Signs characterizing the syndrome of acute vascular insufficiency. What is acute vascular insufficiency? Types of acute vascular insufficiency

Acute vascular insufficiency (AHF) is a pathological condition characterized by a sudden decrease in the volume of circulating blood and a sharp violation of the function of blood vessels. Most often it is due to heart failure and is rarely observed in its pure form.

Classification

Depending on the severity of the course of the condition and the consequences for the human body, the following types of syndrome are distinguished:

fainting;
collapse;
shock.

Important! All types of pathology pose a threat to human health and life; in case of untimely emergency care, the patient develops acute heart failure and death.

Pathogenesis and causes

The entire human body is permeated with large and small blood vessels, through which blood circulates and supplies oxygen to organs and tissues. The normal distribution of blood through the arteries occurs due to the contraction of the smooth muscles of their walls and a change in tone.

Maintaining the desired tone of arteries and veins is regulated by hormones, metabolic processes of the body and the work of the autonomic nervous system. In violation of these processes and hormonal imbalance, there is a sharp outflow of blood from vital internal organs, as a result of which they stop working as expected.

The etiology of AHF can be very diverse, a sudden violation of blood circulation in the vessels occurs as a result of such conditions:

massive blood loss;
extensive burns;
heart disease;
prolonged stay in a stuffy room;
traumatic brain injury;
severe fear or stress;
acute poisoning;
insufficiency of adrenal function;
Iron-deficiency anemia;
excessive loads with severe hypotension, as a result of which the internal organs experience a lack of oxygen.

Depending on the duration of the course, vascular insufficiency can be acute or chronic.

Clinical manifestations

The AHF clinic is always accompanied by a decrease in pressure and directly depends on the severity of the condition, this is presented in more detail in the table.

Table 1. Clinical forms of pathology

Name	How does it manifest itself clinically?
Fainting	The patient suddenly feels weak, dizzy, flickering "flies" before the eyes. Consciousness may or may not be preserved. If after 5 minutes the patient does not come to his senses, then fainting is accompanied by convulsions, as a rule, it rarely comes to this, and with properly organized assistance, the person's condition quickly returns to normal
Collapse	This condition is much more severe than fainting. The patient's consciousness can be preserved, but there is a sharp lethargy and disorientation in space. Arterial pressure is sharply reduced, the pulse is weak and thready, breathing is shallow and rapid. The skin is pale, there is acrocyanosis and sticky cold sweat.
Shock	Clinically, shock is not much different from collapse, but in this condition, a sharp depression of the work of the heart and other vital organs develops. Due to severe hypoxia, the brain suffers, against which degenerative changes can develop in its structure.

Fainting, collapse, shock: more about each condition

Fainting

Fainting is a form of AHF, which is characterized by the mildest course.

The reasons for the development of fainting are:

a sudden drop in blood pressure - occurs against the background of diseases and pathologies, which are accompanied by a violation of the heart rhythm. At the slightest physical overload, blood flow in the muscles increases as a result of the redistribution of blood. Against this background, the heart cannot cope with the increased load, the blood output during systole decreases, and the systolic and diastolic pressure indicators decrease.
Dehydration - as a result of repeated vomiting, diarrhea, excessive urination or sweating, the volume of circulating blood through the vessels decreases, which can cause fainting.
Nerve impulses from the nervous system - as a result of strong feelings, fear, excitement or psycho-emotional arousal, sharp vasomotor reactions and vascular spasm occur.
Violation of the blood supply to the brain - against the background of a head injury, a microstroke or a stroke, the brain receives an insufficient amount of blood and oxygen, which can lead to the development of fainting.
Hypocapnia is a condition characterized by a decrease in carbon dioxide in the blood due to frequent and deep breathing, against which fainting may develop.

Collapse

Collapse is a serious vascular dysfunction. The condition develops abruptly, the patient suddenly feels weak, the legs give way, there is a tremor of the extremities, cold sticky sweat, a drop in blood pressure.

Consciousness may be preserved or impaired. There are several types of collapse.

Table 2. Types of collapse

Important! Only a doctor can determine the type of collapse and correctly assess the severity of the patient's condition, so do not neglect to call an ambulance and do not self-medicate, sometimes wrong actions are the price of a person's life.

