Providing emergency care in acute conditions. Emergency and urgent care

You can be sure that nothing will ever happen to you. You don’t have to read a bunch of information and figure out what could happen and how you can help? Perhaps you are lazy and don’t want to waste your precious time on this - this is your personal desire and it has a right to exist. BUT exactly as long as it concerns only you.

If you become parents, you are responsible for your child, his health and safety. Your duty as a parent is to know how and be able to provide emergency medical care to your child in an emergency!

What is first aid, and how do you know when it is needed?

What is emergency first aid?

First aid- a complex of simple urgent measures aimed at saving a person’s life, as well as preventing possible complications if an accident or illness occurs.

Unfortunately, in your life you will more than once be faced with the need to provide medical care to you or other people. And a situation will definitely arise when help will need to be provided to your child. It is quite possible that emergency assistance will be needed.

If something happens to your child, you, like any person without medical education, first of all call " ambulance" Because medical care should be provided by people who have the appropriate education and permission to carry out the necessary manipulations.

They will assess the child's condition and take the necessary measures. But the main question is WHEN? When will the ambulance arrive? When will doctors help? And won't it be too late? You won’t be able to calmly wait for them and see that the child’s condition is worsening. And you have the opportunity to help here and now, you just need to know how!

If something threatens the child’s life, then the situation is critical:

the child is unconscious - does not respond to touch or your words
the child is not breathing - the chest does not move, you cannot hear breathing, you cannot feel the breath on your cheek
there is no pulse in the carotid, brachial, radial and femoral arteries
Pupils are dilated and do not respond to light
pale or bluish skin

If the situation is critical, you need to take immediate action!

What can happen to a child and how to help him?

From birth to 6 months, when the child rolls over and reaches for everything with his hands, the following accidents occur:

the child is injured in his crib or when trying to get out of it
Babies often fall off the changing table
babies get burns from hot coffee or tea
children are injured in accidents because... The child car seat is not used correctly or is not there at all

Children from 6 months to a year are already crawling and taking their first steps:

are injured by children's toys: they cut themselves on sharp edges, swallow small parts
fall off the high chair
hitting the sharp corners of furniture
get burns from cigarettes
are injured when they grab hot objects, sharp knives or broken dishes
fall out of the stroller or walker

Children from one to two years old go everywhere and are interested in everything:

fall from the height they climbed to
are poisoned harmful substances who eat
get injured while exploring their home: they knock over cabinets, eat medicine from the medicine cabinet
drown or choke in water: bath, pool, pond
get cuts
injured in car accidents

Most of the child's injuries occur at home, so your job is to provide him with a safe environment. Everything that a child can get must be as safe as possible for him.

Of course, it is impossible to remove everything - you need to teach your child that certain things should not be touched.

Features of the algorithm for providing emergency pre-hospital medical care

Assess the situation, understand what happened and what caused the accident. This could be electric current, fire, fallen furniture or other objects.
Call an ambulance, call for help
Stop this reason, but be sure to maintain your safety - if something happens to you, you will not be able to help the child
Try to remember how you can help the child, depending on the nature of the injury.
First aid: stop bleeding, do artificial respiration, indirect massage hearts, bandage
If you have the opportunity, take your child to a hospital as soon as possible. medical institution or wait for an ambulance
Emergency kit

If bleeding is severe, there is a risk of blood loss, so you need to apply a tight bandage
If bleeding continues, apply one or two more
Usually more than three dressings are not required. Do not remove the bandage and keep it on the child until the doctor arrives
If blood is flowing"fountain", immediately apply a tourniquet
Before this, clamp the artery by pressing firmly on it with your finger, if the child is under 2 years old, if the child is older, press with your fist
The tourniquet is applied either to upper third hands, if the hand is injured, or on inguinal fold on the leg, if the wound is on the leg

The tourniquet is always tied above the wound, and there should be thin fabric or clothing underneath it. If you did everything correctly, the bleeding will stop immediately.

REMEMBER: Symptoms heatstroke In children, internal changes in the body appear later, so if you notice them you need to act very quickly!

Symptoms of heat stroke:

body temperature rises
skin is dry and hot
the child hardly sweats
pulse and breathing quicken
hallucinations, convulsions, delirium, lack of coordination, and even loss of consciousness are possible

You must help your child immediately:

reduce body temperature and cool it down - give the child a cool bath or wrap the child in a wet, cool sheet
Give your child water, often and little by little, with teaspoons, so as not to provoke vomiting and more severe dehydration
Call emergency services or take him to the hospital as quickly as possible.

Providing emergency care to children with anaphylactic shock

Anaphylactic shock is allergic reaction, which most often occurs when a child is given medication or from insect bites. This reaction develops very quickly and is very pronounced. Anaphylactic shock suddenly begins - the child turns pale, blue, shows anxiety and fear, shortness of breath appears, vomiting is possible, itching and rash appear. The child begins to choke, cough, pain in the heart area and headache appear. There is a sharp decline blood pressure and the child loses consciousness, convulsions appear, and there is a possibility of death.

First aid. Immediately place the child horizontally on his back, lift his legs up and put something on him. Turn your head to the side lower jaw push it out and make sure that the tongue does not fall back and the child does not choke on vomit.

If the allergen was administered as an injection:

stop introducing the allergen immediately
make several injections around the injection site with 0.1% adrenaline solution in a dosage of 0.05-0.1 ml for each year of life, but not more than 1 ml
apply ice to the injection site
apply a tourniquet above this area and hold for 30 minutes

If the allergen gets dropped into your nose or eyes, immediately rinse them under running water.

If the allergen has been eaten, you need to immediately rinse the child’s stomach, if this is possible in his condition.

In the last two cases, you also need to give an injection of 0.1% adrenaline solution intramuscularly and into the muscles of the floor of the mouth with 3% prednisolone solution at a dosage of 5 mg/kg body weight.

You need to give your child antihistamines:

1% solution of diphenhydramine at a dosage of 0.05 ml/kg body weight, but not more than 0.5 ml for children under one year and 1 ml for over one year
2% Suprastin solution 0.1-0.15 ml/year of life

Open the windows to allow oxygen in. Be sure to monitor your pulse, blood pressure, breathing and call an ambulance!

Emergency first aid for children: tips and reviews

According to statistics, a third of accidents occur with children at home, so the main task of parents is to ensure the safety of the home and prevent trouble.

We hope that after reading this article you will be able to provide first aid to your child if he or she needs it.

