordially- vascular system(myocarditis, myocardial infarction, pulmonary embolism, etc.), as a result of acute loss of blood or plasma (for example, with extensive burns), dysregulation of vascular tone during shock, severe intoxication, infectious diseases, in diseases of the nervous, endocrine systems, as well as with an overdose of ganglioblockers, neuroleptics, sympatholytics.

Symptoms

The clinical picture of collapse depends on its cause, but the main manifestations are similar in collapse different origin. There is a sudden progressive weakness, chilliness, dizziness, tinnitus, tachycardia (rapid pulse), weakening of vision, and sometimes a feeling of fear. The skin is pale, the face becomes earthy, covered with sticky cold sweat, with cardiogenic collapse, cyanosis (bluish color of the skin) is often noted. The body temperature drops, breathing becomes superficial, speeded up. Arterial pressure decreases: systolic - up to 80-60, diastolic - up to 40 mm Hg. Art. and below. With the deepening of the collapse, consciousness is disturbed, heart rhythm disorders often join, reflexes disappear, pupils dilate.

Cardiogenic collapse, as a rule, is combined with cardiac arrhythmia, signs of pulmonary edema (respiratory failure, cough with profuse froth, sometimes with a pink tinge, sputum).

orthostatic collapse occurs with a sharp change in body position from horizontal to vertical and quickly stops after the patient is transferred to the prone position.

Infectious collapse, as a rule, develops as a result of a critical decrease in body temperature. Moisture of the skin, pronounced weakness of the muscles is noted.

Toxic collapse is often combined with vomiting, nausea, diarrhea, signs of acute kidney failure(edema, urinary incontinence).

Diagnostics

Diagnosis is based on clinical picture. The study of hematocrit, blood pressure in dynamics give an idea of the severity and nature of the collapse.

Types of disease

Cardiogenic collapse - as a result of a decrease cardiac output;
Hypovolemic collapse - as a result of a decrease in the volume of circulating blood;
Vasodilation collapse - as a result of vasodilation.

Patient's actions

In the event of a collapse, you should immediately contact the ambulance service.

Collapse treatment

Therapeutic measures are carried out intensively and urgently. In all cases, the patient with collapse is placed in a horizontal position with raised legs, covered with a blanket. A 10% solution of caffeine-sodium benzoate is administered subcutaneously. need to be eliminated possible cause collapse: removal toxic substances from the body and the introduction of an antidote for poisoning, stopping bleeding, thrombolytic therapy. With thromboembolism of the pulmonary arteries, acute infarction myocardial arrest with medication paroxysm atrial fibrillation and other cardiac arrhythmias.

Pathogenetic therapy is also carried out, which includes intravenous administration saline solutions and blood substitutes for blood loss or thickening of the blood in patients with hypovolemic collapse, the introduction of a hypertonic solution of sodium chloride during collapse against the background of indomitable vomiting, diarrhea. If necessary, an urgent increase in blood pressure is administered norepinephrine, angiotensin, mezaton. In all cases, oxygen therapy is indicated.

Complications of collapse

The main complication of collapse is loss of consciousness. varying degrees. Light fainting is accompanied by nausea, weakness, pallor of the skin. Deep fainting may be accompanied by convulsions, increased sweating, involuntary urination. Also, due to fainting, injuries are possible when falling. Sometimes the collapse leads to the development of a stroke (impaired cerebral circulation). Possible various damage brain.

Repetitive episodes of collapse lead to severe cerebral hypoxia, aggravation of concomitant neurological pathology development of dementia.

Prevention

Prevention is the treatment of the underlying pathology, constant surveillance for the sick in serious condition. It is important to take into account the peculiarities of the pharmacodynamics of drugs (neuroleptics, ganglionic blockers, barbiturates, antihypertensives, diuretics), individual sensitivity to drugs and nutritional factors.

Collapse: what is it

Collapse is an acute vascular insufficiency, which is characterized by a sharp drop in arterial and venous pressure caused by a decrease in the mass of blood circulating in the circulatory system, a drop in vascular tone, or a decrease in cardiac output.

As a result, the metabolic process slows down, hypoxia of organs and tissues begins, and the most important functions of the body are inhibited.

Collapse is a complication in pathological conditions or serious diseases.