Shock

Shock is the most severe form of acute heart failure. During shock, a severe circulatory disorder develops, as a result of which the death of the patient may occur. The shock has several phases of flow.

Table 3. Phases of shock

shock phase	How does it manifest itself clinically?
erectile	Accompanied by a sharp psychomotor agitation, the patient screams, waves his arms, tries to get up and run somewhere. High blood pressure, fast pulse
Torpidnaya	Quickly changes the erectile phase, sometimes even before the ambulance has time to arrive. The patient becomes lethargic, lethargic, does not react to what is happening around. Blood pressure drops rapidly, the pulse becomes weak, thready or not palpable at all. The skin is pale with severe acrocyanosis, shallow breathing, shortness of breath
Terminal	It occurs in the absence of adequate timely assistance to the patient. Blood pressure is below critical, the pulse is not palpable, breathing is rare or absent at all, the patient is unconscious, there are no reflexes. In such a situation, death quickly develops.

Depending on the causes of the shock syndrome of AHF, it happens:

hemorrhagic - develops against the background of massive blood loss;
traumatic - develops as a result of a severe injury (accident, fractures, soft tissue damage);
burn - develops as a result of severe burns and damage to a large area of \u200b\u200bthe body;
anaphylactic - an acute allergic reaction that develops against the background of the administration of a drug, insect bites, vaccination;
hemotransfusion - occurs against the background of a transfusion of an incompatible red blood cell mass or blood to a patient.

The video in this article details all types of shock and the principles of emergency first aid. This instruction, of course, is a general fact-finding and cannot replace the help of a doctor.

Treatment

First aid for AHF directly depends on the type of pathology.

Fainting

As a rule, syncope is treated without the use of drugs.

Emergency help for fainting by fainting type consists of the following actions:

give the patient a horizontal position with a raised foot end;
unbutton shirt buttons, free from clothes squeezing the chest;
provide access to fresh cool air;
splash water on your face or wipe your forehead and cheeks with a wet rag;
give warm sweet tea or not strong coffee to drink if the patient is conscious;
in the absence of consciousness, pat on the cheeks and apply cold to the temples.

If these actions are ineffective, you can inject vasoconstrictor drugs, for example, Cordiamin.

Collapse

First aid for collapse is aimed at eliminating the causes that provoked the development of this condition. First aid for collapse consists in immediately giving the patient a horizontal position, raising the foot end and warming the patient.

If a person is conscious, then you can give him hot sweet tea to drink. Before being transported to the hospital, the patient is given an injection of a vasoconstrictor.

In a hospital, the patient is administered drugs that eliminate both the symptoms of vascular insufficiency and the causes of this pathological condition:

drugs that stimulate the respiratory and cardiovascular center - these drugs increase the tone of the arteries and increase the stroke volume of the heart;
vasoconstrictors - adrenaline, Dopamine, Norepinephrine and other drugs are injected intravenously, which quickly increase blood pressure and stimulate the heart;
infusion of blood and erythrocyte mass - required for blood loss to prevent shock;
conducting detoxification therapy - prescribe droppers and solutions that quickly remove toxic substances from the blood and replenish the volume of circulating fluid;
oxygen therapy - is prescribed to improve metabolic processes in the body and saturate the blood with oxygen.

Possible nursing problems in AHF according to the type of collapse are the difficulty of getting the patient drunk if his consciousness is disturbed, and injecting the drug intravenously at low pressure - it is not always possible to immediately find a vein and get into the vessel.

Important! Salt solutions are not effective if the collapse is due to the deposition of blood in the intercellular space and internal organs. In such a situation, to improve the patient's condition, it is necessary to introduce colloidal solutions into the plasma.

Shock

Treatment of shock consists in carrying out measures aimed at improving the systemic functions of the body and eliminating the causes of this condition.

The patient is prescribed:

painkillers - in case of injuries and burns, before carrying out any actions, it is necessary to administer painkillers to the patient, which will help prevent the development of shock or stop it in the erectile stage;
oxygen therapy - the patient is supplied with humidified oxygen through a mask to saturate the blood with oxygen and normalize the functioning of vital organs, with depression of consciousness, the patient is given artificial ventilation of the lungs;
normalization of hemodynamics - drugs are administered that improve blood circulation, for example, erythrocyte mass, colloidal solutions, saline solutions, glucose and others;
the introduction of hormonal drugs - these funds contribute to the rapid restoration of blood pressure, improve hemodynamics, stop acute allergic reactions;
diuretics - prescribed for the prevention and elimination of edema.