Take care of your children!

Video: K How to perform artificial respiration on an adult and an infant?

The most important thing before the doctors arrive is to stop the influence of factors that worsen the well-being of the injured person. This step involves eliminating life-threatening processes, for example: stopping bleeding, overcoming asphyxia.

Determine the actual status of the patient and the nature of the disease. The following aspects will help with this:

what are the blood pressure values?
are bleeding wounds visible?
the patient has a reaction of the pupils to light;
has your heart rate changed?
respiratory functions are preserved or not;
how adequately a person perceives what is happening;
whether the victim is conscious or not;
if necessary - provision respiratory functions by accessing fresh air and gaining confidence that there is no air in the air ducts foreign objects;
carrying out non-invasive ventilation (artificial respiration using the “mouth to mouth” method);
performing indirect (closed) in the absence of a pulse.

Quite often, the preservation of health and human life depends on the timely provision of high-quality first aid. At emergency conditions all victims, regardless of the type of illness, need competent emergency actions before the arrival of the medical team.

First aid for emergency conditions cannot always be offered by qualified doctors or paramedics. Every modern person should have the skills pre-medical measures and know the symptoms of common diseases: the result depends on the quality and timeliness of measures, the level of knowledge, and the skills of witnesses to critical situations.

ABC Algorithm

Emergency pre-medical actions involve the implementation of a set of simple therapeutic and preventive measures directly at the site of the tragedy or near it. First aid for emergency conditions, regardless of the nature of the illness or received, has a similar algorithm. The essence of the measures depends on the nature of the symptoms shown by the affected person (for example: loss of consciousness) and on the suspected causes emergency(for example: hypertensive crisis with arterial hypertension). Rehabilitation activities within the framework of first aid in emergency conditions, they are carried out according to uniform principles - the ABC algorithm: these are the first English letters denoting:

Air (air);
Breathing (breathing);
Circulation (blood circulation).

Life sometimes brings surprises, and they are not always pleasant. We find ourselves in difficult situations or become witnesses to them. And often we're talking about about the life and health of loved ones or even random people. How to act in this situation? After all quick action, proper emergency assistance can save a person’s life. What emergency conditions and emergency medical care are, we will consider further. We will also find out what assistance should be provided in case of emergency conditions, such as respiratory arrest, heart attack and others.

Types of medical care

The medical care provided can be divided into the following types:

Emergency. It turns out that there is a threat to the patient’s life. This may be during an exacerbation of any chronic diseases or during sudden acute conditions.
Urgent. Necessary during periods of exacerbation chronic pathology or in case of an accident, but there is no threat to the patient’s life.

Planned. This is the implementation of preventive and planned measures. Moreover, there is no threat to the patient’s life even if the provision of this type of assistance is delayed.

Emergency and urgent care

Emergency and emergency medical care are very closely related to each other. Let's take a closer look at these two concepts.

In case of emergency, medical care is required. Depending on where the process occurs, in case of emergency, assistance is provided:

External processes that arise under the influence of external factors and directly affect a person’s life.
Internal processes. The result of pathological processes in the body.

Emergency care is one of the types of primary health care, provided during an exacerbation of chronic diseases, in acute conditions that do not threaten the patient’s life. It may turn out to be day hospital, and in an outpatient setting.

Emergency help should be provided in case of injuries, poisoning, acute conditions and diseases, as well as in accidents and in situations where assistance is vital.

Emergency care must be provided in any medical institution.

First aid in emergency situations is very important.

Major emergencies

Emergency conditions can be divided into several groups:

Injuries. These include:

Burns and frostbite.
Fractures.
Damage to vital organs.
Damage to blood vessels with subsequent bleeding.
Hit electric shock.

2. Poisoning. Damage occurs inside the body, unlike injury, it is the result external influence. Disruption internal organs if untimely emergency care is not given, it can lead to death.

Poison can enter the body:

Through the respiratory system and mouth.
Through the skin.
Through the veins.
Through mucous membranes and through damaged skin.

Treatment emergencies include:

1. Acute conditions of internal organs:

Stroke.
Myocardial infarction.
Pulmonary edema.
Acute liver and kidney failure.
Peritonitis.

2. Anaphylactic shock.

3. Hypertensive crises.

4. Attacks of suffocation.

5. Hyperglycemia in diabetes mellitus.

Emergency conditions in pediatrics

Every pediatrician must be able to provide emergency care to a child. It may be required in case of a serious illness or accident. IN childhood A life-threatening situation can progress very quickly, since the child’s body is still developing and all processes are imperfect.

Pediatric emergencies that require medical attention:

Convulsive syndrome.
Fainting in a child.
Comatose state in a child.
Collapse in a child.
Pulmonary edema.
State of shock in a child.
Infectious fever.
Asthmatic attacks.
Croup syndrome.
Continuous vomiting.
Dehydration of the body.
Emergency conditions in diabetes mellitus.

In these cases, emergency medical services are called.

Features of providing emergency care to a child

The doctor's actions must be consistent. It must be remembered that in a child, disruption of the functioning of individual organs or the entire body occurs much faster than in an adult. Therefore, emergency conditions and emergency medical care in pediatrics require a quick response and coordinated actions.

Adults must provide calm state child and provide full assistance in collecting information about the patient’s condition.

The doctor should ask the following questions:

Why did you seek emergency help?
How was the injury sustained? If it's an injury.
When did the child get sick?
How did the disease develop? How did it go?
What medications and remedies were used before the doctor arrived?

The child must be undressed for examination. The room should be at normal room temperature. In this case, the rules of asepsis must be observed when examining a child. If it is a newborn, a clean robe must be worn.

It is worth considering that in 50% of cases when the patient is a child, the diagnosis is made by the doctor based on the information collected, and only in 30% - as a result of the examination.

At the first stage, the doctor must:

Assess the degree of impairment of the respiratory system and the functioning of the cardiovascular system. Determine the degree of need for emergency treatment measures based on vital signs.
It is necessary to check the level of consciousness, breathing, the presence of seizures and cerebral symptoms and the need for emergency measures.

It is necessary to pay attention to the following points:

How the child behaves.
Lethargic or hyperactive.
What an appetite.
State skin.
The nature of the pain, if any.

Emergency conditions in therapy and assistance

The health care professional must be able to quickly assess emergency conditions, and emergency medical care must be provided in a timely manner. Correctly and quickly diagnosed is the key to a quick recovery.

