Providing first aid in emergency conditions. Emergency conditions and emergency medical care

Clinical manifestations

First aid

In case of a neurovegetative form of crisis Sequence of actions:

1) administer 4–6 ml of 1% furosemide solution intravenously;

2) administer 6–8 ml of 0.5% dibazole solution dissolved in 10–20 ml of 5% glucose solution or 0.9% sodium chloride solution intravenously;

3) administer 1 ml of 0.01% solution of clonidine in the same dilution intravenously;

4) administer 1–2 ml of a 0.25% solution of droperidol in the same dilution intravenously.

In the water-salt (edematous) form of crisis:

1) administer 2–6 ml of 1% furosemide solution intravenously once;

2) administer 10–20 ml of 25% magnesium sulfate solution intravenously.

In a convulsive form of crisis:

1) administer intravenously 2–6 ml of a 0.5% solution of diazepam, diluted in 10 ml of a 5% glucose solution or 0.9% sodium chloride solution;

2) antihypertensive drugs and diuretics - according to indications.

In case of a crisis associated with sudden withdrawal (cessation of taking) antihypertensive drugs: administer 1 ml of 0.01% solution of clonidine diluted in 10–20 ml of 5% glucose solution or 0.9% sodium chloride solution.

Notes

1. Drugs should be administered sequentially, under blood pressure control;

2. In the absence of a hypotensive effect within 20–30 minutes, the presence of acute cerebrovascular accident, cardiac asthma, or angina pectoris requires hospitalization in a multidisciplinary hospital.

Angina pectoris

Clinical manifestations s–m. Nursing in therapy.

First aid

1) stop physical activity;

2) sit the patient with support on his back and with his legs down;

3) give him a nitroglycerin or validol tablet under his tongue. If heart pain does not stop, repeat taking nitroglycerin every 5 minutes (2-3 times). If there is no improvement, call a doctor. Before he arrives, move on to the next stage;

4) in the absence of nitroglycerin, you can give the patient 1 tablet of nifedipine (10 mg) or molsidomine (2 mg) under the tongue;

5) give an aspirin tablet (325 or 500 mg) to drink;

6) invite the patient to drink hot water in small sips or place a mustard plaster on the heart area;

7) if there is no effect of therapy, hospitalization of the patient is indicated.

Myocardial infarction

Clinical manifestations– see Nursing in Therapy.

First aid

1) lay or sit the patient down, unfasten the belt and collar, provide access to fresh air, complete physical and emotional rest;

2) with systolic blood pressure not less than 100 mm Hg. Art. and heart rate is more than 50 per minute, give a nitroglycerin tablet under the tongue at intervals of 5 minutes. (but no more than 3 times);

3) give an aspirin tablet (325 or 500 mg) to drink;

4) give a propranolol tablet 10–40 mg sublingually;

5) administer intramuscularly: 1 ml of a 2% solution of promedol + 2 ml of a 50% solution of analgin + 1 ml of a 2% solution of diphenhydramine + 0.5 ml of a 1% solution of atropine sulfate;

6) with systolic blood pressure less than 100 mm Hg. Art. 60 mg of prednisolone diluted with 10 ml of saline must be administered intravenously;

7) administer heparin 20,000 units intravenously, and then 5,000 units subcutaneously into the area around the navel;

8) the patient should be transported to the hospital in a lying position on a stretcher.

Pulmonary edema

Clinical manifestations

It is necessary to differentiate pulmonary edema from cardiac asthma.

1. Clinical manifestations of cardiac asthma:

1) frequent shallow breathing;

2) exhalation is not difficult;

3) position of orthopnea;

4) upon auscultation, dry or wheezing sounds.

2. Clinical manifestations of alveolar pulmonary edema:

1) suffocation, bubbling breathing;

2) orthopnea;

3) pallor, cyanosis of the skin, moisture of the skin;

4) tachycardia;

5) secretion of a large amount of foamy, sometimes blood-stained sputum.

First aid

1) give the patient a sitting position, apply tourniquets or tonometer cuffs to the lower extremities. Reassure the patient and provide fresh air;

2) administer 1 ml of a 1% solution of morphine hydrochloride dissolved in 1 ml of saline or 5 ml of a 10% glucose solution;

3) give nitroglycerin 0.5 mg sublingually every 15–20 minutes. (up to 3 times);

4) under blood pressure control, administer 40–80 mg of furosemide intravenously;

5) in case of high blood pressure, inject intravenously 1–2 ml of a 5% solution of pentamine dissolved in 20 ml of physiological solution, 3–5 ml each with an interval of 5 minutes; 1 ml of 0.01% solution of clonidine dissolved in 20 ml of saline solution;

6) establish oxygen therapy - inhalation of humidified oxygen using a mask or nasal catheter;

7) inhale oxygen humidified with 33% ethyl alcohol, or administer 2 ml of a 33% ethyl alcohol solution intravenously;

8) administer 60–90 mg of prednisolone intravenously;

9) if there is no effect of therapy, pulmonary edema increases, or blood pressure drops, artificial ventilation is indicated;

10) hospitalize the patient.

Fainting can occur during prolonged stay in a stuffy room due to lack of oxygen, in the presence of tight clothing that restricts breathing (corset) in a healthy person. Repeated fainting is a reason to visit a doctor to rule out a serious pathology.

Fainting

Clinical manifestations

1. Short-term loss of consciousness (for 10–30 s.).

2. The medical history contains no indications of diseases of the cardiovascular, respiratory systems, or gastrointestinal tract; there is no obstetric-gynecological history.

First aid

1) give the patient’s body a horizontal position (without a pillow) with slightly raised legs;

2) unfasten the belt, collar, buttons;

3) spray your face and chest with cold water;

4) rub the body with dry hands - arms, legs, face;

5) let the patient inhale ammonia vapor;

6) intramuscularly or subcutaneously inject 1 ml of a 10% solution of caffeine, intramuscularly - 1–2 ml of a 25% solution of cordiamine.

Bronchial asthma (attack)

Clinical manifestations– see Nursing in Therapy.

First aid

1) sit the patient down, help him take a comfortable position, unfasten his collar, belt, provide emotional peace and access to fresh air;

2) distraction therapy in the form of a hot foot bath (water temperature at the level of individual tolerance);

3) administer 10 ml of a 2.4% solution of aminophylline and 1–2 ml of a 1% solution of diphenhydramine (2 ml of a 2.5% solution of promethazine or 1 ml of a 2% solution of chloropyramine) intravenously;

4) inhale an aerosol of bronchodilators;

5) in case of a hormone-dependent form of bronchial asthma and information from the patient about a violation of the course of hormone therapy, administer prednisolone in a dose and method of administration corresponding to the main course of treatment.

Asthmatic status

Clinical manifestations– see Nursing in Therapy.

First aid

1) calm the patient, help him take a comfortable position, provide access to fresh air;

2) oxygen therapy with a mixture of oxygen and atmospheric air;

3) if breathing stops - mechanical ventilation;

4) administer rheopolyglucin intravenously in a volume of 1000 ml;

5) administer 10–15 ml of a 2.4% aminophylline solution intravenously during the first 5–7 minutes, then 3–5 ml of a 2.4% aminophylline solution intravenously in an infusion solution or 10 ml 2.4 % solution of aminophylline every hour into a dropper tube;

6) administer 90 mg of prednisolone or 250 mg of hydrocortisone intravenously;

7) administer heparin up to 10,000 units intravenously.

Notes

1. Taking sedatives, antihistamines, diuretics, calcium and sodium supplements (including saline) is contraindicated!

2. Repeated sequential use of bronchodilators is dangerous due to the possibility of death.

Pulmonary hemorrhage

Clinical manifestations

Discharge of bright scarlet foamy blood from the mouth during a cough or with virtually no coughing impulses.

First aid

1) calm the patient down, help him take a semi-sitting position (to facilitate expectoration), forbid him to get up, talk, call a doctor;

2) place an ice pack or cold compress on the chest;

3) give the patient a cold liquid to drink: table salt solution (1 tablespoon of salt per glass of water), nettle decoction;

4) carry out hemostatic therapy: 1–2 ml of 12.5% ​​solution of dicinone intramuscularly or intravenously, 10 ml of 1% solution of calcium chloride intravenously, 100 ml of 5% solution of aminocaproic acid intravenously drip, 1–2 ml 1 % solution of vikasol intramuscularly.

If it is difficult to determine the type of coma (hypo- or hyperglycemic), first aid begins with the administration of a concentrated glucose solution. If the coma is associated with hypoglycemia, then the victim begins to come to his senses, the skin turns pink. If there is no response, then the coma is most likely hyperglycemic. At the same time, clinical data should be taken into account.

Hypoglycemic coma

Clinical manifestations

2. Dynamics of development of a comatose state:

1) feeling of hunger without thirst;

2) anxious anxiety;

3) headache;

4) increased sweating;

5) excitement;

6) stunned;

7) loss of consciousness;

8) convulsions.

3. Absence of symptoms of hyperglycemia (dry skin and mucous membranes, decreased skin turgor, soft eyeballs, smell of acetone from the mouth).