Important! With the development of AHF, all drugs should be administered intravenously, because due to a violation of the microcirculation of tissues and internal organs, the absorption of drugs into the systemic circulation changes.

Prevention measures

In order to prevent the development of acute vascular insufficiency, it is important to follow the doctor's recommendations:

promptly detect and treat diseases of the cardiovascular system;
do not take any medicines without a doctor's prescription, especially for the treatment of arterial hypertension;
do not stay in direct sunlight for a long time, in a bath, sauna, especially if there are any disorders in the work of the heart and blood vessels;
before a blood transfusion, it is imperative to take tests to make sure that the donor’s blood is suitable for the group and Rh factor.

Maintaining an active lifestyle, giving up bad habits, a full and balanced diet will help prevent disorders of the cardiovascular system and blood pressure.

Vascular insufficiency is a violation of local or general circulation, which is based on the insufficiency of the function of blood vessels, caused in turn by a violation of their patency, a decrease in tone, and the volume of blood passing through them.

Deficiency can be systemic or regional (local), depending on how the violations spread. Depending on the rate of the course of the disease, there may be acute vascular insufficiency and chronic.

Pure vascular insufficiency is rare, most often along with symptoms of vascular insufficiency, heart muscle insufficiency is manifested. Cardiovascular insufficiency develops due to the fact that the heart muscle and vascular musculature are often affected by the same factors. Sometimes cardiovascular failure is secondary and heart disease occurs due to poor muscle nutrition (lack of blood, low pressure in the arteries).

Reasons for the appearance

The cause of the disease is usually circulatory disorders in the veins and arteries that have arisen for various reasons.

Basically, acute vascular insufficiency develops due to traumatic brain and general injuries, various heart diseases, blood loss, in pathological conditions, for example, in acute poisoning, severe infections, extensive burns, organic lesions of the nervous system, adrenal insufficiency.

Symptoms of vascular insufficiency

Acute vascular insufficiency manifests itself in the form of fainting, shock or collapse.

Fainting is the mildest form of insufficiency. Symptoms of vascular insufficiency during fainting: weakness, nausea, darkening in the eyes, rapid loss of consciousness. The pulse is weak and rare, the pressure is lowered, the skin is pale, the muscles are relaxed, there are no convulsions.

In collapse and shock, the patient is in most cases conscious, but his reactions are inhibited. There are complaints of weakness, low temperature, and pressure (80/40mm Hg and less), tachycardia.

The main symptom of vascular insufficiency is a sharp and rapid decrease in blood pressure, which provokes the development of all other symptoms.

Chronic insufficiency of vascular function most often manifests itself in the form of arterial hypotension. Conditionally, this diagnosis can be made with the following symptoms: in older children, systolic pressure is below 85, up to 30l. - pressure below the level of 105/65, in older people - below 100/60.

Diagnosis of the disease

At the stage of examination, the doctor, assessing the symptoms of vascular insufficiency, recognizes which form of insufficiency manifested itself, fainting, shock or collapse. At the same time, the level of pressure is not decisive in making a diagnosis; one should study the medical history and find out the causes of the attack. It is very important at the examination stage to establish what type of insufficiency has developed: cardiac or vascular, because. emergency care for these diseases is provided in different ways.

If cardiovascular insufficiency is manifested, the patient is forced to sit - in the supine position, his condition worsens significantly. If it is vascular insufficiency that has developed, the patient needs to lie down, because. in this position, his brain is better supplied with blood. The skin with heart failure is pinkish, with vascular insufficiency it is pale, sometimes with a grayish tinge. Also, vascular insufficiency is distinguished by the fact that venous pressure is not increased, the veins in the neck are collapsed, the boundaries of the heart do not shift, and there is no stagnation in the lungs characteristic of cardiac pathology.

After a preliminary diagnosis is made on the basis of the general clinical picture, the patient is given first aid, if necessary, hospitalized, and an examination of the circulatory organs is prescribed. To do this, he may be assigned to undergo auscultation of blood vessels, electrocardiography, sphygmography, phlebography.