Emergency conditions in therapy include:

Fainting. Symptoms: pale skin, skin moisture, muscle tone is reduced, tendon and skin reflexes are preserved. Blood pressure is low. There may be tachycardia or bradycardia. Fainting can be caused by the following reasons:

Failure of the cardiovascular system.
Asthma, various types of stenosis.
Brain diseases.
Epilepsy. Diabetes mellitus and other diseases.

The assistance provided is as follows:

The victim is placed on a flat surface.
Unbutton clothes and provide good air access.
You can spray water on your face and chest.
Give ammonia a whiff.
Caffeine benzoate 10% 1 ml is administered subcutaneously.

2. Myocardial infarction. Symptoms: burning, squeezing pain, similar to an angina attack. Painful attacks are wave-like, decrease, but do not stop completely. The pain gets stronger with each wave. It may radiate to the shoulder, forearm, left shoulder blade or hand. There is also a feeling of fear and loss of strength.

Providing assistance is as follows:

The first stage is pain relief. Nitroglycerin is used or Morphine or Droperidol with Fentanyl is administered intravenously.
It is recommended to chew 250-325 mg of Acetylsalicylic acid.
Blood pressure must be measured.
Then it is necessary to restore coronary blood flow.
Beta-adrenergic blockers are prescribed. During the first 4 hours.
Thrombolytic therapy is carried out in the first 6 hours.

The doctor’s task is to limit the extent of necrosis and prevent the occurrence of early complications.

It is necessary to urgently hospitalize the patient in an emergency medicine center.

3. Hypertensive crisis. Symptoms: headache, nausea, vomiting, feeling of “goose bumps” in the body, numbness of the tongue, lips, hands. Double vision, weakness, lethargy, high blood pressure.

Emergency assistance is as follows:

It is necessary to provide the patient with rest and good air access.
For type 1 crisis, take Nifedipine or Clonidine under the tongue.
At high blood pressure intravenously "Clonidine" or "Pentamine" up to 50 mg.
If tachycardia persists, use Propranolol 20-40 mg.
For type 2 crisis, Furosemide is given intravenously.
For convulsions, Diazepam or Magnesium sulfate is administered intravenously.

The doctor’s task is to reduce the pressure by 25% of the initial value during the first 2 hours. In case of a complicated crisis, urgent hospitalization is necessary.

4. Coma. May be of different types.

Hyperglycemic. It develops slowly and begins with weakness, drowsiness, and headache. Then nausea, vomiting appears, the feeling of thirst intensifies, itchy skin. Then loss of consciousness.

Urgent Care:

Eliminate dehydration, hypovolemia. Sodium chloride solution is administered intravenously.
Insulin is administered intravenously.
At severe hypotension solution of 10% “Caffeine” subcutaneously.
Oxygen therapy is administered.

Hypoglycemic. It starts off sharp. The humidity of the skin is increased, the pupils are dilated, blood pressure is reduced, the pulse is increased or normal.

Emergency assistance includes:

Ensuring complete peace.
Intravenous administration of glucose.
Correction of blood pressure.
Urgent hospitalization.

5. Spicy allergic diseases. Severe diseases include: bronchial asthma and angioedema. Anaphylactic shock. Symptoms: the appearance of skin itching, excitability, increased blood pressure, feeling of heat. Then loss of consciousness and respiratory arrest are possible, failure heart rate.

Emergency assistance is as follows:

Place the patient so that the head is lower than the level of the legs.
Provide air access.
Release Airways, turn your head to the side, protrude your lower jaw.
Enter "Adrenaline", allowed reintroduction after 15 minutes.
"Prednisolone" IV.
Antihistamines.
For bronchospasm, a solution of "Eufillin" is administered.
Urgent hospitalization.

6. Pulmonary edema. Symptoms: shortness of breath is pronounced. Cough with white or yellow color. The pulse is increased. Convulsions are possible. Breath is bubbling. Moist rales can be heard, and in severe conditions “silent lungs”

We provide emergency assistance.

The patient should be in a sitting or semi-sitting position, legs down.
Oxygen therapy is carried out with antifoam agents.
Lasix is administered intravenously in saline solution.
Steroid hormones such as Prednisolone or Dexamethasone in saline solution.
"Nitroglycerin" 1% intravenously.

Let us pay attention to emergency conditions in gynecology:

Disturbed ectopic pregnancy.
Torsion of the pedicle of an ovarian tumor.
Apoplexy of the ovary.

Let's consider providing emergency care for ovarian apoplexy:

The patient should be in a supine position, with her head raised.
Glucose and sodium chloride are administered intravenously.

It is necessary to monitor indicators:

Blood pressure.
Heart rate.
Body temperature.
Respiratory frequency.
Pulse.

Cold is applied to the lower abdomen and urgent hospitalization is indicated.

How are emergencies diagnosed?

It is worth noting that the diagnosis of emergency conditions should be carried out very quickly and take literally seconds or a couple of minutes. The doctor must use all his knowledge and make a diagnosis in this short period of time.

The Glasgow scale is used when it is necessary to determine impairment of consciousness. In this case they evaluate:

Opening the eyes.
Speech.
Motor reactions to painful stimulation.

When determining the depth of coma, the movement of the eyeballs is very important.

In acute respiratory failure, it is important to pay attention to:

Color of the skin.
Color of mucous membranes.
Breathing frequency.
Movement during breathing of the muscles of the neck and upper shoulder girdle.
Retraction of intercostal spaces.

Shock can be cardiogenic, anaphylactic or post-traumatic. One of the criteria may be a sharp decrease in blood pressure. In case of traumatic shock, the following is determined first:

Damage to vital organs.
The amount of blood loss.
Cold extremities.
"White spot" symptom.
Decreased urine output.
Decreased blood pressure.
Violation of acid-base balance.

The organization of emergency medical care consists, first of all, in maintaining breathing and restoring blood circulation, as well as in delivering the patient to a medical facility without causing additional harm.

Emergency care algorithm

Treatment methods are individual for each patient, but the algorithm of actions in emergency conditions must be followed for each patient.

The operating principle is as follows:

Recovery normal breathing and blood circulation.
Help with bleeding is provided.
It is necessary to stop seizures of psychomotor agitation.
Anesthesia.
Elimination of disorders that contribute to disruption of the heart rhythm and its conductivity.
Carrying out infusion therapy to eliminate dehydration.
Decrease in body temperature or increase.
Carrying out antidote therapy in case of acute poisoning.
Enhance natural detoxification.
If necessary, enterosorption is performed.
Fixing the damaged body part.
Correct transportation.
Constant medical supervision.