4. Quick positive effect from intravenous administration of a 40% glucose solution.

First aid

1) administer 40–60 ml of 40% glucose solution intravenously;

2) if there is no effect, re-introduce 40 ml of a 40% glucose solution intravenously, as well as 10 ml of a 10% calcium chloride solution intravenously, 0.5–1 ml of a 0.1% solution of adrenaline hydrochloride subcutaneously (in the absence of contraindications );

3) when you feel better, give sweet drinks with bread (to prevent a relapse);

4) patients are subject to hospitalization:

a) when a hypoglycemic state occurs for the first time;

b) if hypoglycemia occurs in a public place;

c) if emergency medical care measures are ineffective.

Depending on the condition, hospitalization is carried out on a stretcher or on foot.

Hyperglycemic (diabetic) coma

Clinical manifestations

1. History of diabetes mellitus.

2. Development of coma:

1) lethargy, extreme fatigue;

2) loss of appetite;

3) uncontrollable vomiting;

4) dry skin;

6) frequent excessive urination;

7) decreased blood pressure, tachycardia, heart pain;

8) adynamia, drowsiness;

9) stupor, coma.

3. The skin is dry, cold, lips are dry, cracked.

4. The tongue is raspberry colored with a dirty gray coating.

5. The smell of acetone in the exhaled air.

6. Sharply reduced tone of the eyeballs (soft to the touch).

First aid

Sequencing:

1) carry out rehydration using 0.9% sodium chloride solution intravenously at a rate of 200 ml per 15 minutes. under the control of blood pressure levels and spontaneous breathing (cerebral edema is possible if rehydration is too rapid);

2) emergency hospitalization in the intensive care unit of a multidisciplinary hospital, bypassing the emergency department. Hospitalization is carried out on a stretcher, lying down.

Acute stomach

Clinical manifestations

1. Abdominal pain, nausea, vomiting, dry mouth.

2. Pain on palpation of the anterior abdominal wall.

3. Symptoms of peritoneal irritation.

4. The tongue is dry, coated.

5. Low-grade fever, hyperthermia.

First aid

Urgently deliver the patient to the surgical hospital on a stretcher, in a position comfortable for him. Pain relief, drinking water and food are prohibited!

Acute abdomen and similar conditions can occur with a variety of pathologies: diseases of the digestive system, gynecological, infectious pathologies. The main principles of first aid in these cases are: cold, hunger and rest.

Gastrointestinal bleeding

Clinical manifestations

1. Paleness of the skin and mucous membranes.

2. Vomiting blood or “coffee grounds.”

3. Black tarry stools or scarlet blood (with bleeding from the rectum or anus).

4. The stomach is soft. There may be pain on palpation in the epigastric region. There are no symptoms of peritoneal irritation, the tongue is moist.

5. Tachycardia, hypotension.

6. History: peptic ulcer, gastrointestinal cancer, liver cirrhosis.

First aid

1) give the patient ice in small pieces;

2) with worsening hemodynamics, tachycardia and a decrease in blood pressure - polyglucin (reopolyglucin) intravenously until systolic blood pressure stabilizes at 100–110 mm Hg. Art.;

3) administer 60–120 mg of prednisolone (125–250 mg of hydrocortisone) – add to the infusion solution;

4) administer up to 5 ml of a 0.5% dopamine solution intravenously in an infusion solution in case of a critical drop in blood pressure that cannot be corrected by infusion therapy;

5) cardiac glycosides according to indications;

6) emergency delivery to a surgical hospital while lying on a stretcher with the head end down.

Renal colic

Clinical manifestations

1. Paroxysmal pain in the lower back, unilateral or bilateral, radiating to the groin, scrotum, labia, anterior or inner thigh.

2. Nausea, vomiting, bloating with retention of stool and gas.

3. Dysuric disorders.

4. Motor restlessness, the patient is looking for a position in which the pain will ease or stop.

5. The abdomen is soft, slightly painful along the ureters or painless.

6. Tapping on the lower back in the kidney area is painful, symptoms of peritoneal irritation are negative, the tongue is wet.

7. History of kidney stones.

First aid

1) administer 2–5 ml of a 50% solution of analgin intramuscularly or 1 ml of a 0.1% solution of atropine sulfate subcutaneously, or 1 ml of a 0.2% solution of platiphylline hydrotartrate subcutaneously;

2) place a hot heating pad on the lumbar area or (in the absence of contraindications) place the patient in a hot bath. Do not leave him alone, monitor his general well-being, pulse, respiratory rate, blood pressure, skin color;

3) hospitalization: with the first attack, with hyperthermia, failure to stop the attack at home, with a repeated attack within 24 hours.

Renal colic is a complication of urolithiasis that occurs due to metabolic disorders. The cause of the painful attack is the displacement of the stone and its entry into the ureters.

Anaphylactic shock

Clinical manifestations

1. Relationship of the condition to the administration of a drug, vaccine, intake of a specific food, etc.

2. Feeling of fear of death.

3. Feeling of lack of air, chest pain, dizziness, tinnitus.

4. Nausea, vomiting.

5. Cramps.

6. Severe pallor, cold sticky sweat, urticaria, soft tissue swelling.

7. Tachycardia, thready pulse, arrhythmia.

8. Severe hypotension, diastolic blood pressure is not determined.

9. Comatose state.

First aid

Sequencing:

1) in case of shock caused by intravenous administration of an allergen drug, leave the needle in the vein and use it for emergency anti-shock therapy;

2) immediately stop administering the drug that caused the development of anaphylactic shock;

3) give the patient a functionally advantageous position: raise the limbs at an angle of 15°. Turn your head to the side, if you lose consciousness, push your lower jaw forward, remove dentures;

4) carry out oxygen therapy with 100% oxygen;

5) administer intravenously 1 ml of a 0.1% solution of adrenaline hydrochloride, diluted in 10 ml of a 0.9% solution of sodium chloride; the same dose of adrenaline hydrochloride (but without dilution) can be administered under the root of the tongue;

6) start administering polyglucin or other infusion solution as a bolus after stabilization of systolic blood pressure by 100 mm Hg. Art. – continue drip infusion therapy;

7) introduce 90–120 mg of prednisolone (125–250 mg of hydrocortisone) into the infusion system;

8) introduce 10 ml of 10% calcium chloride solution into the infusion system;

9) if there is no effect from the therapy, repeat the administration of adrenaline hydrochloride or administer 1–2 ml of a 1% mesatone solution intravenously in a stream;

10) for bronchospasm, administer 10 ml of a 2.4% solution of aminophylline intravenously;

11) for laryngospasm and asphyxia - conicotomy;

12) if the allergen was introduced intramuscularly or subcutaneously or an anaphylactic reaction occurred in response to an insect bite, it is necessary to inject the injection or bite site with 1 ml of a 0.1% solution of adrenaline hydrochloride diluted in 10 ml of a 0.9% solution of sodium chloride ;

13) if the allergen enters the body orally, it is necessary to rinse the stomach (if the patient’s condition allows);

14) for convulsive syndrome, administer 4–6 ml of 0.5% diazepam solution;

15) in case of clinical death, perform cardiopulmonary resuscitation.

Each treatment room must have a first aid kit for providing first aid for anaphylactic shock. Most often, anaphylactic shock develops during or after the administration of biological products and vitamins.

Quincke's edema

Clinical manifestations

1. Association with an allergen.

2. Itchy rash on various parts of the body.

3. Swelling of the back of the hands, feet, tongue, nasal passages, oropharynx.

4. Puffiness and cyanosis of the face and neck.

6. Mental agitation, motor restlessness.

First aid

Sequencing:

1) stop introducing the allergen into the body;

2) administer 2 ml of a 2.5% solution of promethazine, or 2 ml of a 2% solution of chloropyramine, or 2 ml of a 1% solution of diphenhydramine intramuscularly or intravenously;

3) administer 60–90 mg of prednisolone intravenously;

4) administer 0.3–0.5 ml of a 0.1% solution of adrenaline hydrochloride subcutaneously or, diluting the drug in 10 ml of a 0.9% solution of sodium chloride, intravenously;

5) inhale bronchodilators (fenoterol);

6) be ready to perform conicotomy;

7) hospitalize the patient.

Life sometimes brings surprises, and they are not always pleasant. We find ourselves in difficult situations or become witnesses to them. And often we are talking about the life and health of loved ones or even random people. How to act in this situation? After all, quick action and proper emergency assistance can save a person’s life. What are emergency conditions and emergency medical care, 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. It is necessary during a period of acute chronic pathology or in the event 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 exacerbation of chronic diseases, in acute conditions that do not threaten the patient’s life. It can be provided either as a day hospital or on an outpatient basis.

Emergency assistance 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:

1. Injuries. These include:

• Burns and frostbite.
• Fractures.
• Damage to vital organs.
• Damage to blood vessels with subsequent bleeding.
• Electric shock.

2. Poisoning. Damage occurs inside the body, unlike injuries, it is the result of external influences. Disruption of the functioning of internal organs in case of untimely emergency care 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 should ensure that the child remains calm and fully cooperate 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.
• Condition of the 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:

1. 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.
• For high blood pressure, intravenous Clonidine or Pentamin up to 50 mg.
• If tachycardia persists, use Propranolol 20-40 mg.
• For type 2 crisis, Furosemide is administered 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 increases, and skin itching occurs. Then loss of consciousness.