Treatment of vascular insufficiency

Medical care for vascular insufficiency should be provided immediately.

With all forms of development of acute vascular insufficiency, the patient should be left in a supine position (otherwise there may be a fatal outcome).

If fainting occurs, it is necessary to loosen the clothes on the victim’s neck, pat him on the cheeks, spray his chest and face with water, give him a sniff of ammonia, and ventilate the room. This manipulation can be carried out independently, usually a positive effect occurs quickly, the patient regains consciousness. After that, you should definitely call a doctor who, after conducting simple diagnostic tests on the spot, will inject subcutaneously or intravenously a solution of caffeine with sodium benzoate 10% - 2 ml (with a fixed reduced pressure). If severe bradycardia is noticed, atropine 0.1% 0.5-1 ml is additionally administered. If bradycardia and low blood pressure persist, orciprenaline sulfate 0.05% - 0.5-1 ml or adrenaline solution 0.1% is administered intravenously. If after 2-3 minutes the patient is still unconscious, the pulse, pressure, heart sounds are not detected, there are no reflexes, they begin to administer these drugs already intracardiac, and do artificial respiration, heart massage.

If, after fainting, additional resuscitation measures were needed, or the cause of fainting remained unclear, or this happened for the first time, or the patient's pressure after bringing him to consciousness remains low, he must be hospitalized for further examination and treatment. In all other cases, hospitalization is not indicated.

Patients with collapse, who are in a state of shock, regardless of the cause that caused this condition, are urgently taken to the hospital, where the patient receives first emergency care to maintain pressure and heart activity. If necessary, stop bleeding (if necessary), carry out other procedures of symptomatic therapy, focusing on the circumstances that caused the attack.

With cardiogenic collapse (often develops with cardiovascular insufficiency), tachycardia is eliminated, atrial flutter is stopped: atropine or isadrin, adrenaline or heparin are used. To restore and maintain pressure, mezaton 1% is injected subcutaneously.

If the collapse is caused by an infection or poisoning, caffeine, cocarboxylase, glucose, sodium chloride, ascorbic acid are injected subcutaneously. Strychnine 0.1% is very effective in this type of collapse. If such therapy does not bring results, mezaton is injected under the skin, prednisolonehemisuccinate is injected into the vein, sodium chloride 10% is again injected.

Disease prevention

The best prevention of vascular insufficiency is to prevent diseases that can cause it. It is recommended to monitor the condition of the vessels, consume less cholesterol, undergo regular examinations of the circulatory system and the heart. In some cases, hypotensive patients are prescribed a prophylactic course of pressure-maintaining drugs.

Video from YouTube on the topic of the article:

Cardiovascular insufficiency is a condition characterized by the inability of the cardiovascular system to provide adequate perfusion of organs and tissues. Distinguish between acute cardiovascular failure and chronic heart failure (CHF). Acute circulatory insufficiency

It includes the following forms: acute vascular insufficiency (fainting, collapse, shock), acute right ventricular failure and acute left ventricular failure (cardiac asthma, pulmonary edema, cardiogenic shock). Fainting(apopsychia) is characterized by a short-term loss of consciousness due to insufficient blood circulation in the brain. With fainting, generalized muscle weakness occurs, arterial and venous pressure decreases, tension, filling and pulse rate decrease, heart rhythm and respiratory activity are often disturbed. Fainting is quite common, with about 30% of the adult population having at least one faint. It can be short-term, transient (lipathimia), or longer, deep (syncope). Often states with loss of consciousness are called syncope. The most common pathogenetic variant of syncope is vasodepressor, which develops with a strong psycho-emotional

voltage. In the period of precursors, weakness, nausea, yawning, ringing in the ears, darkening of the eyes, dizziness, pallor, sweating, moderate hypotension, bradycardia are revealed. After leaving the unconscious state, pallor, sweating, and a feeling of nausea may persist for some time. Collapse- a form of acute vascular insufficiency without obvious metabolic disorders, when the clinical picture is dominated by hypotensive syndrome. With timely adequate therapy, the prognosis is often favorable. The causes of collapse can be divided into two groups: those associated with a primary decrease in circulating blood volume (BCV) and with a primary decrease in vascular tone.