What to do before the doctor arrives

First aid in emergency conditions consists of performing actions that are aimed at saving human life. They will also help prevent the development of possible complications. First aid in case of emergency conditions should be provided before the doctor arrives and the patient is taken to a medical facility.

Algorithm of actions:

Eliminate the factor that threatens the health and life of the patient. Assess his condition.
Accept Urgent measures to restore life important functions: restoring breathing, performing artificial respiration, cardiac massage, stopping bleeding, applying a bandage, and so on.
Maintain vital functions until the ambulance arrives.
Transport to the nearest medical facility.

Acute respiratory failure. It is necessary to carry out artificial respiration “mouth to mouth” or “mouth to nose”. We tilt our head back, the lower jaw needs to be moved. Cover your nose with your fingers and take a deep breath into the victim’s mouth. You need to take 10-12 breaths.

2. Heart massage. The victim is in a supine position. We stand on the side and place our palm on top of our chest at a distance of 2-3 fingers above the lower edge of the chest. Then we apply pressure so that rib cage shifted by 4-5 cm. 60-80 pressures must be applied within a minute.

Let's consider the necessary emergency care for poisoning and injuries. Our actions in case of gas poisoning:

First of all, it is necessary to remove the person from the gas-polluted area.
Loosen tight clothing.
Assess the patient's condition. Check pulse, breathing. If the victim is unconscious, wipe his temples and give him a sniff of ammonia. If vomiting begins, it is necessary to turn the victim's head to the side.
After the victim has been brought to his senses, it is necessary to inhale pure oxygen to avoid complications.
Next, you can drink hot tea, milk or slightly alkaline water.

Help with bleeding:

Capillary bleeding is stopped by applying a tight bandage, which should not compress the limb.
We stop arterial bleeding by applying a tourniquet or squeezing the artery with a finger.

It is necessary to treat the wound with an antiseptic and contact the nearest medical facility.

Providing first aid for fractures and dislocations.

At open fracture it is necessary to stop the bleeding and apply a splint.
It is strictly forbidden to correct the position of the bones or remove fragments from the wound yourself.
Having recorded the location of the injury, the victim must be taken to the hospital.
It is also not allowed to correct a dislocation on your own; you cannot apply a warm compress.
It is necessary to apply cold or a wet towel.
Provide rest to the injured part of the body.

First aid for fractures should occur after the bleeding has stopped and breathing has normalized.

What should be in a first aid kit

In order for emergency care to be provided effectively, it is necessary to use a first aid kit. It should contain components that may be needed at any moment.

An emergency first aid kit must meet the following requirements:

All medications medical instruments, as well as dressings, should be in one special case or box that is easy to carry and transport.
A first aid kit should have many sections.
Store in a place easily accessible to adults and out of the reach of children. All family members should know about her whereabouts.
You need to regularly check the expiration dates of medications and replenish used medications and supplies.

What should be in the first aid kit:

Preparations for treating wounds, antiseptics:

Brilliant green solution.
Boric acid in liquid or powder form.
Hydrogen peroxide.
Ethanol.
Alcohol iodine solution.
Bandage, tourniquet, adhesive plaster, dressing bag.

2. Sterile or simple gauze mask.

3. Sterile and non-sterile rubber gloves.

4. Analgesics and antipyretic drugs: “Analgin”, “Aspirin”, “Paracetamol”.

5. Antimicrobials: "Levomycetin", "Ampicillin".

6. Antispasmodics: “Drotaverine”, “Spazmalgon”.

7. Heart medications: Corvalol, Validol, Nitroglycerin.

8. Adsorbing agents: “Atoxil”, “Enterosgel”.

9. Antihistamines: “Suprastin”, “Diphenhydramine”.

10. Ammonia.

11. Medical instruments:

Clamp.
Scissors.
Cooling pack.
Disposable sterile syringe.
Tweezers.

12. Antishock drugs: “Adrenaline”, “Eufillin”.

13. Antidotes.

Emergency conditions and emergency medical care are always highly individual and depend on the person and specific conditions. Every adult should have an understanding of emergency care in order to be able to help their loved one in a critical situation.

Introduction

Anaphylactic shock

Arterial hypotension

Angina pectoris

Myocardial infarction

Bronchial asthma

Comatose states

Liver coma. Vomiting "Coffee Grounds"

Convulsions

Poisoning

Electric shock

Renal colic

List of sources used

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

Primary requirements

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

Availability of equipment, tools and medicines. Medical staff must master the necessary manipulations, be able to work with equipment, know doses, indications and contraindications for the use of basic medicines. You need to become familiar with the operation of the equipment and read reference books in advance, and not in an emergency situation.

2. Simultaneity of diagnostic and therapeutic measures.

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

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

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

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

3. Focus primarily on the clinical situation

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

4. Remember your own safety

The patient may be infected (HIV, hepatitis, tuberculosis, etc.). The place where emergency care is provided is dangerous (poisonous substances, radiation, criminal conflicts, etc.). Incorrect behavior or errors in providing emergency care may be grounds for prosecution.

What are the main reasons for the development anaphylactic shock?

This is a life-threatening acute manifestation of an allergic reaction. Most often develops in response to parenteral administration drugs such as penicillin, sulfonamides, serums, vaccines, protein preparations, radiocontrast agents etc., and also appears during provocative tests with pollen and less often food allergens. Anaphylactic shock may occur from insect bites.

The clinical picture of anaphylactic shock is characterized by rapid development - a few seconds or minutes after contact with the allergen. There is depression of consciousness, a drop in blood pressure, convulsions, and involuntary urination. The fulminant course of anaphylactic shock ends in death. For most, the disease begins with the appearance of a feeling of heat, skin hyperemia, fear of death, excitement or, conversely, depression, headache, chest pain, suffocation. Sometimes swelling of the larynx develops like Quincke's edema with stridorous breathing, skin itching, rashes, rhinorrhea, and dry hacking cough appear. Blood pressure drops sharply, the pulse becomes threadlike, and hemorrhagic syndrome with petechial rashes may be expressed.

How to provide emergency care to a patient?