Urgent Care:

• Eliminate dehydration, hypovolemia. Sodium chloride solution is administered intravenously.
• Insulin is administered intravenously.
• For severe hypotension, a solution of 10% “Caffeine” is administered 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. Acute allergic diseases. Severe diseases include: bronchial asthma and angioedema. Anaphylactic shock. Symptoms: the appearance of skin itching, excitability, increased blood pressure, and a feeling of heat. Then loss of consciousness and respiratory arrest, heart rhythm failure are possible.

Emergency assistance is as follows:

• Place the patient so that the head is lower than the level of the legs.
• Provide air access.
• Clear the airways, turn your head to the side, and extend your lower jaw.
• Introduce "Adrenaline", repeated administration is allowed 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 sputum. 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:

1. Disturbed ectopic pregnancy.
2. Torsion of the pedicle of an ovarian tumor.
3. 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.
• Respiration rate.
• 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:

• Restoring 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 for 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:

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

1. 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 the chest moves by 4-5 cm. Within a minute, you need to do 60-80 pressures.

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.

• In case of an 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 medical 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:

1. 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. Antimicrobial drugs: 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.

First aid in emergency situations can save a person’s life. Before talking about the types of emergency conditions, an important point should be mentioned, namely the concept of these very conditions. From the name of the definition it is clear that emergency conditions are those that when a patient urgently needs medical care, waiting for it cannot be delayed even for a second, because then all this can have a detrimental effect on the health, and sometimes even the life of the person.

Such conditions are divided into categories depending on the problem itself.

• Injuries. Injuries include fractures, burns and vascular damage. In addition, electrical damage and frostbite are considered injuries. Another broad subgroup of injuries is damage to vital organs - the brain, heart, lungs, kidneys and liver. Their peculiarity is that they most often arise due to interaction with various objects, that is, under the influence of some circumstance or object.
• Poisoning. Poisoning can be obtained not only through food, respiratory organs and open wounds. Poisons can also penetrate through the veins and skin. The peculiarity of poisoning is that the damage is not visible to the naked eye. Poisoning occurs inside the body at the cellular level.
• Acute diseases of internal organs. These include stroke, heart attack, pulmonary edema, peritonitis, acute renal or liver failure. Such conditions are extremely dangerous and lead to loss of strength and cessation of the activity of internal organs.
• In addition to the above groups, emergency conditions are bites of poisonous insects, attacks of disease, injuries resulting from disasters, etc.

All such conditions are difficult to divide into groups; the main feature is a threat to life and urgent medical intervention!

Principles of emergency care

To do this, you need to know the rules of first aid and be able to apply them in practice if necessary. Also, the main task of the person who finds himself next to the victim is to remain calm and immediately call for medical help. To do this, always keep emergency phone numbers handy or in your cell phone notebook. Do not let the victim harm himself, try to protect him and immobilize him. If you see that the ambulance does not arrive for a long time, take resuscitation actions yourself.

First aid

Algorithm of actions for providing first aid in emergency conditions

• Epilepsy. This is a seizure in which the patient loses consciousness and makes convulsive movements. He's also foaming at the mouth. To help the patient, you need to lay him on his side so that his tongue does not sink in, and hold his arms and legs during convulsions. Doctors use aminazine and magnesium sulfate, after which they take the patient to a medical facility.
• Fainting.
• Bleeding.
• Electric shock.
• Poisoning.

Artificial respiration

How to help children

Children, like adults, have emergency conditions. But the trouble is that children may not notice that something is wrong, and also begin to be capricious, cry, and adults may simply not believe him. This is a great danger, because timely help can save the child’s life, and if his condition suddenly worsens, call the doctor immediately. After all, the child’s body is not yet strong, and the emergency situation should be urgently eliminated.

• First, calm the child so that he does not cry, push, kick, or be afraid of doctors. Describe to the doctor everything that happened as accurately as possible, more details and faster. Tell us what medications he was given and what he ate; perhaps the child had an allergic reaction.
• Before the doctor arrives, prepare antiseptics, clean clothes and fresh air in a room with a comfortable temperature so that the child can breathe well. If you see that the condition is rapidly deteriorating, begin resuscitation measures, cardiac massage, artificial respiration. Also measure the temperature and do not let the child fall asleep until the doctor arrives.
• When the doctor arrives, he will look at the functioning of the internal organs, heart function and pulse. In addition, when making a diagnosis, he will definitely ask how the child behaves, his appetite and usual behavior. Have you had any symptoms previously? Some parents do not tell the doctor everything, for various reasons, but this is strictly forbidden, because he must have a complete picture of your child’s life and activities, so tell everything as detailed and accurate as possible.

First aid standards for emergencies

• Fainting. You need to tilt your head down and keep it in this position in the fresh air, and also bring a cotton swab with ammonia to the patient. Provide the patient with peace and quiet, and eliminate sources of stress.
• Bleeding. To prevent blood loss in huge quantities, it needs to be stopped. If this is arterial bleeding, that is, the blood flows like a fountain, it will be more difficult to stop. Apply a tight bandage or tourniquet, and be sure to write down the application time underneath! If this is not done, there is a risk of losing a limb.
• Electric shock. The degree of electric shock may vary, because it depends on the device with which you received a burn and the time of interaction with it. Here, the first thing you need to do is remove the source of the lesion, using a wooden stick. Before the ambulance arrives, you need to check the necessary indicators: pulse, breathing, and consciousness.
• Poisoning. To help a person in case of poisoning, you need to minimize the amount of poison in his body and remove them. Rinse your stomach and intestines, give a laxative, and call an ambulance immediately!

Foreign bodies

Foreign body of the external ear, as a rule, does not pose a danger to the patient and does not require urgent removal. Inept attempts to remove a foreign body are dangerous. It is forbidden to use tweezers to remove round objects; tweezers can only be used to remove an elongated foreign body (a match). For living foreign bodies, it is recommended to infuse heated sunflower or petroleum jelly into the external auditory canal, which leads to the death of the insect. Before removing swollen foreign bodies (peas, beans), a few drops of heated 70° ethyl alcohol are first poured into the ear to dehydrate them. Removal of a foreign body is done by washing the ear with warm water or a disinfectant solution (potassium permanganate, furatsilin) ​​from a Janet syringe or rubber balloon. A stream of liquid is directed along the superoposterior wall of the external auditory canal, and the foreign body is removed along with the liquid. While washing the ear, the head should be well fixed. Ear lavage is contraindicated in case of perforation of the eardrum, complete obstruction of the ear canal by a foreign body, or sharp-shaped foreign objects (metal shavings).

When hit foreign body in the nasal passage close the opposite nostril and ask the child, straining very hard, to blow his nose. If a foreign body remains, only a doctor can remove it from the nasal cavity. Repeated attempts to remove a foreign body and instrumental interventions at the prehospital stage are contraindicated, as they can lead to the pushing of foreign objects into the underlying parts of the respiratory tract, blocking them and causing suffocation.

When hit foreign body in the lower respiratory tract a young child is turned upside down, held by the legs, and shaking movements are made in an attempt to remove the foreign object. For older children, if they are unable to get rid of a foreign body when coughing, perform one of the following methods:

The child is placed with his stomach on the adult’s bent knee, the victim’s head is lowered down and the hand is lightly tapped on the back;

The patient is grabbed with the left hand at the level of the costal arch and 3-4 blows are applied with the palm of the right hand to the spine between the shoulder blades;

The adult clasps the child from the back with both arms, clasps his hands and places them slightly below the costal arch, then sharply presses the victim to himself, trying to put maximum pressure on the epigastric region;

If the patient is unconscious, he is turned over on his side and 3-4 sharp and strong blows are performed with the palm of the hand on the spine between the shoulder blades.

In any case, you must call a doctor.

Stenosing laryngotracheitis

Emergency first aid for stenotic laryngotracheitis is aimed at restoring airway patency. They are trying to remove or reduce the symptoms of laryngeal stenosis using distracting procedures. Alkaline or steam inhalations, warm foot and hand baths (temperature from 37°C with a gradual increase to 40°C), hot water or semi-alcohol compresses on the neck and calf muscle area are performed. If there is no increase in body temperature, a general hot bath is performed in compliance with all precautions. Give warm alkaline drink in small portions. Provide access to fresh air.

Artificial ventilation

The most important condition for successful artificial respiration is ensuring the patency of the airways. The child is placed on his back, the patient’s neck, chest and abdomen are freed from constricting clothing, and the collar and belt are unfastened. The oral cavity is freed from saliva, mucus, and vomit. Then one hand is placed on the parietal area of ​​the victim, the second hand is placed under the neck and the child’s head is tilted back as much as possible. If the patient's jaws are tightly closed, the mouth is opened by pushing the lower jaw forward and pressing the index fingers on the cheekbones.