The most common postural orthostatic hypotension is due to a sharp decrease in blood pressure when standing up. It is observed in patients who have been on bed rest for a long time, with severe varicose veins of the lower extremities, in the last trimester of pregnancy,

with a sharp cessation of significant physical activity, it can be iatrogenic in the treatment of ganglionic blockers, beta-blockers, diuretics and other antihypertensive drugs. Shock- this is a severe, life-threatening condition of the body with profound violations of all systems, primarily the cardiovascular system, due to the body's reaction to physical or mental damage. There is total vascular insufficiency with dysfunction of internal organs, changes at the level of microcirculation and metabolic disorders (acidosis, hormonal changes, hypercoagulability) are increasing. In acute vascular insufficiency, the return

blood to the heart, which inevitably leads to a decrease in cardiac output, which in turn exacerbates the violations of the blood supply to the organs. Of practical interest is the classification of pathogenetic variants of shock C. Saunders (1992):

1 - hypovolemic (loss of BCC during blood loss, plasma loss during burns, profuse vomiting, diarrhea);

2 - cardiogenic (myocardial infarction, severe arrhythmias);

3 - obstructive (massive pulmonary embolism);

4 - redistribution shock (sepsis, anaphylactic shock).

Almost always, as a result of insufficient perfusion in the brain, the psyche of patients suffers to one degree or another. Consciousness is often impaired, sometimes absent. If it is preserved, patients may be inhibited, it is difficult to make contact. In some cases, anxiety may appear. Acrocyanosis develops, tissue turgor is sharply reduced, to the touch of the limb

cold, skin covered with sticky sweat, pulse becomes thready. Auscultation reveals weakened tones, tachycardia. The tongue is dry, the liver may be enlarged, diuresis drops. According to the severity of clinical manifestations, the numbers of blood pressure and hourly diuresis, there are three degrees of severity of shock. Acute right ventricular failure in the classical

In its most variant, it occurs with pulmonary embolism (PE). Of all the symptoms of pulmonary embolism, signs of right ventricular failure proper are pronounced cyanosis, swelling of the jugular veins, enlarged veins, radiological bulging of the pulmonary cone, on the ECG - deviation of the electrical axis to the right, overload of the right heart. Cardiac asthma, from a morphological point of view, corresponds to interstitial pulmonary edema, more often it develops acutely, manifested by increasing shortness of breath, suffocation, and dry cough. It often occurs at night. The patient from the very beginning tries to assume a sitting position. On auscultation, hard breathing is heard, sometimes dry wheezing in a small amount. With progression, interstitial pulmonary edema can turn into alveolar edema, i.e. to true cardiogenic pulmonary edema. Pulmonary edema(cardiogenic) - often develops very quickly, within a few minutes, and only urgent measures can sometimes take the patient out of a serious condition. There is a sharp shortness of breath, a cough appears, at first dry and jerky. Excitation sets in, fear of death appears. Consciousness may become confused, acrocyanosis appears, turning into diffuse cyanosis. Dry cough is quickly replaced by a wet cough with the release of bloody, and then frothy sputum. IN

Vascular insufficiency is a disease characterized by a violation of the general or local blood circulation, which appears due to insufficient function of the blood vessels, which, in turn, can be caused either by a decrease in their tone, impaired patency, or a significant decrease in the volume of blood passing through the vessels.

Failure is divided into systemic and regional (local), which differ in how violations spread. In addition, there is acute and chronic vascular insufficiency (difference in the rate of the disease).

Usually, pure vascular insufficiency is very rare and manifests itself simultaneously with insufficiency of the heart muscle. The development of cardiovascular insufficiency is facilitated by the fact that both the musculature of the vessels and the heart muscle are often influenced by the same factors.

Sometimes the pathology of the heart becomes primary and appears due to insufficient nutrition of the muscles, and cardiovascular insufficiency (including acute cardiovascular insufficiency) is secondary.

Reasons for the appearance

Usually, the cause of acute vascular insufficiency is a violation of blood circulation in the arteries and veins, which appeared for various reasons (suffered craniocerebral and general injuries, various heart diseases). Acute vascular insufficiency also occurs due to a violation of the contractile function of the myocardium, blood loss or a drop in vascular tone due to acute poisoning, severe infections, extensive burns, organic lesions of the nervous system, adrenal insufficiency.