The reasons

There are two main causes:

Sudden massive blood loss leads to a decrease in the volume of circulation, to its inconsistency with the throughput capabilities vascular bed;
Due to exposure to toxic and pathogenic substances the walls of blood vessels and veins lose their elasticity, subside general tone the entire circulatory system.

The steadily growing manifestation of acute insufficiency of the vascular system leads to a decrease in the volume of circulating blood, acute hypoxia occurs, caused by a decrease in the mass of oxygen transported to organs and tissues.

This, in turn, leads to a further drop in vascular tone, which provokes a decrease in blood pressure. Thus, the state progresses like an avalanche.

Reasons for launch pathogenetic mechanisms at different types collapse are different. The main ones are:

internal and external bleeding;
general toxicity of the body;
a sharp change in body position;
decrease in the mass fraction of oxygen in the inhaled air;
acute pancreatitis.

Symptoms

The word collapse comes from the Latin "colabor", which means "I fall." The meaning of the word accurately reflects the essence of the phenomenon - falling blood pressure and the fall of man himself in the collapse.

Main Clinical signs collapse various origins basically the same:

Protracted forms can lead to loss of consciousness, dilated pupils, loss of basic reflexes. Failure to provide timely medical care can lead to serious consequences or death.

Kinds

Despite the fact that in medicine there is a classification of types of collapse according to the pathogenetic principle, the most common classification according to etiology, which distinguishes the following types:

infectious, toxic caused by the presence of bacteria in infectious diseases, which leads to disruption of the heart and blood vessels;
toxic- the result of general intoxication of the body;
hypoxemic, which occurs when there is a lack of oxygen or in conditions of high atmospheric pressure;
pancreatic caused by trauma to the pancreas;
burn that occurs after deep burns skin;
hyperthermic coming after a strong overheating, sunstroke;

dehydration, due to the loss of fluid in large volumes;
hemorrhagic caused by massive bleeding recent times considered as a deep shock;
cardiogenic associated with the pathology of the heart muscle;
plasmorrhagic arising from the loss of plasma in severe forms of diarrhea, multiple burns;
orthostatic, which occurs when the body is brought to a vertical position;
enterogenic(fainting) that occurs after eating in patients with resection of the stomach.

Separately, it should be noted that hemorrhagic collapse can occur both from external bleeding and from invisible internal ones: ulcerative colitis, stomach ulcer, damage to the spleen.

In cardiogenic collapse, stroke volume decreases due to myocardial infarction or angina pectoris. The risk of developing arterial thromboembolism is high.

Orthostatic collapse also occurs with prolonged standing in a vertical state, when the blood is redistributed, the venous part increases and the flow to the heart decreases.

Collapse due to poisoning is also possible. medicines: sympatholytics, neuroleiptics, adrenergic blockers.

Orthostatic collapse often occurs in healthy people particularly in children and adolescents.

Toxic collapse can be caused professional activity associated with toxic substances: cyanides, amino compounds, carbohydrate oxide.

Collapse in children is observed more often than in adults and proceeds in a more complex form. may develop in the background intestinal infections, influenza, pneumonia, anaphylactic shock, adrenal dysfunction. The immediate cause may be fright, trauma and blood loss.

First aid

At the first sign of collapse, an ambulance should be called immediately. A qualified doctor will determine the severity of the patient, if possible, establish the cause of the collapsing condition and prescribe the primary treatment.

The provision of first aid will help to alleviate the patient's condition, and possibly save his life.

Necessary actions:

lay the patient on a hard surface;
raise your legs with a pillow;
tilt your head back, ensure free breathing;
unbutton the collar of the shirt, free from everything that binds (belt, belt);
open windows, provide fresh air;
bring ammonia to the nose, or massage the earlobes, dimple upper lip, whiskey;
stop bleeding if possible.

Prohibited actions:

give drugs with a pronounced vasodilating effect (nosh-pa, valocordin, glycerin);
hit on the cheeks, trying to bring to life.

Treatment

Non-stationary treatment is indicated for orthostatic, infectious and other types of collapse, which are caused by acute vascular insufficiency. With hemorrhagic collapse caused by bleeding, urgent hospitalization is necessary.