When using the method "mouth to nose" Cover the child’s mouth tightly with your palm and, after a deep breath, exhale vigorously, wrapping your lips around the victim’s nose. When using the method "mouth to mouth" They pinch the patient’s nose with their thumb and forefinger, inhale the air deeply and, tightly pressing their mouth to the child’s mouth, exhale into the victim’s mouth, having previously covered it with gauze or a handkerchief. Then the patient’s mouth and nose are opened slightly, after which the patient exhales passively. Artificial respiration is performed for newborns at a frequency of 40 breaths per minute, for young children - 30, for older children - 20.

During artificial ventilation of the lungs Holger-Nielsen method The child is placed on his stomach, they press with their hands on the patient’s shoulder blades (exhale), then they stretch out the victim’s arms (inhale). Artificial respiration Sylvester's way performed with the child in a supine position, the victim’s arms are crossed on the chest and pressed on the sternum (exhalation), then the patient’s arms are straightened (inhalation).

Indirect cardiac massage

The patient is placed on a hard surface, removed from clothing, and the belt is unfastened. With hands straightened at the elbow joints, press on the lower third of the child’s sternum (two transverse fingers above the xiphoid process). Squeezing is performed with the palmar part of the hand, placing one palm on top of the other, raising the fingers of both hands. For newborn babies, indirect cardiac massage is performed with two thumbs of both hands or the index and middle finger of one hand. Pressure on the sternum is carried out with quick rhythmic pushes. The compression force should ensure a displacement of the sternum towards the spine in newborns by 1-2 cm, in young children - 3-4 cm, in older children - 4-5 cm. The frequency of pressure corresponds to the age-related heart rate.

Pulmonary-cardiac resuscitation

Stages of pulmonary-cardiac resuscitation;

Stage I – restoration of airway patency;

Stage II – artificial ventilation;

Stage III – indirect cardiac massage.

If pulmonary-cardiac resuscitation is performed by one person, then after 15 compressions on the chest, he performs 2 artificial breaths. If there are two resuscitators, the ratio of pulmonary ventilation/cardiac massage is 1:5.

The criteria for the effectiveness of pulmonary-cardiac resuscitation are:

The appearance of pupil reaction to light (constriction);

Restoration of pulsation in the carotid, radial, femoral arteries;

Increased blood pressure;

The appearance of independent respiratory movements;

Restoring the normal color of the skin and mucous membranes;

Return of consciousness.

Fainting

When fainting, the child is given a horizontal position with his head slightly lowered and his legs raised in order to improve blood supply to the brain. Free from restrictive clothing, unfasten the collar and belt. Provide access to fresh air, open windows and doors wide, or take the child out into the open air. Spray your face with cold water and pat your cheeks. Give a cotton swab moistened with ammonia to smell.

Collapse

Measures to provide emergency care for collapse before the doctor arrives include placing the child in a horizontal position on his back with raised lower limbs, wrapping him in a warm blanket, and warming him with heating pads.

Paroxysmal tachycardia

To relieve an attack of paroxysmal tachycardia, techniques are used that cause irritation of the vagus nerve. The most effective methods are straining the child at the height of a deep breath (Valsava maneuver), influencing the sinocarotid zone, pressing on the eyeballs (Aschner reflex), and artificially inducing vomiting.

Internal bleeding

Patients with hemoptysis and pulmonary hemorrhage They are given a semi-sitting position with their legs down, they are prohibited from moving, talking, or straining. They remove clothing that restricts breathing and provide an influx of fresh air by opening the windows wide. The child is recommended to swallow small pieces of ice and drink cold water in small portions. Apply an ice pack to the chest.

At gastrointestinal bleeding Strict bed rest is prescribed, food and liquid intake is prohibited. An ice pack is placed on the abdominal area. Constant monitoring of pulse rate and filling, and blood pressure levels are carried out.

Urgent hospitalization is indicated.

External bleeding

Child with nosebleeds give a semi-sitting position. It is forbidden to blow your nose. A cotton ball moistened with a 3% solution of hydrogen peroxide or a hemostatic sponge is inserted into the vestibule of the nose. The wing of the nose is pressed against the nasal septum. Ice or gauze soaked in cold water is placed on the back of the head and bridge of the nose.

The main urgent action for external traumatic bleeding is a temporary stop of bleeding. Arterial bleeding from the vessels of the upper and lower extremities is stopped in two stages: first, the artery is pressed above the site of injury to the bony protrusion, then a standard rubber or improvised tourniquet is applied.

To compress the brachial artery, place the fist in the armpit and press the arm to the body. Temporary stopping of bleeding from the arteries of the forearm is achieved by placing a cushion (bandage package) in the elbow bend and bending the arm to the maximum at the elbow joint. If the femoral artery is affected, press with a fist on the upper third of the thigh in the area of ​​the inguinal (pupart) ligament. Pressing the arteries of the lower leg and foot is carried out by inserting a cushion (bandage package) into the popliteal area and bending the leg at the knee joint to the maximum.

After pressing the arteries, they begin to apply a hemostatic tourniquet, which is placed over clothing or a towel, a scarf, or a piece of gauze. The tourniquet is brought under the limb above the wound site, stretched strongly and, without reducing the tension, tightened around the limb and fixed. If the tourniquet is applied correctly, bleeding from the wound stops, the pulse in the radial artery or dorsal artery of the foot disappears, and the distal parts of the limb turn pale. It should be remembered that excessive tightening of the tourniquet, especially on the shoulder, can cause paralysis of the peripheral parts of the limb due to damage to the nerve trunks. A note is placed under the tourniquet indicating the time the tourniquet will be applied. After 20-30 minutes, the pressure of the tourniquet can be released. The tourniquet, applied to a soft pad, should not be on the limb for more than 1 hour.

Arterial bleeding from the arteries of the hand and foot does not require the application of a tourniquet. It is enough to tightly bandage a tight roll of sterile napkins (a pack of sterile bandage) to the wound site and give the limb an elevated position. A tourniquet is used only for extensive multiple wounds and crush injuries of the hand and foot. Injuries to the digital arteries are stopped with a tight pressure bandage.

Arterial bleeding in the scalp (temporal artery), neck (carotid artery) and torso (subclavian and iliac arteries) is stopped by tight wound tamponade. Using tweezers or a clamp, the wound is tightly packed with napkins, on top of which you can apply an unwrapped bandage from a sterile package and bandage it as tightly as possible.

Venous and capillary bleeding is stopped by applying a tight pressure bandage. If a large main vein is damaged, a tight tamponade of the wound can be performed or a hemostatic tourniquet can be applied.

Acute urinary retention

Emergency care for acute urinary retention is to remove urine from the bladder as quickly as possible. Independent urination is facilitated by the sound of running water from a tap and irrigation of the genitals with warm water. If there are no contraindications, place a warm heating pad on the pubic area or place the child in a warm bath. If these measures are ineffective, they resort to catheterization of the bladder.

Hyperthermia

During the period of maximum increase in body temperature, the child should be given plenty of water often: liquid is given in the form of fruit juices, fruit drinks, and mineral waters. When body temperature rises above 37°C for each degree, additional fluid administration is required at the rate of 10 ml per 1 kg of the child’s body weight. Cracks on the lips are lubricated with Vaseline or other oil. Carry out thorough oral care.

With the “pale” type of fever, the child experiences chills, pale skin, and cold extremities. First of all, the patient is warmed up, covered with a warm blanket, heating pads are applied, and a warm drink is given.

The “red” type of fever is characterized by a feeling of heat, the skin is warm, moist, and a blush on the cheeks. In such cases, to increase heat transfer, physical methods of reducing body temperature are used: the child is undressed, air baths are given, the skin is wiped with a semi-alcohol solution or a solution of table vinegar, the head and liver area is cooled with an ice pack or a cold compress.

Overheating (heatstroke) may occur in a child who is in a poorly ventilated room with high air temperature and humidity, during intense physical work in stuffy rooms. Warm clothing, poor drinking habits, and overwork contribute to overheating. In infants, heat stroke can occur when wrapped in warm blankets or when a crib (or stroller) is near a central heating radiator or stove.

Signs of heat stroke depend on the presence and degree of hyperthermia. With mild overheating, the condition is satisfactory. Body temperature is not elevated. Patients complain of headache, weakness, dizziness, tinnitus, and thirst. The skin is moist. Breathing and pulse are slightly increased, blood pressure is within normal limits.

With a significant degree of overheating, severe headaches occur, nausea and vomiting often occur. A short-term loss of consciousness is possible. The skin is moist. Breathing and pulse are increased, blood pressure is increased. Body temperature reaches 39-40°C.

Severe overheating is characterized by an increase in body temperature to 40°C and above. Patients are excited, delirium, psychomotor agitation are possible, contact with them is difficult. Infants often experience diarrhea, vomiting, sharpened facial features, a rapid deterioration in their general condition, and possible convulsions and coma. A characteristic sign of severe overheating is the cessation of sweating, the skin is moist and dry. Breathing is frequent and shallow. Possible respiratory arrest. The pulse is sharply increased, blood pressure is reduced.

If signs of heat stroke appear, the patient is immediately taken to a cool place and provided with access to fresh air. The child is undressed, given a cold drink, and a cold compress is placed on the head. In more severe cases, wrapping sheets soaked in cold water, dousing with cool water, applying ice to the head and groin area, and hospitalization are indicated.