Symptoms of vascular insufficiency

Acute vascular insufficiency may manifest as shock, syncope, or collapse. Fainting is one of the mildest forms of insufficiency. Symptoms of fainting include: weakness, darkening of the eyes, nausea, rapid loss of consciousness. The pulse is rare and weak, the skin is pale, the pressure is lowered, the muscles are relaxed, no seizures are observed.

In shock and collapse, the patient, as a rule, does not lose consciousness, but his reactions are severely inhibited. The patient complains of weakness, tachycardia, low blood pressure (80/40 mm Hg or less), temperature below normal.

The main symptom of vascular insufficiency is a rapid and sharp decrease in blood pressure.

In chronic vascular insufficiency, arterial hypotension develops, determined by a low level of pressure. So, systolic pressure in older children falls below 85, in people under 30 years of age, the pressure is below 105/65, for the elderly this figure is below 100/60.

Diagnosis of vascular insufficiency

In the process of examining the patient, the doctor evaluates the symptoms of vascular insufficiency, determines its form: fainting, shock or collapse. In making a diagnosis, the level of pressure is not decisive. In order for the conclusion to be correct, the doctor analyzes and studies the medical history, tries to find out the causes of the attack.

To provide qualified first aid, it is necessary to determine what type of insufficiency the patient has developed: cardiac or vascular. The fact is that with these diseases, emergency care is provided in different ways.

In heart failure, it is easier for the patient to be in a sitting position, in the prone position, the condition worsens significantly. In case of vascular insufficiency, the lying position will be optimal for the patient, since it is in this position that the brain receives the best blood supply.

With heart failure, the patient's skin has a pinkish tint, with vascular integument - the skin is pale, in some cases with a grayish tint. Vascular insufficiency is also characterized by the fact that venous pressure remains within the normal range, the veins in the neck are collapsed, the borders of the heart are not displaced, there is no pathology of stagnation in the lungs, as is the case with heart failure.

After clarifying the overall clinical picture and determining the preliminary diagnosis, the patient is given first aid, if necessary, hospitalized and examined by the circulatory system. To do this, the patient is directed to auscultation of blood vessels, sphygmography, electrocardiography or phlebography.

Treatment of vascular insufficiency

In case of vascular insufficiency, medical care should be provided immediately. Regardless of the form of development of the disease, the patient is left in the supine position (a different position of the body can cause death).

If the victim is in a fainting state, loosen the clothes around his neck, pat his cheeks, spray his face and chest with water, give him a sniff of ammonia, ventilate the room.

Such manipulations can be carried out independently before the arrival of a doctor. As a rule, a person quickly regains consciousness. The doctor conducts simple diagnostic studies, injects intravenously or subcutaneously two milliliters of a solution of caffeine with sodium benzoate 10% (in case of recorded low blood pressure).

With severe bradycardia, an additional injection of atropine 0.1% at a dose of 0.5-1 milliliter or an adrenaline solution of 0.1% is additionally made. After 2-3 minutes, the patient should regain consciousness. If this does not happen, pressure, heart sounds and pulse are not detected, the same drugs begin to be administered intracardiac, heart massage and artificial respiration are additionally performed.

The patient is hospitalized if the fainting happened for the first time or if its cause remains unclear or additional resuscitation measures are required, the pressure remains much lower than normal. In all other cases, there is no need for hospitalization.

Patients with collapse or in shock are urgently taken to the hospital, regardless of the reasons that caused this condition. In a medical institution, first aid is provided, maintaining pressure and heart activity. When bleeding occurs, it is stopped, other symptomatic therapy procedures are performed, indicated in a particular situation.

With cardiogenic collapse, often developing in acute cardiovascular failure, it is necessary to eliminate tachycardia, stop atrial flutter, for which isadrin or atropine, heparin or adrenaline is used. To restore and maintain pressure, mezaton 1% is injected subcutaneously.

If the cause of the collapse is an infection or poisoning, cocarboxylase, caffeine, sodium chloride, glucose, ascorbic acid are injected subcutaneously. Strychnine 0.1% gives a good effect. In the case when the patient remains in the same condition and no improvement is observed, mezaton is administered subcutaneously, prednisolonehemisuccinate intravenously, and sodium chloride 10% is repeated again.