The administration of medications or other allergens should be stopped and a tourniquet should be applied proximal to the allergen injection site. Help must be provided on the spot; for this purpose, it is necessary to lay the patient down and fix the tongue to prevent asphyxia. Inject 0.5 ml of 0.1% adrenaline solution subcutaneously at the site of allergen injection (or at the site of the bite) and 1 ml of 0.1% adrenaline solution intravenously. If blood pressure remains low, the injection of adrenaline solution should be repeated after 10-15 minutes. Corticosteroids are of great importance for removing patients from anaphylactic shock. Prednisolone should be administered into a vein at a dose of 75-150 mg or more; dexamethasone - 4-20 mg; hydrocortisone - 150-300 mg; If it is not possible to inject corticosteroids into a vein, they can be administered intramuscularly. Administer antihistamines: pipolfen - 2-4 ml of a 2.5% solution subcutaneously, suprastin - 2-4 ml of a 2% solution or diphenhydramine - 5 ml of a 1% solution. For asphyxia and suffocation, administer 10-20 ml of a 2.4% solution of aminophylline intravenously, alupent - 1-2 ml of a 0.05% solution, and isadrin - 2 ml of a 0.5% solution subcutaneously. If signs of heart failure appear, administer corglicon - 1 ml of 0.06% solution in isotonic sodium chloride solution, lasix (furosemide) 40-60 mg intravenously in a rapid stream in isotonic sodium chloride solution. If an allergic reaction has developed to the administration of penicillin, administer 1,000,000 units of penicillinase in 2 ml of isotonic sodium chloride solution. The administration of sodium bicarbonate (200 ml of 4% solution) and anti-shock fluids is indicated. If necessary, carry out resuscitation measures, including closed cardiac massage, artificial respiration, bronchial intubation. For laryngeal edema, tracheostomy is indicated.

What are the clinical manifestations arterial hypotension?

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

2 ml of a 20% caffeine solution or 1 ml of a 5% ephedrine solution are administered. No hospitalization required.

What is characteristic of heart pain caused by angina pectoris?

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

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

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

An analgesic effect is achieved by intramuscular injection of 2 ml of a 50% analgin solution. Sometimes its use allows you to reduce the dose of injected narcotic analgesics, since analgin enhances their effect. Sometimes a good analgesic effect is obtained by applying mustard plasters to the heart area. Skin irritation causes reflex expansion coronary arteries and improves blood supply to the myocardium.

Myocardial infarction

What are the main causes of myocardial infarction?

Myocardial infarction is necrosis of a section of the heart muscle that develops as a result of a disruption in its blood supply. The immediate cause of myocardial infarction is the closure of the lumen of the coronary arteries or narrowing by an atherosclerotic plaque or thrombus.

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

Emergency assistance in acute stage heart attack involves, first of all, removing pain attack. If preliminary repeated administration of nitroglycerin (0.0005 g per tablet or 2-3 drops of 1% alcohol solution) does not relieve the pain, it is necessary to administer promedol (1 ml of 2% solution), pantopon (1 ml of 2% solution) or morphine (1 cl 1% solution) subcutaneously along with 0.5 ml of 0.1% atropine solution and 2 ml of cordiamine. If subcutaneous administration of narcotic analgesics does not have an analgesic effect, you should resort to intravenous infusion of 1 ml of morphine with 20 ml of 40% glucose solution. Sometimes anginal pain can be relieved only with the help of anesthesia with nitrous oxide mixed with oxygen in a ratio of 4:1, and after the pain stops - 1:1. IN last years To relieve pain and prevent shock, use fentanyl 2 ml of a 0.005% solution intravenously with 20 ml saline solution. Together with fentanyl, 2 ml of a 0.25% solution of droperidol is usually administered; This combination enhances the pain-relieving effect of fentanyl and makes it last longer. The use of fentanyl soon after administration of morphine is undesirable due to the risk of respiratory arrest.

The complex of emergency measures in the acute stage of myocardial infarction includes the use of drugs against acute vascular and heart failure and anticoagulants direct action. With a slight decrease in blood pressure, sometimes cordiamine, caffeine, and camphor administered subcutaneously are sufficient. A significant drop in blood pressure (below 90/60 mm Hg), the threat of collapse requires the use of more powerful means- 1 ml of 1% mesatone solution or 0.5-1 ml of 0.2% norepinephrine solution subcutaneously. If collapse persists, these drugs should be re-administered every 1-2 hours. In these cases, it is also shown intramuscular injections steroid hormones (30 mg prednisolone or 50 mg hydrocortisone) that help normalize vascular tone and blood pressure.

Bronchial asthma

What is general characteristics attack bronchial asthma?

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

During an attack of bronchial asthma it is necessary: 1) cessation of contact with the allergen; 2) administration of sympathomimetics; adrenaline - 0.2-0.3 ml of a 0.1% solution subcutaneously, ephedrine - 1 ml of a 5% solution subcutaneously; 3) inhalation administration of a sympathomimetic (Berotec, Alupent, Ventolin, salbutamol); 4) administration of xanthine preparations: 10 ml of 2.4% aminophylline solution intravenously or 1-2 ml of 24% solution intramuscularly.

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 - acute vascular insufficiency, which manifests itself sharp decline blood pressure and disorder 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 death of the patient.

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

The severity of symptoms depends on the nature of the underlying disease. So when acute blood loss the pallor of the skin and visible mucous membranes is striking; with myocardial infarction, one can often notice bluishness of the facial skin, acrocyanosis, etc.

In case of collapse, the patient must be given horizontal position(remove pillows from under your head), place heating pads on your limbs. Call a doctor immediately. Before his arrival, the patient must be given cardiovascular drugs (cordiamin, caffeine) subcutaneously. As prescribed by the doctor, a set of measures is carried out depending on the cause of the collapse: hemostatic therapy and blood transfusion for blood loss, administration of cardiac glycosides and painkillers for myocardial infarction, etc.

What is a coma?

Coma is an unconscious state with profound impairment of reflexes and lack of response to stimulation.

The general and main symptom of a coma of any origin is a deep loss of consciousness caused by damage to vital parts of the brain.

Coma can occur suddenly in the midst of relative well-being. Acute development typical for cerebral coma with stroke, hypoglycemic coma. However, in many cases, a coma, complicating the course of the disease, develops gradually (with diabetic, uremic, hepatic coma and many others comatose states). In these cases, coma, a deep loss of consciousness, is preceded by a precoma stage. Against the background of increasing exacerbation of the symptoms of the underlying disease, signs of damage to the central nervous system in the form of stupor, lethargy, indifference, confusion of consciousness with periodic clarifications. However, during this period, patients retain the ability to respond to severe irritation, late, monosyllabic, but still answer loudly asked question, they retain pupillary, corneal and swallowing reflexes. Knowing the symptoms of a precomatous state is especially important, since it is often timely provision assistance during this period of illness prevents the development of coma and saves the life of the patient.