Sunstroke occurs in children exposed to the sun for a long time. Currently, the concepts of “heat” and “sunstroke” are not distinguished, since in both cases changes occur due to the general overheating of the body.

Emergency care for sunstroke is similar to the care provided to patients with heatstroke. In severe cases, urgent hospitalization is indicated.

Cold damage found in various climatic zones. This problem is especially relevant for the regions of the Far North and Siberia, however, cold injury can also be observed in areas with relatively high average annual temperatures. Cold can have a general and local effect on the child’s body. The general effect of cold leads to the development of general cooling (freezing), and the local effect causes frostbite.

General cooling or freezing– a state of the human body in which, under the influence of unfavorable external conditions, body temperature drops to +35°C and below. At the same time, against the background of a decrease in body temperature (hypothermia), functional disorders develop in the body with a sharp suppression of all vital functions, up to complete extinction.

All victims, regardless of the degree of general cooling, should be hospitalized. It should be borne in mind that victims with mild degrees of freezing may refuse hospitalization because they do not adequately assess their condition. The main principle of treatment for general cooling is warming. At the prehospital stage, first of all, further cooling of the victim is prevented. To do this, the child is immediately brought into a warm room or car, wet clothes are removed, wrapped in a blanket, covered with heating pads, and given hot sweet tea. Under no circumstances should the victim be left outside, rubbed with snow, or drink alcoholic beverages. In the absence of signs of breathing and blood circulation at the prehospital stage, the entire complex of cardiopulmonary resuscitation is carried out while warming the victim.

Frostbite occurs with local prolonged exposure to low temperatures. Exposed parts of the body (nose, ears) and extremities are most often affected. A circulatory disorder occurs, first of the skin, and then of the underlying tissues, and necrosis develops. Depending on the severity of the lesion, there are four degrees of frostbite. I degree is characterized by the appearance of edema and hyperemia with a bluish tint. At stage II, blisters filled with light exudate form. III degree of frostbite is characterized by the appearance of blisters with hemorrhagic contents. With IV degree frostbite, all layers of skin, soft tissue and bones die.

The injured child is brought into a warm room, shoes and mittens are removed. A heat-insulating aseptic bandage is applied to the affected area of ​​the nose and ear. The frostbitten limb is first rubbed with a dry cloth, then placed in a basin with warm (32-34°C) water. Within 10 minutes, the temperature is brought to 40-45°C. If the pain that occurs during warming up quickly passes, the fingers return to their normal appearance or are slightly swollen, sensitivity is restored - the limb is wiped dry, wiped with a semi-alcohol solution, put on cotton socks and warm woolen socks or mittens on top. If warming up is accompanied by increasing pain, the fingers remain pale and cold, which indicates a deep degree of frostbite - the affected child is hospitalized.

Poisoning

Providing first aid to children with acute poisoning is aimed at accelerating the elimination of toxic substances from the body. For this purpose, vomiting is stimulated, the stomach and intestines are washed, and diuresis is forced. Stimulation of vomiting is carried out only in children who are fully conscious. After drinking the maximum possible amount of water, irritate the back wall of the pharynx with a finger or spoon. Stimulation of vomiting is facilitated by the use of a warm solution of table salt (1 tablespoon per glass of water). The procedure is repeated until the impurities completely disappear and clean water appears. Gastric lavage is the main measure for removing toxic substances and should be performed as early as possible. When ingesting strong acids (sulfuric, hydrochloric, nitric, oxalic, acetic), gastric lavage is carried out with cold water using a probe lubricated with vaseline or vegetable oil. In case of poisoning with alkalis (ammonia, ammonia, bleach, etc.), the stomach is washed with cold water or a weak solution (1-2%) of acetic or citric acid through a probe lubricated with vaseline or vegetable oil, after cleansing, enveloping agents are introduced into the stomach cavity ( mucous decoctions, milk) or sodium bicarbonate. To cleanse the intestines, use a saline laxative and perform cleansing enemas. Forcing diuresis at the prehospital stage is achieved by prescribing plenty of fluids.

In order to change the metabolism of a toxic substance in the body and reduce its toxicity, antidote therapy is used. Atropine is used as an antidote for poisoning with organophosphorus compounds (chlorophos, dichlorvos, karbofos, etc.), for poisoning with atropine (belladonna, henbane, belladonna) - pilocarpine, for poisoning with copper and its compounds (copper sulfate) - unithiol.

In case of poisoning by inhaled toxic substances (gasoline, kerosene), carbon monoxide (carbon monoxide), the child is taken out of the room, access to fresh air is provided, and oxygen therapy is administered.

Emergency care for poisoning with poisonous mushrooms involves washing the stomach and intestines with the introduction of a saline laxative and a suspension of enterosorbent. In case of fly agaric poisoning, atropine is additionally administered.

Burns

At thermal skin burns it is necessary to stop exposure to the thermal agent. When clothing catches fire, the fastest and most effective means of extinguishing is to pour water on the victim or throw a tarpaulin, blanket, etc. over the victim. Clothes from damaged areas of the body are carefully removed (cut with scissors without touching the wound surface). Parts of clothing tightly adhering to the burnt skin are carefully cut off. Cool the burned area with cold running water or use an ice pack. The bubbles should not be opened or cut off. Ointments, powders, and oil solutions are contraindicated. Aseptic dry or wet-dry dressings are applied to the burn surface. If there is no dressing material, the affected area of ​​skin is wrapped in a clean cloth. Victims with deep burns are hospitalized.

At chemical skin burns caused by acids and alkalis, the most universal and most effective means of providing first aid is prolonged rinsing of the burned area with copious amounts of running water. Quickly remove clothing soaked in the chemical agent, continuing to wash the burned surface of the skin. Contact with water is contraindicated for burns caused by quicklime and organic aluminum compounds. In case of alkali burns, the burn wounds are washed with a weak solution of acetic or citric acid. If the damaging agent was acid, then a weak solution of sodium bicarbonate is used for washing.

Electrical injury

First aid for electric shock is to eliminate the damaging effects of the current. Urgently turn off the switch, cut, chop or discard the wires, using objects with a wooden handle. When freeing a child from exposure to electric current, you should observe your own safety, do not touch the exposed parts of the victim’s body, you must use rubber gloves or dry rags wrapped around your hands, rubber shoes, and stand on a wooden surface or car tire. If the child does not have breathing or cardiac activity, they immediately begin performing artificial ventilation and chest compressions. A sterile bandage is applied to the electrical burn wound.

Drowning

The injured child is removed from the water. The success of resuscitation measures largely depends on their correct and timely implementation. It is advisable that they begin not on the shore, but already on the water, while towing the child to the shore. Even several artificial breaths carried out during this period significantly increase the likelihood of subsequent revival of the drowned person.

More advanced assistance to the victim can be provided in a boat (dinghy, cutter) or on the shore. If the child is unconscious, but breathing and cardiac activity are preserved, they are limited to freeing the victim from restrictive clothing and using ammonia. The absence of spontaneous breathing and cardiac activity requires immediate artificial ventilation and chest compressions. First, the oral cavity is cleaned of foam, mucus, sand, and silt. To remove water that has entered the respiratory tract, the child is placed with his stomach on the thigh of the person providing assistance bent at the knee joint, the head is lowered down and, supporting the victim’s head with one hand, the other hand is lightly struck several times between the shoulder blades. Or the lateral surfaces of the chest are compressed with sharp jerking movements (for 10-15 seconds), after which the child is turned onto his back again. These preparatory measures are carried out as quickly as possible, then artificial respiration and chest compressions begin.

Poisonous snake bites

When bitten by poisonous snakes, the first drops of blood are squeezed out of the wound, then cold is applied to the bite site. It is necessary that the affected limb remain motionless, since movements enhance lymphatic drainage and accelerate the entry of poison into the general circulation. The victim is kept at rest, the affected limb is fixed with a splint or improvised means. You should not burn the bite site, inject it with any drugs, bandage the affected limb above the bite site, suck out the poison, etc. Urgent hospitalization to the nearest hospital is indicated.

Insect bites

For insect bites (bees, wasps, bumblebees), remove the insect sting from the wound using tweezers (if not, use your fingers). The bite site is moistened with a semi-alcohol solution and cold is applied. Drug therapy is carried out as prescribed by a doctor.

CONTROL QUESTIONS

What is the help when a foreign body gets into the nasal passages and respiratory tract?

What should be the first aid for laryngeal stenosis?

What methods of artificial ventilation are there?

What measures should be taken in case of cardiac arrest?

Determine the sequence of actions when performing pulmonary-cardiac resuscitation.

What activities can help bring a child out of fainting?

What emergency care is provided for poisoning?

What measures are taken for acute urinary retention?

What methods of temporarily stopping external bleeding do you know?

What are the ways to reduce body temperature?

What is the help for frostbite?

What first aid is provided for thermal burns?

How to help a child with an electrical injury?

What measures should be taken in case of drowning?

What is the help for insect and poisonous snake bites?

Angina pectoris.