The treatment of collapse has several directions:

Etiological therapy designed to eliminate the causes that caused the collapsing state. Stop bleeding, general detoxification of the body, elimination of hypoxia, administration of adrenaline, antidote therapy, stabilization of the heart will help stop the further deterioration of the patient's condition.
tricks pathogenetic therapy will allow the body to return to its usual working rhythm as quickly as possible. Among the main methods, it is necessary to highlight the following: increase in arterial and venous pressure, stimulation of respiration, activation of blood circulation, administration of blood-substituting drugs and plasma, blood transfusion, activation of the activity of the central nervous system.
oxygen therapy used for poisoning carbon monoxide accompanied by acute respiratory failure. Prompt implementation therapeutic measures allows you to restore the most important functions of the body, return the patient to normal life.

Collapse is a pathology caused by acute vascular insufficiency. Different kinds collapse have a similar clinical picture and require urgent and qualified treatment sometimes surgery.

Collapse I Collapse (lat. collapsus weakened, fallen)

Hemorrhagic K. develops with acute massive blood loss (vessels, internal), due to a rapid decrease in the volume of circulating blood. Similar state may occur due to abundant plasma loss during burns, water and electrolyte disorders due to severe diarrhea, indomitable vomiting, inappropriate use of diuretics.

Collapse is possible with heart diseases accompanied by a sharp and rapid decrease in stroke volume (myocardial infarction, cardiac arrhythmias, acute myocarditis, hemopericardium or pericarditis with rapid accumulation of effusion in the pericardial cavity), as well as in pulmonary embolism. Acute cardiovascular failure, which develops under these conditions, is considered by some authors not as K., but as the so-called small outlier, the manifestations of which are especially characteristic for cardiogenic shock(cardiogenic shock) . Sometimes reflex called collapse, which develops in patients with angina pectoris or myocardial infarction.

Pathogenesis. Conventionally, two main mechanisms of collapse development can be distinguished, which are often combined. One mechanism is a drop in the tone of arterioles and veins as a result of the action of infectious, toxic, physical, allergic and other factors directly on the vascular wall, vasomotor and vascular (, aortic arch, etc.). In case of insufficiency compensatory mechanisms decrease in peripheral vascular resistance (vessels) leads to pathological increase capacity of the vascular bed, a decrease in the volume of circulating blood with its deposition in some vascular areas, a drop in venous flow to the heart, an increase in heart rate, a decrease.

Another mechanism is directly related to a rapid decrease in the mass of circulating blood (for example, with massive blood and plasma loss that exceeds the compensatory capabilities of the body). Arising in response to this reflex small vessels and increased heart rate under the influence increased emission in the blood of catecholamines (catecholamines) may not be sufficient to maintain a normal level of blood pressure. A decrease in circulating blood volume is accompanied by a decrease in the return of blood to the heart through the veins great circle blood circulation and, accordingly, a decrease in cardiac output, a violation of the microcirculation system (Microcirculation) , accumulation of blood in the capillaries, a drop in blood pressure. Develop hypoxia of the circulatory type, metabolic. Hypoxia and acidosis lead to damage vascular wall, increase its permeability . The loss of tone of precapillary sphincters and the weakening of their sensitivity to vasopressor substances develop against the background of maintaining the tone of postcapillary sphincters, which are more resistant to acidosis. In conditions of increased capillary permeability, this contributes to the transfer of water and electrolytes from the blood into the intercellular spaces. Rheological properties are disturbed, hypercoagulability of blood occurs and pathological erythrocytes and platelets, conditions are created for the formation of microthrombi.

In the pathogenesis of infectious K., especially important role play an increase in the permeability of the walls of blood vessels with the release of liquid and electrolytes from them, a decrease in the volume of circulating blood, as well as significant dehydration as a result profuse sweating. A sharp rise in body temperature causes, and then the respiratory and vasomotor centers. With generalized meningococcal, pneumococcal and other infections and the development of myocarditis or allergic myopericarditis on the 2-8th day, the pumping force of the heart decreases, the filling of the arteries and blood flow to the tissues decrease. Reflex mechanisms always take part in K.'s development also.

With a prolonged course of K., as a result of hypoxia and metabolic disorders, vasoactive substances are released, while vasodilators predominate (, histamine, Prostaglandins) and tissue (, adenosine and its derivatives) are formed, providing hypotensive action. and histamine-like substances, lactic acid increase vascularity.