Liver coma. Vomiting "Coffee Grounds"

When examining the skin, it should be taken into account that with uremia, thrombosis cerebral vessels, anemia, pale skin. At alcoholic coma, cerebral hemorrhage, the face is usually hyperemic. Pink coloration of the skin is characteristic of coma due to poisoning carbon monoxide. Yellowness of the skin is usually observed when hepatic coma. Important has a determination of the skin moisture of a patient in a coma. Moist, sweaty skin is characteristic of a hypoglycemic coma. At diabetic coma skin is always dry. Traces of old scratching on the skin can be noted in patients with diabetic, hepatic and uremic coma. Fresh boils, as well as skin scars from old boils found in comatose patients, suggest diabetes mellitus.

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

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

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

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

In case of hepatic coma, as prescribed by a doctor, drops of glucose solutions are administered, steroid hormones, vitamins.

What is the pathogenesis and main causes of fainting?

Fainting is a sudden short-term loss of consciousness with weakening of cardiac and respiratory systems. Fainting is mild form acute vascular brain failure and is caused by anemia of the brain; occurs more often in women. Fainting can occur as a result of mental trauma, the sight of blood, painful stimulation, prolonged stay in a stuffy room, intoxication and infectious diseases.

The severity of fainting may vary. Fainting is usually characterized by sudden occurrence slight clouding of consciousness in combination with non-systemic dizziness, ringing in the ears, nausea, yawning, increased intestinal motility. Objectively, a sharp pallor of the skin, coldness of the hands and feet, beads of sweat on the face, and dilated pupils are noted. The pulse is weak, blood pressure is reduced. The attack lasts several seconds.

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

Convulsive syncope is characterized by the addition of convulsions to the picture of syncope. IN in rare cases salivation, involuntary urination and defecation are noted. The unconscious state sometimes lasts several minutes.

After fainting they persist general weakness, nausea, unpleasant feeling in a stomach.

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

The patient should be examined by a doctor.

What are features convulsive seizure in epilepsy?

One of the most common and dangerous species convulsive conditions is a generalized convulsive seizure that occurs 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 unpleasant odors, sounds, etc. Then the patient suddenly loses consciousness and falls. At the beginning of the first phase (in the first seconds) of the seizure, he often emits a loud cry.

When providing first aid to a patient, first of all, it is necessary to warn possible bruises head, arms, legs in case of falls and convulsions, for which a pillow is placed under the patient’s head, arms and legs are held. To prevent asphyxia, it is necessary to unfasten the collar. A hard object, such as a spoon wrapped in a napkin, must be inserted between the patient’s teeth to prevent tongue bite. To avoid inhaling saliva, the patient's head should be turned to the side.

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

For status epilepticus, emergency care consists of prescribing an enema with chloral hydrate (2.0 g per 50 ml of water), intravenous administration of 10 ml of a 25% magnesium sulfate solution and 10 ml of a 40% glucose solution, intramuscular injection 2-3 ml of a 2.5% solution of aminazine, intravenous infusion of 20 mg of diazepam (seduxen), dissolved in 10 ml of a 40% glucose solution. For ongoing seizures, 5-10 ml of a 10% hexenal solution is administered slowly intravenously. A spinal puncture is performed to remove 10-15 ml of solution.

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

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

What are the general characteristics of poisonings?

Poisoning - pathological condition caused by the effects of poisons on the body. The causes of poisoning may be poor quality food products and poisonous plants, various chemical substances, used in everyday life and at work, medications, etc. Poisons have a local and general effect on the body, which depends on the nature of the poison and the route of its entry into the body.

In front of everyone acute poisoning emergency assistance must be pursued following goals: 1) the fastest possible removal of poison from the body; 2) neutralization of the poison remaining in the body with the help of antidotes (antidotes); 3) combating breathing and circulatory disorders.

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

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

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

Electric shock with voltages above 50 V causes thermal and electrolytic effects. Most often, damage occurs as a result of non-compliance with safety precautions when working with electrical devices, both at home and at work.

The higher the voltage and the longer the current, the more severe the damage (up to deaths). Severe electrical burns, including charring, are observed at the places where the current enters and exits (most often on the arms and legs). In milder cases, there are so-called current marks - round spots from 1 to 5-6 cm in diameter, dark inside and bluish along the periphery. Unlike thermal burns, the hair is not singed. Of significant importance is the organs through which the current passes, which can be established by mentally connecting the places of entry and exit of the current. The passage of current through the heart and brain is especially dangerous, as it can cause cardiac and respiratory arrest. In general, with any electrical injury there is damage to the heart. In severe cases, a frequent soft pulse and low blood pressure are observed; the victim is pale, frightened, and has shortness of breath. Convulsions and respiratory arrest are often observed.

First of all, the victim is released from contact with electric current (if this has not been done earlier). Turn off the power source, and if this is not possible, then remove the broken wire with a dry wooden stick. If the person providing assistance is wearing rubber boots and rubber gloves, then you can pull the victim away from the electrical wire. If breathing stops, artificial respiration is performed, cardiac and cardiovascular drugs are administered (0.1% adrenaline solution - 1 ml, cordiamine - 2 ml, 10% caffeine solution - 1 ml subcutaneously), drugs that stimulate breathing (1% lobeline solution - 1 ml intravenously slowly or intramuscularly). Apply a sterile bandage to the electrical burn wound.

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

Renal colic

What are the causes of renal colic?

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

The attack begins suddenly. Most often it is caused physical stress, but can also occur in the midst of complete rest, at night during sleep, often after drinking heavily. The pain is cutting with periods of calm and exacerbation. Patients behave restlessly, rushing about in bed in search of a position that would ease their suffering. An attack of renal colic often becomes protracted and, with short remissions, can last for several days in a row. Typically, pain begins in lumbar region and spreads into the hypochondrium and into the 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 genital organs than in the kidney area. The pain is usually accompanied by an increased urge to urinate and cutting pain in the urethra.