Angina pectoris

Symptoms:

Nurse tactics:

Actions	Rationale
Call a doctor	To provide qualified medical care
Calm and comfortably seat the patient with legs down	Reducing physical and emotional stress, creating comfort
Unbutton tight clothing and allow fresh air to flow	To improve oxygenation
Measure blood pressure, calculate heart rate	Condition monitoring
Give nitroglycerin 0.5 mg, nitromint aerosol (1 press) under the tongue, repeat the drug if there is no effect after 5 minutes, repeat 3 times under the control of blood pressure and heart rate (BP not lower than 90 mm Hg).	Relieving spasm of the coronary arteries. The effect of nitroglycerin on the coronary vessels begins after 1-3 minutes, the maximum effect of the tablet is at 5 minutes, the duration of action is 15 minutes
Give Corvalol or Valocardin 25-35 drops, or valerian tincture 25 drops	Removing emotional stress.
Place mustard plasters on the heart area	In order to reduce pain, as a distraction.
Give 100% humidified oxygen	Reduced hypoxia
Monitoring pulse and blood pressure.	Condition monitoring
Take an ECG	In order to clarify the diagnosis
Give if pain persists - give a tablet of 0.25 g of aspirin, chew slowly and swallow

1. Syringes and needles for intramuscular and subcutaneous injections.

2. Drugs: analgin, baralgin or tramal, sibazon (seduxen, relanium).

3. Ambu bag, ECG machine.

Assessment of achievements: 1. Complete cessation of pain

2. If the pain persists, if this is the first attack (or attacks within a month), if the primary stereotype of the attack is violated, hospitalization in the cardiology department or intensive care unit is indicated

Note: If a severe headache occurs while taking nitroglycerin, give a validol tablet sublingually, hot sweet tea, nitromint or molsidomine orally.

Acute myocardial infarction

Myocardial infarction- ischemic necrosis of the heart muscle, which develops as a result of disruption of coronary blood flow.

It is characterized by chest pain of unusual intensity, pressing, burning, tearing, radiating to the left (sometimes right) shoulder, forearm, scapula, neck, lower jaw, epigastric region, pain lasts more than 20 minutes (up to several hours, days), can be wavy (it intensifies, then it subsides), or increasing; accompanied by a feeling of fear of death, lack of air. There may be disturbances in heart rhythm and conduction, instability of blood pressure, and taking nitroglycerin does not relieve pain. Objectively: pale skin or cyanosis; cold limbs, cold sticky sweat, general weakness, agitation (the patient underestimates the severity of the condition), motor restlessness, thread-like pulse, may be arrhythmic, frequent or rare, muffled heart sounds, pericardial friction noise, increased temperature.

atypical forms (variants):

Ø asthmatic– attack of suffocation (cardiac asthma, pulmonary edema);

Ø arrhythmic- rhythm disturbances are the only clinical manifestation

or predominate in the clinic;

Ø cerebrovascular- (manifested by fainting, loss of consciousness, sudden death, acute neurological symptoms such as a stroke;

Ø abdominal- pain in the epigastric region, which can radiate to the back; nausea,

vomiting, hiccups, belching, severe bloating, tension in the anterior abdominal wall

and pain on palpation in the epigastric region, Shchetkin’s symptom -

Bloomberg negative;

Ø low-symptomatic (painless) - vague sensations in the chest, unmotivated weakness, increasing shortness of breath, causeless increase in temperature;

Ø with atypical irradiation of pain in – neck, lower jaw, teeth, left arm, shoulder, little finger ( upper - vertebral, laryngeal - pharyngeal)

When assessing the patient’s condition, it is necessary to take into account the presence of risk factors for coronary artery disease, the appearance of pain attacks for the first time or a change in habitual

Nurse tactics:

Actions	Rationale
Call a doctor.	Providing qualified assistance
Observe strict bed rest (place with head elevated), reassure the patient
Provide access to fresh air	In order to reduce hypoxia
Measure blood pressure and pulse	Condition monitoring.
Give nitroglycerin 0.5 mg sublingually (up to 3 tablets) with a 5-minute break if blood pressure is not lower than 90 mm Hg.	Reducing spasm of the coronary arteries, reducing the area of ​​necrosis.
Give an aspirin tablet 0.25 g, chew slowly and swallow	Prevention of blood clots
Give 100% humidified oxygen (2-6L per minute)	Reducing hypoxia
Pulse and blood pressure monitoring	Condition monitoring
Take an ECG	To confirm the diagnosis
Take blood for general and biochemical analysis	to confirm the diagnosis and perform a tropanin test
Connect to heart monitor	To monitor the dynamics of myocardial infarction.

Prepare instruments and preparations:

1. Intravenous system, tourniquet, electrocardiograph, defibrillator, cardiac monitor, Ambu bag.

2. As prescribed by the doctor: analgin 50%, 0.005% fentanyl solution, 0.25% droperidol solution, promedol solution 2% 1-2 ml, morphine 1% IV, Tramal - for adequate pain relief, Relanium, heparin - for the purpose of prevention recurrent blood clots and improvement of microcirculation, lidocaine - lidocaine for the prevention and treatment of arrhythmia;

Hypertensive crisis

Hypertensive crisis - a sudden increase in individual blood pressure, accompanied by cerebral and cardiovascular symptoms (disorder of the cerebral, coronary, renal circulation, autonomic nervous system)

- hyperkinetic (type 1, adrenaline): characterized by a sudden onset, with the appearance of an intense headache, sometimes of a pulsating nature, with a predominant localization in the occipital region, dizziness. Excitement, palpitations, trembling throughout the body, tremors of the hands, dry mouth, tachycardia, increased systolic and pulse pressure. The crisis lasts from several minutes to several hours (3-4). The skin is hyperemic, moist, diuresis is increased at the end of the crisis.

- hypokinetic (2 types, norepinephrine): develops slowly, from 3-4 hours to 4-5 days, headache, “heaviness” in the head, “veil” before the eyes, drowsiness, lethargy, the patient is lethargic, disorientation, “ringing” in the ears, transient visual impairment , paresthesia, nausea, vomiting, pressing pain in the heart, such as angina (pressing), swelling of the face and pasty legs, bradycardia, mainly diastolic pressure increases, pulse decreases. The skin is pale, dry, diuresis is reduced.

Nurse tactics:

Actions	Rationale
Call a doctor.	In order to provide qualified assistance.
Reassure the patient
Maintain strict bed rest, physical and mental rest, remove sound and light stimuli	Reducing physical and emotional stress
Place the patient in bed with the head of the bed raised, and turn your head to the side when vomiting.	For the purpose of blood outflow to the periphery, prevention of asphyxia.
Provide access to fresh air or oxygen therapy	In order to reduce hypoxia.
Measure blood pressure, heart rate.	Condition monitoring
Place mustard plasters on the calf muscles or apply a heating pad to the legs and arms (you can put the hands in a bath of hot water)	For the purpose of dilating peripheral vessels.
Place a cold compress on your head	To prevent cerebral edema, reduce headaches
Provide intake of Corvalol, motherwort tincture 25-35 drops	Removing emotional stress

Prepare drugs:

Nifedipine (Corinfar) tab. under the tongue, ¼ tab. capoten (captopril) under the tongue, clonidine (clonidine) tab., & anaprilin tab., amp; droperidol (ampoules), furosemide (Lasix tablets, ampoules), diazepam (Relanium, Seduxen), dibazol (amp), magnesium sulfate (amp), aminophylline amp.

Prepare tools:

Device for measuring blood pressure. Syringes, intravenous infusion system, tourniquet.

Assessment of what has been achieved: Reduction of complaints, gradual (over 1-2 hours) decrease in blood pressure to the normal value for the patient

Fainting

Fainting this is a short-term loss of consciousness that develops due to a sharp decrease in blood flow to the brain (several seconds or minutes)

Causes: fear, pain, sight of blood, blood loss, lack of air, hunger, pregnancy, intoxication.

Pre-fainting period: feeling of lightheadedness, weakness, dizziness, darkening of the eyes, nausea, sweating, ringing in the ears, yawning (up to 1-2 minutes)

Fainting: no consciousness, pale skin, decreased muscle tone, cold extremities, rare, shallow breathing, weak pulse, bradycardia, blood pressure - normal or reduced, pupils constricted (1-3-5 minutes, prolonged - up to 20 minutes)

Post-syncope period: consciousness returns, pulse, blood pressure return to normal , Possible weakness and headache (1-2 minutes – several hours). Patients do not remember what happened to them.

Nurse tactics:

Actions	Rationale
Call a doctor.	In order to provide qualified assistance
Lay without a pillow with your legs raised at 20 - 30 0 . Turn your head to the side (to prevent aspiration of vomit)	To prevent hypoxia, improve cerebral circulation
Provide a supply of fresh air or remove it from a stuffy room, give oxygen	To prevent hypoxia
Unbutton tight clothes, pat your cheeks, and splash your face with cold water. Give a cotton swab with ammonia a whiff, rub your body and limbs with your hands.	Reflex effect on vascular tone.
Give tincture of valerian or hawthorn, 15-25 drops, sweet strong tea, coffee
Measure blood pressure, control respiratory rate, pulse	Condition monitoring

Prepare instruments and preparations:

Syringes, needles, cordiamine 25% - 2 ml IM, caffeine solution 10% - 1 ml s/c.