Disease prevention

In order to prevent the development of chronic vascular insufficiency, you need to constantly pay attention to the condition of the vessels, try to eat less foods containing a large amount of cholesterol, and regularly examine the heart and circulatory system. As a prophylaxis, antihypertensives are prescribed pressure-maintaining drugs.

Acute vascular insufficiency a pathological condition characterized by disorders of the general or local circulation, the basis of which is the insufficiency of the hemodynamic function of blood vessels due to violations of their tone, patency, and a decrease in the volume of blood circulating in them.

Diagnosis OSN. set on the basis of a combination of symptoms of systemic hemodynamic insufficiency, which can form a clinical picture of syncope, collapse or shock.

Fainting not in all cases is accompanied by a complete loss of consciousness (syncope), sometimes limited to its predecessors: a sudden feeling of lightheadedness, ringing or tinnitus, non-systemic dizziness, the appearance of paresthesias and severe muscle weakness, and only clouding of consciousness (lipothymia), in connection with which the patient does not falls and gradually subsides.

Clinic: rapidly increasing pallor of the face, cold sweat, coldness and pallor of the hands and feet, a significant weakening of pulse filling and bradycardia, except in cases where lipothymia is due to a paroxysm of tachycardia (in this case, the pulse rate, as a rule, exceeds 200 in 1 min).

With loss of consciousness: pallor and coldness of all skin and mucous membranes, loss of muscle tone, areflexia, a significant decrease in the frequency and depth of breathing, which sometimes becomes invisible (but is determined by fogging of a mirror brought to the patient's mouth or nose), sometimes the appearance of tonic convulsions (convulsive fainting). At the same time, blood pressure and pulse on the peripheral arteries are often not determined, but rare and small pulse waves can usually be detected on the carotid arteries. in the initial stages of vagovasal syncope, the pupils are often constricted, with deep syncope of any etiology, the pupils become wide, pupillary reactions are absent. With a horizontal position of the body, the symptoms of fainting regress, as a rule, within 1-3 min.

The occurrence of fainting in a stuffy room or as a reaction to pain, the sight of blood (especially in adolescents and young women), constriction of the pupils, rapid (less than 1 min) restoration of consciousness, blood pressure and the correct heart rhythm, the absence of pathological tones and noises during auscultation of the heart after the restoration of consciousness are characteristic of simple syncope. If a deep syncope occurs with a rapid (almost without precursors) loss of consciousness due to turning the head, fastening a button of a tight collar or in response to palpation of the neck (especially in the elderly), if a sharp constriction of the pupils is detected and relatively long (up to 20-30 With) asystole - hypersensitivity of the carotid sinus.

Orthostatic - with a sharp transition from a horizontal to a vertical position, or with prolonged immobility, the period of lipothymia is limited (if the patient manages to take a horizontal or semi-horizontal position), and in the event of syncope, consciousness in a horizontal position of the body is restored as quickly as with simple fainting.

Cardiogenic syncope is characterized by less respiratory depression than with other syncope (it may even be increased), a possible combination of pallor of the skin with cyanosis (especially of the lips) and the presence of auscultatory signs of cardiac arrhythmias or mitral stenosis or aortic heart disease.

Collapse as an independent form of clinical manifestations of acute S. n. It is characterized by symptoms of progressive insufficiency of blood supply to all organs and tissues (primarily peripheral), most often in combination with signs of compensatory reactions of centralization of blood circulation. The patient suddenly develops a growing general weakness, initially accompanied by a feeling of fear (anxiety, melancholy), arousal, which are replaced by hypodynamia, apathy; cold sweat appears, hands and feet become cold; facial features are sharpened, the skin acquires a pale gray color; lips, sometimes also hands (with cardiogenic collapse) cyanotic; breathing quickens, becomes shallow. Heart sounds often remain normal or even become louder, but with toxic and cardiogenic collapse, they are often muffled, arrhythmic; in the vast majority of cases, tachycardia is noted, in all cases - a small (filamentous) pulse and a decrease in systolic blood pressure. Diastolic and, accordingly, pulse blood pressure changes in different ways - depending on the origin of the collapse. As blood pressure decreases, oliguria and anuria develop. Consciousness is preserved in most cases (it may be absent due to the underlying disease, such as a traumatic brain injury), but when you try to seat the patient, fainting often occurs.

collapse develops against the background of the underlying disease, poisoning or injury. most often there is internal bleeding (for example, due to ectopic pregnancy, perforated stomach ulcer), and in middle-aged and elderly people - acute myocardial infarction and pulmonary embolism.

Hemorrhagic collapse is characterized by severe pallor and cooling of the skin (practically without cyanosis), a predominant decrease in pulse pressure at the beginning, increasing significant tachycardia, sometimes euphoria, mental disorders, orthostatic syncope. In acute myocardial infarction, collapse is often preceded or accompanied by anginal status, characterized by a significant muffling of cardiac gonads, the appearance of various cardiac arrhythmias, sometimes a gallop rhythm and other signs of acute left ventricular heart failure. Assume pulmonary embolism should be in all cases when the collapse is accompanied by severe tachypnea and tachycardia, a sharp increase and accent of the second heart sound over the pulmonary trunk.

Shock in its manifestations, it is wider than manifestations of S. n. its clinical picture is different and depends on the etiology of shock (Anaphylactic shock, Traumatic shock, etc.) and the stage of its development. As a particularly severe clinical form of acute S. n. shock is characterized by a picture of collapse in combination with signs of severe microcirculation disorders in the body. In this regard, the diagnosis of shock is substantiated by the addition to the manifestations of a deep collapse of anuria, hypothermia of the body (a sign of blockade of cellular metabolism) and the symptom of "marble skin" - the appearance of white, cyanotic and red-cyanotic spots and stripes on the pale gray cold skin of the limbs and trunk due to with severe disorders of microcirculation.

Treatment. First aid for fainting. The patient should be laid on his back with an elevated position of the legs, unfasten tight clothes, provide fresh air, inhale ammonia (irritation of the nasal mucosa with a reflex effect on the vasomotor center of the brain); subcutaneous injections of cordiamine (2 ml), caffeine (1 ml of a 10% solution) are indicated. Patients with suspected organic diseases and with an unclear genesis of fainting are subject to hospitalization.

intravenously or subcutaneously 2 ml 10% solution of caffeine-sodium benzoate, and with persistent severe bradycardia, also 0.5-1 ml 0.1% atropine solution. The latter quickly eliminates bradycardia in carotid sinus hypersensitivity syndrome, but is not always effective enough in cardiogenic syncope, and if bradycardia and low blood pressure persist, a 0.1% solution of adrenaline should be slowly injected intravenously at 20 ml isotonic solution of sodium chloride or glucose .. If after 2-3 min since the onset of syncope, the patient remains unconscious, there are no reflexes, blood pressure, pulse and heart sounds cannot be determined (a picture of clinical death), these drugs are administered intracardiac and chest compressions and artificial respiration begin. With recurrent orthostatic and vagovasal syncope, the patient is indicated for planned hospitalization. With simple syncope, hospitalization in most cases is not needed.

Patients with collapse or shock of any etiology are urgently hospitalized in departments. At the prehospital stage, if possible, the cause of the collapse is eliminated (for example, by stopping external bleeding by applying a bandage or tourniquet), pathogenetic therapy is carried out and symptomatic means of restoring and maintaining blood pressure, cardiac activity and other vital autonomic functions are used.

With cardiogenic collapse, etiotropic therapy is leading: relief of paroxysm of tachycardia, atrial flutter, the use of atropine and alupent (izadrin) or adrenaline in the event of sinoauricular or atrioventricular heart block, the administration of heparin or thrombolytic agents in acute myocardial infarction and in pulmonary embolism, if collapse has developed on the background of anginal status - neuroleptanalgesia is performed. To restore blood pressure and maintain it during transportation of the patient at the prehospital stage, it is advisable to use a 1% solution of mezaton (0.5-1 ml subcutaneously), other α-agonists (norepinephrine, adrenaline) act for a short time, so they (like dopamine) are administered intravenously in the hospital.

With hypovolemic collapse against the background of severe dehydration of the body (including with burn shock), as well as with hemorrhagic collapse (shock), saving the patient's life depends on the earliest possible infusion of plasma substitutes or blood. Therefore, after emergency measures that ensure the possibility of transporting the patient (stopping bleeding, resuscitation procedures), the main attention is paid to the rapid delivery of the patient to the hospital.