Clinical picture at To. of a various origin it is basically similar. To. develops more often sharply, suddenly. the patient is saved, but he is indifferent to the environment, often complains of a feeling of melancholy and depression, weakening of vision, thirst. turns pale, lips, tip of the nose, arms and legs acquire a shade. tissue decreases, may become marbled, earthy in color, covered with cold sticky sweat, dry. often lowered, patients complain of cold and. Breathing is superficial, rapid, less often slow. Despite shortness of breath, patients do not experience suffocation. soft, rapid, rarely slow, weak filling, often irregular, on radial arteries sometimes difficult or absent. BP is low, sometimes systolic BP drops to 70-60 mmHg st. and even lower, but initial period K. in persons with previous arterial hypertension BP may remain close to normal. also decreases. Superficial veins subside, blood flow velocity, peripheral and central venous pressure decrease. In the presence of right ventricular heart failure, central venous pressure may persist for normal level or decrease slightly the volume of circulating blood decreases. Deafness of heart sounds, often arrhythmia (, atrial fibrillation), are noted.

Diagnosis in the presence of a characteristic clinical picture and relevant history data, it is usually not difficult. Studies of the volume of circulating blood, cardiac output, central venous pressure, hematocrit and other indicators can supplement the nature and severity of K., which is necessary for the choice of etiological and pathogenetic therapy. The differential refers mainly to the causes that caused K., which determines the nature of the assistance, as well as to hospitalization and the choice of a hospital profile.

Treatment. On the prehospital stage only K. due to acute vascular insufficiency (orthostatic K., infectious K.) can be effective; with hemorrhagic K., an emergency patient is needed at the nearest, preferably a surgical profile. An important section of the course of any K. is etiological; (Bleeding) , removal of toxic substances from the body (see Detoxification Therapy) , specific antidote therapy, elimination of hypoxia, giving the patient a strictly horizontal position with orthostatic K., immediate administration of adrenaline, desensitizing agents for anaphylactic K., elimination, etc.

The main task of pathogenetic therapy is blood circulation and respiration, an increase in blood pressure. An increase in venous flow to the heart is achieved by transfusion of blood-substituting fluids, blood plasma and other fluids, as well as agents that act on the peripheral. Therapy for dehydration and intoxication is carried out by the introduction of polyionic pyrogen-free solutions of crystalloids (acesols, disols, chlosols, lactasol). The volume of infusion in emergency therapy is 60 ml crystalloid solution per 1 kg body weight. Infusion rate - 1 ml/kg in 1 min. Infusion of colloidal blood substitutes in severely dehydrated patients is contraindicated. With hemorrhagic K., it is of paramount importance. In order to restore the volume of circulating blood, massive intravenous administration of blood substitutes (polyglucin, rheopolyglucin, hemodez, etc.) or blood is carried out by jet or drip; apply also transfusions of native and dry plasma, the concentrated solution of albumine and protein. Infusions of isotonic saline solutions or glucose solution are less effective. Quantity infusion solution depends on clinical indicators, blood pressure level, diuresis; if possible, it is controlled by determining hematocrit, circulating blood volume and central venous pressure. The introduction of drugs that stimulate the center (cordiamin, caffeine, etc.) is also aimed at eliminating hypotension.

Resuscitation care for K. is provided by general rules. To maintain an adequate minute volume of blood during external cardiac massage in conditions of hypovolemia, it is necessary to increase the frequency of cardiac compressions to 100 in 1 min.

Forecast. Quick Elimination causes that caused K. often leads to full recovery hemodynamics. For severe illnesses and acute poisoning often depends on the severity of the underlying disease, the degree of vascular insufficiency, the age of the patient. When not enough effective therapy To. can recur. Patients endure repeated K. more difficult.

Prevention consists in intensive treatment of the underlying disease, constant monitoring of patients in severe and moderate condition; in this regard, monitoring observation plays a special role. . It is important to take into account the features of the pharmacodynamics of drugs (ganglion blockers, antipsychotics, antihypertensive and diuretics, barbiturates, etc.), allergic and individual to some drugs and nutritional factors.

Features of collapse in children. In pathological conditions (dehydration, starvation, hidden or obvious blood loss, "sequestration" of fluid in the intestines, pleural or abdominal cavities), K. in children is more severe than in adults. More often than in adults, K. develops with toxicosis and infectious diseases, accompanied by high temperature body, vomiting, diarrhea. A decrease in blood pressure and impaired blood flow in the brain occur with deeper tissue hypoxia, accompanied by loss of consciousness and convulsions. Because the children early age alkaline reserve in tissues is limited, violation oxidative processes during K. easily leads to decompensated acidosis. Insufficient concentration and filtration capacity of the kidneys and the rapid accumulation of metabolic products complicate K.'s therapy and delay the restoration of normal vascular reactions.

K.'s diagnosis in young children is difficult due to the fact that it is impossible to find out the patient's sensations, and systolic blood pressure in children even in normal conditions may not exceed 80 mmHg st. The most characteristic for K. in a child can be considered a set of symptoms: a weakening of the sonority of heart sounds, a decrease in pulse waves when measuring blood pressure, general weakness, pallor or spotting of the skin, increasing.

Therapy of orthostatic K., as a rule, does not require medication prescriptions; it is enough to lay the patient horizontally without a pillow, raise the legs above the level of the heart, unbutton the clothes. A favorable effect is provided by fresh, inhalation of ammonia vapors. Only with deep and persistent K. with a decrease in systolic blood pressure below 70 mmHg st. shows intramuscular or intravenous administration of vascular analeptics (caffeine, ephedrine, mezaton) in doses appropriate for age. In order to prevent orthostatic K., it is necessary to explain to teachers and coaches that it is unacceptable for children and adolescents to stand still for a long time on rulers, training camps, and sports constructions. At To. owing to blood loss and at infectious diseases the same actions, as at adults are shown.

II Collapse

heavy life threatening a condition characterized by a sharp decrease in blood pressure, inhibition of the activity of the central nervous system and metabolic disorders. and a decrease in blood pressure is the result of a drop in vascular tone caused by inhibition of the vasomotor center in the brain. At K. vessels of bodies abdominal cavity filled with blood, while the blood supply to the vessels of the brain, muscles and skin is sharply reduced. Vascular insufficiency accompanied by a decrease in the oxygen content in the blood, washing the tissues and organs.

Collapse can occur with a sharp blood loss, lack of oxygen, malnutrition, injuries, sudden changes in posture (orthostatic K.), excessive physical activity, as well as in case of poisoning and some diseases (abdominal and typhus, pancreatitis, etc.).

With K., the skin turns pale, covered with a cold sticky sweat, the limbs become marbled blue, the veins collapse and become indistinguishable under the skin. Eyes sunken, facial features sharpened. Blood pressure drops sharply, the pulse is barely palpable or even absent. Breathing is rapid, shallow, sometimes intermittent. Involuntary and emptying of the intestine may occur. Body temperature drops to 35 ° and below. The patient is lethargic, consciousness is darkened, and sometimes completely absent.

When K. needs emergency treatment: you need to urgently call an ambulance medical care. Before the arrival of the doctor, the patient is laid without a pillow, lower part the torso and legs are slightly raised, they are allowed to smell the vapors of ammonia. Apply to the limbs, give the patient hot strong tea or coffee, ventilate the room.

III Collapse (collapsus; lat collabor, collapsus to suddenly fall, fall into)

acutely developing vascular insufficiency, characterized by a drop in vascular tone and a decrease in the mass of circulating blood; manifested by a sharp decrease in arterial and venous pressure, signs of cerebral hypoxia and inhibition of vital body functions.

Hemorrhagic collapse(s. haemorrhagicus) - K., arising from massive blood loss.

Hypoxemic collapse(c. hypoxaemicus) - see The collapse is hypoxic.

Hypoxic collapse(c. hypoxicus; . K. hypoxemic) - K. that occurs with acute oxygen deficiency, for example, with rapid decline atmospheric pressure (in the pressure chamber), when breathing air with reduced content oxygen.

Infectious collapse(s. infectiosus) - K., arising at the height of development infectious disease or with a critical decrease in body temperature.

Orthostatic collapse(p. orthostaticus) - K., which occurs with a sharp transition from a horizontal to a vertical position or with prolonged standing, mainly in individuals with weakened vascular tone.