Prepare drugs: aminophylline 2.4% 10 ml IV or atropine 0.1% 1 ml s.c., if fainting is caused by transverse heart block

Assessment of achievements:

1. The patient regained consciousness, his condition improved - consultation with a doctor.

3. The patient’s condition is alarming - call emergency help.

Collapse

Collapse- this is a persistent and long-term decrease in blood pressure due to acute vascular insufficiency.

Causes: pain, injury, massive blood loss, myocardial infarction, infection, intoxication, sudden drop in temperature, change in body position (standing up), standing up after taking antihypertensive drugs, etc.

Ø cardiogenic form - for heart attack, myocarditis, pulmonary embolism

Ø vascular form– for infectious diseases, intoxication, critical decrease in temperature, pneumonia (symptoms develop simultaneously with symptoms of intoxication)

Ø hemorrhagic form - with massive blood loss (symptoms develop several hours after blood loss)

Clinic: the general condition is severe or extremely serious. First, weakness, dizziness, and noise in the head appear. Worried about thirst, chilliness. Consciousness is preserved, but patients are inhibited and indifferent to their surroundings. The skin is pale, moist, cyanotic lips, acrocyanosis, cold extremities. BP less than 80 mm Hg. Art., pulse is frequent, thread-like", breathing is frequent, shallow, heart sounds are muffled, oliguria, body temperature is reduced.

Nurse tactics:

Prepare instruments and preparations:

Syringes, needles, tourniquets, disposable systems

Cordiamine 25% 2ml IM, caffeine solution 10% 1 ml s/c, 1% 1ml mezatone solution,

0.1% 1 ml adrenaline solution, 0.2% norepinephrine solution, 60-90 mg prednisolone polyglucin, rheopolyglucin, saline solution.
Assessment of achievements:

1. Condition has improved

2. The condition has not improved - be prepared for CPR

Shock - a condition in which there is a sharp, progressive decrease in all vital functions of the body.

Cardiogenic shock develops as a complication of acute myocardial infarction.
Clinic: a patient with acute myocardial infarction develops severe weakness, skin
pale, moist, “marbled”, cold to the touch, collapsed veins, cold hands and feet, pain. Blood pressure is low, systolic about 90 mm Hg. Art. and below. The pulse is weak, frequent, “thread-like”. Breathing is shallow, frequent, oliguria

Ø reflex form (pain collapse)

Ø true cardiogenic shock

Ø arrhythmic shock

Nurse tactics:

Prepare instruments and preparations:

Syringes, needles, tourniquet, disposable systems, cardiac monitor, ECG machine, defibrillator, Ambu bag

0.2% norepinephrine solution, mezaton 1% 0.5 ml, saline. solution, prednisolone 60 mg, reopo-

liglucin, dopamine, heparin 10,000 units IV, lidocaine 100 mg, narcotic analgesics (Promedol 2% 2ml)
Assessment of achievements:

The condition has not worsened

Bronchial asthma

Bronchial asthma - a chronic inflammatory process in the bronchi, predominantly of an allergic nature, the main clinical symptom is an attack of suffocation (bronchospasm).

During an attack: a spasm of the smooth muscles of the bronchi develops; - swelling of the bronchial mucosa; formation of viscous, thick, mucous sputum in the bronchi.

Clinic: The appearance of attacks or their increase in frequency is preceded by exacerbation of inflammatory processes in the bronchopulmonary system, contact with an allergen, stress, and meteorological factors. The attack develops at any time of the day, most often at night in the morning. The patient develops a feeling of “lack of air”, he takes a forced position with support on his hands, expiratory shortness of breath, unproductive cough, auxiliary muscles are involved in the act of breathing; There is retraction of the intercostal spaces, retraction of the supra-subclavian fossae, diffuse cyanosis, a puffy face, viscous sputum, difficult to separate, noisy, wheezing breathing, dry wheezing, audible at a distance (remote), boxy percussion sound, rapid, weak pulse. In the lungs - weakened breathing, dry wheezing.

Nurse tactics:

Actions	Rationale
Call a doctor	The condition requires medical attention
Reassure the patient	Reduce emotional stress
If possible, find out the allergen and separate the patient from it	Termination of influence of the causative factor
Sit down with emphasis on your hands, unfasten tight clothing (belt, trousers)	To make breathing easier heart.
Provide fresh air flow	To reduce hypoxia
Offer to hold your breath voluntarily	Reducing bronchospasm
Measure blood pressure, calculate pulse, respiratory rate	Condition monitoring
Help the patient use a pocket inhaler, which the patient usually uses no more than 3 times per hour, 8 times a day (1-2 puffs of Ventolin N, Berotek N, Salbutomol N, Bekotod), which the patient usually uses, if possible, use a metered-dose inhaler with spencer, use nebulizer	Reducing bronchospasm
Give 30-40% humidified oxygen (4-6l per minute)	Reduce hypoxia
Give a warm fractional alkaline drink (warm tea with soda on the tip of a knife).	For better sputum removal
If possible, make hot foot and hand baths (40-45 degrees, pour water into a bucket for the feet and a basin for the hands).	To reduce bronchospasm.
Monitor breathing, cough, sputum, pulse, respiratory rate	Condition monitoring

Features of the use of freon-free inhalers (N) - the first dose is released into the atmosphere (these are alcohol vapors that have evaporated in the inhaler).

Prepare instruments and preparations:

Syringes, needles, tourniquet, intravenous infusion system

Medicines: 2.4% 10 ml aminophylline solution, prednisolone 30-60 mg mg IM, IV, saline solution, adrenaline 0.1% - 0.5 ml s.c., suprastin 2% -2 ml, ephedrine 5% - 1 ml.

Assessment of what has been achieved:

1. Choking has decreased or stopped, sputum is released freely.

2. The condition has not improved - continue the measures taken until the ambulance arrives.

3. Contraindicated: morphine, promedol, pipolfen - they depress breathing

Pulmonary hemorrhage

Causes: chronic lung diseases (EBD, abscess, tuberculosis, lung cancer, emphysema)

Clinic: cough with the release of scarlet sputum with air bubbles, shortness of breath, possible pain when breathing, decreased blood pressure, pale, moist skin, tachycardia.

Nurse tactics:

Prepare instruments and preparations:

Everything you need to determine your blood type.

2. Calcium chloride 10% 10ml i.v., vikasol 1%, dicinone (sodium etamsylate), 12.5% ​​-2 ml i.m., i.v., aminocaproic acid 5% i.v. drops, polyglucin, rheopolyglucin

Assessment of achievements:

Reducing cough, reducing the amount of blood in sputum, stabilizing pulse, blood pressure.

Hepatic colic

Clinic: intense pain in the right hypochondrium, epigastric region (stabbing, cutting, tearing) with irradiation to the right subscapular region, scapula, right shoulder, collarbone, neck area, jaw. Patients rush about, moan, and scream. The attack is accompanied by nausea, vomiting (often mixed with bile), a feeling of bitterness and dry mouth, and bloating. The pain intensifies with inspiration, palpation of the gallbladder, positive Ortner's sign, possible subictericity of the sclera, darkening of the urine, increased temperature

Nurse tactics:

Prepare instruments and preparations:

1. Syringes, needles, tourniquet, intravenous infusion system

2. Antispasmodics: papaverine 2% 2 - 4 ml, but - spa 2% 2 - 4 ml intramuscularly, platiphylline 0.2% 1 ml subcutaneously, intramuscularly. Non-narcotic analgesics: analgin 50% 2-4 ml, baralgin 5 ml IV. Narcotic analgesics: promedol 1% 1 ml or omnopon 2% 1 ml i.v.

Morphine should not be administered - it causes spasm of the sphincter of Oddi

Renal colic

It occurs suddenly: after physical exertion, walking, bumpy driving, or drinking copious amounts of fluid.

Clinic: sharp, cutting, unbearable pain in the lumbar region, radiating along the ureter to the iliac region, groin, inner thigh, external genitalia, lasting from several minutes to several days. Patients are tossing about in bed, moaning, screaming. Dysuria, pollakiuria, hematuria, sometimes anuria. Nausea, vomiting, fever. Reflex intestinal paresis, constipation, reflex pain in the heart.

Upon inspection: asymmetry of the lumbar region, pain on palpation along the ureter, positive Pasternatsky's sign, tension in the muscles of the anterior abdominal wall.

Nurse tactics:

Prepare instruments and preparations:

1. Syringes, needles, tourniquet, intravenous infusion system

2. Antispasmodics: papaverine 2% 2 - 4 ml, but - spa 2% 2 - 4 ml intramuscularly, platiphylline 0.2% 1 ml subcutaneously, intramuscularly.

Non-narcotic analgesics: analgin 50% 2-4 ml, baralgin 5 ml IV. Narcotic analgesics: promedol 1% 1 ml or omnopon 2% 1 ml i.v.

Anaphylactic shock.

Anaphylactic shock- this is the most dangerous clinical variant of an allergic reaction that occurs when administered various substances. Anaphylactic shock can develop if it enters the body:

a) foreign proteins (immune sera, vaccines, organ extracts, poisons);

insects...);

b) medications (antibiotics, sulfonamides, B vitamins...);

c) other allergens (plant pollen, microbes, food products: eggs, milk,

fish, soy, mushrooms, tangerines, bananas...

d) with insect bites, especially bees;

e) in contact with latex (gloves, catheters, etc.).