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

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

1. Evdokimov N.M. Providing first pre-medical aid.-M., 2001

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

3. First medical aid: reference book M., 2001

BP - blood pressure

AG - antigen

AT - antibody

IVL - artificial ventilation lungs

Health care facility - medical and preventive institution

ODN - acute respiratory failure

BCC - circulating blood volume

ESR - erythrocyte sedimentation rate

PE - pulmonary embolism

FOS - organophosphorus compounds

CNS - central nervous system

RR - respiratory rate

HR - heart rate

ECG - electrocardiogram

Modern civilization has brought into our lives a lot of economic, technical and other achievements and benefits that have made it simpler, more convenient and better. However, along with this, people found themselves under the influence of a huge number of a wide variety of unfavorable influences, which in turn led to an increase in the frequency of acute therapeutic and surgical diseases, injuries and poisonings.

Every day, injuries and acute illnesses disrupt the normal rhythm of life of hundreds and thousands of people. Natural disasters, train crashes, harmful industrial emissions that cause mass poisoning - all these events require urgent, and most importantly, correct and coordinated assistance to the victims, because only in this case there is hope for a positive result of further treatment.

That is why in modern conditions the quality of first aid at the prehospital stage plays such an important role. The leading link in the system of prehospital care is considered to be a paramedic and a nurse. As a rule, they are the first to come into contact with injured and critically ill patients, when time is counted by minutes and from the average medical worker Not only the effectiveness of further treatment, but often life, depends. In this case, one should take into account the conditions in which ambulance and emergency care must be provided - on the street, in a production workshop, in transport, at home. All this dictates special requirements for the qualifications of medical personnel, who must be able to quickly assess the patient’s condition, as soon as possible make a preliminary diagnosis, act consistently and energetically, and remain calm and self-controlled in any situation.

Despite this, in real life the need for first aid is often underestimated, and the technique for performing emergency measures is incorrect or outdated.

Due to the fact that classes are taught by several teachers, it was necessary to develop a unified approach to the topics being studied. Teachers of the Center for Advanced Training of Healthcare Specialists of the Moscow Healthcare Department E.G. Moiseeva and I.M. Krasilnikova created methodological recommendations for providing emergency first aid. The collection of methodological recommendations can be used by teachers of emergency care cycles when preparing and conducting classes.

The general purpose of this publication is to teach a specialist with secondary medical education to diagnose an acute condition and provide the necessary emergency pre-medical care.

BURNS

A specialist with secondary medical education must be able to:

Determine the degree of thermal burn;

Assess the area of the burn;

Provide first emergency first aid for thermal burns;

Recognize a chemical burn;

Provide first emergency pre-medical aid.

THESIS STATEMENT OF THE TOPIC

The problem of thermal injuries remains one of the most serious and complex problems in medicine. The pathogenesis of thermal injuries is very complex and not fully understood. With thermal injuries, profound dysfunctions of almost all major organs and systems can occur, therefore, a necessary condition for successful pre-medical care, guaranteeing high efficiency of treatment and a reduction in the level of disability in the future, is the maximum reduction in the time from the occurrence of thermal injury to the provision of medical care. That is why the prehospital stage is considered the most important, key element of treatment and evacuation support for these emergency conditions.

CONCEPT OF BURNS, CLINICAL MANIFESTATIONS

Burns are injuries caused by thermal, chemical, or radiation energy. Among peacetime injuries, burns account for approximately 6%. The severity of burns is determined by the area and depth of tissue damage, the presence or absence of burns to the respiratory tract, poisoning by combustion products, and concomitant diseases. The greater the area and depth of tissue damage, the more severe the burn. Thermal burns can be caused by flames, hot gases, molten metal, hot liquids, steam, and sunlight.

In modern clinical practice Most often they use the classification of burns introduced by A.A. Vishnevsky and M.I. Shreiberg, approved at the XXVII All-Union Congress of Surgeons.

According to the depth of damage, burns are divided into four degrees:

I degree - erythema and swelling of the affected area, accompanied by a feeling of pain and burning;

II degree - against the background of erythema and edema, blisters appear filled with serous yellowish-transparent liquid;

Grade III - necrosis of the epidermis, the germ layer of the skin is partially preserved, and the skin glands are partially preserved. Burn surfaces are represented by a scab, that is, dead, insensitive layers of skin. The scab retains pain sensitivity when pricked with a needle. When burned with a hot liquid or steam, the scab is whitish-gray; when burned by a flame or in contact with a hot object, the scab is dry, dark brown;

SB degree - necrosis of all layers of skin. The scab is denser than in grade III. All types of sensitivity are absent, including pain when pricked with a needle. When exposed to hot liquids, the scab is dirty gray; when burned by a flame, it is dark brown;

IV degree - necrosis of the skin and underlying tissues: fascia, tendons, muscles, bones. The scab is dark brown and dense. Thrombosed saphenous veins are often visible. All types of sensitivity are absent in the scab.

Burns of I, II and III degrees are classified as superficial lesions, burns of III and IV degrees are deep.

DETERMINATION OF THE LESION AREA

The severity of the victim’s general condition depends not only on the depth, but also on the volume of the affected tissue. In this regard, already at the pre-medical stage it is necessary to determine the area of the burn.

To quickly approximately determine the affected area, you can use the “rule of nines.”

Head and neck - 9%.

Upper limb - 9% (each).

Lower limb - 18% (each).

The anterior surface of the body is 18%.

Posterior surface of the body - 18%.

Perineum and genitals - 1%.

You can use the “rule of the palm”: the area of the palm of an adult is 1% of the total surface of the skin.

Depending on the area of damage, burns are conventionally divided into limited and extensive. Extensive burns include burns covering more than 10% of the skin surface. Victims with extensive burns of any degree, as well as burns of the head and neck, palm, plantar surface of the foot, perineum, starting from the second degree, are subject to urgent hospitalization. This is explained by the fact that these groups of burns are preferably treated using the open method: burn surface dried evenly under the frame until a dry scab is formed, under which further epithelization of the affected surfaces occurs. All patients over 60 years of age and children are also hospitalized. Prognostically, first degree burns are very dangerous when more than 1/2 of the body surface is affected, second degree when 1/3 of the body surface is affected, and third degree when less than 1/3 of the body surface is affected.

PROGNOSTIC INDEX

When triaging victims, it is necessary to assess the severity and possible outcome of the burn. The Frank prognostic index is used as a universal prognostic test that determines the outcome of a burn in both adults and children. The Frank index is obtained by adding the area of the superficial burn, expressed as a percentage, and three times the area of the deep burn. For example, the total burn area is 50% of the body surface, with 20% being deep lesions. The Frank index in this case is equal to:

Franc Index Score:

If it is less than 30, then the prognosis is considered favorable;

30-60 - the prognosis is relatively favorable;

61-90 - the prognosis is doubtful;

More than 91 - unfavorable.

A simpler prognostic method for determining the severity of a burn is the “rule of hundreds.” To do this, sum up the patient's age and the total area of the burn as a percentage. If the amount is less than or equal to 60, the prognosis is favorable, 61-80 is relatively favorable, 81-100 is doubtful, 101 or more is unfavorable. The hundred rule can only be used with adults.

FIRST AID FOR BURNS

First of all, it is necessary to stop the action of the thermal agent on the skin. Clothing around the burned surface is trimmed. For first degree burns, the affected area of skin can be placed under a running stream. cold water to a feeling of numbness in the burned area. This reduces pain and burning sensation. Then, anti-burn aerosols or an ointment dressing with chloramphenicol (synthomycin), sulfanilamide (streptocide), nitrofural (furacilin), etc. can be applied to the first-degree burn. For burns of II-IV degree, accompanied by pronounced pain syndrome, anesthesia is performed and only after that the skin around the burn is cleaned with antiseptic solutions.

A dry aseptic bandage is applied to the burned surface without pre-treatment. If the face is affected, bandages are not applied. The patient must be sent to a medical facility. Before and during transportation, it is very important to provide the patient with peace, warm him up (wrap him up) with a blanket, and give him warm tea. For burns of second degree and above, it is necessary to carry out tetanus prophylaxis.

BURN SHOCK

With deep and extensive burns, in addition to local disturbances in the victim’s body, pathophysiological changes occur that clinically occur as a severe general disease - burn disease. There are four periods of burn disease: burn shock, acute burn toxemia, burn septicotoxemia and convalescence. Immediately after the lesion the picture develops burn shock. An important role in the development of burn shock is played by disruption of the central nervous system (CNS), associated with irritation of numerous nerve endings at the site of the lesion. With burn shock, circulatory disorders, disorders of water-salt metabolism, protein metabolism, and hormonal regulation occur.

In the clinical picture of burn shock, two phases are distinguished.

Phase I - erectile (excitement phase). Excitement, motor restlessness, and muscle tremors are observed. Patients complain of pain, thirst, nausea, and chills. The skin is pale and cold to the touch. Breathing is rapid and shallow. Tachycardia up to 100-120 per minute, pulse is weak, pressure remains within the conventional norm or may be slightly increased. Consciousness is preserved.

Phase II - torpid (braking phase). The victim is sluggish and adynamic. The skin is pale with a cyanotic tint. Facial features are pointed. Breathing is shallow and rapid. The pulse cannot be counted, and there is a decrease in blood pressure (below 95 mm Hg). Diuresis decreases; in the most severe cases, urine may be dark red or almost black with a burning smell. Oliguria and anuria are considered the most important and persistent signs of burn shock. At the same time, the volume of circulating blood in burned people decreases, hemolysis of red blood cells occurs and acidosis develops. Body temperature drops to 35 °C and below. Vomiting and bloating often occur.

URGENT CARE

In case of burn shock, first aid requires pain relief (as prescribed by a doctor). If possible, it is necessary to immediately establish intravenous transfusion of blood substitutes (rheopolyglucin, polyglucin, etc.), if the duration of transportation exceeds 1 hour, then the volume of infused fluids is increased to 1000-1500 ml, glucocorticoids are administered: prednisolone 60-90 mg, hydrocortisone 125-250 mg. To maintain the cardiovascular system, cardiac and diuretics are administered. The burned surfaces are covered with dry sterile bandages or wrapped in a sterile sheet. Urgent hospitalization is required. In the hospital, bacterial complications are prevented from the very first days.

CHEMICAL BURNS

Chemical burns occur from exposure to cauterizing chemicals (acids, alkalis, salts) heavy metals, phosphorus).

The symptoms of the injury are the same as for thermal burns.

Chemical burns are divided into dry coagulation burns from exposure to strong acids and weeping coagulation burns from exposure to strong alkalis.

The division into degrees and severity of burns is the same as for chemical burns.

At I degree chemical burn pain and burning are noted, the burned surface is hyperemic and somewhat swollen. With alkali burns, the swelling is somewhat more pronounced.

In case of a second degree chemical burn, scabs are identified locally: dry - for burns with acids, jelly-like (soapy) - for burns with alkalis. The scabs are thin and easily folded.

For chemical burns III-IV degrees motionless, dense, thick scabs are determined: in the form of dry necrosis - in case of burn with acids, in the form of wet necrosis - in case of burn with alkalis. The exact depth of necrosis can only be determined when the burn scab is rejected: if only necrotic skin is rejected, this is a third-degree burn, deeper tissue is a fourth-degree burn.

URGENT CARE

When providing first aid to patients with chemical burns, it is necessary to thoroughly wash the burned area under running cool water. If necessary, administer painkillers and apply dry aseptic dressings. Consultation with a doctor is required. Further treatment is carried out in the same way as for thermal burns.

Contact with skin of substances that simultaneously have chemical and thermal effects (phosphorus, napalm) leads to the formation of thermochemical burns. Phosphorus, when combined with fats, causes necrosis of soft tissues. If phosphorus comes into contact with the skin, it can continue to burn, causing thermal injury. Phosphorus burns are characterized by extensiveness, depth and intoxication as a result of absorption of the drug and its effect on the liver. To extinguish phosphorus, use a stream of water or a 1% and 2% solution of copper sulfate. Pieces of phosphorus are removed with tweezers, a bandage is applied, generously moistened with a 2% solution of copper sulfate, a 5% solution of sodium bicarbonate or a 3-5% solution of potassium permanganate. Further management is based on the principle of thermal burns. Ointment dressings are contraindicated, as they promote the absorption of phosphorus into the body. A doctor's consultation is required.

Burns with quicklime should not be treated with water. Remove pieces of quicklime mechanically and cover the affected surface with a dry aseptic dressing. The victim is sent to a medical facility.

Chemical burns to the eyes occur when they come into contact with the eyes. chemical compounds, medications, cosmetics, toxic substances. First aid: prolonged rinsing of the eye with a stream of running water, application of a dry aseptic bandage and urgent consultation with an ophthalmologist.