Ø lightning form develops 1-2 minutes after administration of the drug -

is characterized by the rapid development of the clinical picture of an acute ineffective heart; without resuscitation assistance, it ends tragically in the next 10 minutes. Symptoms are scanty: severe pallor or cyanosis; dilated pupils, lack of pulse and pressure; agonal breathing; clinical death.

Ø moderate shock, develops 5-7 minutes after drug administration

Ø severe form, develops within 10-15 minutes, maybe 30 minutes after administration of the drug.

Most often, shock develops within the first five minutes after the injection. Food shock develops within 2 hours.

Clinical variants of anaphylactic shock:

1. Typical shape: feeling of heat “swept with nettles”, fear of death, severe weakness, tingling, itching of the skin, face, head, hands; a feeling of a rush of blood to the head, tongue, heaviness behind the sternum or compression of the chest; pain in the heart, headache, difficulty breathing, dizziness, nausea, vomiting. In the fulminant form, patients do not have time to make complaints before losing consciousness.
2. Cardiac option manifested by signs of acute vascular insufficiency: severe weakness, pale skin, cold sweat, “thready” pulse, blood pressure drops sharply, in severe cases consciousness and breathing are depressed.
3. Asthmoid or asphyxial variant manifests itself as signs of acute respiratory failure, which is based on bronchospasm or swelling of the pharynx and larynx; chest tightness, coughing, shortness of breath, and cyanosis appear.
4. Cerebral variant manifests itself as signs of severe cerebral hypoxia, convulsions, foaming from the mouth, involuntary urination and defecation.

5. Abdominal option manifested by nausea, vomiting, paroxysmal pain in the
stomach, diarrhea.

Hives appear on the skin, in some places the rashes merge and turn into dense pale swelling - Quincke's edema.

Nurse tactics:

Actions	Rationale
Ensure that a doctor is called through an intermediary. The patient is not transportable, assistance is provided on the spot
If anaphylactic shock develops due to intravenous administration of a drug
Stop drug administration, maintain venous access	Reducing the allergen dose
Give a stable lateral position, or turn your head to the side, remove the dentures
Raise the foot end of the bed.	Improving blood supply to the brain, increasing blood flow to the brain
	Reduced hypoxia
Measure blood pressure and heart rate	Condition monitoring.
For intramuscular administration: stop administering the drug by first pulling the piston towards you. If an insect bites, remove the sting;	In order to reduce the administered dose.
Provide intravenous access	For administering drugs
Give a stable lateral position or turn your head to the side, remove the dentures	Prevention of asphyxia with vomit, tongue retraction
Raise the foot end of the bed	Improving blood supply to the brain
Access to fresh air, give 100% humidified oxygen, no more than 30 minutes.	Reduced hypoxia
Apply cold (ice pack) to the injection or bite area or apply a tourniquet above	Slowing down the absorption of the drug
Apply 0.2 - 0.3 ml of 0.1% adrenaline solution to the injection site, diluting them in 5-10 ml of saline. solution (diluted 1:10)	In order to reduce the rate of absorption of the allergen
In case of an allergic reaction to penicillin, bicillin, administer penicillinase 1,000,000 units intramuscularly
Monitor the patient’s condition (BP, respiratory rate, pulse)

Prepare instruments and preparations:

tourniquet, ventilator, tracheal intubation kit, Ambu bag.

2. Standard set of drugs “Anaphylactic shock” (0.1% adrenaline solution, 0.2% norepinephrine, 1% mezatone solution, prednisolone, 2% suprastin solution, 0.05% strophanthin solution, 2.4% aminophylline solution, saline . solution, albumin solution)

Medical assistance for anaphylactic shock without a doctor:

1. Intravenous administration of adrenaline 0.1% - 0.5 ml per physical session. r-re.

After 10 minutes, the injection of adrenaline can be repeated.

In the absence of venous access, adrenaline
0.1% -0.5 ml can be injected into the root of the tongue or intramuscularly.

Actions:

Ø adrenaline increases heart contractions, increases heart rate, constricts blood vessels and thus increases blood pressure;

Ø adrenaline relieves spasm of bronchial smooth muscles;

Ø adrenaline slows down the release of histamine from mast cells, i.e. fights allergic reactions.

2. Provide intravenous access and begin fluid administration (physiological

solution for adults > 1 liter, for children - at the rate of 20 ml per kg) - replenish the volume

fluid in the vessels and increase blood pressure.

3. Administration of prednisolone 90-120 mg IV.

As prescribed by a doctor:

4. After stabilization of blood pressure (BP above 90 mm Hg) - antihistamines:

5. For bronchospastic form, aminophylline 2.4% - 10 i.v. In saline solution. When on-
in the presence of cyanosis, dry wheezing, oxygen therapy. Possible inhalations

alupenta

6. For convulsions and severe agitation - IV sedeuxene

7. For pulmonary edema - diuretics (Lasix, furosemide), cardiac glycosides (strophanthin,

korglykon)

After recovery from shock, the patient is hospitalized for 10-12 days.

Assessment of achievements:

1. Stabilization of blood pressure and heart rate.

2. Restoration of consciousness.

Urticaria, Quincke's edema

Hives: allergic disease , characterized by a rash of itchy blisters on the skin (swelling of the papillary layer of the skin) and erythema.

Causes: medicines, serums, food products...

The disease begins with unbearable skin itching on various parts of the body, sometimes on the entire surface of the body (on the torso, limbs, sometimes on the palms and soles of the feet). Blisters protrude above the surface of the body, from pinpoint sizes to very large ones; they merge, forming elements of different shapes with uneven, clear edges. The rash may persist in one place for several hours, then disappear and reappear in another place.

There may be fever (38 - 39 0), headache, weakness. If the disease lasts more than 5-6 weeks, it becomes chronic and is characterized by an undulating course.

Treatment: hospitalization, withdrawal of medications (stop contact with the allergen), fasting, repeated cleansing enemas, saline laxatives, activated charcoal, oral polypephane.

Antihistamines: diphenhydramine, suprastin, tavigil, fenkarol, ketotefen, diazolin, telfast...orally or parenterally

To reduce itching - iv solution of sodium thiosulfate 30% -10 ml.

Hypoallergenic diet. Make a note on the title page of the outpatient card.

Conversation with the patient about the dangers of self-medication; when applying for honey. With this help, the patient must warn the medical staff about drug intolerance.

Quincke's edema- characterized by swelling of the deep subcutaneous layers in places with loose subcutaneous tissue and on the mucous membranes (when pressed, no pit remains): on the eyelids, lips, cheeks, genitals, back of the hands or feet, mucous membranes of the tongue, soft palate, tonsils, nasopharynx, gastrointestinal tract (clinic of acute abdomen). If the larynx is involved in the process, asphyxia may develop (restlessness, puffiness of the face and neck, increasing hoarseness, “barking” cough, difficult stridor breathing, lack of air, cyanosis of the face); with swelling in the head area, the meninges are involved in the process (meningeal symptoms) .

Nurse tactics:

Actions	Rationale
Ensure that a doctor is called through an intermediary. Stop contact with the allergen	To determine further tactics for providing medical care
Reassure the patient	Relieving emotional and physical stress
Find the sting and remove it along with the poisonous sac	In order to reduce the spread of poison in tissues;
Apply cold to the bite site	A measure to prevent the spread of poison in tissue
Provide access to fresh air. Give 100% humidified oxygen	Reducing hypoxia
Place vasoconstrictor drops into the nose (naphthyzin, sanorin, glazolin)	Reduce swelling of the mucous membrane of the nasopharynx, make breathing easier
Pulse control, blood pressure, respiratory rate	Pulse control, blood pressure, respiratory rate
Give cordiamine 20-25 drops	To maintain cardiovascular activity

Prepare instruments and preparations:

1. System for intravenous infusion, syringes and needles for IM and SC injections,
tourniquet, ventilator, tracheal intubation kit, Dufault needle, laryngoscope, Ambu bag.

2. Adrenaline 0.1% 0.5 ml, prednisolone 30-60 mg; antihistamines 2% - 2 ml of suprastin solution, pipolfen 2.5% - 1 ml, diphenhydramine 1% - 1 ml; fast-acting diuretics: lasix 40-60 mg IV in a stream, mannitol 30-60 mg IV in a drip

Inhalers salbutamol, alupent

3. Hospitalization in the ENT department

First aid for emergencies and acute diseases

Angina pectoris.

Angina pectoris- this is one of the forms of coronary artery disease, the causes of which can be: spasm, atherosclerosis, transient thrombosis of the coronary vessels.

Symptoms: paroxysmal, squeezing or pressing pain behind the sternum, exercise lasting up to 10 minutes (sometimes up to 20 minutes), which goes away when the exercise stops or after taking nitroglycerin. The pain radiates to the left (sometimes right) shoulder, forearm, hand, shoulder blade, neck, lower jaw, epigastric region. It may manifest itself as atypical sensations such as lack of air, difficult-to-explain sensations, or stabbing pains.

Nurse tactics: